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1. Planning and implementing community-based drug checking services in Scotland: a qualitative exploration using the consolidated framework for implementation research

Author

Danilo Falzon, Hannah Carver, Wendy Masterton, Bruce Wallace, Harry Sumnall, Fiona Measham, Vicki Craik, Rosalind Gittins, Elizabeth V. Aston, Kira Watson, Carole Hunter, Saket Priyadarshi, and Tessa Parkes

Subjects
Drug checking services, Harm reduction, Substance use, Drug use interventions, Consolidated framework for implementation research, Drug-related deaths, Public aspects of medicine, RA1-1270, Social pathology. Social and public welfare. Criminology, HV1-9960
Abstract

Abstract Background Drug checking services (DCS) provide harm reduction support and advice to individuals based on chemical analysis of submitted substances of concern. Whilst there are currently no DCS in Scotland, community-based services are being planned in three cities. Methods In this paper, we report qualitative findings based on interviews with 43 participants, focused on perceptions of DCS and their implementation. Participants were relevant professionals, those with experience of drug use, and family members of those with experience of drug use. The Consolidated Framework for Implementation Research (CFIR) was used to inform data collection and analysis. We report findings under nine constructs/themes across the five CFIR domains. Results Participants noted the importance of DCS being implemented in low-threshold, trusted services with a harm reduction ethos, and outlined a range of further service design considerations such as speed of testing, and information provided through the analysis process. In relation to the ‘inner setting’, a key finding related to the potential value of leveraging existing resources in order to expand both reach and effectiveness of drug trend communication. The approach of local and national police to DCS, and the attitudes of the public and local community, were described as important external factors which could influence the success (or otherwise) of implementation. Bringing together a range of stakeholders in dialogue and developing tailored communication strategies were seen as ways to build support for DCS. Overall, we found high levels of support and perceived need for DCS amongst all stakeholder groups. Conclusions Our findings present initial implementation considerations for Scotland which could be further explored as DCS are operationalised. Further, our focus on implementation contexts is relevant to research on DCS more generally, given the minimal consideration of such issues in the literature.

Published
2024
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2. 'I t’s not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland

Author

Hannah Carver, Danilo Falzon, Wendy Masterton, Bruce Wallace, Elizabeth V. Aston, Fiona Measham, Carole Hunter, Harry Sumnall, Rosalind Gittins, Fiona Raeburn, Vicki Craik, Saket Priyadarshi, Laura Rothney, Kira Weir, and Tessa Parkes

Subjects
Drug checking services, Harm reduction, Substance use, Drug use intervention, Drug related deaths, Qualitative research, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Scotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants’ views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland. Methods Semi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Results Participants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs. Conclusions Drug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.

Published
2023
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3. Challenges for drug checking services in Scotland: a qualitative exploration of police perceptions

Author

Danilo Falzon, Elizabeth V. Aston, Hannah Carver, Wendy Masterton, Bruce Wallace, Harry Sumnall, Fiona Measham, Emma Fletcher, Rosalind Gittins, Saket Priyadarshi, and Tessa Parkes

Subjects
Drug checking, Policing, Criminalisation, Community based, Harm reduction, Stop and search, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The impact of policing practices on the engagement of people who use drugs (PWUD) with harm reduction services is well evidenced. Although the police have traditionally taken an enforcement role in responding to drug use, it is increasingly clear that they can play an important part in multiagency delivery of harm reduction interventions. Despite this, there have been no studies exploring police officer perceptions of drug checking services (DCS), which provide analytical testing of client drug samples alongside harm reduction support and advice. Methods Semi-structured interviews were conducted with 10 police officers to explore the policing and legal challenges which could be encountered in the delivery of DCS in Scotland. Results Participants expressed general support for DCS and described this support as part of a wider organisational shift towards public health-oriented policing. Participants also discussed different potential approaches to the policing of areas surrounding DCS including: formal limits on police presence around the service and/or stop and search powers in relation to personal possession; the effective decriminalisation of personal possession within a specified boundary around the service; and informal agreements between local divisions and DCS outlining expected policing practices. Any formal limitation on the capacity of police officers to respond to community concerns was viewed as problematic and as having the potential to erode public confidence in policing. Participants also highlighted the potential for frontline officers to utilise discretion in ways which could undermine public health goals. Legislative change, or national strategic guidance from relevant stakeholders, was seen as a means of providing ‘cover’, enabling local divisions to support the operation of drug checking. Conclusions Despite a small sample of participants, this study summarises key challenges to be addressed in the implementation and operation of DCS in Scotland, and more widely. The paper concludes with suggested opportunities to develop approaches to policing that can facilitate rather than impede implementation and operation of these services.

Published
2022
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4. OR25-03 Self-administration Of Post-cycle Therapy Is Associated With Increased Probability Of Subsequent Normalisation Of Reproductive Hormones Following Anabolic-androgenic Steroid Cessation In Men

Author

Grant, Bonnie, primary, Campbell, John, additional, Pradeep, Anjali, additional, Dawn Burns, Angela, additional, Bassett, Paul, additional, Saket, Priyadarshi, additional, Minhas, Sukhbinder, additional, Singh Dhillo, Waljit, additional, McVeigh, James, additional, Bhasin, Shalender, additional, and Nalin Jayasena, Channa, additional

Published
2023
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5. 'Taking away the chaos': a health needs assessment for people who inject drugs in public places in Glasgow, Scotland

Author

Emily J. Tweed, Mark Rodgers, Saket Priyadarshi, and Emilia Crighton

Subjects
Drug use, Public injecting, Health needs assessment, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions. Methods We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services. Results Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread – though not unanimous – support for the introduction of safer injecting facilities and heroin-assisted treatment services. Conclusions The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world’s first co-located safer injecting facility and heroin-assisted treatment service.

Published
2018
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6. Factors predicting normalisation of reproductive hormones after cessation of anabolic-androgenic steroids in men: a single centre retrospective study

Author

Grant, Bonnie, Campbell, John, Pradeep, Anjali, Burns, Angela, Bassett, Paul, Abbara, Ali, Saket, Priyadarshi, Minhas, Sukhbinder, Dhillo, Waljit, McVeigh, James, Bhasin, Shalender, Jayasena, Channa, Grant, Bonnie, Campbell, John, Pradeep, Anjali, Burns, Angela, Bassett, Paul, Abbara, Ali, Saket, Priyadarshi, Minhas, Sukhbinder, Dhillo, Waljit, McVeigh, James, Bhasin, Shalender, and Jayasena, Channa

Abstract

Objective: Symptomatic hypogonadism discourages men from stopping anabolic-androgenic steroids (AAS). Some men illicitly take drugs temporarily stimulating endogenous testosterone following AAS cessation (post-cycle therapy; PCT) to lessen hypogonadal symptoms. We investigated whether prior PCT use was associated with normalisation of reproductive hormones following AAS cessation. Methods: Retrospective analysis of 641 men attending a clinic between 2015-2022 for a single, non-fasting, random blood test <36 months following AAS cessation, with or without PCT. Normalised reproductive hormones (i.e., combination of reference range serum luteinising hormone, follicle-stimulating hormone, and total testosterone levels) was the surrogate marker of biochemical recovery. Results: Normalisation of reproductive hormones was achieved in 48.2% of men. PCT use was associated with faster biochemical recovery (13.0 (IQR8.0 – 19.0) weeks, PCT; 26.0 (IQR10.5 – 52) weeks, no-PCT; P<0.001). Odds of biochemical recovery during multivariable analysis were: (1) higher with PCT (OR3.80) versus no-PCT (P=0.001), in men stopping AAS ≤3 months previously; (2) reduced when two (OR0.55), three (OR0.46) or four (OR0.25) AAS were administered versus one drug (P=0.009); (3) lower with AAS >6 versus ≤3 months previously (OR0.34, P=0.01); (4) higher with last reported AAS >3 months (OR 5.68) versus ≤3 months (P=0.001). PCT use was not associated with biochemical recovery in men stopping AAS >3 months previously. Conclusion: Without evidence-based withdrawal protocols, men commonly try avoiding post-AAS hypogonadism with PCT, which is illicit, ill-defined, and not recommended. Only half of men had complete biochemical testicular recovery after stopping AAS. The surprising association of self-reported PCT use with short-term biochemical recovery from AAS-induced hypogonadism warrants further investigation.

Published
2023

7. Self-administration Of Post-cycle Therapy Is Associated With Increased Probability Of Subsequent Normalisation Of Reproductive Hormones Following Anabolic-androgenic Steroid Cessation In Men

Author

Grant, Bonnie, Campbell, John, Pradeep, Anjali, Dawn Burns, Angela, Bassett, Paul, Saket, Priyadarshi, Minhas, Sukhbinder, Singh Dhillo, Waljit, McVeigh, James, Bhasin, Shalender, Nalin Jayasena, Channa, Grant, Bonnie, Campbell, John, Pradeep, Anjali, Dawn Burns, Angela, Bassett, Paul, Saket, Priyadarshi, Minhas, Sukhbinder, Singh Dhillo, Waljit, McVeigh, James, Bhasin, Shalender, and Nalin Jayasena, Channa

Abstract

Context: Millions of men worldwide illicitly use anabolic-androgenic steroids (AAS) for muscle growth. However, AAS can cause death, cardiomyopathy, stroke, and psychosis. AAS use suppresses endogenous testosterone secretion for several months following cessation. Therefore, AAS cessation causes tiredness, low mood, insomnia, absent sexual function, and suicidality. There is currently no treatment recommended to reduce symptoms when men stop AAS. Some men empirically self-administer post-cycle therapy (PCT) drugs such as human chorionic gonadotrophin (hCG), selective oestrogen receptor modulators (SERM) and aromatase inhibitors (AI), aiming to restore endogenous testosterone. hCG directly stimulates endogenous testosterone production, while SERMs and AIs reduce the oestrogenic negative feedback on gonadotrophin secretion. Currently evidence is lacking to support the use of PCT in AAS-induced hypogonadism. Methods: Clinical audit from a single addiction service clinic, of 613 men stopping AAS in Scotland between 2015-2022. Men attended for a single, non-fasting, random blood test performed within 12 months of AAS cessation, with or without PCT use. Primary endpoint was the combination of reference range levels of serum LH, serum FSH and total testosterone, as a surrogate marker of biochemical recovery from hypogonadism. Results: PCT use was reported by 76% of men. Men using PCT had a significantly higher serum total testosterone following AAS cessation compared to men who did not (mean total testosterone nmol/L: 11.3 ± 6.7, no PCT; 12.8 ± 7.6, PCT; P=0.024). PCT use was associated with a higher probability (223/466, 48%, PCT; 56/147; 38%, no-PCT; P=0.04), and shorter time interval between stopping AAS and blood test of normalised reproductive hormones (13.3 ± 8.8 weeks, PCT;18.7 ± 12.0 weeks, no-PCT; P<0.01). The odds of biochemical normalisation during multivariable analysis were statistically significant when: (1) PCT was used (P=0.01); (2) fewer AAS were used (P=0

Published
2023

8. 'Taking away the chaos': a health needs assessment for people who inject drugs in public places in Glasgow, Scotland

Author

Emilia Crighton, Saket Priyadarshi, Mark Rodgers, and Emily J Tweed

Subjects
Adult, Male, medicine.medical_specialty, Recreational Drug, Substance-Related Disorders, Psychological intervention, 030508 substance abuse, HIV Infections, Context (language use), Social Welfare, Health needs assessment, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Harm Reduction, Nursing, Risk Factors, Humans, Medicine, 030212 general & internal medicine, Drug use, Substance Abuse, Intravenous, Harm reduction, Illicit Drugs, business.industry, Public injecting, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Stakeholder, lcsh:RA1-1270, Middle Aged, 3. Good health, Heroin, Harm, Scotland, Female, Drug Overdose, Public Facilities, 0305 other medical science, business, Needs Assessment, Research Article
Abstract

Background Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions. Methods We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services. Results Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread – though not unanimous – support for the introduction of safer injecting facilities and heroin-assisted treatment services. Conclusions The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world’s first co-located safer injecting facility and heroin-assisted treatment service. Electronic supplementary material The online version of this article (10.1186/s12889-018-5718-9) contains supplementary material, which is available to authorized users.

Published
2018

9. Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

Author

Catriona Milosevic, Norah Palmateer, Kirsten M.A. Trayner, Rory Gunson, Saket Priyadarshi, Emily J Tweed, Samantha J. Shepherd, Sharon J. Hutchinson, Andrew McAuley, and David J. Goldberg

Subjects
Adult, Male, Drug, media_common.quotation_subject, Human immunodeficiency virus (HIV), 030508 substance abuse, Medicine (miscellaneous), HIV Infections, Logistic regression, medicine.disease_cause, Drug Users, Drug-related harms, 03 medical and health sciences, Risk-Taking, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Environmental health, Prevalence, Humans, Medicine, 030212 general & internal medicine, Substance Abuse, Intravenous, media_common, Population Density, Harm reduction, Risk behaviour, Public injecting, business.industry, Public place, Health Policy, HIV, Outbreak, Cross-Sectional Studies, Increased risk, Scotland, Female, 0305 other medical science, business, People who inject drugs, Research Paper
Abstract

Background:\ud Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI).\ud \ud Methods:\ud Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI).\ud \ud Results:\ud Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p

Published
2020

12. Increased risk of HIV and other drug-related harms associated with injecting in public places among people who inject drugs in Scotland: a national bio-behavioural survey

Author

Emily J Tweed, Saket Priyadarshi, Norah Palmateer, Rory Gunson, Sharon J. Hutchinson, David J. Goldberg, Samantha J. Shepherd, Kirsten M.A. Trayner, Catriona Milosevic, and Andrew McAuley

Subjects
Drug, Harm reduction, business.industry, media_common.quotation_subject, Human immunodeficiency virus (HIV), Outbreak, General Medicine, Odds ratio, 030204 cardiovascular system & hematology, Logistic regression, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Increased risk, Environmental health, medicine, Drug consumption, 030212 general & internal medicine, business, media_common
Abstract

Background Although public injecting is considered a proxy for high-risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking. Furthermore, none have hitherto examined this issue in the context of an HIV outbreak, which has been ongoing in Glasgow, Scotland since 2015. We aimed to estimate the prevalence of public injecting in Scotland and associated risk factors; and estimate the association between public injecting and HIV, active HCV, overdose, and skin and soft tissue infections (SSTI). Methods A cross-sectional, bio-behavioural survey (including dried-blood spot testing to determine HIV and HCV) of PWID recruited by independent interviewers from 139 harm reduction services across Scotland was done between July 7, 2017, and Oct 1, 2018. Participants were eligible if they had a history of injecting drug use. Only current PWID (ie, in the past 6 months) were included in the analysis. Primary outcomes were injecting in a public place (yes or no; used both as outcome and exposure); HIV infection; active HCV infection; self-reported overdose in the past year (yes or no), and SSTI the past year (yes or no). Multivariable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and related harms (HIV, active HCV, overdose, and SSTI). Findings 1469 eligible PWID were included in the study. Prevalence of public injecting among PWID was 16% [95% CI 15–18] overall in Scotland and 47% [40–53] in Glasgow city centre. Factors associated with public injecting were recruitment in Glasgow city centre (adjusted odds ratio 5·45 [95% CI 3·48–8·54], p Interpretation In the context of UK policy debates about the provision of safer drug consumption facilities, these findings highlight the need to address the additional harms evident among people injecting in public places. Funding Health Protection Scotland.

Published
2019

13. The UK Government must help end Scotland's drug-related death crisis

Author

Fiona Measham, Saket Priyadarshi, Shirley Cramer, James Nicholls, Ian Hamilton, Steve Ryder, Arfon Jones, Carole Hunter, Alex Stevens, Niamh Eastwood, Martin Powell, Susanne Millar, Ron Hogg, Iain McPhee, and Deborah Gold

Subjects
medicine.medical_specialty, Government, business.industry, Public health, MEDLINE, Poison control, Human factors and ergonomics, Suicide prevention, Occupational safety and health, Psychiatry and Mental health, Family medicine, Injury prevention, Medicine, business, Biological Psychiatry
Published
2019

18. High willingness to use drug consumption rooms among people who inject drugs in Scotland: findings from a national bio-behavioural survey among people who inject drugs

Author

Norah Palmateer, Saket Priyadarshi, Sharon J. Hutchinson, David J. Goldberg, Rory Gunson, Emily J Tweed, Kirsten M.A. Trayner, Amanda Atkinson, Harry Sumnall, Samantha J. Shepherd, and Andrew McAuley

Subjects
Human immunodeficiency virus (HIV), Short Report, 030508 substance abuse, Medicine (miscellaneous), medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, RA0421, Environmental health, medicine, Humans, City centre, 030212 general & internal medicine, Cities, Substance Abuse, Intravenous, Harm reduction, Risk behaviour, Supervised injection facilities, business.industry, Health Policy, Patient attitude toward treatment, Willingness to use, Pharmaceutical Preparations, Scotland, Drug consumption, Drug consumption rooms, 0305 other medical science, business, People who inject drugs
Abstract

BACKGROUND:\ud To address rising drug-related harms (including significant transmission of HIV) among people who inject drugs (PWID) in Glasgow, officials have proposed the introduction of the UK's first drug consumption room (DCR) in Glasgow city centre. Using a nationally representative sample, this study aimed to determine willingness to use a DCR among PWID nationally, in Glasgow city centre (the proposed DCR location), other Scottish city centres (excluding Glasgow) and the rest of Scotland (excluding city centres).\ud \ud METHODS:\ud Bio-behavioural survey, of 1469 current PWID (injected in last 6 months) across Scotland during 2017-18. Willingness to use DCRs was examined by drug-related risk behaviours and harms overall in Scotland, and then stratified by Glasgow city centre (n = 219), other Scottish city centres (n = 226) and the rest of Scotland (n = 1024).\ud \ud RESULTS:\ud The majority of PWID overall in Scotland (75%) were willing to use a DCR; willingness was higher among those recruited in Glasgow city centre (83%) and other Scottish city centres (83%), compared to the rest of Scotland (72%) (p < 0.001). Willingness was greater among PWID who reported (compared to those who did not report) injecting heroin (76%, p = 0.002), cocaine injecting (79%, p = 0.014), homelessness (86%, p < 0.001), public injecting (87%, p < 0.001) and an overdose (80%, p = 0.026). Willingness was found to be associated with a cumulative multiple risk variable: increased from 66% among those with a score of zero to 85% with a score of at least three (p < 0.001).\ud \ud CONCLUSIONS:\ud The vast majority of PWID at greatest risk of drug-related harm in Glasgow and elsewhere in Scotland would be willing to use a DCR, supporting proposals for the introduction of DCRs nationally.

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