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NETWORK A national newsletter on substance misuse management in primary care



The Scots and scotch

From Robert Burns to The Simpsons the Scot has often been portrayed as a drunk. Sadly this is even more true now than it was in the past. But while it is true that drink has always been part of Scottish culture there is nothing fixed about our culture and the amount drunk, and the harm suffered has greatly increased in the last fifty years:

■ alcohol related death rates in Scotland are twice as high as in England and Wales and have doubled over the last 15 years

■ 15 of the 20 worst areas for male alcohol related deaths in the UK are in Scotland1

■ more than 42,000 discharges from hospital per year relate to an alcohol- related admission2

■ Scotland has one of the fastest growing chronic liver disease and cirrhosis death rates in the world3

■ women in Scotland are as likely to die of liver cirrhosis as men in England

■ in 2005, men who lived in the most deprived areas of Scotland were 6-7 times more likely to die an alcohol- related death than those in the least deprived areas

1 Office of National Statistics (2007) Trends and Geographical Variations on Alcohol-Related Deaths in the UK 1991-2004

2 SMR01

3 Leon and McCambridge (2006) Changing Scot- land’s Relationship with Alcohol, The Lancet 367

In this issue

Jack Leach discusses what we can offer to the small minority of patients who do not respond to the evidence based treatments of buprenorphine and methadone. Page 2.

David McCartney highlights the importance of supporting people in their recovery and how we can do this. Page 4.

Adam Winstock and John Marsden take us through a brief history of mephedrone, its effects, and offer some tips for basic harm reduction advice. Page 5.

Martyn Hull takes us through the development of the Royal College of General

Practitioners Certificate in the Management of Drug Misuse. Page 7.

Charles Lind and David Ewart describe two very different responses from primary care in Scotland to the same problem: the rise of drug use and its associated harms in the 1980s and 90s. Page 8.

Ewen Stewart explores the different responses of the English and Scottish policy makers to prevent the harms associated with hepatitis C infection. Page 10.

Mark Gilman describes the process that the North West Region has gone through to

develop treatment systems that have at their heart the recovery of service users. Page 12.

Peter Balfour, Pam Wells and Christine Ramsden outline their experience of

dealing with insomnia in an acute setting, and provide guidance which may prove very useful to service users in a community setting. Page 13.

We are pleased to introduce our first Dentist Fixit! Chris Cunningham offers advice to a

GP who is struggling to find treatment for their patient who is homeless. Page 14.

Mick Webb and Gordon Morse are Dr Fixit to a GP who is trying to support a patient who is using amphetamines. Page 15.

For the latest news on courses and events, see page 16

We hope you enjoy this edition.



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■ enough alcohol was sold in Scotland in the last three years for which figures are available to enable every man and women over the age of 16 to exceed the sensible drinking guidelines in every single week

■ alcohol misuse is estimated to cost Scotland £2.25 billion per year in extra services and lost productivity - £500 for every taxpayer.

“ Some seem to think

that it is a national duty to drink to excess, part of their Scottish identity

I work as a general practitioner in Glasgow and the daily evidence of my own eyes confirms the accuracy of these statistics. When I ask my patients how much they drink they often answer: “As much as I can afford.” They are not joking. Some seem to think that it is a national duty to drink to excess, part of their Scottish identity. But it need not be like this. Cultures change, and ours has changed for the worse in the last fifty years with regard to alcohol consumption.

In their document Changing Scotland’s

Relationship with Alcohol; A Framework for Action (2009) Scotland’s Scottish

National Party (SNP) government has put forward a number of measures to reduce

alcohol related harm 4 . The main drivers

on alcohol consumption have been referred to as the ‘Three As’; accessibility, affordability and advertising. Controlling advertising, and especially a ban on sporting sponsorship, would make a big difference, but is a matter reserved for Westminster legislation. Accessibility is, to some extent, being tackled through the licensing act5

. It is on affordability that

the real effort is now centred. Banning discounts for multiple purchases has widespread support and will probably be passed. But it is minimum alcohol pricing that is the main measure and the one that has caused the most debate.

Research suggests that a 40p minimum price, combined with a ban on quantity discounts in off sales, would:

l save the lives of about 70 Scots in

4 tions/2009/03/04144703/0

5 Licensing (Scotland) Act 2005 legislation/scotland/acts2005/asp_20050016_en_1

…continued overleaf


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