Drugs action plan update

Actions to tackle Dundee drugs deaths following the report of a specially-convened commission are to be outlined to councillors, alongside details of how services have responded to the coronavirus crisis by providing “innovative initiatives and new ways of working”.

Dundee City Council’s policy and resources committee, which meets on Monday September 28, will consider a progress report on implementation of the Dundee Alcohol and Drug Partnership – Action Plan for Change.

The Dundee Partnership - made up of representatives from key local public agencies, academic institutions and representatives of the business, voluntary and community sector - published the action plan last year following the report of the Dundee Drugs Commission.

The latest progress report to councillors details a number of achievements, and outlines how services across agencies have adapted in the face of the pandemic and given “immediate and flexible responses to emerging issues”.

As lockdown took effect, the Dundee Alcohol and Drug Partnership introduced a weekly multi-agency call which enabled the fast establishment of a joint response for:

• home delivery of Opioids Substitute Treatment (OST);
• OST supervision at community pharmacies;
• issues relating to the availability of safe injecting equipment (IEP);
• issues relating to the availability of naloxone;
• continuation of the multi-agency response to Non-Fatal Overdoses;
• ensuring continuation of mental health and wellbeing supports;
• identifying support to vulnerable groups, including women and children at risk; and
• ensuring everyone had access to food.

Specific progress on the action plan outlined in the report explains that the availability and reach of naloxone in the city has been extended, and front-line staff worked hard, especially during the Covid-19 lockdown, to ensure harm reduction services and messages continued to be delivered. This included using outreach measures to deliver Injecting Equipment Provision (IEP) and also wrap around support to family members, carers and significant others.

The report highlights that the Dundee multi-agency Non-fatal Overdose Rapid Response team was established in November 2019. This developed an assertive outreach response engaging with every person who experienced a non- fatal overdose within 72 hours. This team continued operating during the Covid-19 lockdown and since June and have been gradually returning to normal service.

The Integrated Substance Misuse Service (ISMS) developed Direct Access clinics offering same-day prescribing, and plans are in place to extend this provision. Three new appointments have been made for non-medical prescribers and five new Band-5 nurses were appointed to support access to and retainment within treatment. Closer collaboration and joint working arrangements between ISMS and Children & Family teams have been established and progressing well.

Membership of the alcohol and drug partnership has been strengthened, while a lived experience network has been established allowing input around issues like substance use and mental health.

Meanwhile, efforts to protect children and women suffering from the consequences of drug use are being taken forward.

The report also asks that timescales for the action plan can be adjusted in light of the pandemic.

Council leader John Alexander, who is also chair of the Dundee Partnership, said: “From the outset we were confronting huge challenges, but we have been tackling these problems in the face of the biggest health emergency in living memory.

“I would like to pay tribute to everyone involved in this effort as it has proved how agencies and individuals are committed to helping people in this city have better lives away from the scourges of drugs and addiction.

“Staff are working so hard and it is so important to recognise them for this.

“I am impressed by the way that services have been adapted and real innovation has been shown to ensure that nobody was left behind during lockdown.

“This report shows what is still very much a work in progress and I am heartened by what has been achieved so far. There are no easy solutions to any of these issues. The action plan demonstrates we are striving for a full-rounded approach that also helps the children and families who often suffer from the consequences of addiction.

“I would like to restate that recovery is an important component of this action plan and I am hopeful that we will be calling Dundee a City of Recovery in the future as this action plan takes full effect.

“We cannot be complacent and everyone in the partnership takes their responsibilities around these issues extremely seriously.”

Simon Little, independent chair of the Dundee Alcohol and Drug Partnership, said: "Progress is being made, especially with reaching out to and engaging people who are at high risk.

“Some progress has been made in addressing the overall capacity of services, but the pandemic has set back our work on redesigning the whole system of care. That said, the immediate response to the pandemic has been encouraging; there has been excellent collaboration between Statutory and Third sector organisations and some innovative ways of working that we will want to build upon.

“Ambitious proposals are being discussed amongst partners and I look forward to these being taken forward in discussion with all stakeholders; including those with Lived Experience and Carers"

Eric Knox, Chief Executive of Dundee Volunteer and Voluntary Action, said: “This has been a difficult time for individuals struggling with substance issues. Quite rightly the partnership has focused on what is the needed on the ground at the moment to ensure people are as safe as they can be. Even so there has still be innovation on the way we are delivering services. The use of the Dundee Safe Zone bus in particular to support vulnerable people is a perfect example of how we have adapted services to give real support to people in the communities.”

NHS Tayside’s Associate Director of Public Health, Emma Fletcher, said, “COVID-19 has presented a number of challenges for people who use substances, as many will have significant underlying health conditions and therefore be more vulnerable to the infection. In Tayside we have been working closely with all our partner agencies to ensure the continued safe prescribing of opioid substitution therapy at this time, supporting people who were isolating or shielding and continuing to provide assertive outreach following a non-fatal overdose.

“In addition, we rolled out COVID-19 testing to all people with problem substance use in the community who are reporting symptoms that may be consistent with the infection. We have also made preparations to support people with problem substance use in the event of a local outbreak. Providing appropriate care and support to people with problem substance use continues to be a priority for all partner agencies in the three Alcohol and Drug Partnerships in Tayside.”

The 12 key priorities included in the Dundee Partnership Action Plan for Change and Improvement are:

1. Tackle the immediate risk factors for drug deaths
2. Urgently increase the capacity and capability of specialist services to support access, quality and safety
3. Improve retention in treatment and recovery services
4. Implement a revised person centered, seamless, sustainable and comprehensive model of care
5. Win the trust and confidence of all stakeholders through effective Leadership, Governance and Accountability
6. Ensure the meaningful involvement and engagement of people who experience problems with drugs, families and carers and those that advocate for them
7. Confront and address stigma and strengthen mutual and community support
8. Keep children safe from substance use and its consequences
9. Implement trauma informed approaches, targeting those at increased risk of substance use / and death
10. Tackle the root causes of substance use
11. Ensure gendered approaches are considered in all activities and accommodated in design and delivery of services
12. Ensure clear and consistent communications are delivered through a partnership approach

The full action plan is available at https://www.dundeecity.gov.uk/sites/default/files/publications/dp_action_plan.pdf

The Dundee Drugs Commission was set up by the Partnership as a response to the increasing number of drug-related deaths in the city.

Its report, “Responding to Drug Use with Kindness, Compassion and Hope’, detailed a number of key recommendations, some of them immediate actions and others longer-term pieces of work to be delivered across a period of five years.

The Dundee Partnership is made up of representatives from key local public agencies, academic institutions and representatives of the business, voluntary and community sectors.

It pools the strengths of all partners to deliver a vision for the city which improves people’s lives. Among its key priorities is tackling the root causes of social and economic exclusion, creating a community which is healthy, safe, confident, educated and empowered.