Substance use

• Ask about drug use (type of drug, quantity of drug used per day or week, method of drug use i.e. injecting / smoking, pattern of drug use and for how long)
• If injecting drugs, ask about shared paraphernalia and if risks of BBV infection, offer BBV screen.

If the patient is prescribed opiates via primary care for chronic pain then look at a reduction plan. This should be slow and steady. Please see local prescribing guideline for more information (NHS Dumfries and Galloway Opioid Prescribing Guidelines for Chronic Non Malignant Pain)

If the patient is using illicit drugs offer general advice on harm reduction including:

• Overdose awareness
• Safer injecting - Avoiding sharing needles, spoons, filters and other paraphernalia

Naloxone

If the patient is dependent to opioids, either prescribed high dose or illicit and at risk of overdose, naloxone can be prescribed. This should be prescribed as Prenoxad 1mg/ml prefilled syringe or Nyxoid 1.8mg nasal spray. Patients should be counselled on how to recognise an overdose and how to administer naloxone. Training can be sought from the Scottish Drugs Forum website → (Overdose Prevention, Intervention, and Naloxone (e-Learning) – SDF Learning Centre) or via local addiction services.

Injecting Equipment Provision (IEP):

If the patient is injecting drugs, please signpost to services where they can obtain Injecting Equipment Provision.

• Addiction services : SDAS or With You.
• For a list of community pharmacies who provide IEP, please click this link : NHS Dumfries & Galloway

Non-opiate drugs:

If the patient is prescribed benzodiazepines via primary care, advice on reduction plans can be found within the Quality Prescribing Guidelines for benzodiazepines and z-drugs → https://www.gov.scot/publications/quality-prescribing-benzodiazepines-z-drugs-guide-improvement-2024-2027/pages/5/

If the patient is prescribed gabapentinoids via primary care, advice on reduction plans can be found within the NHS Scotland guidance on Gabapentinoid Prescribing for Chronic Pain in Primary Care → https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/12/Gabapentinoid-Guidance-updated-11122018-Final-v12-1.docx

Patient self referral:

With You (3rd sector support) - for all types of illicit drug use (opioids, cannabis, cocaine, benzodiazepines, gabapentinoids)

• Dumfries: 79 Buccleuch Street, DG1 2AB — Tel: 01387 263208
• Stranraer: 32 Charlotte Street, DG9 7EF — Tel: 01776 705907

ADS (Alcohol and Drugs Support) - for all types of illicit drug use

• Dumfries: 79 Buccleuch Street, DG1 2AB — Tel: 01387 259999
• Castle Douglas: 225 King Street, DG7 1DT — Tel: 01556 503550
• Stranraer: 32 Charlotte Street, DG9 7EF — Tel: 01776 702626

Specialist Drug and Alcohol Service (SDAS) - for opioid or alcohol dependence only.* SDAS does not provide replacement prescribing for benzodiazepines or gabapentinoids.

• Dumfries: Lochfield Road Primary Care Centre, 12-28 Lochfield Road, DG2 9BH - Tel 01387 244555
• Stranraer: Innistaigh, Dalrymple Street, DG9 7DQ - Tel: 01387244555
• Cocaine Anonymous Helpline -01419596363 www.cascotland.org.uk

Young people (<18 years)

• ISSU18 (via CAMHS) Tel: 01387 244662 Email: dumf-uhb.CAMHS-mail@nhs.scot

Specialist Drug & Alcohol Service (SDAS):

• Patients with probable dependence to illicit opioids.
• Pregnancy with opioid dependence.
• Any patients being referred should have U&E, LFTs including AST and GGT and ECG within a month of referral date. Patients should also have been offered a BBV screen.
• Please see Shared Care OST for more information on patients prescribed OST in primary care.

Other services:

• Mental health complications or suicidality → Community Mental Health Team.
• With You → Patients with dependence to any substance
• ADS - 1:1 counselling

Family and friend support:

• Being there service (run by ADS) - Tel: 0333 8806950, email: beingthere@asdsws.co.uk
• Scottish Families Affected by Alcohol and Drugs: https://www.sfad.org.uk/ - naloxone is available to order online via this website.

Further information and training can be found at https://learn.nes.nhs.scot/71415/pharmacy-cpd-resources/therapeutics-and-patient-factors/central-nervous-system/substance-use
Local OST guidelines are available on Beacon (Opioid Dependence Treatment Guideline).

For additional learning resources - https://sdflearningcentre.org.uk/courses/