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Safer consumption facility could provide substantial financial gain for services

Wednesday, February 15, 2017

Public injecting of drugs places considerable financial costs on the health, social care and criminal justice systems. This is the finding of the draft, full-business case for Glasgow Health and Social Care Partnership’s (HSCP) proposed safer consumption facility for heroin users.

Discussed by the partnership’s board today (Wednesday, 15 February), the draft business case also identifies evidence that indicates safer consumption facilities not only improve health outcomes for people who inject drugs, but are also ‘highly cost effective and contribute to savings’ for health services.  Establishing a safer consumption facility would also create the potential for savings in other services in Glasgow.

The conclusions are based on the assessment that a safer consumption facility would reduce the spread of blood borne viruses, reduce drug-related deaths, reduce the use of unscheduled care and crisis services and reduce drug-related offending as well as improving service engagement with drug users with complex needs.

Proposals for a safer consumption facility, alongside a heroin-assisted treatment service, arose after a steep rise in the number of HIV cases among people who inject drugs.  According to the draft, full-business case, the 78, new HIV cases diagnosed in Glasgow since 2015 among people who inject drugs could potentially create lifetime costs to the health services of £28.08million.

Based on local research of 350 people who inject drugs in Glasgow city centre, it was also found that this group accounted for a £1.7m cost to accident and emergency services alone over a two year period between 2014 and 2016. This does not include the cost engagement with other health services.

A further study of social work records found that 99% of people in this group of public injectors were currently involved with social care services or were previously known to social care services. Existing research highlighted in the draft, full-business case suggests that the average monthly spend on health, addictions, housing and criminal justice service for people with complex needs ranges from £1,120 and £3,069 per individual per month.

The business case also highlights the well-established cost-effectiveness of heroin-assisted treatment for chronic heroin user who have not benefited from other interventions.

Susanne Millar, the HSCP’s Chief Officer for Strategy, Planning and Commissioning, said the work to understand the economic impact of public injecting pointed towards a substantial economic benefit to services if a safer consumption facility and the heroin assisted treatment programme are eventually given a green light.

Susanne Millar commented: “The health and social impact on those involved in public injecting leads directly to significant costs for support services.

“The need for a safer consumption facility is about improving the health of those involved in public injecting, providing a route to recovery for a group of people often disengaged from support services and improving the general amenity of Glasgow city centre.

“Our proposals to transform how we support those who publicly inject drugs would help to address a wide range of issues and so relieve considerable pressure on services elsewhere in the system.  The evidence clearly shows the potential for these proposals to create long-terms savings and so the economics of this issue are also compelling.”

Elsewhere the full business case looks at the benefits created by safer consumption and heroin-assisted treatment for public health, promoting recovery for people injecting drugs and reducing the impact of public injecting on local communities and local businesses in the city centre.

The identified advantages of developing this service include:

-          Reducing the risk of blood-borne virus transmission, reducing the risk of overdose or drug-related death and reducing injecting-related infections by promoting safer injecting practices and safer forms of drug use.

-           Bringing a population with complex needs in contact with effective addictions support and providing an opportunity to address other adverse circumstances in housing, welfare rights and other medical needs.

-          Improving the amenity of the city centre by reducing drug-related litter and public injecting while also tackling other drug-related criminal activity and anti-social behaviour.

The draft, full business case also identifies that work is on-going in relation to key issues such as identifying suitable premises and also an exemption from the Lord Advocate to the Misuse of Drugs Act 1971 to allow the possession of street-purchased heroin within the safer consumption facility.  Work on developing the financial framework for the overall proposals and also personnel-issues related to the creation of a new service.

A further update on the progress with the development of the full-business case is anticipated to be put before the Glasgow Health and Social Care Partnership Board on June 17.

The Glasgow HSCP board approved on October 31 last year the development of a full-business case for a pilot of a co-located safer drug consumption facility and heroin assisted treatment programme.

The proposals followed a sharp rise in HIV cases in Glasgow in 2015. In previous years there was a consistent average of ten cases but in 2015 this figure rose to 47.  Since this outbreak of HIV a total of 78 new cases have been confirmed. There have also been outbreaks of other serious diseases such as botulism and anthrax. In 2015 Glasgow City also recorded 157 drug-related deaths.

Medically supervised drug injecting facilities have been in operation across the world since the 1980s. There are now 90 such facilities in 61 cities, mainly in Europe but also in Sydney and Vancouver. The evidence drawn from over 100 scientific papers highlights the positive impact of these facilities.

The figure of the 78 HIV cases creating a lifetime cost to health services of £28.08m is based on a study which identified a £360,000 cost of treatment for an individual with HIV over the course of their lifetime. This study drew upon research with men who have sex with men. No similar study exists for people who have contracted HIV through injecting drugs but it is anticipated that the costs of a lifetime of treatment would similarly high, subject to certain variations.

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