Evaluating the Public Health Impact of Interventions for the Prevention of Drug-related Deaths in the Population: in Scotland [EPHESUS]

Funding

National Institute for Health and Care Research (NIHR) Public Health Research (PHR) Ref. NIHR 160569

What is the Research Question?

How many drug-related deaths have existing interventions in Scotland prevented and how many more deaths could be prevented in future by introducing new interventions and changing  the delivery of existing ones.

What is the problem?

Drug-related deaths have doubled in the UK during the last decade. Scotland has the highest rate of drug-related deaths in Europe and is recognised by Scottish Government as a public health crisis.

Opioid dependence (such as heroin) is treated with replacement drugs such as methadone or buprenorphine, this is called “opioid agonist treatment” and can reduce the risk of drug-related deaths by over 50%. Implementing opioid agonist treatment in prisons can prevent people from dying in the first month after their release. Opioid agonist treatment is currently widely available in Scotland.

Naloxone is a medicine and antidote that rapidly reverses an opioid overdose and can prevent a fatal overdose if given to people who stop breathing after using heroin or other opioids. Scotland has a national programme and since 2011 has given out over 150,000 naloxone kits. However, opioid overdose deaths have continued to rise; more needs to be done to prevent drug-related deaths.

What is the aim of the research?

The EPHESUS study has two key aims:

  • To show how many drug-related deaths have been prevented in Scotland by current levels of opioid agonist treatment and national naloxone programme.
  • To show how many more drug-related deaths could be prevented in the future by introducing new interventions and/or changing the way drug treatment and naloxone programme are delivered

How will this be achieved?

We propose creating a computer model that will help citizens, people with lived experience, health care workers, researchers and policymakers assess how effective current interventions are at preventing drug-related deaths and identify what else can be done to reduce drug-related deaths.

The model will be based on analyses from national datasets in Scotland that link people in drug treatment with information on deaths. This will give a detailed picture of drug-related death risk at different periods on and off opioid agonist treatment.

We will:

  1. Create a model that simulates trends in drug-related deaths, the population of people who use opioids and the number of people in opioid agonist treatment. Then we will predict how the trends and numbers of drug-related deaths and other causes of death would differ if there was no opioid agonist treatment to estimate how many lives have been saved by opioid agonist treatment as delivered in Scotland.
  2. Estimate how many drug-related deaths have been saved by the naloxone programme. This is done by extending the model to include non-fatal overdoses and naloxone. The model also will estimate how cost-effective the naloxone programme has been in Scotland.
  3. Use the model to look forward to show how drug-related deaths and other deaths can be reduced. We will show the effects of changing the way opioid agonist treatment or naloxone is delivered or by introducing new interventions, such as safer drug consumption facilities and safer prescribing of benzodiazepines. When doing so we will include priorities of our community network, Public Health Scotland and Scottish Drug Forum. We aim to transform evidence available to policymakers by showing what level of change is needed to significantly reduce drug-related deaths and compare the additional costs and lives saved for different policy changes.

Who is leading the Research?

Dr Jack Stone, Associate Professor in Infectious Disease Mathematical Modelling, Population Health Sciences, Bristol Medical School at the University of Bristol.

Professor Matt Hickman (Co-PI), Bristol Medical School, University of Bristol.

Further Information:

CI Email: jack.stone@bristol.ac.uk

For more information or to get involved in this project, please contact bnssg.research@nhs.net.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.