Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial
Abstract Background Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-023-00771-4 |
| _version_ | 1827970586713784320 |
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| author | Richard Lowrie Andrew McPherson Frances S. Mair Kate Stock Caitlin Jones Donogh Maguire Vibhu Paudyal Clare Duncan Becky Blair Cian Lombard Steven Ross Fiona Hughes Jane Moir Ailsa Scott Frank Reilly Laura Sills Jennifer Hislop Natalia Farmer Sharon Lucey Stephen Wishart George Provan Roy Robertson Andrea Williamson |
| author_facet | Richard Lowrie Andrew McPherson Frances S. Mair Kate Stock Caitlin Jones Donogh Maguire Vibhu Paudyal Clare Duncan Becky Blair Cian Lombard Steven Ross Fiona Hughes Jane Moir Ailsa Scott Frank Reilly Laura Sills Jennifer Hislop Natalia Farmer Sharon Lucey Stephen Wishart George Provan Roy Robertson Andrea Williamson |
| author_sort | Richard Lowrie |
| collection | DOAJ |
| description | Abstract Background Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019. |
| first_indexed | 2024-04-09T18:56:06Z |
| format | Article |
| id | doaj.art-86e52909c50d434cbee5b3795fddbfa8 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-04-09T18:56:06Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-86e52909c50d434cbee5b3795fddbfa82023-04-09T11:11:44ZengBMCHarm Reduction Journal1477-75172023-04-0120111810.1186/s12954-023-00771-4Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trialRichard Lowrie0Andrew McPherson1Frances S. Mair2Kate Stock3Caitlin Jones4Donogh Maguire5Vibhu Paudyal6Clare Duncan7Becky Blair8Cian Lombard9Steven Ross10Fiona Hughes11Jane Moir12Ailsa Scott13Frank Reilly14Laura Sills15Jennifer Hislop16Natalia Farmer17Sharon Lucey18Stephen Wishart19George Provan20Roy Robertson21Andrea Williamson22Pharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydePharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydeGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowPharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydeGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowEmergency Medicine, Glasgow Royal InfirmarySchool of Pharmacy, University of BirminghamAddictions Psychiatry, NHS Ayrshire and ArranPharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydePharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydeSimon Community Scotland Street TeamPharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydePharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydeSimon Community Scotland Street TeamSimon Community Scotland Street TeamEast End Addictions Services, Alcohol and Drug Recovery Service, Glasgow Health and Social Care Partnership, NHS Greater Glasgow and ClydeHealthcare Improvement ScotlandDepartment of Social work, School of Health and Life Sciences, Glasgow Caledonian UniversityPharmacy Services, Homeless Health/Research and Development, NHS Greater Glasgow and ClydeShelter ScotlandSimon Community Scotland Street TeamUsher Institute, College of Medicine and Veterinary Medicine, The University of EdinburghGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of GlasgowAbstract Background Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019.https://doi.org/10.1186/s12954-023-00771-4HomelessnessChronic diseaseOpioid addictionPrimary health careRandomised controlled trialPublic health |
| spellingShingle | Richard Lowrie Andrew McPherson Frances S. Mair Kate Stock Caitlin Jones Donogh Maguire Vibhu Paudyal Clare Duncan Becky Blair Cian Lombard Steven Ross Fiona Hughes Jane Moir Ailsa Scott Frank Reilly Laura Sills Jennifer Hislop Natalia Farmer Sharon Lucey Stephen Wishart George Provan Roy Robertson Andrea Williamson Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial Harm Reduction Journal Homelessness Chronic disease Opioid addiction Primary health care Randomised controlled trial Public health |
| title | Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial |
| title_full | Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial |
| title_fullStr | Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial |
| title_full_unstemmed | Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial |
| title_short | Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial |
| title_sort | baseline characteristics of people experiencing homelessness with a recent drug overdose in the phoenix pilot randomised controlled trial |
| topic | Homelessness Chronic disease Opioid addiction Primary health care Randomised controlled trial Public health |
| url | https://doi.org/10.1186/s12954-023-00771-4 |
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