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

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Lowrie, Richard and McPherson, Andrew and Mair, Frances S. and Stock, Kate and Jones, Caitlin and Maguire, Donogh and Paudyal, Vibhu and Duncan, Clare and Blair, Becky and Lombard, Cian and Ross, Steven and Hughes, Fiona and Moir, Jane and Scott, Ailsa and Reilly, Frank and Sills, Laura and Hislop, Jennifer and Farmer, Natalia and Lucey, Sharon and Wishart, Stephen and Provan, George and Robertson, Roy and Williamson, Andrea (2023) Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial. Harm Reduction Journal, 20 (1). 46. ISSN 1477-7517 (https://doi.org/10.1186/s12954-023-00771-4)

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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.

ORCID iDs

Lowrie, Richard, McPherson, Andrew, Mair, Frances S., Stock, Kate, Jones, Caitlin, Maguire, Donogh, Paudyal, Vibhu, Duncan, Clare, Blair, Becky, Lombard, Cian, Ross, Steven, Hughes, Fiona, Moir, Jane, Scott, Ailsa, Reilly, Frank ORCID logoORCID: https://orcid.org/0000-0002-3742-6668, Sills, Laura, Hislop, Jennifer, Farmer, Natalia, Lucey, Sharon, Wishart, Stephen, Provan, George, Robertson, Roy and Williamson, Andrea;
CORE (COnnecting REpositories)