Health, Social Care and Sport Committee
Response to request for additional information on drugs policy implementation
Letter from Minister for Drugs Policy - Response to request for additional information on drugs policy implementation - 25 October 2021
Dear Convener,Re: Request for additional information on drugs policy implementation
Thank you for your letter of 22 September 2021 asking for further information for on particular topics following my appearance at the Health, Social Care and Sport Committee
Naloxone - Test of Change – Police Scotland
You asked for an update on the Naloxone Test of Change trial including how many times naloxone has been used by area and how it is being/will be evaluated.
I can confirm that training is complete in each of the three test bed areas - Glasgow East, Dundee City and Falkirk & Grangemouth. Additional training has also been provided to officers in Caithness and Stirling in custody settings. This means 803 police officers have been trained. At present 651 of these officers (81%) have volunteered to take part in the test of change.
So far naloxone has been administered at 48 incidents: 18 in Glasgow East: 23 in Dundee; 5 in Falkirk, Grangemouth and Stirling; and 2 in Caithness.
The Test of Change is being evaluated independently by a team of academics. That is in its final stage of information gathering and will conclude by 1 November 2021.
The team has conducted a number of group sessions and one-to-one interviews with officers in each of the test bed areas as well as with the Naloxone Coordination Team and external partners involved in the training programme.
The evaluation team has collated and will assess baseline and post-training surveys with officers and will consult with drug treatment groups, people with lived/living experience of drugs and family members affected by drug use.
It is anticipated that the evaluation team will consider:
• Police officer attitude towards drug use and people who have a drug dependency;
• Police officer understanding and awareness of drug overdose incidents and Naloxone as a first aid intervention;
• Effectiveness of naloxone training (considering knowledge/skills of officers both before and after training);
• Experience of naloxone carriage/use by officers;
• Barriers/facilitators (actual or perceived) impacting on police carriage/use of naloxone.
• Feedback from local communities (including recovery communities, people who use drugs, their families and/or relevant support services. It is hoped that the approach taken during the Test of Change will be supported by the general public and have a positive impact upon community relations between police and people who use drugs).
The evaluation team aim to submit their findings to Police Scotland by the end of December to mid-January.
Flumazenil
You also asked for information about what consideration has been given to widening the use of drugs such as flumazenil to reverse the effects of overdose with benzodiazepines.
I can confirm that flumazenil is not currently being considered as an option for wider access to reverse the effects of a benzodiazepine overdose. The latest study in Scotland on this was carried out in 2016 by NHS Health Scotland. A report was published on its investigation into the role of benzodiazepines in drug-related mortality.
The report includes a summary of evidence on the use of flumazenil which concluded that although flumazenil can be effective in reversing benzodiazepine effects, as the majority of drug-related deaths in Scotland are due to poly-drug overdoses “the widespread use flumazenil would appear to be inappropriate.”
The Scottish Government has recently consulted on benzodiazepine prescribing and the Drug Deaths Taskforce has considered best advice on the management of benzodiazepine dependencies. The Taskforce expert group on this has published interim harm reduction guidance earlier this year.
The co-authors of this guidance have advised that flumazenil can cause withdrawal seizures which may be life threatening. They have advised that it is unlikely to be helpful in street benzo overdose situations - as the risk of seizures and other side effects would outweigh any benefit.
This is in stark contrast to the risk-benefit of naloxone for opiate overdose – where the benefit far outweighs the risks. As such, it would not be appropriate to see flumazenil as being a naloxone equivalent. There are significant risks associated with the use of this medication outside controlled hospital environments.
I hope the additional information provided is helpful to Committee Members.
Yours sincerely
ANGELA CONSTANCE
Minister for Drugs Policy