Have Scottish substitution measures limited opioid deaths in the pandemic?

One in ten Scots are given opioids despite overdose fears | Scotland | The  Times
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In July 2020, researchers in Italy identified a major trend in drug abuse, triggered by the pandemic, away from classic streets drugs consumed in social, group settings, toward greater misuse of psychoactive prescription drugs, in isolation, such as benzodiazepines and opioid painkillers. [1]

Writing, in Frontiers in Psychiatry, they suggest that the pandemic measures such as border closures affected illicit drug routes and led to a scarcity of classic street drugs such as cannabis, cocaine and MDMA.

The researchers suggested, in the light of these trends, improvements in postal police controls to stem the intensification and spread of this activity but also, to save lives, they argue for radical changes in the access to legal substitution treatments such as methadone, and buprenorphine, which social distancing has now made more difficult and which has unavoidably increased the risk of isolated overdose, failure to administer naloxone, and consequently more deaths.

To prevent these deaths, they called for the urgent implementation of contingency plans such as patients under opioid addiction treatment with a reasonable degree of stabilization being able to get several doses of methadone, sufficient for several days or refill their buprenorphine prescription over the phone.

Researchers in Portugal, working for the European Monitoring Centre for Drugs and Drug Addiction pointed to the lives that such measures would save in reducing the high incidence of cardiovascular diseases among opiates, opioids, and cocaine users.[2]

Remarkably, in April 2020, well ahead of the academics, the Home Secretary had heard no bells and had asked the Advisory Council for Misuse of Drugs, to consider the risks of lifting restrictions on certain substances controlled under the Misuse of Drugs Act.[3]

In its response, the council ultimately supported the emergency proposals but warned that the move could lead to a rise in drug misuse, especially of opioids, and drew attention to the dangers of asking pharmacists to work outside the scope of their professional practice.

These emergency measures are still in place in England [4]. Guidance in Scotland, though broadly similar, goes further and provides detailed criteria for the safety of ‘door-step’ daily delivery based on ‘nominated persons’. [5] The effectiveness of this approach, based on protocols developed by the Edinburgh Health Social Care Partnership, in preventing death by overdose is not yet known.

Have the council’s predictions proved correct? Have my concerns been confirmed?

Data on opioid deaths in 2020 are not yet available.  In response to a Freedom of Information request of the ONS, in May 2021, no data for opioid deaths was apparently available for any later than March 2020 as the pandemic began. [6]

However, we do know from US statistics published in March 2021, even though only up to September 2020, that overdose deaths, driven by increased opioid abuse and at least in part by disruptions in addiction support such as those described above have resulted there in 19 000 extra deaths, a shocking 27% increase. [7]

I shouldn’t tempt fate, but the measures adopted in Scotland, as with so many other health strategies, seem more developed.

If any reader can identify early statistics, that would be really interesting.

[1] New Trends of Substance Abuse During COVID-19 Pandemic: An International Perspective https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00700/full

[2]  European Monitoring Centre for Drugs and Drug Addiction. European Drug Report 2019. Lisbona, Portogallo: EMCDDA (2019). p. 1 -94.  http://www.emcdda.europa.eu/publications/joint-publications/eu-drug-markets-report-2019_en [Accessed April 29, 2020].

[3] https://www.theguardian.com/politics/2020/apr/08/methadone-to-be-handed-out-without-prescription-during-covid-19-crisis

[4] https://www.gov.uk/government/publications/covid-19-guidance-for-commissioners-and-providers-of-services-for-people-who-use-drugs-or-alcohol/covid-19-guidance-for-commissioners-and-providers-of-services-for-people-who-use-drugs-or-alcohol

[5] http://www.sdf.org.uk/wp-content/uploads/2020/05/Guidance-on-Contingency-Planning-for-PWUD-and-COVID19-V2.0-May-2020.pdf

[6] https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/deathscausedbyopioids2005to2021

[7] https://www.commonwealthfund.org/blog/2021/spike-drug-overdose-deaths-during-covid-19-pandemic-and-policy-options-move-forward

One thought on “Have Scottish substitution measures limited opioid deaths in the pandemic?

  1. Scottish Gov funding £250million over the next five years to drink/drug addiction. Scotland needs proper total abstinence rehab facilities. It should have been kept under SNHS instead of going under social care. Drs used to be able to refer people. It is the same in the rest of the UK. A recent report. Decline in proper total abstinence facilities.

    Councils will not fund proper total abstinence rehab facilities. People are put on methadone or prescribed drugs for years. A total waste of money. Prison costs £40,000 a year. Spend £Millions to save £Billions. Poverty is caused by drink/drug addiction. MUP has saved lives. Cut consumption.

    ‘Shuggy Bain’. Booker prize winner.

    The Taliban reduced production.

    The Tories reduced foreign aid increased Defence (attack) spending. The cause of conflict worldwide.


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