Renfrewshire Council

The report and recommendations are provided against the backdrop of the COVID-19 pandemic and subsequent lockdown which has had a significant impact on individuals, families and communities, and on the way, services are delivered in Renfrewshire.

In light of this and of the potential economic and social impact in the short, medium and longer term, understanding the human and financial cost of alcohol and drug use in Renfrewshire and how to ensure that resources are targeted in the most effective way has never been more important.

The Commission, in its final meeting, considered additional evidence from local partners and organisations on the impact that COVID-19 and the resulting restrictions have had on individuals, families and communities impacted by alcohol/drugs and on the support and services that they rely on.

Renfrewshire Health and Social Care Partnership's Alcohol and Drug Recovery Manager highlighted the significant impact that COVID had on service provision, with many changes required at very short notice. For example, face-to-face provision had to be drastically reduced and buildings closed to the public with the priority being to keep people safe - particularly those most at risk.

Vulnerable service users and staff also had to shield at home which presented a further barrier to ensuring that individuals received the support they needed. Major changes to how services were delivered had to be implemented - including how to reach service users and where and how staff operated.

The service experienced barriers in terms of accommodation with the existing building at Back Sneddon Street unsuitable for use as it did not meet new health and safety guidelines. 

An urgent review was undertaken of how medication was prescribed, dispensed and supervised. The Whole System Review was temporarily suspended due to the pandemic. 

In response to the pandemic, the immediate focus of the service was on:

• retained service users in treatment, including prescribed medications
• continuing with commencement of Opiate Replacement Therapy new starts and re-starts
• continuing with blood-borne virus testing - Renfrewshire is one of two areas across NHSGGC participating in Dry Blood Spot Test pilot as a response to COVID-19
• safe process implemented for Injecting Equipment Provision
• increasing the distribution of naloxone and progressing with new 'Naloxone November' initiative
• a Red, Amber, Green (RAG) exercise was undertaken to ensure that the most vulnerable and most at risk service users were provided with sufficient support, treatment and guidance
• an emergency triage system was implemented to provide essential support, direction and harm reduction guidance
• delivery of Opiate Replacement Therapy and Welfare Checks
• a Multi-Disciplinary Team was established to discuss complex cases and prioritise essential treatment
• a new patient clinic was established to support urgent Opiate Replacement Therapy prescribing.

Further engagement activity was undertaken in September/October 2020 which involved follow up discussions with some of the groups and individuals who had been involved in the Commission's initial programme of engagement. These sessions were facilitated online and by telephone and provided an opportunity for Commission members to hear directly from individuals, groups and frontline staff in the statutory, third and community sector about the impact of the pandemic and restrictions.

The key themes from these sessions included:

Increase in drug and alcohol use

Frontline staff reported that alcohol/drug use has increased - although Etizolam does not seem to have been as prevalent.

Mental Health

The impact of the pandemic and restrictions on mental health - particularly young people's mental health. The mental health and wellbeing of frontline staff - both those working in the community and at home was also highlighted.

Access to services and support

It was felt that support has worked well for those already linked into services, however, for those not already engaged accessing services has been more difficult than prior to the pandemic.

Recovery

The impact of restrictions and isolation on those in recovery who were unable to participate in activities and access the support they had utilised to support their recovery.

Changes to the way services are delivered

Practice has had to adapt significantly with services having to provide support in new ways - including online and by telephone. Online support was felt to work for some but not others. Digital poverty was also highlighted as potentially impacting on some individuals being able to access support. The importance of face-to-face contact - digital contact cannot replace this. It was felt that relationships with support for service users were suffering.

Improved partnership working and the positive impact of some of the changes to service provision

Partnership working was felt to have been a key strength throughout the restrictions. Partnership working of all kind was highlighted, including between statutory services; between the statutory and voluntary sector; across the voluntary sector; and between peer support groups and the voluntary sector. Some changes to service provision were felt to have been for the better - including the provision of RDS services on an outreach basis.

Young people and schools

With the work of external agencies in schools currently on hold, the role of schools in prevention and early intervention and harm reduction was felt to be key.

Peer support

The resilience of group members and their willingness to support one other was highlighted as a key strength during the restrictions. Having partner organisations that they could turn to and being able to reach out for support meant that peer support groups did not feel as isolated as they may have.

The welcoming attitude of local companies was highlighted - including a local supermarket which allowed groups to meet safely and socially distanced in a space that wasn't being used.

A key message from statutory and third sector services and from individuals has been that many of the changes implemented in response to the pandemic have been very positive. It was felt strongly that there have been some significant benefits as a result and that we should not be trying to get back to 'normal' when some of the changes to provision have suited people well and have impacted them positively.

While the true impact of COVID-19 is not yet fully understood, community planning partners in Renfrewshire are currently undertaking a Community Impact Assessment to identify the impact of the pandemic and subsequent restrictions across Renfrewshire. The impact of the pandemic on alcohol and drug use and on those affected by alcohol or drugs will be considered as part of this approach. The partnership recognises that those inequalities that already existed in Renfrewshire are likely to have been exacerbated with the most vulnerable disproportionately affected by the pandemic and restrictions.

The significant impact of the COVID-19 restrictions on alcohol consumption is highlighted in a new survey commissioned by Alcohol Focus Scotland and Alcohol Change UK. The survey found that in Scotland people who were already drinking at high levels before the pandemic were more likely to have increased their drinking during lockdown, and stress was a key factor. The representative Opinium survey of 550 adults in Scotland showed that over a quarter (27%) of respondents reported drinking more than usual during lockdown, with this figure increasing to a third for those drinking at higher levels before lockdown (33% of those drinking seven or more units on a single occasion).

In times of stress some people can drink more often or more heavily. Dealing with stress was cited by around one fifth of all respondents as a reason for drinking. For those drinking more than usual, more than half (51%) said this has been a way to handle stress or anxiety. Almost half (48%) of those who reported drinking more during lockdown reported having felt concerned at the levels they are consuming. Meanwhile almost one fifth of all respondents (18%) reported feeling concerned about the amount a friend or family member is drinking during lockdown.

54% of those who reported drinking more than usual during lockdown had already taken steps to manage their drinking, and 59% planned to do so when lockdown eases. Almost two fifths (37%) of those drinking more than usual expected to drink less as pubs and restaurants reopen, however a quarter (24%) expect their drinking to increase further at this time.

The table below highlights changes in alcohol consumption by parental status identified by the survey.

42% of parents indicated that they drank alcohol more frequently during lockdown that prior to lockdown compared to 16% of non-parents. 26% of parents also indicated that the amount they drank had increased during lockdown compared to 9% of non-parents.

Heavy alcohol consumption is also likely to increase the risk of poor outcomes from COVID-19. According to the World Health Organization [WHO Office for Europe, 2020, Frequently Asked Questions About Alcohol and COVID-19]:

"alcohol consumption is associated with a range of communicable, non-communicable and mental health disorders, which can make a person more vulnerable to COVID-19. As alcohol compromises the body's immune system, there is an increased likelihood of being infected by the virus and of adverse health outcomes. Heavy alcohol use is also a risk factor for pneumonia and other lung infections and the development of acute respiratory distress syndrome (ARDS), which is one of the main complications of COVID-19. There is preliminary evidence suggesting that chronic alcohol consumption is a probable risk factor for the severity of COVID-19, but information is currently not systematically collected from patients."

The impact of increased alcohol consumption during the pandemic has also raised questions for the Commission in terms of a potential more urgent need to draw people's attention to the increased likelihood of babies being born with FASD. In terms of what is known from previous pandemics, pregnancies (particularly in adolescent girls) could potentially increase significantly. A specific intervention in relation reducing alcohol intake amongst this group could have a significant impact and would have massive long terms benefits to their children.