Context and Introduction
Rates of drug-related deaths in Scotland are among the highest in Europe. In 2016, 867 people lost their lives to preventable overdose deaths, the majority of which were accidental (National Records of Scotland, 2017).
In response to the rising number of opioid-related deaths, the Scottish Government introduced a National Naloxone Programme in 2010, which was launched in 2011.
Context
Rates of drug-related deaths in Scotland are among the highest in Europe. In 2016, 867 people lost their lives to preventable overdose deaths, the majority of which were accidental (National Records of Scotland, 2017).
In response to the rising number of opioid-related deaths, the Scottish Government introduced a National Naloxone Programme in 2010, which was launched in 2011.
Scotland has a population of approximately 5.2 million people with 14 Health Boards, 15 Prisons and 30 Alcohol and Drug Partnerships. All 14 of the Health Boards participate in the take-home naloxone programme and all 15 Prisons are involved in supplying naloxone to people on-release.
There are around 61,500 people with problematic drug use in Scotland and in the region of 23,255 of those are known to services. Between 22-25,000 people receive methadone prescriptions. Every August, the National Records of Scotland report is published which details the number of people who died from a drug-related death the previous year, their ages, demographics and the drugs that were implicated in the deaths. From the 2016 figures, the average number of people dying in Scotland every year is 659 and the average is 41.
The main drugs involved in the deaths are consistently heroin, methadone, benzodiazepines and alcohol. In 2016, opiates were implicated in, or potentially contributed to, 88% of the deaths.
Around 6 months* after the NRS report, Information Services Division (ISD) Scotland publishes the Drug Deaths Database report that provides a more detailed picture of the individual circumstances surrounding the deaths (Information Services Division 2016a).
* This has now been changed to a biannual report from 2016.
Many common themes emerge from this:
- There are often several hours between the overdose and death.
- The person is likely to have had a previous non-fatal overdose.
- A combination of drugs have been taken.
- Witnesses are present.
- The person is an older (35-44 years) drug user with a long history of problematic drug use.
- The person is not in treatment, but in a large number of cases has been in treatment within 6 months prior to their death.
Given that two of the main drugs involved are opioids and that in most cases witnesses are present, it makes sense to get naloxone in to the hands of those most likely to witness an overdose.
The Prison Programme
A major focus of the national programme was to ensure that naloxone was provided to prisoners on-release because of their elevated risk of overdose and drug-related deaths within the weeks following liberation (Bird and Hutchison, 2003).
On average, 7800 individuals are incarcerated within Scotland’s prisons daily (Scottish Government, 2015) and a third of those entering prison test positive for opiates at reception (Scottish Prison Service, 2014).
Training is offered to people with a history of opiate use and is provided by NHS staff, during their sentence, often within the 6 weeks prior to release. A naloxone kit is placed in their personal belongings by reception staff which is handed to people at the point of release (Horsburgh and McAuley, 2017).
In addition, Scottish Drugs Forum has delivered ‘peer education’ training to numerous groups of prisoners across Scotland to allow them to train others within the prison. This approach has reportedly increased the acceptability of naloxone within the Scottish prison estate and undoubtedly assisted the staff to increase the number of kits provided.
In the latest national naloxone report, a cumulative total of 4,343 THN kits were issued in prisons in Scotland from 2011/12 to 2015/16 (Information Services Division, 2016b).
More recently, training was provided to almost 300-night staff prison officers to give them the skills to identify an overdose and respond with naloxone. This is currently in the process of being approved by the Scottish Prison Service and awaiting a launch date. This training took place due to the fact that there is no nursing cover overnight in Scottish prisons and by providing officers with naloxone this will save valuable time while waiting for an ambulance to arrive.
