The Primary Care Facilitator Team provides advice, information and support for GP teams managing those with drug dependence or alcohol problems. Their site gives advice on approaches to harm reduction, including for BBVs.
Alcohol and Drugs Services in Lothian.
NHS Lothian provides a range of services across Lothian and works in close partnership with Social Work and third sector agencies.
Most services are organised by locality –West, East and Midlothian and the four Health and Social Care Partnerships in Edinburgh. Within each area there are drop-in clinics (staffed either by third sector or NHS staff). Arrangements can also be made for people to be assessed out-with these clinics
Other services have a Lothian wide remit and come under REAS:
- The Ritson clinic Potential Ritson referrals should be referred to the local hub in the first instance
- LEAP For information about LEAP, please see https://services.nhslothian.scot/leap
- Harm Reduction Team please see: http://intranet.lothian.scot.nhs.uk/Directory/harmreductionteam
Substance Misuse Services are not able to provide emergency assessment.
Who to refer:
- Patients who have been assessed as having problematic alcohol or drug use
- Patients already in treatment who have become unstable and would benefit from reassessment by the specialist service
- Adults 18 years of age and above who consent to the referral
- Patients looking for further help to achieve recovery
Who not to refer:
- Patients whose drug use is stable and who require specialist mental health assessment are usually more appropriately referred to General Adult Mental Health Services
- Patients with acute medical needs
Please refer to the appropriate acute medical service at the RIE, WGH or St John’s Hospitals. Such medical emergencies include:
- acute confusional states
- and/or withdrawal seizure(s),
- with or without Wernicke’s encephalopathy,
- acute alcoholic hallucinations
- or delirium tremens
- Patients with acute psychiatric needs
Patients with suicidal intent, or other psychiatric emergencies, please refer to: Emergencies Mental Health (Adults) – RefHelp (nhslothian.scot).
- Patients under 18 years of age:
- Edinburgh and East Lothian The Adolescent Substance Use Service (ASUS) offers treatment and support to young people (living in Edinburgh or East Lothian) aged 18 and under experiencing difficulties with drugs, alcohol or new psychoactive substance. Referrals can be made by professionals, family or the young people themselves. There is no criteria on the level of substance use but it must be causing the young person problems. Referrals to Jayne Reed, ASUS, City Chambers level 6, 249 High Street Edinburgh EH1 1YJ 0131 529 6700 or email ASUS@nhslothian.scot.nhs.uk
- Midlothian Under 18s with addiction problems can self refer to MYPAS in Midlothian Contact via 0131 454 0757 or www.mypas.co.uk
- West Lothian – awaiting further info – please seeks advice from local substance misuse service – see below
Primary Stimulant or Cannabis Users should be referred to: CREW 32-32a Cockburn St, Edinburgh, EH1 1PB, 0131 2203404 https://www.crew.scot/
How to refer:
Local Drop in Hubs – please see individual locality services for details.
Most patients can simply be directed to their local drop-in service. They may be seen by a member of staff from any of the partnership agencies – NHS, SW or third sector.
Prescriptions will not be provided at triage appointments.
SCI gateway:
Written referrals via the SCI gateway can still be made and may be helpful in situations where additional information about medical history or social background would be helpful or the referrer has a specific request.
If you believe your patient would be unable to attend then we can offer to assess the patient at their GP practice, at another site or in their home. This will not be offered routinely but if this is something which you feel would be required for your patient please let the service know.
For each referral please:
- Move patients who are currently unstable on opiate replacement prescriptions to daily supervised pickup unless there is a compelling reason not to. This is safer practice in this group and is the first intervention in those referred before decisions are made about increasing doses.
- Arrange toxicology testing which will help the assessment process; and a drug diary if appropriate.
- Check contact details including a current mobile phone number where possible: advise patients that they may be contacted by phone and that the number may appear ‘unlisted’.
- Ensure patients have given consent to a referral and understand that the services operate in partnership Local Authorities & Third Sector Organisations.
- Move patients who are currently unstable on opiate replacement prescriptions to daily supervised pickup unless there is a compelling reason not to. This is safer practice in this group and is the first intervention in those referred before decisions are made about increasing doses.
- Arrange toxicology testing which will help the assessment process; and a drug diary if appropriate.
- Check contact details including a current mobile phone number where possible: advise patients that they may be contacted by phone and that the number may appear ‘unlisted’.
- Ensure patients have given consent to a referral and understand that the services operate in partnership Local Authorities & Third Sector Organisations.
Alcohol screening – CAGE & FAST
There is also an app (free to download from www.arcapp.co.uk) which has been developed by Edinburgh ADP. It contains details of services, lists of Mutual Aid and other meetings, a diary, a calendar and relaxation
NICE Alcohol Guidance https://pathways.nice.org.uk/pathways/alcohol-use-disorders
Orange book Department of Health Drugs misuse https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/673978/clinical_guidelines_2017.pdf
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