Improving our treatment system to prevent further drug-related deaths

New treatment standards to support people with a drug problem were recently published by the Scottish Government on behalf of the Drugs Death Taskforce and in collaboration with Public Health Scotland.

Public Health Scotland’s Elinor Dickie, co-author of the standards who helped lead their development, shares her hopes of the lasting change that they will deliver.

In 2020, 1,339 people lost their lives to a preventable drug overdose.

This figure is again another record high, and is a crushing reminder of how far we as a country have to go in order to make an impact on the current drugs death crisis that our communities are experiencing.

An important part of our response is offering people high quality treatment and support. Public Health Scotland and the Scottish Government published new standards of care for drug treatment at the end of May. Known as the Medication Assisted Treatment (MAT) standards, these define what is needed for high quality, safe and accessible drug treatment and support in Scotland.

Standards of care are common elsewhere in the treatment system, but for drug treatment they are new. The standards are a collective effort to improve access to treatment across the country - a shared effort to do better, driven by compassion, urgency and evidence.

Too many people die in Scotland as a result of problematic drug use. Problems that not all of us experience, problems that people in our most deprived communities experience the most. Problems of inequality.

The standards target this inequality. They aim to ensure intensive support for those in need. Support that is tailored to address the experiences that have led people to drug use. Support delivered with kindness and empathy, to build trust and bring back hope. Support and care to prevent deaths.

Quality care, provided with dignity and respect is something everyone is entitled to. Getting the right medication is important, but it is not the only thing. Drug treatment is not just about a prescription, it is about the whole person, all their wants and needs.

The standards have been developed with people who use substances, their families and the people who care for and support them. They translate the evidence of what we know works and offer real system change to make it easier to access and navigate different services. Meeting these ten standards will improve our treatment response and can save lives. I believe they will – but only if effectively implemented.

Here is a summary of the ten standards, and why they are important:

1. Help on the day you ask: Being in treatment is a matter of life and death - when people ask for help we should be ready to provide it. Services will bring in new guidance to allow this to either be a prescription when clinically appropriate, or to ensure access to other support from day one.
2. Choice: We should all be involved in the decisions that affect our care, after all, it is us that have to live with it. Different medication options that are available will be discussed with people and they will be supported to make the right choice for them.
3. Reaching out: Staff contact and follow up with individuals they are concerned about, especially during times of high risk. Support will also be offered when a person’s risk factors might be changing - e.g when a person is leaving hospital.
4. Harm reduction for everyone: While a person is in treatment and prescribed medication, they are still able to access harm reduction services – e.g needles and syringes, testing for blood-borne viruses, injecting risk assessments, wound care and naloxone. They would be able to receive these from a range of providers - including their treatment service - and this would not affect their treatment or prescription.
5. Staying in treatment: People are to be given support to stay in treatment for as long as they like and especially at times when things are difficult for them. All discharges from services should be planned with the person to ensure this is managed safely.
6. Improving mental wellbeing and understanding: We know that for many people, substances are used as a way to cope with difficult emotions and issues from the past. Services will focus on supporting people to develop positive relationships and new ways of coping as these are just as important as having the right medication.
7. Involving GPs and primary care: Not everyone needs specialist services throughout their recovery, and people should be able to choose to receive their medication and other support through primary care providers.
8. Meeting everyday needs: To support the whole person not just their drug use, people have the right to ask for support to improve their living circumstances, such as housing and access to their welfare entitlements. Dedicated independent workers will support people to make sure they get what best suits them and that they are treated fairly.
9. Recognising and treating mental health: People have the right to ask for support with mental health difficulties and to engage in mental health treatment while being supported as part of their drug treatment and care.
10. Respecting traumatic life experiences: This ensures we listen to people and offer the kind of relationship that promotes their recovery, does not cause further trauma or harm, and helps builds resilience.

What’s next?

A new team within Public Health Scotland is being set up to directly support implementation across the country. They will work with local teams to develop services that meet the standards within their local context. This will provide a platform to share learning and improvement, and to bring us all together in our efforts to improve our treatment response.

We are also working to ensure we know the improvements translate into a better experience for people, that we understand what people in services think of the care they receive and where we must continue to improve. Importantly, we want to be accountable for those improvements and to remain accountable for years to come.

The standards are intended to ensure open conversations and promote people’s rights to access the range of services they need. They focus on the essential elements of care, on what people want and should expect from services. They put the onus on us to do the right thing for the people we support.

Elinor Dickie, Organisational Lead, Drugs Team

For more information on the MAT Standards, please a recent webinar which includes details of the national programme (external link)

You can also find out more about our work in our Strategic Plan.