SDF report provides the insights of people using drug treatment services and suggests reasons why Scotland has struggled to reach treatment targets.
On Tuesday this week National Records of Scotland will publish the latest figures on drug-related deaths in Scotland. In anticipation of that publication, Scottish Drugs Forum publishes new report Medication Assisted Treatment: Evaluation of Current Practice Across Eight Health Board Areas in Scotland.
The report is the result of months of activity interviewing and then re-interviewing people as they progressed through their engagement with drug treatment services in Scotland.
Treatment is the best protection against drug overdose deaths that can be offered to a person experiencing a drug dependency. It is concerning to note that Scotland has struggled to achieve the target 9% increase in the number of people in treatment. That target was set by the Scottish Government in March 2022 and was to be achieved by April 2024.
Likewise, it is discouraging that the Medication Assisted Treatment Standards introduced in May 2021 have not been fully implemented even under their revised schedule by the deadline of March 2024. These standards were designed to make treatment services accessible and acceptable to people experiencing drug problems.
SDF’s new report explains some of the issues people face in engaging with services which mean that they are difficult to access or are not offering what people want and need.
Scottish Drugs Forum CEO Kirsten Horsburgh said, “The observational component of this peer research project provides a unique insight into the logistics, experiences and emotions of participants accessing medication assisted treatment. The strength of the peer research approach was evident in the relationship between peers and participants, often resulting in authentic and engaging conversation which has enriched the findings.
Directly observing some of the positive changes to treatment provision in Scotland through this work has been hugely encouraging but inevitably this work also highlights the shortfalls and some highly unacceptable practice. The examples speak for themselves as to why more people are still disengaged from the treatment system.
“The examples of stigma and discrimination were painful to observe during the project and difficult to read now. People’s expectations of services are often very low yet even the basic standards of care and human decency can be sorely lacking.
“The primary aim of all treatment should be the empowerment of people in treatment. This would be achieved by successful implementation of all ten MAT standards – of which there is some way to go.
“The treatment services need to be capable of change and be supported to change. That requires more radical change in practice and a clearer vision that the MAT Standards implementation remains a priority.”
MAIN REPORT FINDINGS
Waiting times: Some participants had delays of up to several months for an appointment and two had further delays in getting a prescription.
Travel: People said travel to services was a barrier, due to cost and/or distance. Some had to cover their travel costs themselves.
Choice: Initial medication choice was limited – methadone was offered to people who accessed/re-accessed MAT
Some felt they needed more information about treatment options and local support activities
Some people received little explanation about starting dose and potential effects of their medication.
When changing medication people felt the process was lengthy and stressful.
Half the participants felt in control of their dose. Other participants felt workers dictated whether their dose would be changed and felt frustrated about not being able to reduce their dose.
Most people had a say in which gender of keyworker they wanted but choices could be more limited in rural areas.
Stigma: Participants reported experiencing stigma when accessing MAT.
People referred to negative feelings triggered by service buildings and felt dismissed/judged by their GPs.
They felt pharmacies were stigmatising due to things like being made to queue separately and consume their methadone publicly.
Contact: The majority of participants wanted more frequent contact with MAT services. Communication is important for people, with many preferring direct contact through phone calls/texts with workers.
Barriers including reliance on reception lines for contact and issues with letters, such as tone perceived to be threatening and late delivery of letters.
Participants wanted more choice in appointment frequency and preferred face-to-face meetings than phone calls.
Relationship with worker: The relationship built with an allocated worker was more important to people than having a specific choice of who this was.
All participants felt the relationship with their keyworker was an important factor to engage/keep them in treatment.
Some people had positive relationships with their keyworker; they described being in regular contact and feeling heard and respected.
Other participants had limited contact with their assigned worker and others felt unsupported/uncared for by theirs.
Some participants found the relationship they built with the lead researcher to be more valuable than the one with their allocated keyworker.
Some participants had no allocated keyworker and relied on duty workers instead. They reported feeling isolated, left behind and unable to make progress in their MAT due to this.
Buvidal: Some people felt they received positive support alongside their Buvidal, usually due to positive keyworker relationships. However, others felt the support provided with Buvidal was limited/non-existent and some said support was less compared to that received with methadone and Subutex. Short ‘injection only’ appointments where no other help/discussion was offered were mentioned by several people.
Mental health: Some people were seen by mental health professionals but most participants felt they needed much more support with their mental health. People were on waiting lists for psychiatry appointments, often for several months.
Several people said they did not receive any mental health support, even psychosocial interventions, or discuss this with their keyworker.
Lived & living experience: Participants explained the valuable role peers had in recovery, third sector and residential rehab services. Some people described ways people with lived/living experience could feature in statutory services, such as supporting people in their appointments.
Recovery communities/third sector: Participants felt these services filled gaps of statutory support, including via provision of psychosocial interventions and harm reduction.
Some people felt they had stronger relationships in these contexts, often due to extra time they could spend with workers/peers.
Harm reduction: Harm reduction provision was generally limited. A few people reported accessing injecting equipment provision where they also received blood testing and injection advice.
Some people felt more support was needed for other substances they were using, such as cocaine, as this could be a barrier to receiving/changing MAT. Some were signposted to third sector support for this use but otherwise no harm reduction was offered in these cases.
To view the Executive Summary – CLICK HERE
To view the full report – CLICK HERE