Chamber and committees

Prior to 2007-08, this information had not been collected. To address this evidence gap the Scottish Government has:

(1) Invested in, and enhanced, the Scottish Drug Misuse Database (SDMD) to improve the information available on people entering and completing drug treatment in Scotland. This will enable us to understand more about people’s journeys through treatment and the outcomes they achieve. The first release of follow-up and outcomes-based information will be published by Information Services Division (ISD) of NHS National Services Scotland in December 2012.

(2) Developed the Scottish Drug and Alcohol Treatment Waiting Times Database, which went live from 1 April 2011. This provides quarterly information, which is published by ISD, on the length of time people are waiting for treatment and the treatment interventions started.

Prior to 2007-08, this information had not been collected. That is why the Scottish Government invested in the research Assessing the Scale and Impact of Illicit Drug Markets in Scotland http://www.scotland.gov.uk/Publications/2009/10/06103906/0, which was published in October 2009.

The report estimates that the total economic and social cost of illicit drug use in Scotland is just under £3.5 billion. Costs associated with problem drug use accounts for 96% of the total cost and this equates to just under £61,000 per problem drug user. Recreational drug use accounts for 4% of the total estimated cost equating to £134 per user.

Table 5.9.1 of this Report Breaks Down the Wider Costs of Drug Misuse

This report also offers some useful cost / benefit analysis of drug treatment in the context of preventative spend:

The Road to Recovery is a long-term strategy and is under continual review from both within and out with government.

In order to do this effectively and sustainably the Scottish Government established the Drugs Strategy Delivery Commission (DSDC) in 2009 to give expert advice on the impact and progress of the strategy.

In addition to the work of the DSDC, we recognise that the strategy is a product of political consensus and so it was right that the Scottish Government requested and led a parliamentary debate in September 2010 to hear the challenge and consensus of all political parties. Additionally briefing in parliament from the, then, Minister for Community Safety, Fergus Ewing MSP, was offered to all MSPs, as well as individual briefings for all party leaders, in March 2011.

In 2009 we committed to a HEAT target that states by March 2013, 90% of clients will wait no longer than three weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. We are well on our way to achieving this target, and in June 2012, Information Services Division (ISD) of NHS National Services Scotland reported that between January to March 2012, 87% of people received treatment for drug use within three weeks of referral.

The Scottish Government has invested in the enhancement of the Scottish Drugs Misuse Database (SDMD) so that it includes the collection of follow-up and outcomes based information from clients as they progress through their treatment pathway.

The analysis and reporting of this information by ISD from December 2012 will, over time, provide us with some key answers to the numbers of people in drug treatment in Scotland (by treatment type); and provide an opportunity for additional analysis which will inform our understandings of people’s journeys through drug treatment (for particular cohort groups), the effectiveness of different types of treatment (including length of time) and the outcomes that individuals are achieving (e.g. around accommodation, family, employment/training, drug use and offending).

So far from the SDMD we note that since 2007 more and more people are coming in to treatment (39,458 recorded entries into treatment, 2007-08 to 2010-11).

Furthermore the Scottish Government developed the Scottish Drug and Alcohol Treatment Waiting Times Database, introduced in April 2011. This provides us with quarterly reports on the length of time people are waiting for treatment and the treatments they started. 19,043 drug treatments started between 1 April 2011 and 31 March 2012 and these included the following:

The Scottish Government continues to work closely with the independent National Forum on Drug Related Deaths (NFDRD). In partnership with the forum we have established a database that offers information and context behind each drug-related death in Scotland (information that prior to 2007-08 was previously not routinely collected or analysed). This in turn offers challenge to the strategy and an opportunity to develop critical interventions, for example the National Naloxone programme.

The Scottish Government remains committed to providing the Parliament with regular updates on the implementation and impact of Road to Recovery for the review and challenge of MSPs. We want to continue to work with parties across the Parliament to build on and reinforce the consensus of this important approach.

The Drugs Misuse and Dependence – UK Guidelines on Clinical Management (more commonly known as the Orange Guidelines) advises clinicians to undertake random urine tests if and when appropriate. The guidelines further state that urine tests may be used to assess how a client is responding to treatment and to assess if they are failing to benefit from a specific course of treatment.

As this is a decision for the clinician to make in line with UK agreed clinical guidelines there is no, and never has been, any centrally held information.

The Review of Methadone in Drug Treatment: Prescribing Information and Practice published in 2007 (for the year 2006) estimated that 22,224 individuals were receiving methadone.

Prior to 2007-08, this information had not been routinely collected. To address this evidence gap, the Scottish Government has invested in three approaches:

(1) In 2011 and 2012 the Scottish Government Drugs Policy Unit asked every NHS Board in Scotland how many individuals were receiving opioid substitute treatment in the month of April. This provided an estimate of 24,994 individuals receiving methadone prescriptions in 2011 and 24,507 individuals receiving methadone prescriptions in 2012.

(2) The Scottish Government has invested in the enhancement of the Scottish Drug Misuse Database (SDMD) so that it includes the collection of follow-up data and outcomes-based information from people as they progress through their treatment pathway. The first release of this information will be published by Information Services Division (ISD) of NHS National Services Scotland in December 2012.

(3) The Scottish Government developed the Scottish Drug and Alcohol Treatment Waiting Times Database, introduced April 2011. This provides us with quarterly information on the length of time people are waiting for treatment and the treatments started. Nineteen thousand and forty-three drug treatments started between 1 April 2011 and 31 March 2012 and they were broken down as follows:

Prior to 2007-08, this information had not been collected. To respond to this evidence gap, the Scottish Government has:

(1) Developed the Scottish Drug and Alcohol Treatment Waiting Times Database. This recorded that 15,600 people entered drug treatment (and that 19,043 treatments started) between April 2011 and March 2012. The treatments started in 2011-12 included the following:

(2) Enhanced the Scottish Drugs Misuse Database (SDMD) which is why Information Services Division (ISD) of NHS National Services Scotland is now collecting data on people’s pathways through treatment.

The purpose of the SDMD is to help us understand the needs of people with drug problems presenting for specialist treatment. It will help inform recovery plans and, over time, enable us to understand more about people’s journey through treatment and the outcomes they achieve (including paid and unpaid employment, support into employment and full-time education and training). The first release of follow-up information from the SDMD will be published by ISD Scotland in December 2012.

2011-12 information on new clients who presented to specialist drug treatment services and who received an assessment of their drug use and care needs is due to be published by ISD in late 2012/ early 2013 (ISD is yet to confirm the date for the reporting of SMR25a information from the SDMD).

We do have information, from the SDMD, on the employment status of new clients who received a specialist assessment of their drug use and care needs in 2010-11. This information was published by ISD on the 28 February 2012 in Drug Misuse Statistics Scotland 2011.

In 2010-11, 12% of new clients who received a specialist assessment of their drug use and care needs reported that they were employed (includes paid and unpaid employment, support into employment and full-time education and training). Information from the SDMD also told us that 67% of new clients in 2010-11 reported that they were unemployed (73% in 2009-10). This information from the Scottish Drug Misuse Database (SDMD) on the employment status of "new clients" presenting to specialist treatment via SMR25a has been published annually by ISD in Drug Misuse Statistics Scotland. http://www.drugmisuse.isdscotland.org/publications/11dmss/11dmssb.htm

Methadone solution is purchased by community pharmacies who dispense it against NHS prescriptions and are then reimbursed for all dispensings. The purchase price varies by contractor, and over time, as they strive to achieve the best possible purchase price from suppliers on behalf of the NHS.

A reimbursement price is set for Scotland after consultation with pharmacy contractor representatives and published in the Drug Tariff. The current reimbursement price for generic methadone hydrochloride solution 1mg/ml 500mls, which is the most common prescribed form, is £4.70.

Pharmacy contractors dispensing methadone may also receive dispensing and supervision fees set by the relevant health board. These fees are agreed locally and vary between health boards.

Information on the number of hospital admissions, with a diagnosis of drug misuse since 1 April 1999, as reported by Information Services Division (ISD) of NHS National Services Scotland is presented in Tables 1 and 2.

Table 1 shows the number of psychiatric discharges with a diagnosis of drug misuse in Scotland between 1 April 1999 and 31 March 2010 and Table 2 shows the number of general acute inpatient and day case discharges with a diagnosis of drug misuse in Scotland between 1 April 1999 and 31 March 2011.

Table 1: Psychiatric Hospital Discharges¹ with a Diagnosis of Drug Misuse^2,3,4 as Main or Secondary Diagnosis^5,6; Years Ending 31 March 2000 to 2010⁷

Source: ISD / IR2012-01512.

Notes:

1. Information is based on date of discharge (rather than date of admission)

2. Excludes misuse of tobacco or alcohol.

3. Includes type of admission not known, and cases with a missing or invalid response.

4. Includes transfers from other psychiatric inpatient care.

5. Diseases recorded using the World Health Organization's International Classification of Diseases 10th Revision (ICD10). ). Drug-related codes: F11, F12, F13, F14, F15, F16, F18, F19. Up to six diagnoses are recorded. All six diagnoses have been used to identify drug related conditions.

6. Caution is necessary when interpreting these figures. The recording of drug misuse may vary from hospital to hospital. Where drug misuse is suspected but unconfirmed it may not be recorded by the hospital.

7. Information on psychiatric discharges for drug misuse in 2010-11 is not currently available for public release. Figures for this period will be published by NHS Information Services Division (ISD) Scotland in 2013.

8. Patients resident outside Scotland or whose NHS board or council area of residence is not known are included in this analysis. Therefore these figures will be between 3-5% greater than previously published figures.

Table 2: General Acute¹ Inpatient and Day Case Discharges^2,3 with a Diagnosis of Drug Misuse^4,5 as Main or Secondary Diagnosis; Years Ending 31 March 2000 to 2011

Source: ISD / IR2012-01512.

Notes:

1. Excludes mental illness hospitals, psychiatric units and maternity hospitals.

2. Information is based on date of discharge (rather than date of admission) because the SMR01 dataset is a discharge summary record.

3. Figures in Table 2 relate only to those individuals who are treated as inpatients or day cases in an acute hospital. They do not include individuals managed as outpatients.

4. Diseases recorded using the World Health Organisation’s International Classification of Diseases 10th Revision (ICD10). Drug-related codes: F11, F12, F13, F14, F15, F16, F18, F19. Up to six diagnoses are recorded. All six diagnoses have been used to identify drug related conditions.

5. Caution is necessary when interpreting these figures. The recording of drug misuse may vary from hospital to hospital. Where drug misuse is suspected, but unconfirmed it may not be recorded by the hospital.

6. Patients resident outside Scotland or whose NHS board or council area of residence is not known are included in this analysis. Therefore, these figures will be between 1-2% higher than previously published figures by ISD.

Prior to 2007-08, this information had not been collected. That is why the Scottish Government developed the Scottish Drug and Alcohol Treatment Waiting Times Database, introduced in April 2011. This reports on the number of people entering drug and alcohol treatment and the types of support they access, broken down by NHS board and Alcohol and Drug Partnership (ADP). From this, we know that during 2011-12, approximately 15,600 people entered drug treatment to support their recovery. This does not equal the number of rehabilitation (or drug treatment and support) places available.

The Scottish Drug and Alcohol Treatment Waiting Times Database also provides us with quarterly information on the length of time people are waiting for treatment and the treatments started. 19,043 drug treatments were started between 1 April 2011 and 31 March 2012 and the types of treatment started included the following:

The above is reported nationally on a quarterly basis but is not routinely published on an individual NHS board basis.

This government recognised that the number of drug rehabilitation places made available each year has not been broken down by those made available by the Scottish Prison Service. Prison staff have now started reporting to Information Services Division (ISD) of NHS National Services Scotland on waiting times data. The current level of data under-represents all the treatment and support provided in the prison. Officials are meeting with representatives of all prisons on 27 September to discuss how the data can be improved and to agree timescales for publishing this data.

Prior to 2007-08, this information had not been collected. That is why the Scottish Government invested in the research Assessing the Scale and Impact of Illicit Drug Markets in Scotland http://www.scotland.gov.uk/Publications/2009/10/06103906/0, which was published in October 2009. The report estimated that the total cost of illicit drug use to the health service in Scotland was £180,452,500.

Table 5.9.1 of this report breaks down the wider costs of drug misuse:

This report also offers some useful cost / benefit analysis of drug treatment in the context of preventative spend: