A retrospective observational cohort study evaluating a nurse-led multicomponent healthcare pathway for people who use drugs in Tayside, Scotland, found that the intervention maintained repeated contacts for diverse healthcare services while recording higher odds of non-fatal overdose and no statistically significant difference in fatal overdose compared to conventional support services.
The evaluated intervention was implemented across harm reduction settings to deliver integrated care and clinical referrals through three six-monthly visits for people who use drugs, a population experiencing high levels of multimorbidity and mortality. Between August 17, 2021, and August 31, 2024, a total of 150 individuals received healthcare through this low-threshold pathway.
Among the 150 participants who received care via the pathway, polydrug use was reported by 142 individuals (95 percent), who disclosed using a mean of 7 substances (standard deviation: 3) amid substantial physical and mental health morbidity. Pathway re-engagement was recorded at 98 of 142 individuals (69 percent) at the second visit and 53 of 97 individuals (55 percent) at the third visit.
To evaluate outcomes, researchers compared participants in the pathway group against a comparison group drawn from other substance use support services. The investigators conducted logistic regression analyses matched on sex and age, adjusting model estimates for opioid agonist therapy to evaluate the odds of overdose and mortality across the two cohorts.
During the study period, the pathway cohort recorded 74 non-fatal overdoses, corresponding to an incidence rate of 26.49 (95% CI: 20.80 to 33.26) per 100 person-years, alongside eight overdose fatalities at a rate of 2.86 (95% CI: 1.24 to 5.65) per 100 person-years. In the comparison cohort, researchers observed 78 non-fatal overdoses, representing 13.61 (95% CI: 10.75 to 16.98) per 100 person-years, and eight overdose fatalities, representing 1.39 (95% CI: 1.06 to 2.75) per 100 person-years. In adjusted analyses, pathway participation was associated with significantly higher odds of non-fatal overdose (adjusted odds ratio 2.50, 95% CI: 1.55 to 4.02, p = .001), whereas the association with fatal overdose was not statistically significant (adjusted odds ratio 1.82, 95% CI: 0.66 to 4.97, p = .245).
The study authors concluded that co-locating a holistic care pathway within harm reduction services can sustain ongoing contacts for unmet health needs in a population previously disengaged from healthcare. The authors noted that the lack of detectable excess mortality despite elevated non-fatal overdose probability is plausibly consistent with enhanced care monitoring, while emphasizing that observational design, participant attrition, and inconsistent assessment limit study interpretation.
Subject of Research: Evaluation of a low-threshold integrated healthcare pathway for people who use drugs
Article Title: Retrospective evaluation of a low-threshold multicomponent healthcare pathway for people who use drugs in Tayside, Scotland: an observational cohort study
Article References: Byrne, C. J., Donaldson, S. R., Radley, A., Malaguti, A., Sharkey, C., Thain, D., Stephens, B. P., & Dillon, J. F. (2026). Retrospective evaluation of a low-threshold multicomponent healthcare pathway for people who use drugs in Tayside, Scotland: an observational cohort study. Harm Reduction Journal. https://doi.org/10.1186/s12954-026-01526-7
Image Credits: AI Generated
DOI: 10.1186/s12954-026-01526-7
Keywords: harm reduction, substance use, healthcare pathways, cohort study, overdose risk, integrated care, Tayside, Scotland, Retrospective, evaluation, low-threshold, multicomponent
News Source: Glenn Wilkins. (November 6, 2026). Integrated Healthcare Pathway for People Who Use Drugs Evaluated in Scotland. Scienmag.
