Preventing drug related deaths and widening access to treatment
Drug-related deaths are at their highest, and treatment services have an important role to play in reducing mortality for vulnerable groups.
Change Grow Live’s Dr Prun Bijral led on the identification work stream to inform the recent report Improving Clinical Responses to Drug Related Deaths, produced by Collective Voice and NHS Substance Misuse Provider Alliance.
The findings from this work stream and recommendations from the Department of Health and ACMD reports on reducing drug related deaths, have been used to shape and develop CGL’s clinical practice in a number of areas:
Identifying the risk of drug-related death
We’ve created a risk profiling approach which brings together data from individual service user records, assessment forms (including healthcare assessment), case records and risk and recovery plans to help identify those clients with the highest risk of overdose. The report acts as a red flag to our teams who can implement appropriate safeguarding measures.
Our new quality improvement tool enables our services to audit themselves against a set of quality standards focussed on reducing mortality. We are currently piloting these and aim to roll them out nationally.
We continue to work closely with HM Coroner’s Office to understand cause of death and are using these outcomes to facilitate learning.
Delivering safe, recovery-orientated drug treatment
- CGL services follow the individualised approach to treatment recommended by the Department of Health’s Orange guidelines.
- We recognise that the most effective route to recovery for someone with an opioid requirement is through prescribed treatment. We ensure people receive a prescription as soon as possible, regardless of any other issues we need to respond to.
- From a population aspect, we are looking to improve penetration rates for all areas, as the risk of drug-related death increases outside of treatment. Alongside this we need to make sure we recognise and remove any potential barriers that may impact on people’s ability to access treatment.
- We aim to make sure the balance of risk is held by the Service rather than the service user, to ensure that their priorities are the ones being are met.
- We have done a considerable amount of work on engagement and re-engagement and the critical periods when people fall out of treatment, for example the transition between services. We offer rapid re-entry into treatment if required and build in a period of follow-up to ensure clients are stable in recovery.
- Our clients know they can come back to us at any time. Our door is always open.
Meeting physical and mental health needs
- We are developing a comprehensive dual diagnosis toolkit to ensure we work effectively with partners where there are multiple mental health complexities. The toolkit will include a set of dual diagnosis quality standards to support continual improvement.
- We are developing our response to the ageing cohort of service users affected by multiple health issues.
- We have successfully piloted a COPD clinic looking at integrating COPD identification and referral within a substance misuse service in the Wirral. As an indicator of this unmet need in one month’s screening our nurses assessed 182 people 85 of whom had indications of COPD and were referred for follow-up treatment and diagnosis.
- We have reviewed and rewritten our national approach to Hepatitis C and wherever possible have co-located Hep C clinics in our services. For example, in Birmingham we have a Hep C specialist who sees clients and connects them up to NHS treatment.
Preventing overdose in people who use drugs
- Over the last year, we have worked hard to prevent overdose through our take home naloxone programme. We are accessing its effectiveness to ensure that it becomes embedded and becomes a core part of treatment similar to Opioid Substitution Therapy.
- This year we trained 15,140 people to administer naloxone, including staff, service users, police, hostel workers and lifeguard.
- We issued 13,000 naloxone kits and of these 464 have been used in an overdose situation, potentially saving a life.
Reducing the risk of drug-related death for people outside drug treatment
- We recognise that the measures of performance for our services must include our ability to engage people not currently in treatment. We are looking at treatment penetration and equality and offering multiple access points including digital interventions.
- We watch closely for emerging trends and threats. We are currently monitoring drug related deaths from fentanyls and held a national multi agency/disciplinary summit to consider a robust response plan, should fentanyls become a greater threat. Read our Fentanyl report to find out more.
- We are preparing responses to Club Drugs, the threat from New Psychoactive Substances and are part of the Spice Taskforce in Manchester.
- We are working with Pharmaceutical companies to inform the best use of new interventions to ensure our service users are in the place to benefit from new medications and technologies.
- We are speaking to commissioners about alternative ways to facilitate treatment penetration in the community for hard to reach groups. We are exploring interventions that have an evidence base for reducing death such as Heroin Assisted Treatment and drug consumption rooms.
- We want to expand our dialogue with commissioners to explore the wider factors that contribute to addiction, such as homelessness and unemployment and bring together partners and key influencers to try and address these issues.
For further details of CGL’s work, please visit the Evidence and Impact hub.