A multicomponent holistic care pathway for people who use drugs in Tayside, Scotland

• Published in: The International journal of drug policy Vol. 120; p. 104159
• Main Authors: Byrne, Christopher J, Radley, Andrew, Fletcher, Emma, Thain, Donna, Stephens, Brian P, Dillon, John F
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2023
• Subjects: Community; Hepatitis c virus; Holistic; People who use drugs; Hepatitis c virus; People who use drugs; Holistic; Community
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2023.104159

•Existing nurse-led blood-borne virus pathways were adapted to provide a sustained holistic healthcare package for people who use drugs in Tayside, Scotland.•Prevalence of non-fatal overdose and risk of depression were high.•Polysubstance use and Covid-19 vaccine hesitancy were common. Mortality – all cause and drug-induced – was noteworthy despite high take-home naloxone uptake.•Most fatalities during observation were due to overdose.•Future work should assess impact of holistic care pathways upon overdose fatalities, and consider strategies to improve vaccine uptake. People Who Use Drugs (PWUD) are at high risk of non-fatal overdose and other drug-related harms. The United Kingdom drugs policy landscape makes it challenging to support those at risk. Tayside, in East Scotland, has a sizeable population at risk of drug-related harms. In 2021, the National Health Service implemented a care pathway for PWUD to provide multidimensional healthcare interventions. We aimed to quantify drug-related harms; assess wider health and well-being; and understand substance use trends and behaviours, among those engaged in the pathway. Existing community-embedded blood-borne virus pathways were adapted to provide multiple healthcare assessments over three visits. We undertook an observational cohort study to analyse uptake and outcomes for the initial cohort of PWUD engaged at appointment one. From August 2021–September 2022, 150 PWUD engaged with the pathway. Median age was 39 (34–42) years, 108 (72%) were male, and 124 (83%) lived in deprived areas. Seventy (47%) had been disengaged from healthcare for over a year. Polysubstance use was reported by 124 (83%), 42 (28%) disclosed injecting daily, and 54 (36%) shared equipment. Fifty-four (36%) experienced recent non-fatal overdose, and there were six overdose fatalities (4.1 [1.5–9.0] per 100PY). The offer of take-home naloxone was accepted by 108 (72%). Fourteen (9%) were diagnosed with Hepatitis C and two (1%) with HIV. Renal, hepatological, and endocrine impairment were observed among 30 (20%), 23 (15%), and 11 (7%), people respectively. Ninety-six (65%) had high risk of clinical depression. Forty-eight (32%) declined Covid-19 vaccination. The pathway engaged PWUD with high exposure to recent non-fatal overdose and other drug-related harms, alongside co-morbid health issues. Our results suggest multi-dimensional health assessments coupled with harm reduction in community settings, with appropriate linkage to care, are warranted for PWUD. Service commissioners should seek to integrate these assessments where possible.