Five studies launched into drug-related harms and deaths

Experts from the University of Stirling have launched five interdisciplinary research projects to address drug-related harms and deaths in Scotland.

The studies – which have received almost £380,000 in Scottish Government funding – will feed into the work of the Drug Deaths Taskforce, set up last year to tackle rising numbers of drug deaths.

Researchers from the University’s Faculty of Health Sciences and Sport, Faculty of Social Sciences and the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU) will work alongside experts from other universities, the Scottish Ambulance Service, health boards, charities and consultancies as part of the programme of work.

The Stirling-led studies are among 10 projects – totalling almost £800,000 – announced by the Scottish Government, to inform the work of the Taskforce. The Taskforce is chaired by the University of Stirling’s Professor Catriona Matheson. Professor Matheson is Chair of the Drug Deaths Taskforce.

Professor Matheson said: “Scotland’s challenge is unique and multi-faceted. In our early assessment of evidence to support our work, it was clear there are gaps. This research fund will fill those gaps whilst we progress other actions where the evidence is already established. Gaining further insight on what could contribute towards tackling Scotland’s challenge is vital. These research programmes will further enable the Taskforce in its mission to get evidence into action and save lives.”
Professor Niamh Fitzgerald is leading a study on ambulance call-outs to overdoses.

Study one: Ambulance call-outs to drug overdoses in Scotland: Patterns and practice

A £100,000 18-month study – led by Professor Niamh Fitzgerald, of the Institute for Social Marketing and Health (ISMH) – will be launched into ambulance call-outs to drug overdoses in Scotland. It will use ambulance call-out data and staff interviews to investigate the nature, circumstances, paramedic experiences and management of drug overdoses presenting to the Scottish Ambulance Service.

The findings will identify opportunities for earlier intervention and be used to inform future ambulance service responses, as well as local and national services and interventions to reduce drug-related deaths in Scotland.

Professor Fitzgerald said “The Scottish Ambulance Service attends at least 5,000 suspected drug overdoses each year, and this study will be the first to analyse the circumstances of these call-outs in detail.

“We want to better understand exactly where and when these calls occur in communities, the drugs involved, and how ambulance teams experience and handle the calls. Our findings will identify best practice and opportunities to prevent further overdoses.”

Professor Fitzgerald will work alongside Stirling colleagues Joe Schofield (of the Faculty of Social Sciences) and Dr Allison Ford (of the ISMH); Professor Jim Lewsey (Institute of Health and Wellbeing, University of Glasgow); and Gary Rutherford (Scottish Ambulance Service). Professor Anne Whittaker is looking at the prevention of drug deaths post COVID-19.

Study two: Understanding the role and potential of primary care in the prevention of drug deaths post COVID-19

Professor Anne Whittaker, of the NMAHP-RU at Stirling, and Dr Aileen O'Gorman, of the University of the West of Scotland, will lead a £100,000 14-month study examining how primary care teams in areas of extreme deprivation respond to drug-related harms and deaths. The findings will inform future policy, practice and research on the prevention of drug deaths.

Professor Whittaker said: “GPs working in practices serving the most socio-economically deprived populations in Scotland work with many different professionals and services who are part of a wider complex system of health and social care. However, little is known about their role in the prevention of drug-related deaths and what opportunities there are to improve the care they provide to individuals, families and local communities.

“Our study combines complex systems mapping and interviews with GPs, patients, family members and other health and social care providers to explore models of care delivered by two ‘Deep End’ GP practices – one in Glasgow and one in Edinburgh. In-depth case studies will illustrate the role and potential of primary care in the prevention of drug-related harms and deaths.

“The project will also examine how COVID-19 has had an impact on how GPs provide care for people who use drugs, their families and local communities.”

The research team includes: Professor Stewart Mercer and Professor Roy Robertson (University of Edinburgh); Professor Betsy Thom (Middlesex University); Dr Alison Munro and Dr Andrea Mohan (University of Dundee); as well as two people with lived experience of addiction who will help the team deliver the project and disseminate the findings to communities affected by drug use, practitioners and policymakers. Joe Schofield and his team will look at the safety of benzodiazepine.

Study three: Exploring the utility and safety of benzodiazepine prescribing among people receiving opiate replacement therapy in Scotland

Mr Schofield will also lead a research team to analyse data collected from people who received opiate replacement therapy from a specialist addiction service in four health boards areas: NHS Ayrshire and Arran, Greater Glasgow and Clyde, Lothian and Tayside. The £82,400 study aims to provide an overview of the prevalence, characteristics, and patient outcomes associated with benzodiazepine prescribing among this group.

Mr Schofield will collaborate with colleagues from the Universities of Stirling and Edinburgh and the four health boards for the 16-month project.

He said: “Benzodiazepines are implicated in over two-thirds of Scottish drug-related deaths, often in the context of polydrug use and taken with heroin, methadone, alcohol and other substances. The increase in drug deaths is especially associated with use of illicit or street benzos of unknown ingredients and potency. Some addiction medics prescribe benzos to dependent patients as a safer alternative to street benzos, however little is known about the outcomes for people attending addiction services who are prescribes benzos.

“This study will provide information on prescribing activity, patient safety and outcomes based on real-world practice. We hope the results will help inform policy and practice responses that aim to better support people with a drug problem and reduce the human and social costs of drug deaths in Scotland.”

Study four: Feasibility and acceptability of an overdose prevention intervention delivered by community pharmacies for patients prescribed opioids for non-cancer pain

Dr Rebecca Foster, of the Faculty of Social Sciences, and colleagues will explore the creation, feasibility and acceptability of an intervention involving the distribution of a naloxone nasal spray – known to reverse the effects of an opioid overdose – to treat patients prescribed opioids for pain.

The study will focus on pharmacies in Fife that are facilitating the intervention and explore how pharmacists, individuals and family members experience the intervention through surveys and qualitative interviews.

The £59,600 15-month study builds on previous work carried out by the team in 2019, which found that this group of patients was at increased risk of overdose due to high levels of comorbidities (the presence of more than one condition in the same person) and co-prescribing (the prescription of more than one medication). The Stirling led team includes Dr Tessa Parkes, Professor Catriona Matheson, Mr Schofield, and Tania Browne. They will work with Professor Alex Baldacchino (University of St Andrews), Dr Andrew McAuley (Glasgow Caledonian University), Deborah Steven (NHS Fife), and lived experience advisor Wesley Steele.

Dr Foster said: “People who are prescribed opioids for chronic pain would benefit from being provided with naloxone to help keep them safe. This study gives the team the opportunity to develop the intervention and to understand what those delivering and receiving it think about it.

“We hope our research, and the intervention itself, will help to reduce overdose among this group, and can be used to inform current practice and future research.”

Meanwhile, Dr Hannah Carver (Faculty of Social Sciences) is working on a separate project led by Glasgow Caledonian University focusing on understanding the impact of a programme that distributes naloxone kits within communities, teaching people how to use them.
Dr Foster is leading two projects launched under the new Scottish Government funding.

Study five: Perceptions and attitudes of strategic decision-makers and affected families across Scotland towards Drug Consumption Rooms to prevent drug-related deaths

Dr Foster and colleagues will also explore the views and attitudes of family members of people who use drugs, and strategic decision-makers across Scotland towards Drug Consumption Rooms (DCRs). DCRs are healthcare settings where people can consume drugs under the supervision of healthcare professionals, with clean injecting equipment and support, and access to other services.

During the 10-month project, qualitative interviews with these groups will explore how DCRs are perceived, what factors shape these perceptions, and whether and how these factors shape decision making. The project also aims to identify the barriers, facilitators and workplace requirements and adjustments associated with implementation.

The team behind the £37,200 study includes Dr Parkes, Tracey Price and Joshua Dumbrell (all from Stirling’s Faculty of Social Sciences), Dr James Nicholls (Transform Drug Policy Foundation), Andy Perkins and Dr Wulf Livingston (Figure 8 Consultancy), Kirsten Trayner (Glasgow Caledonian University), Professor Harry Sumnall (Liverpool John Moores University).

Dr Foster said: “This project builds on existing research on Drug Consumption Rooms and focuses specifically on exploring the perceptions and attitudes of affected family members and strategic decision-makers, which have been under-explored. It is essential to uncover these perceptions to determine the extent of support for, and viability of, DCRs in Scotland, and in turn to inform the discussion on potential implementation.”