Reducing Drug Abuse and Overdose: Analysis and Quality Improvement Proposal

Substance Misuse/Opiate Overdose
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Part 4: Critical Analysis of the Background and Drivers for the Quality Improvement Proposal
Substance abuse and addiction are a growing phenomenon among individuals released from police custody despite the criminal justice’s effort to reduce this problem. Most people in police custody report having used drugs in their lifetime (Chamberlain et al., 2019). Although experts have agreed that addiction is a treatable mental disease, most people do not receive treatment (Belenko et al., 2013). Involvement in the criminal justice system often originates from unlawful drug-seeking behavior and participation in illegal activities that reflect disrupted behaviour triggered by repeated substance use (Chandler et al., 2019). Treating drug-involved delinquents offers a unique opportunity to reduce substance abuse, its associated criminal behavior, and negative outcomes (Carver et al., 2021). After release from custody, drug resumption carries several risks, including transmitting infectious diseases, exacerbation of mental health conditions, and death caused by overdose (Chamberlain et al., 2019). Since substance abuse and mental health status co-occur, post-release drug abuse may also lead to severe mental health issues and minimize the medical care required (Gerra et al., 2019). Therefore, clinicians and policymakers need to prioritize preventing negative outcomes of substance abuse and addiction.
Analysis of the Topic and QI Proposal
The quality improvement project aims to use the UK (Scotland) policies and legislation that can help reduce harm among adults over the age of 18 being released from police custody. This is due to the increase in drug-related deaths in Scotland. Most recent reports indicate that drug-related deaths have increased since 1996, but the upward trend has been steeper since 2013 (National Records of Scotland, 2021). For instance, Scotland recorded more than 1,339 drug-related deaths in 2020 (National Records of Scotland, 2021). This was about 5% more than in the previous year and the largest number ever recorded since the beginning of the series in 1996 (McDonald et al., 2021). Over the last two decades, the number of drug-related deaths has increased significantly. Studies indicate 4.6 times as many deaths in 2020 compared with 2000 (National Records of Scotland, 2021). The increase in the number of drug-related deaths in Scotland prompted the quality proposal improvement plan to reduce the drug overdose in people released from police custody. These individuals are at high risk of overdose and negative outcomes. Scottish harm reduction strategies focus on pharmacological and psychotherapy interventions.
NICE guidelines also outlines psychotherapy methods such as cognitive-behavioral therapy (CBT) (Baker et al., 2006). Once the patient is released from police custody, mental health staff can refer them to a reputable therapist or organization for help. Evidence shows that therapists who specialize in addiction recovery can help patients with substance abuse problems set achievable short-term goals as they work to manage their addiction (McHugh et al., 2010). These specialists use CBT to treat addiction. They teach patients to identify their negative automatic thoughts, which are common re-occurring disorders with addiction (Chandler et al., 2019). This helps patients dismiss false beliefs and insecurities that drive them into drug abuse and acquire self-help tools to improve their moods (Reddy et al., 2014).
Rationale
The quality improvement proposal intends to reduce negative outcomes in drug addiction overdose after release from police custody. This plan is driven by the increasing drug-related deaths and the risk of reverting to overdose once a person comes out of custody. This can result in negative outcomes for the patients. Zgierska et al. (2021) linked drug addiction to various health conditions like infectious diseases (HIV and Hepatitis B), bodily and mental health disorders, as well as negative social effects such as relationship instabilities and loss of livelihood. Substance overdose can also lead to death. Effective substance addiction intervention minimises drug use and recidivism (Volkow, 2021). Doing so improves patients’ health outcomes and reduces negative consequences associated with overdose. Medical experts such as police custody mental health staff should provide medication and psychotherapy to individuals before release to achieve this objective. They should also advise the patients to look for a counsellor once they are out of custody.
Gerra et al. (2019) noted that developing an appropriate intervention plan requires understanding the dynamics of drug addiction. They described drug addiction as a brain condition associated with chronic disorder (Gerra et al., 2019). Factors such as repeated exposure to psychoactive drugs, genetic predisposition, and adverse life experiences contribute to the pathogenesis of the addictive process (Conrod, 2016). These factors influence the long-term changes in brain function, creating the neurobiological basis for the occurrence of addictive behavior (Chamberlain et al., 2019).
According to Gerra et al.(2019), healthcare practitioners view substance abuse as a healthcare condition that needs clinical intervention. People released from police custody are likely to abuse drugs or develop drug dependence. Such individuals need clinical and psychological interventions to improve their well-being. They need accessible, affordable, and evidence-based substance addiction treatment and care services (Baker et al., 2006). Treatment requires the involvement of the healthcare system and should be conducted by professionals.
Quality improvement relates to an individual observation regarding the right to health. One understands that this right is associated with the accessibility of health services without prejudice (Gerra et al., 2019). It extends to any person in contact with the criminal justice process. It logically follows that drug addicts released from police custody should access effective treatment for substance abuse to reduce the negative outcomes of drug addiction overdose (Carver et al., 2021). Appropriate intervention improves the well-being of these people by reducing the chances of acquiring infectious diseases and mental illnesses caused by substance overdose (McHugh et al., 2010).
Policy
The continued rise in drug-related deaths in Scotland has called for government intervention to protect lives. The government has responded to this crisis by implementing relevant strategies and policies to target opioid overdose. An evidence-based strategy that targets naloxone distribution has been put in place. Naloxone is an opioid antagonist that can quickly and safely reverse the effects of opioid overdose. Increasing the availability of naloxone to those who need it will require training and equipping people released from custody who are likely to encounter overdose (Scottish Government, 2018). Healthcare providers should equip patients with naloxone kits that they can use in an emergency. 
           According to Hillen et al. (2022), naloxone does not affect people who do not have opioids in their bloodstream. It does not produce physical reliance. It also does not generate psychological or neurological effects of euphoria, but it poses a negligible risk if misused. Training and equipping at-risk populations with this medication minimizes the possible delay between overdose onset and the delivery of life-saving care (Chandler et al., 2019). Targeting naloxone distribution works best when:
* Naloxone is provided to at-risk individuals.
* Healthcare providers are adequately trained and feel comfortable supplying naloxone kits.
* Drug users are knowledgeable about the effectiveness of naloxone.
Therefore, an evidence-based strategy that targets naloxone distribution is one of the many harm reduction approaches established in Scotland to reduce opioid overdose. The same approach applies to this quality improvement project.&nb...