Andrew Rome, Figure 8 Consultancy Services Ltd
April Shaw, Scottish Drugs Forum
Katie Boyle, Figure 8 Consultancy Services Ltd
ISBN 978 0 7559 7290 6 (Web only publication)
ISSN 0950 2254
This document is also available in pdf format (892k)
CONTENTS
ACKNOWLEDGEMENTS
EXECUTIVE SUMMARY
CHAPTER ONE - INTRODUCTION
Context
Aims and objectives
CHAPTER TWO - METHODS
Summary of study methods
Stage 1 Literature review
Synthesising the evidence
Stage 2 Quantitative Surveys
Survey of drug users
Survey of Telephone Responders: Emergency Service Control Room ( ESCR) and NHS 24 Staff
Stage 3 Qualitative Interviews
Interviews with drug users and family members
Interviews with emergency service personnel
Ethical Approval
Limitations of the research
CHAPTER THREE - REVIEW OF LITERATURE
Introduction
Section 1 - Emergency Responses
Overdose Witnesses and Interventions
Ambulance
Police
Accident and Emergency
Communicating public health alerts
Section 2 - Mainstream & Emerging Interventions
Drug Treatment and Methadone
General Practitioners
The impact of services engaging and retaining drug users
Emerging interventions - Take-Home-Naloxone and Safer Injecting Rooms
Safer Injecting Rooms
Section 3 - Early Individual & Social Indicators
Tolerance
The impact of injecting drug use, benzodiazepines, alcohol and cocaine
Health Morbidity
Recent Life Problems/Psychological Factors
Antidepressants
Suicide
Understanding Social Networks
Public Injecting and Overdose
Accommodation
Implications of the Literature Review
Emergency responses
Mainstream & Emerging Interventions
Developing and Disseminating Key Messages
Examples of Innovative Practice
Drug Action Teams
Provision of Information
Training
Harm-Reduction Projects
Naloxone Pilots
Ambulance Protocol
Drug-Related Death Partnership
Joint Working Practices
Festive Overdose Awareness Campaigns
Harm Reduction Measures in SPS
CHAPTER FOUR - PRIMARY DATA COLLECTION
Drug users and family members
Views of people who have experienced an opiate overdose
Views of people who witnessed overdose
Reasons for personal and witnessed overdose
Changes in drug use following overdose experiences
Overdose risk factors
The attributes of the person
The attributes of the setting
The attributes of the drug
Witnesses' perceptions of the signs of overdose
Witness Responses
Barriers to calling emergency services
Encourage calling help sooner
Contact with Emergency Services
999 Operators
Ambulance
Police
Hospital staff
Emotional Consequences of Overdose
Panic
Anger
Guilt
Paranoia
Stigma
Overdose information and training
Naloxone
Raising overdose awareness
Individual
Local Services
Government
Emergency Service Personnel
Police and Ambulance Staff
Experiences of attending overdose events
Views on ways to reduce overdose
Telephone Responders
Number of calls
Care Pathway for the management of opiate overdose
Training on managing an overdose situation
Naloxone
Information or advice relayed to the caller
Issues and challenges for the caller
Resources
Accident and Emergency Consultants
Nature and extent of the problem
Use of protocols for managing overdose
Drug liaison nurses
Admission to hospital
Information and onward referral
How to provide overdose prevention information
CHAPTER FIVE - CONCLUSIONS
Estimating the size of the problem
Cycle of overdose management
Recognise overdose
Manage situation
Get person to hospital
Manage medical emergency
Assessment of needs
Harm reduction strategies
Reduce risks
CHAPTER 6 - RECOMMENDATIONS
Recommendation 1: Improving the quality of existing responses
Recommendation 2: Improving the assessment of needs
Recommendation 3: Improving and extending current care provision
Recommendation 4: Information and training for emergency service staff, clinical staff and service professionals
Recommendation 5: Information and training for drug users and significant others
REFERENCES
APPENDICES
Appendix 1 Literature Review methods
Appendix 2 Review Article Table
Appendix 3a Interview Schedule - Drug Users & Family Members
Appendix 3b Interview Schedule - Emergency Service Staff
Appendix 3c Interview Schedule - A&E Consultants
Appendix 3d Survey Instrument - Experienced Overdose
Appendix 3e Survey Instrument - Witnessed Overdose
Appendix 3f Survey Instrument - NHS 24 & 999 Staff
The views expressed in this report are those of the researcher and
do not necessarily represent those of the Department or Scottish Ministers.