Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

Lowrie, R. et al. (2023) Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial. Harm Reduction Journal, 20, 46. (doi: 10.1186/s12954-023-00771-4) (PMID:37016418) (PMCID:PMC10071267)

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.

• Item Type: Articles
• Additional Information: This study was funded by the NHS Greater Glasgow and Clyde and the Scottish Government’s Drug Deaths Task Force.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Maguire, Donogh and Jones, Dr Caitlin and Mair, Professor Frances and Lowrie, Dr Richard and Williamson, Professor Andrea and McPherson, Dr Andrew
• Authors: Lowrie, R., McPherson, A., Mair, F. S., Stock, K., Jones, C., Maguire, D., Paudyal, V., Duncan, C., Blair, B., Lombard, C., Ross, S., Hughes, F., Moir, J., Scott, A., Reilly, F., Sills, L., Hislop, J., Farmer, N., Lucey, S., Wishart, S., Provan, G., Robertson, R., and Williamson, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Harm Reduction Journal
• Publisher: BioMed Central
• ISSN: 1477-7517
• ISSN (Online): 1477-7517
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Harm Reduction Journal 20: 46
• Publisher Policy: Reproduced under a Creative Commons License