We are acutely aware that the word “surveillance” is a contested term due to its association with the criminalisation of drug use and consequent stigma. It may therefore be helpful to set out here our understanding of what is meant by public health surveillance for drugs.
It is important that public health surveillance for drugs is understood as a process through which improvements in the care and support of people affected by drug use can be identified and put in place. It therefore plays a key part in preventing avoidable harm, saving lives and improving life chances.
Surveillance should be central to the National Mission to improve and save lives. It provides the information necessary to act. When done well, it can support rapid responses to prevent drug-related deaths.
Audit Scotland identified that
“good quality, frequent and timely data will be crucial in supporting clear performance measurement and public reporting” (46).
We believe that anyone who wishes to understand any aspect of drug use and the drug-deaths emergency should be able to access relevant and timely data with ease.
The data gathered should be aligned to the National Mission and should add value, with the objective of effecting change. Critically, public health surveillance should be
focused on the core objective of the National Mission, which is to ensure people get the help they need when they need it.
Providing the right information
Data is a powerful tool to effect change. This has been demonstrated clearly during the Covid-19 pandemic.
While it is important to know “how many”, surveillance must also be able to provide information about “who, what, why and where”.
Gathering rich intelligence takes time. There is a need to prioritise data that provides added value and deprioritise data that does not. Collecting data only where necessary and helpful will also decrease the burden on staff.
The publication of data on drug-related deaths supports efforts to reduce further deaths. We welcomed the recent transition to quarterly publications. There is now a need to move towards a more consistent national picture through data collection and review, as the Drug Death Reporting Short Life Working Group recently noted (49).
What needs to change
All reporting systems (such as annual ADP data) should be person-centred, collaborative and be adaptable to change as lessons are learned.
The information necessary to develop a complete picture is held by a number of partners. Public Health Scotland has a coordination function in improving the availability of quality data on drug-related deaths and harms. It must be owned,
however, by the Scottish Government. This is necessary to ensure all data is included and all agencies and organisations sign up to the principles we have outlined.
A National Co-ordinator for Drug-related Deaths role within Public Health Scotland, as suggested by the Drug Death Reporting Short Life Working Group, would be
valuable (49). The function of the role would be to formalise inter-agency information-sharing. This would support some of our proposed actions.
Ongoing workforce development is necessary. It will ensure that staff know how to report data but also, crucially, how to use the data available to them to improve practice.
As outlined by the Drug Death Reporting Short Life Working Group, a National Co-ordinator for Drug-related Deaths role should be created in Public Health Scotland to improve consistency and data-sharing and coordinate a review of the national drug-related death database. This role should be regularly reviewed to ensure it is effective and still needed.
A full review of public health surveillance should be undertaken, led by the Scottish Government and involving all partners. The aim would be to ensure that the most relevant data is collected and shared in a transparent
and accountable way, thereby furthering achievement of the objectives of the National Mission.
Early warning system
Timely and accurate data about the use of drugs in Scotland identifies trends for early intervention by local areas.
Our Public Health Surveillance Subgroup established an early warning system. The system uses monthly Police Scotland suspected drug-related death data, data from SAS on overdoses and toxicology data. It is managed by Public Health Scotland and provides an initial early warning of high risks of drug-related deaths.
What needs to change
Data gathered through the drug-checking system (see Chapter 3, section 3.4.6) should feed into the early warning system. This data provides vital information on drugs in current use across the country and their levels of purity.
Data from the drug-checking system should be further developed to provide local areas with the most up-to-date and accurate information for responding to risks. This could be an additional role assumed by a National Coordinator on Drug-related Deaths.
Public Health Scotland should build on the established early warning system to improve data linkage and provide the most up-to-date and accurate information for responding to risks.
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