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Update on proposed safer drug consumption facility and heroin assisted treatment in Glasgow

Friday, June 9, 2017

Work is ongoing to establish a safer drug consumption facility (SDCF) and heroin assisted treatment (HAT) in the south east of Glasgow city centre.

Proposals for a SDCF, alongside a separate HAT service, are a result of a public health outbreak which has seen a steep rise in the number of HIV cases among people who inject drugs.  

An update report going to the Glasgow City Integration Joint Board (IJB) on Wednesday, 21 June will update members on a potential site for the co-located facility as well as estimated costs. 

Available and suitable sites in the south east of the city centre are being pursued in the event that permission is granted for the two services to operate. Once a suitable site is identified engagement will be carried out with the local community. 

The SDCF and HAT are intended to aid service user access preventative and supportive health care and advice as well as social care and peer support. Advice and referral to specialist treatment options would be accessed in the after-care area for both services. 

Last year, the draft business case identified the 78 new HIV cases diagnosed in Glasgow since 2015 among people who inject drugs could potentially create lifetime costs to the health service of £29.64 million. This group has now grown to 90, with 12 infections already recorded to date this year. 

In addition, drug deaths in Glasgow remain high with 157 occurring in the city in 2015. Heroin and/or morphine was the cause or contributing factor in 73 of these deaths. 

The total operating costs of the SDCF and HAT are estimated at £2,355,680 per annum. This will be funded by the redirection of existing resources of £885,290, with the balance of £1,470,390 being met from contingency funding for a period of no more than three years. 

Assessing the Scale and Impact of Illicit Drug Markets in Scotland, a research paper published by the Scottish Government in 2009, suggested the total economic and social costs attributable to illegal drug users in Scotland was around £3.5 billion in 2006, however it is anticipated that figure will now be higher. 

In terms of social costs incurred as a result of problem drug use, namely the cost to victims of crime, the cost of pain and suffering for the individuals themselves and their families caused by drug related death, it is estimated that the annual cost of each problem drug user is £31,438. 

Based on that figure, which will be higher than the 2006 estimate, the HAT, if approved,  has the ability to save the public purse more than £940,000 annually through health, social care for every 30 people who access this treatment. 

The report also found the average annual criminal justice cost per problem drug user was £12,713 for those not in any form of drug treatment. This dropped to £6,524 for those in treatment for less than a year. The cost dropped even further to £1,536 for those in treatment for a year or more. 

HAT, a highly specialised clinical intervention where diamorphine is prescribed for the treatment of heroin addiction, can only be undertaken by doctors with a licence allowing them to prescribe the medication. Heroin dependent patients aged 18 and over, with previous unsuccessful treatment episodes, would eligible for the service. 

It is expected the potential SDCF will feature a reception, a drug consumption area and an after-care area. The anticipated consumption area would see a maximum of 12 individual injecting booths and possibly a small drug inhalation room, dependent on the floor space available. 

The draft business case outlines that a SDCF and HAT has the potential to: 

  • Reduce the spread of blood borne viruses
  • Reduce drug-related deaths
  • Reduce the use of unscheduled care and crisis services
  • Reduce drug-related offending
  • Reduce public nuisance caused by injecting in public spaces and associated drug related litter
  • Improve service engagement with drug users with complex needs.

A study of social work records found that 99% of people in the known group of public injectors were currently involved with social care services or were previously known to social care services. 

Susanne Millar, Glasgow City HSCP Chief Officer for Strategy, Planning and Commissioning, said: “The need for a safer consumption facility is about improving the health of those involved in public injecting. 

“Our aim is to provide a route to recovery for a group of people often disengaged from support services and improving the general amenity of Glasgow city centre. 

“Public injecting of drugs places considerable financial costs on the health, social care and criminal justice systems. 

“Existing research suggests the average monthly spend on health, addictions, housing and criminal justice service for people in Glasgow with complex needs ranges from £1,120 and £3,069 per individual per month. 

“These proposals are backed by evidence indicating SDCFs not only improve health outcomes for people who inject drugs, but are also highly cost effective and contribute to savings for health and social care services.”  

Existing policies and procedures, in general, of NHS Greater Glasgow and Clyde and Glasgow City Council, can be directly applied to the SDCF and HAT. However, given the unique nature of the services there is a need to develop a number of bespoke policies and procedures. 

The ethos of the SDCF is one of inclusiveness and those aged 16 and over who are consuming illicit drugs would be eligible to use the facility. Staff will be vigilant and trained to respond appropriately to anyone who appears ineligible to use the service. 

Work is on-going in relation to securing an exemption from the Lord Advocate on specific elements of the Misuse of Drugs Act 1971 to allow the possession of street-purchased heroin within the safer consumption facility. No legal exemption is required to provide a heroin assisted treatment programme as this can legally be delivered within the framework of the existing Medicines legislation.

Although there is no cure for HIV, there are now treatments which reduce the virus to undetectable levels. New guidelines highlight the importance of starting HIV treatment early. This is beneficial for the individual, but is also important in preventing the spread of HIV. 

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, with a number of new sites due to open in Toronto and Montreal. The evidence drawn from over 100 scientific papers highlights the positive impact and cost effectiveness of these facilities.

Current estimates suggest there is a group of approximately 500 very vulnerable people who inject drugs in public places in Glasgow city centre. The majority are individuals experiencing homelessness, mental health issues, recent imprisonment and poverty.

These individuals are substantially responsible for the majority of discarded needles in public areas such as alleyways, car parks, parks, public toilets, and closes causing public alarm.

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