Improving clinical responses to drug-related deaths

A working group of NHS and voluntary sector drug treatment providers have today published a set of best practice principles to support efforts across the country to address the increasing number of people dying from drug use.

For the last four years drug-related deaths in England and Wales have increased. They are now at the highest levels since records began in 1993. Scotland has also seen drug deaths increase dramatically in recent years. This is more individuals whose lives are cut short and denied the opportunity to realise a brighter future. More families blighted by the pain and bereavement that losing a loved one causes. Every effort has to be made by all stakeholders to do all they can to change these statistics, and this will involve action in all contexts in which drugs are used and among all drug users. However as providers of services to the most vulnerable sections of the population we have particular expertise in the delivery of effective evidence-based treatment and harm reduction services, which both Public Health England (PHE) and the Advisory Council on the Misuse of Drugs (ACMD) have identified as fundamental to addressing this crisis. The focus of this document is therefore to pool and share our expertise to maximise the treatment sector’s contribution to minimise early and avoidable deaths, particularly among opiate users where risk is highest.

To this end Collective Voice and the NHS Substance Misuse Provider Alliance (NHS SMPA) have worked together, with PHE’s support, to produce a set of recommendations for providers with the aim of ensuring that everything that can be done is done by service providers to help reverse this damaging trend. This demands a challenging balancing act, retaining a focus on the importance of harm reduction and safety while not undermining the opportunity and ambition for recovery of many people we work with. The document covers a number of subject areas, but detailed below are the key recommendations we believe providers and those commissioning services should commit to:

1. Drug treatment services should review their information systems to enable data relevant to risk of overdose to be captured and deployed to inform individual treatment plans.
2. Treatment plans should be consistent with the 2017 Clinical Guidelines and should be individually tailored to balance the protective benefits of OST with the opportunity to safely progress towards recovery. Providers and commissioners should guard against forced reductions or premature removal from treatment in a desire to achieve targets.
3. All providers should establish clear protocols for managing the risk of overdose and ensure their staff are competent to implement them. This should include ensuring naloxone is widely available.
4. Commissioners and service providers have a responsibility to maximise their contribution to addressing all the physical and mental health needs of service users, ensuring these are met either within their own services or by effective engagement with timely and appropriate access to primary care and specialist services in the NHS. This includes ensuring that more people are tested and treated for hepatitis C.
5. Commissioners and treatment systems need to increase local penetration rates to reduce deaths among those who are currently not engaged in treatment or in contact with harm reduction services. Fundamental to this is promoting and expanding access to needle and syringe programmes.

The constituent members, both voluntary sector and NHS providers, of Collective Voice and the NHS SMPA have contributed and shared their expertise with the aim of increasing best practice across all organisations. A subject as important as this demands openness and transparency to ensure every opportunity is taken by service providers to help save a life. As such the organisations we represent will take a lead in promoting these aims.

We thank the individuals and organisations who have contributed to this document and ask all those who commission or provide services to take the time to read it and apply the recommendations it makes and hopefully benefit from some of the innovative practice included.

Karen Biggs, CEO of Phoenix Futures and chair of Collective Voice, chaired the working group. She said:

“It is a shocking reality that we have the highest level of death from drug use since records began in 1993. The data unequivocally proves that engaging in treatment reduces the risk of death from drug use but half of the people who die each year are not in treatment. The willingness of a wide range of providers to come together and share their best practice demonstrates the sector’s commitment to do all it can to address this.

Through the course of the last six months we have listened to people who use treatment services, researchers and analysts. No one claims to have the whole answer. The causes of the high level of deaths our communities are experiencing over recent years are due to a range of complex interrelated issues that vary depending on your age, your gender and where you live in the country.

The solutions therefore need to be sophisticated, tailored and delivered by a range of agencies working in local communities. We hope the report we have published today inspires a new commitment and new thinking and goes some way to providing a solution.’’