Investigating the role of benzodiazepines in drug-related mortality: A systematic review undertaken on behalf of The Scottish National Forum on Drug-Related Deaths

Owing to a lack of research on benzodiazepines, the National Forum on Drug-Related Deaths commissioned work addressing why benzodiazepines are common in DRDs and what role they play in such deaths, particularly at the high doses often reported. This Report presents the findings of a systematic review of evidence in relation to the use and misuse of benzodiazepines and highlights significant gaps in knowledge

The Operation and Effectiveness of the Scottish Drug Court Pilots: Research Findings

A pilot Drug Court was introduced at Glasgow Sheriff Court in November 2001 with a second pilot becoming operational in Fife in August 2002. The Drug Courts aim to reduce drug use and drug-related offending through access to treatment and other services, ongoing supervision and judicial oversight of Orders. The pilots also aimed to examine the viability of Drug Courts in Scotland especially, in the case of Fife, in a non-urban centre

Evaluation of the Arrest Referral Pilot Schemes

Arrest Referral (AR) is one of a range of recent policy initiatives intended to disrupt the link between substance misuse and offending by improving uptake of services among arrestees whose offending is linked to drug or alcohol use. The development of AR was given new impetus in Scotland by the announcement, in 2003, of Scottish Executive funding for a series of pilot projects. The 6 schemes funded were: Edinburgh & Midlothian (EMARS), Tayside, Renfrewshire, East Renfrewshire & Inverclyde, all extended from existing projects and three new schemes in Lanarkshire; Dumfries & Galloway and Glasgow. All were operated by voluntary sector agencies under contract to the Social Work Department, and were multi-site, except Glasgow. The schemes included a mix of police-based and court-based locations and of police-mediated and direct access to arrestees. The Scottish Centre for Social Research (ScotCen) and the Social Work Research Centre at Stirling University (SWRC) were commissioned to conduct a mixed method, process and outcome evaluation with three largest projects providing case-studies (EMARS, Glasgow and Tayside)

Evaluation of the Airdrie and Hamilton Youth Court Pilots

Pilot Youth Courts were introduced at Hamilton Sheriff Court in June 2003 and at Airdrie Sheriff Court in June 2004. Although introduced as one of a number of measures aimed at responding more effectively to youth crime (including young people dealt with through the Children’s Hearings System), the Youth Courts were intended for young people who would otherwise have been dealt with in the adult Sheriff Summary Court. The objectives of the pilot Youth Courts were to: • reduce the frequency and seriousness of re-offending by 16 and 17 year old offenders, particularly persistent offenders (and some 15 year olds who are referred to the court); • promote the social inclusion, citizenship and personal responsibility of these young offenders while maximising their potential; • establish fast track procedures for those young persons appearing before the Youth Court; • enhance community safety, by reducing the harm caused to individual victims of crime and providing respite to those communities which are experiencing high levels of crime; and • test the viability and usefulness of a Youth Court using existing legislation and to demonstrate whether legislative and practical improvements might be appropriate. Evaluation of the Hamilton and Airdrie Sheriff Youth Court pilots suggested that they had been successful in meeting the objectives set for them by the Youth Court Feasibility Group. Both were tightly run courts that dealt with a heavy volume of business. The particular strengths of the Youth Court model over previous arrangements included the fast-tracking of young people to and through the court, the reduction in trials, the availability of a wider range of resources and services for young people and ongoing judicial review. The successful operation of the pilot Youth Courts was dependent upon effective teamwork among the relevant agencies and professionals concerned. Good information sharing, liaison and communication appeared to exist across agencies and the procedures that were in place to facilitate the sharing of information seemed to be working well. This was also facilitated by the presence of dedicated staff within agencies, resulting in clear channels of communication, and in the opportunity provided by the multi-agency Implementation Groups to identify and address operational issues on an ongoing basis. However, whether Youth Courts are required in Scotland or whether procedural improvement were possible in the absence of dedicated resources and personnel was more difficult to assess. Two issues in particular required further attention. First, consideration needed to be given to whether the Youth Courts should be more explicitly youth focused and what this might entail. Second, greater clarity was required regarding for whom the Youth Courts were intended. This suggested the need for further discussion of Youth Court targeting and its potential consequences among the various agencies concerned

Evaluation of the Arrest Referral Pilot Schemes - Research Findings

Arrest Referral (AR) is one of a range of recent policy initiatives intended to disrupt the link between substance misuse and offending by improving uptake of services among arrestees whose offending may be linked to drug or alcohol use. Although there has been growing interest in AR in recent years, it was given new impetus in Scotland by the announcement in 2003 of Scottish Executive funding for a series of pilot projects. This paper presents the main findings from an evaluation of the schemes carried out by the Scottish Centre for Social Research and Stirling University

Factors associated with SARS-CoV-2 testing, diagnosis and COVID-19 disease among individuals prescribed opioid-agonist treatment: a nationwide retrospective cohort study

Objectives: Among people receiving opioid-agonist treatment (OAT), the risk of COVID-19 infection and disease may be higher owing to underlying health problems and vulnerable social circumstances. We aimed to determine whether recent OAT, when compared with past exposure, affected the risk of (i) testing for SARS-CoV-2, (ii) testing positive for SARS-CoV-2, and (iii) being hospitalized or dying with COVID-19 disease. Methods: We included individuals prescribed OAT in Scotland from 2015 to 2020. We performed record linkage to SARS-CoV-2 PCR testing, vaccination, hospitalization, and mortality data, and followed up from March 2020 to December 2021. We used proportional hazards analysis and multivariate logistic regression to estimate associations between recent OAT prescription (in the previous 2 months), compared with past exposure (off treatment for over a year), and COVID-19 outcomes. Models were adjusted for confounders. Results: Among 36 093 individuals prescribed OAT, 19 071 (52.9%) were tested for SARS-CoV-2; 2896 (8.3%) tested positive; and 552 (1.5%) were hospitalized or died with COVID-19. Recent OAT, compared with past exposure, was associated with lower odds of testing positive among those tested (aOR, 0.63; 95% CI, 0.57–0.69). However, among those testing positive, recent OAT was associated with two-fold higher odds of hospitalization or death (aOR, 2.04; 95% CI, 1.60–2.59). Discussion: We found that recent OAT was associated with lower odds of SARS-CoV-2 infection, but with higher odds of disease once diagnosed. Clinical studies are needed to unravel the role of OAT in these associations. An enhanced effort is warranted to increase vaccine coverage among OAT patients to mitigate the severe consequences of COVID-19.</p

Evaluation of the Airdrie Sheriff Youth Court Pilot - Research Findings

A pilot Youth Court was introduced at Airdrie Sheriff Court in June 2004. It is targeted on alleged offenders aged 16 and 17 (and appropriate 15 year olds) who are resident in areas of North Lanarkshire and are appearing summarily before Airdrie Sheriff Court. The main aim of the Youth Court is to reduce the frequency and seriousness of offending by 16 and 17 year olds through targeted and prompt disposals with judicial supervision and continuing social work involvement

Why are drug-related deaths among women increasing in Scotland? A mixed-methods analysis of possible explanations

Drug-related deaths have increased significantly in Scotland in recent years, with a much greater percentage increase in deaths among women than among men. We undertook a mixed-methods project to identify explanations for this trend, comprising three parallel methodological strands: (i) an analysis of available routine data, including drug treatment data, death registrations, and surveys of people using needle exchanges; (ii) thematic analysis of interviews and focus groups with professional stakeholders and (iii) secondary analysis of interviews with women who use drugs. Results indicated that the observed trend is likely to reflect multiple, interacting causes. Potential contributors identified were: ageing; changing patterns of substance use; increasing prevalence of physical and mental health co-morbidities; changing relationships and parenting roles; changes to treatment services and wider health and social care provision; unintended consequences or poor implementation of recovery-oriented practice; and changes in the social security system. Policy responses to rising drug-related death rates require a gender-informed approach, recognising the commonalities and differences between men and women who use drugs; the diversity of experiences within each gender; and the intersections between gender and other forms of inequality, such as poverty

Evaluation of the Airdrie and Hamilton Youth Court Pilots - Research findings

Pilot Youth Courts were introduced at Hamilton Sheriff Court in June 2003 and at Airdrie Sheriff Court in June 2004. They are targeted at alleged offenders aged 16 and 17 (and appropriate 15 year olds) who are resident in areas of North and South Lanarkshire and are appearing summarily before the Sheriff Courts. Their main aims are to reduce the frequency and seriousness of offending through targeted and prompt disposals with judicial supervision and continuing social work involvement

Risk of drug-related death associated with co-prescribing of gabapentinoids and Z-drugs among people receiving opioid-agonist treatment: a national retrospective cohort study

Background: Prescribing of gabapentinoids and Z-drug-hypnotics has increased in the population and among people receiving opioid-agonist treatment(OAT) for opioid dependence. Evidence is mixed on whether co-prescribing of sedatives such as gabapentinoids and Z-drugs during OAT increases risk of drug-related death (DRD). Methods: We conducted a retrospective cohort study of individuals prescribed OAT between 2011 and 2020 in Scotland. Prescribing records were linked to mortality data and other healthcare datasets(sociodemographic, comorbidity). We identified episodes of treatment with gabapentinoids/Z-drugs and used multivariable quasi-Poisson regression to model associations between co-prescription and DRD risk. Results: Among 46,602individuals with 304,783 person-years of follow-up, we found that co-prescription was common, with 25 % and 34 % ever being co-prescribed gabapentinoids and Z-drugs, respectively. Gabapentinoid exposure was strongly associated (adjusted hazard ratio (aHR)=2⋅18, 95 % CI=1⋅92,2⋅46)and Z-drug exposure moderately associated (aHR=1⋅39, 95 % CI=1⋅15,1⋅66)with elevated risk of DRD. Gabapentinoid exposure was associated with DRD risk on and off OAT; Z-drug exposure was less strongly associated with DRD risk when on OAT. Conclusions: Co-prescription of gabapentinoids and Z-drugs is common among OAT patients. However, co-prescription is associated with increased risk of DRD. Alternatives to prescribing sedative medications to OAT patients and/or greater monitoring – if prescribed – are needed.</p