Dr Saket Priyadarshi

YESTERDAY marked the delayed publication of the latest drugs deaths statistics in Scotland. The figures paint a sobering picture of a public health crisis and the monumental challenge we face across the country, not least here in Glasgow where, although deaths decreased by one, much work is still to be done. However, despite the shocking numbers, we should take a moment to recognise the huge harm reduction effort underway, in Glasgow and elsewhere, without which the stats would be even worse.

The figures relate to 2019, but even this year, where Covid-19 has increased the vulnerability of those most at risk, harm reduction initiatives continue to save lives. Never before have we seen such mobilisation and cooperation between the multitudes of services in the sector – whether through outreach teams, mobile injecting equipment provision or drug treatment services, both community and residential. The hard work, dedication and innovation from staff and volunteers has ensured we’ve been able to continue engaging with and caring for many of those most vulnerable.

For example, more than 90% of our needle exchanges remained open throughout the pandemic. We’ve seen more than 8,000 clients in 2020 – that’s 8,000 people who may not otherwise have had access to clean injecting equipment, and 8,000 opportunities to engage those people in further treatment. We’ve provided nearly 500,000 sheets of foil as an alternative to needles – a ‘so what’ to some, but we know foil allows patients to smoke drugs rather than injecting, reducing risks significantly.

Our mobile outreach van has continued to operate on a nightly basis. In the lockdown months of March - June, it delivered more than 10,000 thousand clean needles –reducing the risk of transmitting blood-borne viruses, and providing the opportunity to engage in further protective care.

For example, we have been able to train those clients in the use of naloxone, a life- saving treatment which reverses overdoses. This year we have distributed more than 5,659 naloxone kits, many have since been used, preventing deaths otherwise added to the statistics.

These services only represent part of the multi-faceted harm reduction policy across Greater Glasgow and Clyde. It’s this same principle which has allowed the successful implementation of the heroin-assisted treatment programme – helping us look after the highest risk drug users in Glasgow. We’ve seen the introduction of Buvidal, an injectable alternative to methadone or oral buprenorphine, which means patients do not need to attend pharmacies and so find reintegration and engagement with recovery supports easier. Buvidal, even in the midst of a pandemic, has brought people into treatment for the first time. In fact, our drug treatment caseload has increased despite the challenge of Covid-19.

Together, these services help prevent deaths and should be supported to engage ever more people who need them. However, a key piece of the puzzle remains the introduction of a legal safer drugs consumption facility – a controlled environment for people who inject drugs which takes them off the streets and out of alleys, where trained staff can respond to overdoses, with opportunities to engage in treatment and support. Unfortunately, despite the scientific evidence, the widespread support and our will to deliver such an initiative, we cannot add this much needed service into our system of care. They remain illegal under UK law and to work effectively, they must be delivered within a legal framework. Whilst our harm reduction services continue to save lives, we know with a safer drug consumption facility, we could save more.

Dr Saket Priyadarshi is associate medical director, Alcohol and Drug Recovery services, NHS Greater Glasgow and Clyde