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Drug Misuse Research Programme 2004-2007

INTRODUCTION

The Drug Misuse Research Programme is an applied programme of research that aims to produce outcomes of practical value to Drug Action Teams (DATs) and other agencies involved in tackling drug misuse. This document sets out the programme of drug misuse research that the Scottish Executive will support and fund over the next three years. The aim of the programme is to ensure that policy development at a national level and the planning and delivery of services locally is based on consistent, reliable and up to date information and research. The emphasis will be on applied research with outcomes directly relevant to practice.

This programme includes research projects that are currently underway and identifies topic areas where research may be required, under the four pillars of the Scottish Executive Drugs Strategy (Availability, Communities, Treatment and Rehabilitation and Young People). The programme is intended to be flexible, so that it is able to respond to the changing needs of policy makers and practitioners in the drugs field in Scotland. As policy development progresses and the evidence base expands, some topic areas set out in this programme may not require research. However, other topics may subsequently be added to meet new demands.

Background information

Remit of the EIU

The Effective Interventions Unit (EIU) was set up in June 2000 to support the implementation of the Scottish Executive's drug misuse strategy, Tackling Drugs in Scotland: Action in Partnership (1999). The Unit is located within the Substance Misuse Division of the Health Department and reports to the Deputy Minister for Justice, who has responsibility for drug misuse in the Executive. The overall remit of the Unit is as follows:

• To identify what is effective - and cost-effective - practice in prevention, treatment, rehabilitation and availability and in addressing the needs of both the individual and the community.

• To disseminate effective practice based on sound evidence and evaluation to policy makers, DATs and practitioners.

• To support DATs and agencies to deliver effective practice by developing good practice guidelines, evaluation tools, criteria for funding, models of service, and by contributing to the implementation of effective practice through the DAT corporate planning cycle.

The EIU publishes an annual work programme, which includes details of work to be undertaken through the Scottish Executive's Drug Misuse Research Programme. This work is co-ordinated by the Drug Misuse Research Team, three Social Researchers ¹ who are located within the Effective Interventions Unit. In addition to co-ordinating the Research Programme, the team also provides research-based advice to other members of the EIU team, the Substance Misuse Division and to DATs. We also work collaboratively with members of the EIU and the Substance Misuse Division on specific projects.

The development of the first Research Programme was rooted in a commitment to improve the research and information base to support practice in this area. The 2001-2004 Research Programme emerged from a consultation process with members of the research community, agencies and other organisations and identified a number of key areas which have guided Scottish Executive drug misuse research and which will continue to impact upon what we do in the course of our next programme. The Research Programme has also responded to the changing needs and priorities of our colleagues in policy and this is reflected in the body of work that has been developed over the past three years.

Drawing on the successful nature of the collaborative and consultative process that moulded our first Research Programme, the 2004-2007 Drug Misuse Research Programme has followed a similar process.

Stakeholders were initially invited to make written contributions to the Research Programme. They were then asked if they wished to take part in a consultation workshop on the Research Programme, which was hosted by the EIU in March 2004.

Consultees were asked to put forward their views on what the priorities should be for Executive-funded drug misuse research over the next three years, and they were also asked to provide their rationale for identifying these themes. Following the consultation process, we collated and analysed all written and verbal feedback. The results of this consultation process have formed the basis for this new programme.

In response to the needs of our colleagues both within and outwith the Scottish Executive, we have developed a Research Programme for 2004-2007 which reflects thematic priorities within which we can respond quickly, flexibly and constructively as needs arise, rather than individually defined projects. The 2004-2007 Research Programme outlines the themes and topic areas which have been identified as research priorities for the Scottish Executive by internal and external stakeholders. The programme also contains information about those projects which were commissioned as part of the 2001-2004 Research Programme.

Remit of the Programme

The Research Programme is intended to produce practical and applied research for the drugs field. We do not have the capacity to fund large scale clinical trials. However we are prepared to consider co-funding such studies with other organisations.

The programme has previously, and will continue to, concentrate on the misuse of illicit drugs. However research on the misuse of solvents and prescription drugs may also be considered under the remit of the Research Programme in future.

Other research is, of course, conducted and funded by other agencies, organisations and researchers, but we have not identified this work for inclusion in the programme. Some research on drug misuse is also currently funded and managed by other research units or branches within the Scottish Executive.

• Social Research Branches:

• • Criminal Justice²: Lead on drug-related crime, interventions for drug users in the criminal justice system (including arrest referral schemes and community disposals for drug using offenders)

  • Education³: Lead on evaluation of drug education within schools and on research on children and young people

  • Transport⁴: Lead on exploring issues relevant to attitudes on drug driving and road safety.

  • Some research of relevance to the drugs field is also co-ordinated in consultation with research colleagues from Housing⁵, Community Care, Mental Health ⁶ and Enterprise and Lifelong Learning⁷ branches.

  • Chief Scientist's Office (CSO):

• The CSO commissions work and supports research initiated by the research community in Scotland through a research grant system. The CSO will continue to fund applied health services research relating to drug misuse, such as trials of the organisation and delivery of services to drug misusers.

• Scottish Prison Service (SPS):

SPS commissions and supports drug related research in Scottish prisons which informs the development of policy and practice on prisoner care and welfare, both while in custody and on release back into the community.

Commissioning and managing research

Most of the research funded through the Research Programme is commissioned by way of selective competitive tendering. This is where a selected number of researchers, who may have previously submitted an expression of interest on the relevant project, are invited to tender for the work as set out in a research specification. We have not identified individual projects in this new programme but, rather, themes within which appropriate projects will be developed. Expressions of interest will be solicited via our mailing lists and announcements that will be posted on our website. If contractors would like their details to be included on the mailing list please email Chris.Rich@scotland.gsi.gov.uk . Further information is available on the research pages of the EIU website ⁸.

Contractors should note that because of Scottish Executive procurement regulations the EIU cannot consider unsolicited research proposals. However, we are able to contribute to large scale ongoing studies as a co-funder (for example, we are currently contributing to the Edinburgh Study of Youth Transitions and Crime and the Drug Outcomes Research in Scotland Study).

Approach

The approach of the Research Team is an inclusive one and we continue to involve a wide range of stakeholders in the development and promotion of our work. We are keen to maintain our collaborative approach to the development of research in order to achieve a high standard of research that can effectively impact on policy and practice in the field.

The Research Team also supports the Scottish Executive's commitment to 'mainstream equality' ⁹ across policy and practice. ¹⁰ This is a long-term process and essentially means that researchers, policy makers and those delivering services should take account of and reflect the diverse needs of the population in Scotland. As such, we recognise that different communities and groups (for example, women, minority ethnic groups and disabled people), may have particular needs and experiences that will need to be taken into account across our research development and practice.

Dissemination of research findings

The effective dissemination of research findings has been a key concern of the EIU from the outset, and continues to be a key priority for the Research Programme. As stated in our original programme, we are committed to implementing the aims and objectives from Tackling Drugs in Scotland: Action in Partnership whichstates:

"There will be a bias towards applied research with outcomes of practical value to Drug Action Teams and other agencies involved in tackling drug misuse, and an emphasis on the dissemination of research findings in an accessible and useable form."

The Effective Interventions Unit will continue to seek to ensure that the messages of research are widely disseminated so that they have a positive impact on the development of policy and practice in the field.

We will continue to explore a variety of different means of dissemination, each designed to target different audiences. Dissemination arrangements will continue to include the conventional publication and distribution of research reports and publication in peer review journals. However, we also intend to hold dissemination events and issue regular digests of research findings.

The wider research context

The Drug Misuse Research Team does not work in isolation. We are closely involved with the work of other research bodies and contribute, where possible, to other research studies outwith the Scottish Executive. It is our intention to continue to work within the wider context of drugs research in the UK and internationally.

The Research and Information Working Group (RIWG), co-ordinated by Drugs Analysis and Research (DAR) at the Home Office, is a forum which aims to co-ordinate government-funded research on drug misuse in the UK and Republic of Ireland. This is one of the main mechanisms through which the Executive maintains links with other government research in the drugs field.

The wider context of research and information also includes a range of national and international sources. We work closely with the Information and Statistics Division of NHS Scotland (ISD) ¹¹ and our research and policy colleagues from NHS Health Scotland ¹². Other bodies funding drugs research include research councils such as the Economic and Social Research Council (ESRC) ¹³ and the Medical Research Council (MRC) ¹⁴.

Charitable organisations and foundations also fund research and evaluation. For example, the Robertson Trust, Barnardo's, the Joseph Rowntree Foundation and the Nuffield Foundation. The Joseph Rowntree Foundation has set up a Drug and Alcohol Research Committee (DARC) ¹⁵ as one of its Single Programme Committees. The Robertson Trust committed 1.1 million to a programme of drug misuse research which is supported and now co-funded by the Executive.

Key topic areas for 2004-2007

This document lists the key areas that we will work in. Some of these topic areas are new to the Research Programme, others build on the existing work of the Research Team. Projects that are currently underway (as of May 2004) are listed at the end of each section and are summarised in Appendix 1.

We expect to commission or support research in the areas set out below between 2004-2007. However, as already stated, the programme is designed to be flexible. New topics may be added to this list as the programme progresses, depending on the requirements of key stakeholders, and the development of research evidence.

A. TREATMENT AND REHABILITATION

The main focus of our research on treatment and rehabilitation has been to provide evidence which will support the development and delivery of effective services and interventions in the field of drug misuse. Significant work in this area has been carried out within the Research Programme over the past three years. We summarise below our ongoing work, and indicate the themes we are likely to focus on during the next three years.

A1. EFFECTIVENESS OF TREATMENT

Ongoing work

Psychosocial interventions: Initial scoping work on the provision of counselling in a sample of agencies in Scotland has been conducted within the Unit. ¹⁶ This has identified a number of possibilities for further research on psychosocial interventions to be taken forward under the new Research Programme.

Residential / community rehabilitation: Work has already been undertaken within EIU on residential services for drug users, ¹⁷ initially to inform the Treatment and Rehabilitation Review. This work also identified further research needs in this area.

Drug-related deaths: A national investigation into drug-related deaths in Scotland has been commissioned and is being managed by the Research Team in EIU. It involves the examination of the social and clinical circumstances surrounding all drug-related deaths in Scotland in 2003, and will make recommendations for policy and practice which may lead to a future reduction in drug-related deaths.

Plans for 2004 - 2007

Psychosocial interventions: Further research in the area of psychosocial interventions will be undertaken during 2004-2005. Some of the specific topics identified in the scoping exercise as priorities include:

• review of the literature on effectiveness of psychosocial interventions.

• mapping of availability / nature of psychosocial interventions in Scotland.

• gender issues in the provision of psychosocial interventions.

Residential / community rehabilitation: The exploratory work carried out by EIU identified the following priorities:

• the need for a better understanding of how residential services are currently used in Scotland.

• effectiveness and cost-effectiveness of residential / community rehabilitation programmes and aftercare.

Research in one or more of these areas is likely to be undertaken during 2004-2005, and a reference group of practitioners and DAT representatives will be established to advise us on the precise focus of this work.

Pharmacotherapies: We are currently considering the part-funding of research comparing the effectiveness of buprenorphine and methadone within a Scottish community treatment context.

A2. TREATMENT AND SUPPORT FOR SPECIFIC POPULATIONS

A diverse range of needs must be considered in the design of services for people with drug misuse problems, and research should reflect this diversity.

Groups who may have specific issues requiring consideration in the design and conduct of future research projects include: young people (see following section), older drug users, women, pregnant drug users and drug using parents, people with co-morbid mental health and substance use problems, homeless people, non-heroin dependent problem drug users (PDUs), people from minority ethnic backgrounds, people living in remote and rural communities, prisoners and ex-prisoners.

Ongoing work

Co-morbidity: EIU-funded research on the nature and scope of existing service provision in Scotland for people with co-existing mental health and substance use problems is currently underway.

Prisoners and ex-prisoners: An evaluation of the Scottish Prison Service Transitional Care initiative is currently underway. Interim reports of this evaluation will be published over the course of 2004-2005, with a final report available in Autumn 2005.

Pregnant drug users and drug using parents: A study of babies born of substance misusing mothers is currently underway. This will evaluate the impact of a structured assessment aimed at identifying babies with Neo-natal Abstinence Syndrome, and is due to report in November 2005.

Plans for 2004 - 2007

Non-heroin dependent PDUs: There is growing interest in the evidence base for ways to design services for / engage and retain non-heroin dependent PDUs. There is a body of knowledge emerging within the UK on these issues as they pertain to psychostimulant drug users, which will be added to through the EIU evaluation of the 'Incite' project in Aberdeen. We will also be considering further work looking at interventions for people experiencing problems with different types of drugs (e.g. volatile substances, benzodiazepines).

Co-morbidity: We will be considering further work on interventions for service users with co-morbid problems.

Families: It is likely that research into the service needs of, and effective interventions for, families with a problem drug user will be of high priority for 2004-2007. In particular, research concerning pregnant drug users, drug using parents and the support needs of carers will feature in this work. Development of research on this theme will of course be closely linked to the priority areas 'children and young people affected by familial drug use' (under the 'Young People' pillar) and 'families of drug users' (under the 'Communities' pillar).

A3. PREVENTION OF TRANSMISSION OF HEPATITIS C and PROMOTION OF SAFER INJECTING

Ongoing work

EIU have commissioned a number of studies on this theme, some of which are still underway. Ongoing studies include a study of the impact of changes in the Lord Advocate's Guidance on needle exchange, an evaluation of an Hepatitis C Virus (HCV) peer intervention project and a study to quantify the risks and outcomes associated with the use of different forms of drug paraphernalia. This latter study will lead on to the production and trial of an injecting kit and new harm reduction advice.

Plans for 2004 - 2007

There are a number of different areas within this theme which are under consideration. Further research on the prevention of blood-borne viruses and the promotion of safer injecting practices may include the evaluation of interventions to prevent or reduce injecting, and / or to promote safer injecting practices among the drug using population.

A4. INTEGRATED CARE

Ongoing work

We are part-funding a process evaluation of the first year of operation of the Glasgow City Community Addiction Teams. These teams have the clear purpose of establishing more rational and effective pathways to care for users of drug and alcohol services. The report will be available in Spring 2005.

We are currently funding a study to explore the role of substance misuse nurses in the treatment of drug misuse. The report of this study will be available in July 2004.

Plans for 2004 - 2007

Research on the broad theme of integrated care will be a priority over the next three years. This work is likely to cover topics that will cut across other themes in the Research Programme. It may involve the exploration of service user and service provider perspectives, the examination of clients' pathways through services and investigation of ways in which clients can best be engaged and retained in treatment. This may also include investigation of issues such as prescribing practices and the role of different types of service providers in the treatment and support of drug users.

SUMMARY

COMPLETED PROJECTS 2001-2004

B. YOUNG PEOPLE

The main focus of EIU research and evidence gathering on young people over the past three years has been on the effectiveness of interventions for young people with drug problems. Work in this area may continue over the next three years, but the focus will be widened to include issues regarding children and young people who are affected by others' drug use.

B1. CHILDREN AND YOUNG PEOPLE AFFECTED BY FAMILIAL DRUG USE

Plans for 2004 - 2007

Priority areas for research on children and young people affected by familial drug use may include work focusing on the following:

• The impacts of familial drug use on children and young people.

• Support needs of children of families affected by problem drug use.

• The nature and extent of existing support provision for these children and young people.

• The effectiveness of interventions providing support for these children and young people.

This is likely to be a high priority area for policy makers, practitioners and researchers, in the light of the recommendations of Hidden Harm¹⁸. It is also likely to be closely linked to any further work on the families and carers of drug users as described in the section on 'Communities'. The Research Team will scope current research in this area, identify significant gaps and commission work as appropriate. We will also liaise with other funders regarding any possibilities for collaborative work in this area at a UK level.

B2. EFFECTIVE INTERVENTIONS FOR YOUNG PEOPLE WITH DRUG PROBLEMS

Plans for 2004 - 2007

Research into the effectiveness of interventions for young people with drug problems was a priority topic under the last Research Programme, and an ongoing study is evaluating a range of young people's projects. We will continue to conduct research into effective interventions for young people with drug problems as appropriate.

SUMMARY

COMPLETED PROJECTS 2001-2004

C. AVAILABILITY

Review work conducted by the Research Team has established that there is already an evidence base on the nature and functioning of drug markets, and interventions to address drug markets. However, there is very little that is specific to Scotland.

The Research Team will continue to keep a watching brief on work ongoing elsewhere in the UK, and link with the Criminal Justice branch of Social Research on cross-cutting areas. We intend to maintain our links with the Research and Information Working Group (see page 8) to improve our understanding of supply side initiatives.

C1. IMPROVING OUR UNDERSTANDING OF DRUG MARKETS

Ongoing work

We are currently conducting qualitative work examining drug markets in three case study areas in Scotland, which will include the perspectives of police, drug service providers, drug users and other members of the local communities. This aims to describe how the drug markets function in each of the three areas, and how they impact upon the communities within which they operate. It will also explore the nature and extent of any interventions designed to address these drug markets and their impacts.

Plans for 2004 - 2007

A good understanding of drug markets and how they operate is fundamental to the design of interventions to tackle drug markets and their effects, and of any evaluations of such interventions. To this end, we may consider further work on drug markets in future; this could include work such as: studies of regional variance in the nature and structure of drug markets, drug dealing 'careers', markets in specific drugs including illicit markets in prescription drugs.

C2. INTERVENTIONS TO ADDRESS LOCAL DRUG MARKETS

Ongoing work

This theme is also explored in the qualitative work in three case study areas described above.

Plans for 2004 - 2007

We will continue to keep under consideration research into the effectiveness / impact of interventions to address local drug markets. The EIU will endeavour to keep up to date with new developments in drug policing, and other initiatives designed to reduce the impact of drug dealing in Scotland, and identify opportunities to evaluate innovative approaches as and when they arise.

SUMMARY

COMPLETED PROJECTS 2001-2004

D. COMMUNITIES

Future Research Programme funded research under the 'Communities' pillar is likely to include research eliciting communities' views on drug related issues that affect them. We are also likely to build on previous research looking at supporting the families and carers of drug users.

D1. COMMUNITY RESPONSES TO DRUG PROBLEMS

Plans for 2004-2007

Work within this theme could include research into the impacts of drug markets on the wider community within which they operate. This would build on the ongoing research into drug markets in three case study areas (see 'Availability' section). It could also include research into public perceptions of problems ensuing within communities as a result of drug use, and exploration of the differences between the ways that drug problems are experienced in urban and rural communities.

We will also consider research on the following:

• Communities' awareness of, and attitudes towards, drug treatment and rehabilitation facilities and practices in their area.

• Communities views on what interventions they would like to see, what they think would make a difference and what role communities can play in putting interventions into practice.

D2. COMMUNITY INTERVENTIONS

Plans for 2004-2007

We will also consider research into the effectiveness of community interventions seeking to reduce drug-related anti-social behaviour. The Research Team will provide support for any evaluation work required by policy colleagues on community interventions into drug-related problems.

D3. FAMILIES OF DRUG USERS

Plans for 2004-2007

Following from previous EIU research in this area, further work on the needs of families and carers of drug users will be considered. Previous research suggests that the majority of carers of drug users are not aware of their rights under the Community Care Act, and do not identify themselves as carers.

We will also consider researching the availability of support services to families and carers across Scotland and the identification of good practice. We may also extend research on families to include work looking at ways in which families / carers can be involved in treatment and rehabilitation processes. Research in this area is likely to be closely linked with research on children and young people affected by familial drug use (as described in the 'Young People' section of this document).

D4. TRAINING AND EMPLOYMENT FOR DRUG USERS

Plans for 2004-2007

Training and employment for drug users remains a highly important policy area. The lead for research in the Scottish Executive for employability issues lies with researchers in the Enterprise and Lifelong Learning Department of the Scottish Executive. However, we will maintain links with relevant colleagues in order to ensure that the specific requirements of drug users are represented in general employability research, and take forward any discrete work into training and employment for drug users as necessary. In particular, we will advise and assist policy colleagues on the evaluation of relevant pilot projects as and when appropriate.

SUMMARY

COMPLETED PROJECTS 2001-2004

APPENDIX 1:

CURRENT PROJECTS FULLY FUNDED BY THE DMRP (AS OF MAY 2004)

* Commissioned and managed by the research team in EIU, but funded directly by the Substance Misuse Division in the Scottish Executive

APPENDIX 2:

COMPLETED DMRP PROJECTS (FEBRUARY 2001 - MAY 2004)

* Commissioned and managed by the research team in EIU, but funded directly by the Substance Misuse Division in the Scottish Executive

APPENDIX 3:

OTHER PROJECTS SUPPORTED BY EIU RESEARCH TEAM

APPENDIX 4:

RESEARCH RESOURCES

The wider context of research and information also includes a range of national and international sources. Examples of useful research resources include:

UK agencies:

Cochrane Collaboration
http://www.cochrane.org/index0.htm

DrugScope
http://www.drugscope.org.uk/

EWODOR, Stirling University
http://www.dass.stir.ac.uk/DRUGS/Ewodor.htm

ISD Drug Misuse in Scotland
http://www.drugmisuse.isdscotland.org/

Home Office - Drug Strategy Directorate
http://www.drugs.gov.uk/NationalStrategy/DrugsStrategyDirectorate

Home Office - Research Development and Statistics Directorate
http://www.homeoffice.gov.uk/rds/index.html

National Treatment Agency
http://www.nta.nhs.uk/

NHS Health Scotland
http://www.hebs.scot.nhs.uk/

Joseph Rowntree Foundation
http://www.jrf.org.uk/

NHS Centre for Reviews and Dissemination
http://nhscrd.york.ac.uk/welcome.html

National Institute for Clinical Excellence
http://www.nice.org.uk/

Scottish Drugs Forum
http://www.sdf.org.uk/

Scottish Executive - Social Research
http://www.scotland.gov.uk/Topics/?pageID=183

International agencies:

European Monitoring Centre for Drugs and Drug Addiction
http://www.emcdda.eu.int/

National Institute on Drug Abuse
http://www.nida.nih.gov/

Treatment Improvement Exchange
http://www.treatment.org/

World Health Organisation
http://www.who.int/substance_abuse/

United Nations Drug Control Programme
http://www.undcp.org/

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