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Recovery charity offers pregnancy support

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A recovery charity is delivering a free pregnancy support service for women in Greater Manchester.

Acorn Recovery Projects, a charity providing a range of recovery services across the North West, is offering confidential advice, guidance and reassurance for anyone concerned about alcohol consumption during pregnancy.

Acorn will be working with Greater Manchester Health and Social Care Partnership (GMHSCP) to support women and their families throughout Bury, Rochdale, Oldham, Tameside and Glossop. The partnership forms part of the wider Alcohol Exposed Pregnancy (AEP) programme.

The free support service is aimed at women aged 18-44 and their partners or support network. The service provides a safe, non-judgemental service for women and their families to receive mentoring, counselling and education on issues surrounding alcohol consumption and pregnancy. Support is not limited to women who are currently pregnant, but also those who are sexually active and identified as at risk of unplanned pregnancy.

Support can be accessed virtually and includes online counselling, group sessions and support from peer mentors. These services can also be delivered by phone, text and email where required. Despite misconceptions, the guidance from the UK chief medical officer advises that there is no safe level of alcohol consumption during pregnancy. Although the advice is clear, the UK currently has the fourth highest level of prenatal alcohol use in the world with 41 per cent of women drinking alcohol during pregnancy.

Recent research shows an alarming rise in alcohol consumption among drinkers since the beginning of lockdown, raising concerns around a potential increase in alcohol exposed pregnancies.

One in five (21 per cent) current and former drinkers said they were drinking more often during lockdown – Alcohol Change UK.

Issues surrounding access to contraception during the pandemic have stoked fears that the proportion of unplanned pregnancies could be set to increase. Department of Health and Social Care figures show that 2019 had already seen a 21 per cent rise in unplanned pregnancies throughout Lancashire. Across the country, Public Health England report that around 45 per cent of pregnancies and one third of births in England are unplanned or associated with feelings of ambivalence.

Louise Whitworth, Alcohol Exposed Pregnancy (AEP) Service Lead
Louise Whitworth, Alcohol Exposed Pregnancy (AEP) Service Lead

‘We’re excited to be working in partnership with Greater Manchester Health and Social Care Partnership to raise awareness of the issues surrounding alcohol exposed pregnancy. We’ll provide a range of person-centred services to support women and their families before, during and after pregnancy.’ 

Acorn’s pregnancy support service is available immediately and can be accessed through health visitors, maternity services, children’s centres and health centres. Alternatively, you can self-refer by calling 07583 052 031 or email lwhitworth@acornrecovery.org.uk

Find out more at: www.acornrecovery.org.uk/pregnancy-support

 


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

 

 

Charity warns of a surge of harmful illicit benzodiazepines

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A surge in illicit prescription drugs has been linked to a number of overdoses in the UK, warns drug, alcohol and mental health charity We Are With You.

The drugs are made to look like benzodiazepines such as Xanax and diazepam and often come as coloured tablets in blister packs or labelled pharmacy pots.

A national alert has been issued by Public Health England and Public Health Scotland, with We Are With You treatment services across the UK reporting increasing numbers of overdoses linked to these illicit substances.

Kevin Flemen
Improving our understanding of benzodiazepines would save many lives, says Kevin Flemen in his recent DDN article which you can read here.

Testing of some seized tablets has shown they don’t contain any of the drugs they purport to be at all, instead containing more dangerous substances that are not used medicinally.

Dr Rachel Britton, Director of Pharmacy at We Are With You, said:

‘You can’t get Xanax prescribed on the NHS so if someone offers it to you it’s extremely likely to be illicitly produced. Testing has shown that these fake pills can often contain different substances in differing strengths, meaning the chances of overdose are far higher.

‘Due to the dangers, we are urging people to avoid taking these drugs. Unlike opiates, there is no readily available overdose reversal drug for these fake tablets within communities. The drug used to reverse benzodiazepines is carried by ambulance crews and in hospitals so it’s vital that anyone feeling unwell after taking these tablets seeks medical help.

‘However, if you do decide to use these drugs, take a very small amount to start with to gauge the effect. Also avoid mixing with other substances including alcohol as this increases the chance of overdose. Finally, never use these drugs alone and if anyone shows signs of overdose call emergency services immediately.’

Signs of overdose include:

  • Problems with breathing
  • Confusion, disorientation and feeling dizzy
  • Uncontrolled eye movements
  • Muscle weakness or tremor
  • Lack of coordination
  • Slurred speech and extreme drowsiness
  • Slowed heart rate

Britton went on to urge people concerned about their drug or alcohol use to access support:

‘If you are concerned about your own drug or alcohol use, or that of someone you know, it’s really important to know support is out there. Our services are free, warm, non-judgemental spaces where we work alongside people to help them make changes. You don’t need to worry about placing extra stain on the NHS. Alternatively, you can talk anonymously to a trained advisor via our website – www.wearewithyou.org.uk.’


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by We Are With You, wearewithyou.org.uk 

 

Northern Ireland to consult on minimum pricing

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Northern Ireland is to launch a ‘full consultation’ on minimum unit pricing (MUP) for alcohol, its health minister Robin Swann has announced. The decision follows a review of its alcohol and drug strategy carried out last year.

Robin Swann: Impact of alcohol misuse is being felt by too many families and communities

Northern Ireland’s new substance use strategy, Making life better – preventing harm and empowering recovery will be issued for consultation in the autumn, with the MUP consultation to follow within a year of its publication. Although the proportion of adults in Northern Ireland drinking above the recommended guidelines fell from 26 per cent to 20 per cent between 2010-11 and 2017-18, alcohol-related deaths have continued to rise while hospital admissions increased from just over 9,500 in 2008-09 to more than 11,500 in 2016-17. MUP has already been introduced in Scotland and Wales.

‘The impact of alcohol misuse is being felt by too many families and communities across Northern Ireland on a daily basis,’ said health minister Robin Swann. ‘We need to consider fully every option available to us to reduce this blight on our society. I have been closely following the Scottish Government introduction of minimum unit pricing on alcohol since 2018 and have been noting with interest the early positive evaluation reports. My department has been working in conjunction with key stakeholders on developing a new substance use strategy and this will be issued for public consultation later this year. As part of the strategy, there will be a commitment to holding a full public consultation on the introduction of minimum unit pricing for alcohol in Northern Ireland within one year.’

Prof Sir Ian Gilmore: MUP will hugely benefit communities

The announcement was a ‘positive step forward’, said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore. ‘If the measure is introduced in the north, then MUP will hugely benefit communities across the whole island of Ireland. Alcohol harm costs Northern Ireland £900m a year. By implementing MUP to raise the price of the very cheapest and strongest drinks on the market, the devastating impact of alcohol harm on families and communities across Northern Ireland can be reduced.

MUP already exists in both Scotland and Wales and legislation has passed for its introduction in the Republic of Ireland. England now risks being left behind in the race to tackle the alcohol harm crisis.’

Big strides made in elimination of hepatitis C, but still a long way to go says Lanarkshire charity

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In the past five years the number of people thought to have hepatitis C in the UK has reduced dramatically.But, on World Hepatitis Day, drug, alcohol and mental health charity We Are With You in Lanarkshire says more needs to be done to meet the UK’s target of eliminating the virus by 2025.

Hepatitis C is a blood borne virus that can infect the liver, with 92% of infections through injecting drugs. Hep C is often symptomless until it reaches the chronic stage – and if left untreated, it can be fatal. 

The number of people thought to have hepatitis C in the UK has reduced from more than 182,000 in 2015 to around 143,000 in 2019. However there is still a way to go for the UK to meet its target set by the World Health Organization of eliminating the virus by 2025. 

In Lanarkshire, drug and alcohol workers at We Are With You are working hard to get more people tested and into treatment and support. 

Helen Hampton, who is We Are With You’s lead clinical nurse for blood borne viruses, explained: “An important part of our charity’s work is taking outreach, diagnosis and treatment for hep C into the community and away from hospitals. By continuing to do this, we can reach, test and treat more people and ultimately help WHO achieve global elimination.”

Jackie (not her real name) accessed treatment for hepatitis C. She said:

“My ex-partner died from hepatitis C. I watched him die what was quite a painful death and it got me really worried about my own health, so I approached We Are With You to get tested. 

“I thought it would be painful but it was just a pinprick; I barely felt anything. The staff were really supportive throughout. All I had to do was take a tablet every day for three months. That was it. When I came off the treatment I was concerned the virus may return but I’m now cured and feel better than ever. 

“I would urge anyone who thinks there’s a chance they may have it to get in touch with their local drug and alcohol service. It’s just one step and it will save your life.” 

Marc Simpson, who works at the We Are With You service in South Lanarkshire, said: “We launched our Positive Support service in 2011 to help people across Lanarkshire get hepatitis diagnosis, support and treatment. As 92% of hepatitis C infections are caused by injecting drugs, we have the specialist knowledge to be able to support the majority of people who have the condition.

“We work closely with NHS harm reduction teams, who put people in the community in touch with us. We take over their care at this point – which could be anything from testing them for hepatitis, free of charge, to taking them to hospital appointments and giving them emotional and practical support. We work with more than 100 people a year in Lanarkshire and it’s amazing to see them progress through treatment and go on to live full and healthy lives.

“Medicine has come so far in recent years that it’s possible to treat and cure hep C with easy-to-take tablets in 8 to 16 weeks. Everyone’s situation is different, so we work closely with hospital staff and consultants to take people on the treatment paths that are right for them.

“Anyone who’s concerned they might have hep C should give We Are With You in Lanarkshire a ring on 0800 599 9774, or you can speak to a trained advisor online via our webchat service. Just visit www.wearewithyou.org.uk.”


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

 

 

Humankind Charity supports World Hepatitis Day with new national Action Plan

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The Humankind charity has launched a new national Hepatitis C Action Plan to mark World Hepatitis Day on 28 July.

Stacey Smith, Nursing Director at Humankind
Stacey Smith, Nursing Director at Humankind.

The action plan aims to further increase testing for Hepatitis C across all Humankind services, ensuring specialist pathways and onsite treatment for the virus. 

‘Hepatitis C is most commonly spread through blood-to-blood contact, such as sharing needles,’ said Stacey Smith, Nursing Director at Humankind, which has drug and alcohol recovery services across the country.

‘The government have recently identified that people are not getting access to needle and syringe services as they should in this country. At Humankind, we are picking up that challenge. We really need to further embed hepatitis testing and treatment within our services so that there is no closed doors.’

She said testing was vital as there can be no noticeable symptoms in the first stages of infection, although it can cause major health problems.

Among a list of pledges set out in the plan, the organisation states it will:

  • Invest in staff to increase testing rates and re-testing rates of people at risk
  • invest in training for staff to ensure we have a skilled workforce
  • allow time for data inputting
  • ensure testing provision is across the whole treatment system
  • reach out to people who are not registered with its services 
  • commit to listening to what people who use its services say on how best to tackle the issue. 

Meanwhile, Humankind is joining a national campaign to raise awareness of Hepatitis C and the fact it can now be cured by a simple course of tablets. 

On World Hepatitis Day, the organisation, along with a range of other charities, NHS Trusts and the Hep C Trust are backing the Hep C U Later campaign online and within its services.

‘Our message is that this virus can be treated and can actually be cured easily!,’ said Stacey Smith. ‘It’s not like the old treatment which lasted for months and sometimes had side effects. The success rate for this short course of tablets is much higher and it’s unlikely you’ll feel ill.’


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Humankind, and first appeared on 

www.humankindcharity.org.uk

 

Tayside achieves world first in effectively eliminating hep C

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NHS Tayside in Scotland has become the first region in the world to effectively eliminate hepatitis C, with 90 per cent of patients diagnosed and 80 per cent of infected cases treated by the end of last year.

Prof John Dillon: The idea of treatment as prevention – the project began in a single needle exchange.

NHS Tayside has diagnosed almost 2,000 people since testing began, and treated more than 1,800 – more than 90 per cent of the estimated prevalence of hep C, meeting the World Health Organization’s elimination target 11 years early. The NHS Tayside project, which was developed in partnership with the University of Dundee, began in a single needle exchange and eventually led to a redesign of services with a focus on testing people who use drugs before they enter treatment.

‘Previous thinking had been that a community of people who inject drugs and their lives are too chaotic to allow for the sort of sustained treatment that hepatitis C needs to achieve a cure,’ said consultant hepatologist Professor John Dillon. ‘However, our view was that with the right approach, supported with appropriate resources, we could tackle what is a very significant problem and reduce the rates of hepatitis C infection. If you can offer treatment at a very early stage, while people who are infected are still actively injecting –when they have contact with other people who inject and share equipment with other people – their chances of transmission disappear because they’re not infected any more. It’s the idea of treatment as prevention.’

Rachel Halford: ‘No one is untreatable.’

‘Getting such a high proportion of people treated is a huge achievement by NHS Tayside,’ said Hepatitis C Trust chief executive Rachel Halford. ‘People who inject drugs often struggle to access treatment due to barriers like stigma around the virus and drug use. NHS Tayside has shown that it doesn’t have to be this way and that everyone can be treated for this virus. No one is ‘untreatable’. If services adapt to patients, everyone can clear the virus and we can make sure we leave no one behind.’

A new digital media campaign has also been launched by Hepatitis Scotland to mark World Hepatitis Day. #BeHepCFree aims to re-engage people who have yet to access specialist treatment and encourage people who may have been at risk to come forward, and highlights the availability of effective tablet-only medicines with minimal side effects.

More information at www.behepcfree.org 

Government to consult on calorie labelling for alcohol

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The government will launch a consultation on plans to provide calorie labelling for alcohol, it has announced. The consultation, which will be launched before the end of the year, forms part of the government’s new obesity strategy designed to ‘beat coronavirus and protect the NHS’.

A cocktail can be the calorific equivalent of a cheeseburger

Other measures in the strategy include a ban on TV adverts for unhealthy foods before 9pm and a requirement to display calories on menus, which could also include ‘hidden liquid calories’ for alcohol drinks. The strategy has been launched alongside a new Better health campaign from Public Health England which is calling on people to ‘embrace a healthier lifestyle’.

Around 80 per cent of people are unaware of the calorie content of alcoholic drinks, the government says, with alcohol consumption estimated to account for almost 10 per cent of calorie intake for those who drink. Around 3.4m people are consuming an additional day’s worth of calories per week, it adds.  

Prof Sir Ian Gilmore: ‘Alcohol is a factor in more than 200 health conditions.’

‘The government’s plans to consult on ending the current exemption for alcohol products from calorie labelling requirements are very welcome,’ said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore. ‘When the calorie equivalent of a large glass of white wine is the same as a slice of pizza or a cocktail is the equivalent of a cheeseburger, it is clear why alcohol products should be included in the government’s plans to tackle the obesity crisis.

‘Alcohol is a factor in more than 200 health conditions and is the leading risk factor of death among 15-49 year olds in England,’ he added. ‘Labelling on all alcohol products with prominent health warnings, low risk drinking guidelines and information on ingredients, nutrition and calories would help equip the public with the knowledge they need to make healthier decisions about what and how much they drink. If we want to build a healthier, more resilient society we need to wake up to the harm alcohol does to people’s health.’

A million have quit smoking since lockdown

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More than a million people in the UK have stopped smoking since the start of the COVID-19 pandemic, according to research by ASH and UCL.

Another 400,000 have attempted to stop during the same period, the organisations say. The figures are based on a survey of more than 10,000 people. 

Quitting rates are around twice as high among younger people, with 17 per cent of 16 to 29-year-olds giving up (around 400,000 people) compared to 7 per cent of over-50s (240,000 people). Around 400,000 30 to 49-year-olds have also stopped, translating to 13 per cent of smokers and ex-smokers in this age group. 

A new stop-smoking campaign funded by the Department of Health and Social Care (DHSC) is also being launched, with a particular focus on older people as they are at risk of worse outcomes from COVID-19 through smoking-related conditions such as COPD. It will also the target local authority areas with the highest rates of smoking.

‘Over a million smokers may have succeeded in stopping smoking since COVID-19 hit Britain, but millions more have carried on smoking,’ said ASH chief executive Deborah Arnott. ‘This campaign is designed to encourage those who’ve not yet succeeded to wake up and decide today is the day to stop smoking.’ 

 

Doorstep Challenge

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Strong partnerships could overturn nimbyism and make supervised injecting facilities a reality, DDN reports.

Read the full article in DDN Magazine

Professor Alex Stevens, University of Kent
Professor Alex Stevens, University of Kent

A supervised injecting facility (SIF, also referred to as a drug consumption room or DCR) is not the only answer to reducing drug-related deaths, but could fit into ‘a multi-component strategy’ to reduce vulnerability, overdose risk and fatal outcomes from overdose. Introducing an online session, Professor Alex Stevens of the University of Kent wanted to discuss the evidence, the obstacles and a way forward for making SIFs a reality.

‘Not only do they save lives, they help people to improve their injecting technique, access treatment and harm reduction services, and address other vulnerabilities in their lives,’ he said.

Niamh Eastwood, executive director of Release
Niamh Eastwood, executive director of Release

looked at whether a SIF could be legal. With the government ignoring the ACMD’s recommendations and continuing to oppose such a facility, three offences relevant to a DCR/SIF stood out in particular – possession, encouraging or assisting a person to commit an offence, and contravening the Anti-Social Behaviour Act.

With legislation unlikely to change anytime soon, she suggested that a way forward would be through multi-agency agreements between the police, local authorities, PHE, health providers and prosecution services. ‘Letters of comfort’ could be provided by police to allow local services to provide harm reduction equipment such as citric acid and foil. ‘The impetus comes from local activity,’ she said.

DCI Jason Kew gave thoughts on working with the police to open a SIF. His strong view was that it was a health matter – ‘a medical facility, a harm reduction facility’ – and it wasn’t the police’s place to lead on this work. The data on drug misuse deaths showed ‘a clear picture of where we need to act sooner,’ he said. With 78 legalised DCRs operating in Europe without a single drug-related death, we needed to ‘humanise the statistics’. ‘Is there really the public interest in prosecuting a healthcare professional trying to safe somebody’s life? Absolutely not,’ he added.

DCR Canada
Health authority staff members work at SafePoint, a supervised injection site in Surrey, Canada. Credit: Xinhua/ Alamy

‘DCRs attract a great deal of emotion for or against them,’ said Rudi Fortson QC. A local memorandum of understanding was the best way forward, he suggested. ‘One has to look at the reality of the situation, which is that despite 14 years of campaigning to even pilot a DCR within the United Kingdom, we haven’t got one. Why not? It comes back to those fundamental issues of public acceptability of a DCR on their doorstep.’

Saket Priyadarshi, medical lead at Glasgow Alcohol and Drug Recovery Service, had been closely involved in making the case for a DCR in the city – a move provoked by an outbreak of HIV in people who injected drugs. A formal health needs assessment by public health colleagues had resulted in recommendations for a heroin-assisted treatment service (HAT) and a SIF. Glasgow’s health and social care partnership – which included police and people with lived experience of using drugs in public places – had accepted the recommendations and asked for a business plan for a SIF in the city.

The model they proposed was co-located with HAT and a very low threshold service ‘to capture as many of our target population as possible’, including pregnant drug users. The large fixed-site model ‘would manage the clinical governance concerns being expressed’ and it included an aftercare area.

The project is currently snagged by ‘a constitutional stand-off between Edinburgh and Westminster’ but they have made plans around public engagement to manage local concerns and ‘have an evaluation and research agenda in place’. A HAT service has already been implemented in the interim, and they anticipate that the SIF will be a ‘scaled-up version’.

DCR in Canada
Health authority staff members work at SafePoint, a supervised injection site in Surrey, Canada. Credit: Xinhua/ Alamy

The West Midlands had also been developing a model, as Megan Jones, head of policy for the Office of the West Midlands Police and Crime Commissioner, explained. The office had begun by looking at the scale of the drug problem in the region, with the cost of heroin and crack cocaine users calculated as £1.4bn and the cost of crime committed by the average heroin or crack user as £26,000.

A drug policy summit had involved the public in looking at a new approach, with the drivers of reducing harm, reducing crime, and reducing cost. The eight recommendations had included DCRs, and an independent report – Out of Harm’s Way, written by Ernie Hendricks in March 2020 – covered evidence from the UK and across the world. Its two main recommendations were to develop a business case through a multi-agency steering group, and to work with government and the steering group to support a DCR pilot site in the West Midlands.

We had to be led by the evidence, take the public with us and have an ‘open mature conversation about drug policy and its failings,’ she said. It needed to be done with existing treatment providers and people with lived experience, be linked to the homelessness agenda, and be done through a partnership approach.

Martin Blakebrough had been asked to talk about developing a model for Wales, and as CEO of Kaleidoscope he had experience of an early SIF model. In the ’70s and ’80s Kaleidoscope ran a club that also had a needle and syringe exchange in it, with a methadone dispensing system and doctors and nurses: ‘In many ways it was a drug consumption room, but it wasn’t actually publicised as that.’

Looking at other places, such as Cardiff, ‘we know there are unofficial consumption rooms there, in hostels,’ he said. ‘So it’s not quite right to say we don’t have consumption rooms – but we don’t have DCRs that can call themselves that, or that are recognised in law.’

Martin Blakebrough, CEO of Kaleidoscope
Martin Blakebrough, CEO of Kaleidoscope

The idea that the facility had to be an expensive option was ‘ridiculous’, he added. ‘In Wales we’re saying “it’s just a room”. The idea that we need to create ridiculously safe spaces that are sterile is also difficult – would you want to be drinking beer in a sterile environment? We have to create services that are hugely attractive to the people we want to serve. And they need to be involved in the design and development of that service.’

Peer mentors were the best people to advise someone on how to inject drugs, and the idea should be around creating a space for service users to help each other – ‘and if it’s part of a drug service or adjacent to it, I don’t really see the public outcry,’ he said. ‘Let’s make this happen by using the skills and passion of our drug using community and champions’, giving them the money to run the services, the legal cover, and the clinical assistance they needed to run the place safely.

Mat Southwell, technical consultant specialising in community mobilisation for people who use drugs, agreed on the value of peers’ central role and added that it was really important to give drug users choice around a highly medicalised model or a drop-in style community centre approach. ‘If you involve people in the design of a project they’re going to have more investment,’ he said.

Mat Southwell, technical consultant specialising in community mobilisation for people who use drugs
Mat Southwell, technical consultant specialising in community mobilisation for people who use drugs

It was important to think about their inclusion in staffing too, as part of an ‘empathic committed service’. Drug user groups had been ‘pivotal’ to delivering NSP around the country and different parts of the world and were well placed to carry on managing many DCR environments, as they did already.

‘It’s not about saying either nurses or peer educators, but saying what’s the combination we can put together to maximise the impact of a system,’ he commented.

Summing up the session, Alex Stevens said it was really important to build the evidence base, both in the UK and globally, for whether and how SIFs work. Three clear stages of development, piloting and evaluation could be taken from the Medical Research Council’s framework and ‘all this needs to be done alongside service user involvement from the very early stages’.

DCI Jason Kew
DCI Jason Kew

We were not starting from scratch, but had research to build on, including a ‘logic model’ of how these services work from Australia and Canada. A look at costs and benefits could lead to a template that people could plug their local data into.

Joining in the summing up, the senior police representative Jason Kew added: ‘This is depoliticising it, about saving people’s lives, about keeping people safe – it’s as basic as that. People talk about going soft on drugs, but there’s nothing soft about preventing deaths. Nothing.’

 

DDN July/August 2020

‘Service users are central to everything’

Conversations at the moment often come back to feelings of anxiety and isolation, so we’re pleased to be able to keep sharing the ways you’re responding positively to the COVID situation. Forward Trust are among those looking for creative ways to engage their service user community (p10), while Open Road and Humankind are also redoubling their efforts to connect with service users and make sure no one is isolated (p16 and p22).

DDN Magazine July 2020With lockdown likely to have a disproportionate effect on women (June issue, p9), we have an insight into domestic abuse support (p12), while Kevin Flemen looks out for young people in the summer party season with some targeted harm reduction advice (p9).

As Bill Nelles (p14) would be the first to remind us, harm reduction must stay top of the agenda so we’re pleased to see the cross-sector mobilisation to make injecting facilities a reality (p18) and to support the call for redoubled efforts on eliminating hepatitis C (p11) as World Hepatitis Day approaches on 28 July.

As one of our letter-writers points out (p20) service user involvement should be central to everything we do, so we hope you get involved with the two initiatives from the research team (p6) and PHE (p8) to bring lived experience to the heart of informing treatment.

Claire Brown Editor of DDN magazine
Claire Brown, editor

Keep in touch claire@cjwellings.com and @DDNmagazine

Read the issue as an online magazine or download the PDF

A Sure Start

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Ed Day, jo Neale, Alice Bowen, Paul lennonOne of the key tasks of the national recovery champion role is to bring people together within the addictions field to tackle a common goal – overcoming the pain and misery that addiction can bring. People with lived experience of addiction have a crucial part to play in recovery-oriented systems of care, and it is important that their voice is heard when policy is being developed. This is particularly so as the country adjusts to the changes imposed by the COVID-19 pandemic, and as the next phase of Dame Carol Black’s review of drug treatment services begins (news, page 5).

The SURE Recovery app offers a new mechanism for supplying anonymised feedback on important topics relevant to the development of good quality treatment services. Each month users of the app will be invited to respond to a key question that will be developed by the recovery champion working with the app development team, which includes researchers from King’s College London and people with lived experience of addiction. Researchers from the app team will analyse the data from those who consent and share the anonymised findings with key policy makers, including Public Health England and NHS England. The sharing of anonymised data is completely optional, and people can use the app without answering any research questions.

Images from UK recovery app
Read the full feature in DDN magazine

SURE Recovery is available to download for free from Google Play and the App Store. The work to produce SURE Recovery was undertaken in collaboration with people using alcohol or other drugs, in treatment and in recovery. It was also supported by an addiction service user research group linked to a London-based peer mentoring service called the Aurora Project.

A wide range of other people were also involved in developing SURE Recovery, including addiction clinicians, Create Recovery (a small arts charity that supports people with experience of addiction issues to develop their creativity) and Mindwave Ventures (an app developer that focuses on user-centred digital design). The work was generously funded from various sources, including Action on Addiction, the Alexander Mosley Charitable Trust, the Mackie Foundation, and the NIHR Maudsley Biomedical Research Centre, King’s College London.

In developing SURE Recovery, the project team followed a co-design process to make sure that the app would meet the needs and expectations of people experiencing addiction. They conducted interviews and focus groups with people who were using substances, in treatment and in recovery, in order to better understand the process of recovery and how an app might support this. Successive versions of the app were also reviewed and tested by people with lived experience of addiction to make sure that functionality was optimised, the meaning of all text was clear, all graphics and images were appropriate, and there were no bugs or system crashes.

Sure Recovery App
Download the app from Google play and The App store

Not everyone has a smartphone or tablet computer, but there is evidence that people who use substances increasingly have good access to mobile technology. Mobile health apps, such as SURE Recovery, tend to be easy to download and cheap to use. They can therefore be an additional valuable resource for people who may not be in contact with services, and for people who may be thinking about, or working on, their recovery. We know that people do not generally use mobile health apps in a sustained way for months and years – instead they tend to be used as and when people feel they meet their current needs. This is how the development team expect that SURE Recovery will be used.

It seems likely that different features of the app will appeal to different populations at different points in time and with different effects. For example, the recovery tracker, with its personalised feedback, may ‘nudge’ people to reduce their substance use, change their behaviours, or encourage those who are not in treatment to enter treatment. The artwork feature may have a therapeutic effect, enhance self-esteem or appeal to those who find it difficult to express themselves in words. Meanwhile, the naloxone feature may increase engagement with take-home naloxone and improve overdose management competency, so potentially saving lives.

We encourage anyone with lived experience of addiction and an interest in recovery to download the app and give it a try. If you like it, we ask that you tell other people so they know about it too. If you think it can be improved, please let the research team know. People with experience of addiction have a right to good mobile health apps just like any other population, and the aim is to ensure that the SURE Recovery app is a resource that can help as many people as possible.

If you have an Android device, the SURE Recovery app can be downloaded from Google Play. If you have an iOS device, the SURE Recovery app can be downloaded from the App Store. People can also follow and communicate with the SURE team via Facebook, Twitter (@SURE-Recovery), Instagram (sure-recovery) and YouTube.

SURE aims and features

SURE Recovery is intended for people who are using drugs or alcohol, in recovery, or thinking about recovery. It has five main aims and six key features. The five aims are:

1. To enable people to track and monitor their own recovery journeys

2. To enable people to recognise when they might need help

3. To enable people to identify sources of support

4. To enable people to find inspiration from others in recovery

5. To generate new data that will help researchers and policy makers better understand substance use and recovery

The six key features are:

1. A recovery tracker: this allows people to monitor their own recovery using a co-designed validated outcome measure called the Substance Use Recovery Evaluator (or SURE). Once SURE is completed within the app, personalised feedback and a score are generated. Weekly, monthly and yearly scores can then be viewed in a graph, allowing app users to view and track how their scores change over time.

2. A sleep tracker: this works in a similar way to the recovery tracker. App users can complete a co-designed validated scale of sleep problems called the Substance Use Sleep Scale (or SUSS). This will then produce personalised feedback and a score that also allows app users to monitor and review their sleep problems over time.

3. A diary function: this provides a private space where people can record their thoughts and feelings.

4. Artwork: the app provides a platform for people to share their artwork with the recovery community. App users can submit their artwork for possible display in the banner on the home screen of the app.

5. A naloxone resource: this feature provides instruction on the use of naloxone in the event of overdose. There are also informational resources, including a training video and a knowledge tracker which uses the Opioid Overdose Attitudes Scale (OOAS), a validated measure of overdose management competency.

6. Reading material: app users have free access to the book The Everyday Lives of Recovering Heroin Users, based on the lived experiences of people in recovery.

• Ed Day is national drug recovery champion and clinical reader in addiction psychiatry at University of Birmingham.

• Jo Neale is professor in addictions qualitative research at King’s College.

• Alice Bowen is research assistant at King’s College.

• Paul Lennon is director of the Aurora Project

Long Hot Summer

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Summer weather and lack of other entertainment mean that young people are once again turning to outdoor partying on a large scale. Drug services are going to have to get creative about harm reduction, says Kevin Flemen.DJ at an outdoor rave

In many post-apocalyptic films there’s an unbearably naff sequence where everyone has a party. It’s like The Matrix Reloaded ‘Zion dance party’ and usually involves everyone getting into tribal drumming and showing off their tattoos. It turns out that all these scriptwriters were, in fact, absolutely on the money. While the COVID-19 pandemic is nowhere near over and social distancing is still in theory the order of the day, we’re at the Zion dance party stage of proceedings.

A few weeks ago I ran a ‘young people and drugs’ webinar and one of the things I flagged up was the likelihood as we exited lockdown of unlicensed events becoming a bigger issue. One participant highlighted that it was already happening in Bristol – that was a month ago. Since then the prediction has come to pass and there has been a massive upsurge in house parties, block parties, illegal raves and spontaneous open-air events. Some of these have made the national news, but the media attention has so far mostly been on litter and conflict with the police – the issue of drugs and safety has not yet been discussed so widely.

The upsurge in unlicensed music events should come as no surprise. Pubs are only now reopening on a restricted basis, nightclubs won’t be reopening for the foreseeable future and organised festivals have been cancelled. A cohort of people who have been furloughed, have lost work or are entering the summer unclear if they are going on to higher education are bored and craving social interaction and entertainment. And the weather’s hot. Partying outside is very clearly going to be the order of the day.

outdoor raveThe drug harm reduction input at some organised events pre-lockdown has been very successful in making festivals and clubs much safer. Onsite drug testing, festival welfare, trained staff and harm reduction interventions were helping to raise awareness of, and reduce the risks from, high-strength pills and powders and pills containing unknown and possibly dangerous cuts, as well as providing help to those in distress. The best of these were collaborative exercises between promoters, police and welfare services.

This festival harm reduction doesn’t translocate to illegal events quite as easily, especially in the current climate. Clandestine events may be organised online with the final location announced at the last minute. Organisers are understandably wary of engaging with any statutory bodies – wariness that is likely to extend to drug services. Even where workers or volunteers could gain access, their own safety needs to be ensured in terms of COVID-19, personal safety and not getting caught up in any enforcement action. There had been concern that scarcity of precursor chemicals could mean a shortage of MDMA and the re-emergence of more dangerous compounds such as PMMA. Conversely there have also been reports of extremely high-potency pills, with peak doses in excess of 350mg being reported.

Kevin Flemen runs the drugs education and training initiative KFx www.kfx.org.uk
Kevin Flemen runs the drugs education and training initiative www.kfx.org.uk

Without any doubt, as we exit lockdown, the explosion in unlicensed events will be the issue to contend with and drug services need to engage with this fast, creatively and at a grassroots level, if they are to provide much-needed input.

Given that unlicensed events are going to be one of the issues over the summer months, interventions are essential. And the ‘how to’ for working with unlicensed events means revisiting earlier harm reduction and being less reliant on permitted access and high-tech onsite testing.

It’s going to need to be more grassroots, including:

• production of clear accessible literature

• use of testing sites such as WEDINOS, Pill Reports and The Loop to promote awareness of contaminated pills, high-strength and other dangerous products

• safety advice about use of nitrous oxide

• engaging with promoters via social media so that they can make events safer – water onsite, access for emergency services, trained volunteers and engaging with drug services to provide outreach if possible

• peer education – as, more often than not, drug services won’t be on site it’s essential to equip those attending events with the resources and tools to manage critical incidents. Making sure attendees know how to spot signs of MDMA overdose and manage it is critical

• using What3Words to ensure that emergency services can locate people at outdoor events with pinpoint accuracy

• general harm reduction with a view to addressing COVID-19 spread including the sharing of snorting tubes, spliffs, drinks and balloons

• legal advice cards such as Release ‘Bust Cards’ so that people detained during enforcement activity know their rights and can access legal advice and personal safety advice

 

The Right Questions

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The Right Questions Survey on harm reduction
Read the full article in DDN Magazine

Now in its 30th year, the Unlinked Anonymous Monitoring Survey is a vital tool for harm reduction, says Emily Phipps.

This year the Unlinked Anonymous Monitoring Survey (UAM) of people who inject drugs celebrates its 30th anniversary in England and Wales and 18th anniversary in Northern Ireland, making it the longest running annual survey of this cohort in the world.

Coordinated by Public Health England (PHE), the survey consists of a self-completed questionnaire and biological sample that is anonymously tested for HIV, hepatitis B and hepatitis C to monitor trends in blood-borne viruses (BBVs) and behaviours that impact transmission, such as needle sharing, testing and treatment uptake. No identifiable information is collected, and the survey or test result cannot be traced back to an individual, making it easier for us to ask questions about risky behaviours that might otherwise go unanswered.

The UAM is a powerful tool for advocacy and service planning, both nationally and locally. Each centre undertaking more than thirty surveys each year is provided with a free, detailed report of their responses to help them understand what the key priorities for their clients are. Nationally, the report feeds in to key annual publications such as Shooting up and Hepatitis C in the UK. The survey data is also shared internationally with the World Health Organization and European Centre for Disease Control to support global BBV elimination initiatives.

In current times, championing the needs of people who inject drugs and ensuring continued access to services is incredibly important. There are valid concerns that reduced uptake of BBV testing and difficulties in delivering the same level of needle and syringe provision during the pandemic will lead to an increase in infections among this group. The UAM, now more than ever, is an essential tool for understanding the impact of COVID-19 on people who inject drugs, and to keep track of progress as services recover.

Dr Emily Phipps consultant epidemiologist at the National Infection Service, PHE.
Dr Emily Phipps consultant epidemiologist at the National Infection Service, PHE.

The UAM team would like to say a huge thank you to all of our volunteers and participants who have been undertaking the survey during the last few difficult months – the data you have collected is absolutely vital. If you would like to join the UAM survey, or have taken part previously and would like to restart, the UAM team would love to hear from you. Every survey completed is a hugely valuable source of information on this population group who are otherwise often under-represented in policy and statistics. For further information, please contact Claire Edmundson, at claire.edmundson@phe.gov.uk.

Louise Hansford, regional hepatitis C elimination co-ordinator for the South of England
Louise Hansford, regional hepatitis C elimination co-ordinator for the South of England

Dr Emily Phipps is consultant epidemiologist at the National Infection Service, PHE. She prepared this work with Megan Bardsley, HIV/STI surveillance and prevention scientist, and Claire Edmundson, senior scientist, at PHE

‘We have had a phenomenal number of responses to the Unlinked Anonymous MonitoringSurvey, which provides us with a wealth of information about our clients – the addition of a finger-prick test for the anonymous blood sample part gives us another opportunity to offer diagnostic testing. Through this testing done alongside the survey, we have picked up 47 cases of hepatitis C that we may not have done otherwise.’ Louise Hansford, regional Hepatitis C elimination coordinator.

 

Aiming High

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Even in the most difficult circumstances recovery is always possible, says Jody Leach.

silhouettes on a mountain
Read the full article in DDN magazine

We are a local charity supporting those struggling with addiction across Essex and Kent. Together with our main substance misuse provisions, some of the other projects we also deliver to support vulnerable populations include our work within a specialised women’s refuge, the Essex Appropriate Adult service, our targeted housing support service and our ‘SOS Bus’ services.

Mirroring previous articles on the ‘new normal’ of delivering substance misuse provision at this time, the pandemic and its restrictions have had an unprecedented impact on all our services and how we have been able to evolve to continue supporting those most vulnerable. While it’s hard not to, rather than detail all the amazing work our teams, wider treatment system partners and the local community have undertaken to help continue supporting our service users, I feel it’s important to share the voice of some of those service users and examples of positive recovery at this uncertain time.

Coping with change

For the majority of those we support, change is not popular and can be anxiety provoking at the best of times. We have worked tirelessly to help manage the imposed uncertainty that the pandemic has created, by continuing to offer the structure and support that is normally provided as standard. We have been impressed with how our service users have accepted and adapted to the required changes – not only have they worked with us to support our teams, many have told us that elements of our new ways of working are actually preferred to practices we had been doing for some time. COVID-19’s impact is tragic, but we are indebted to our service users for their investment in what we do to share these valuable insights. The following examples highlight how the measures we have taken over the last three months have been experienced positively by those using our services.

silhouettes on a mountain illustrating recoveryIn response to many refuges excluding those with substance misuse needs, we deliver a specialist service within a refuge to ensure these vulnerable women are supported into potential recovery. One of our service users told us that while being addicted at any time in life was difficult, ‘adding COVID-19 to the situation poses a whole new dimension to overcome. Having resided at a women’s refuge since January, I have had first-hand knowledge of the detrimental effect COVID-19 has had on others. Lockdown has taught me that I can be patient and content with my own company and it has pushed me to try and learn new things.

‘I am very lucky to be working with Open Road and my worker has been nothing short of brilliant,’ she continued. ‘She has thought of me at every turn and introduced me to meetings all over the county, including many new opportunities. She is fully aware I am not a huge fan of attending meetings, so having Zoom meetings has actually aided my recovery journey and allowed me to meet others all over the county in similar situations as myself. The amount of pressure Open Road have endured in the current pandemic must have been monumental, and without any previous experience to draw on, they have been fantastic.’

Appropriate services

Our Appropriate Adult (AA) service supports many held in custody with additional substance misuse needs. We are proud to have continued delivering this crucial support throughout the lockdown – despite its challenges – thanks to the passion and commitment of our teams. Essex Police’s custody commander said of the service, ‘Of a special note is the fact that Open Road have continued to provide support to detainees – something that is almost unique in my experience in the AA world at this present time.’

Given the impact of the lockdown on the night-time economy, our usual SOS Bus services have not been needed. Instead, in collaboration with the local council, our staff used the service’s minibuses to transport local homeless residents to temporary accommodation.

Pandemic complications

Our housing support service has been extremely busy supporting service users that are being negatively impacted further by the pandemic. One was referred into the service following the death of his brother whose funeral he was unable to finance. Our worker liaised with the relevant housing association and welfare rights advisor to enable the tenancy to be transferred, and an intensive package of support was made available. Had this work not been undertaken, our service user would have remained isolated and alone during a heartbreaking situation that was made all the more difficult by social movement restrictions. The implications for his ongoing recovery are obvious, but we are happy to report that he is continuing to do well with his reduction in substitute prescribing and abstinence from illicit drug use.

One of our young service users has particularly struggled during lockdown and found it hard to get into the new routine of not seeing friends at school and being at home constantly. He is classified as high risk as he self-harms regularly and feels he can’t disclose his self-harm experiences to other professionals. He now looks forward to the increased telephone and video calls from his worker that are helping him to manage his self-harming and drug-using behaviours.

This example highlights the recovery-focused passion that our workers continue to share despite the circumstances, and how we are always trying to put the needs of our service users first. One of our workers spent time speaking with a treatment-naïve individual that just happened to be waiting in the street for a friend that was attending an appointment with our service. This person was street-homeless and had been using heroin and crack since the age of 14. Despite the strict guidelines in place to avoid transmission, the worker was able to safely organise an initial assessment, as she felt that if the person was offered a time to return the opportunity may be missed for them to follow through on their apparent desire to access treatment.

He was extremely grateful for this quick thinking and left the service with his first-ever prescription for substitute medication, and was also issued with – and accepted – naloxone. He was supported to register with a GP and referred into OCAN [Offenders with Complex & Additional Needs] provision and the DWP to access benefit assistance.

It will get better

Jody Leach is quality and treatment manager at Open Road
Jody Leach is quality and treatment manager at Open Road

One of our recovery support service users perfectly sums up how they have experienced our response during the lockdown: ‘I miss everyone at Open Road and can see how important the service is even more now through the COVID-19 pandemic. I have always isolated myself and shut myself away, feeling like a burden or a pathetic weak person who cannot even sort themselves out. Open Road helps me to feel like I am able and can try again and not give up.’

To our fellow service providers and service users who may be reading this, things will get better. Until this new normal allows us to fully resume helping even more people struggling with addiction, we will keep trying to showcase to others that recovery continues to be a possibility for anyone that seeks support at this most unusual time.

 

Doubling Down

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With World Hepatitis Day on 28 July, now is the time to redouble our efforts towards hepatitis C elimination, says Rachel Halford.

Rachel Halford, chief executive officer at the Hepatitis C Trust
Rachel Halford is chief executive officer at the Hepatitis C Trust

World Hepatitis Day this year will be unlike any other we have celebrated before. Hepatitis C continues to have a huge impact on people who inject drugs, with the latest statistics showing the rate of new infections among injecting drug users remains worryingly high. The surge of activity we have seen since last summer when NHS England signed an elimination deal with the pharmaceutical industry – not only to provide medication but also to commission case-finding initiatives – has largely come to a halt as a different virus has taken centre stage.

As with almost all other areas of healthcare, the impact of COVID-19 on services providing hepatitis C treatment has been sudden and dramatic: nurses and doctors were re-deployed overnight, clinics were cancelled, most testing ceased and new treatment starts were generally delayed. HCV Action, a network for professionals working in hepatitis C coordinated by The Hepatitis C Trust, found that around one quarter of the 22 hepatitis C treatment networks (operational delivery networks) were only able to treat patients already on their registers or no cases at all at the end of May, even as clinics began to recover.

Understandably, as many doctors and nurses have had their time diverted from clinics to wards in order to provide much needed additional capacity, some areas were under greater strain than others. Despite these difficulties, a number of services have demonstrated phenomenal creativity and determination to continue to help people. Many of The Hepatitis C Trust’s peer-to-peer support staff and volunteers have been going into temporary accommodation across the country to test people who had been living on the streets. This brilliant partnership working between NHS trusts, other charities, alcohol and drug services, and the hotels and hostels themselves has allowed many hundreds of people who had been rough sleeping to be tested and referred on to treatment – engaging a population for whom the traditional treatment model is often not accessible.

COVID-19 has laid bare the extent of health inequality in this country. In England, people living in the most deprived areas are around twice as likely to die from COVID-19 compared to those in the least deprived. Hepatitis C likewise impacts disproportionately upon the most vulnerable in our society – almost half of the people with hepatitis C who go to hospital come from the poorest fifth of the population.

As health services begin to recover from the strain of increased admittances to intensive care, it is essential we re-focus efforts to address those disease areas which predominantly affect disadvantaged and marginalised populations, of which hepatitis C is one. With easy-to-take drugs that have a short treatment term and high cure rate there is no excuse for the UK not to meet its commitment to eliminate hepatitis C by 2030 – the World Health Organization’s hepatitis elimination goal, which we joined many other countries in signing up to. Progress has been positive on diagnosis and reducing hepatitis C-related deaths, but we have a long way to go before we can viably achieve and sustain elimination.

Even with the persistence of laudable efforts to target those people most at risk of infection, there has been no notable reduction in new transmissions in recent years. Prevention is absolutely vital to achieving elimination and yet currently harm reduction provision does not go far enough, with 36 per cent of people who inject drugs reporting in 2018 that they did not have adequate needle and syringe equipment for their needs, heightening the risk of hepatitis C transmission through sharing injecting equipment. We must ensure people are supported to access needle and syringe exchanges adequate for their needs and so reduce the spread of blood-borne viruses such as hepatitis C.

Hep C Trust jobs Logo
Do you want to help the Hep C Trust tackle the virus? Click here to see their latest vacancies.

The majority of hepatitis C cases in the UK remain undiagnosed, resulting in potentially tens of thousands of people experiencing health complications including liver damage and an increased risk of mortality. This World Hepatitis Day we must applaud services for their incredible hard work and dedication so far, and redouble our efforts to prevent new infections and expand testing and treatment until we have achieved elimination.

Find out more and download free resources at www.worldhepatitisday.org

 

The Heat is On – Doctor Wars (part two)

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In the second part of ‘Doctor Wars’, Bill Nelles describes the tumultuous days of the 1980s.

Read part one here.

By 1983, the cold war among doctors treating drug users was becoming a lot hotter, and there was still no public health response to drug use.

The Home Office consultants still met regularly, and included private doctors as well as NHS consultants. The NHS doctors felt the private doctors prescribed overly generously, didn’t demand reductions, left their patients ‘still addicted’, and even charged them fees. The private doctors felt the NHS doctors were too rigid and their patients poorly treated. Guidelines on the treatment of drug misuse (‘orange guidelines’) were the first national guidance issued by this group in 1984 – they pleased few. For instance, the guidelines considered that medically supervised detoxification was a ‘simple and short-term process with spontaneous remission possible’, and also stated that maintenance was not acceptable. ‘Evidence-based treatments’ didn’t really exist in addiction medicine at that time.

Ironically, the main use of the orange guidelines was as evidence in 1986 at Dr Anne Dally’s General Medical Council (GMC) hearing. She was a feisty senior private doctor on the working group and one of the signatories of the 1984 guidelines. I gave testimony supporting her at her GMC hearing, having become the drug education officer at the Terrence Higgins Trust (THT) a year earlier, but her verdict was guilty of maintenance! While she was able to still be a doctor, she was never allowed to prescribe controlled drugs again. Her practice evaporated almost overnight.

Because of its policy of avoiding methadone and arresting users for the possession of syringes alone, Scotland was one of the first parts of the UK to see the unusual and mostly lethal illnesses associated with AIDS and injecting drug use. Cheap heroin from Iran and the easy availability of Temgesic, (ironically, an early sublingual form of buprenorphine) had vastly increased the number of people injecting opioids, and police pressure had made clean needles impossible to obtain.

But two factors had yet to reveal themselves. The first was, of course, the AIDS epidemic, with the first Scottish drug user dying in Scotland in 1983. The second was the growing involvement of general practitioners in providing services to drug users and their influence on practice. Britain had not made methadone a drug needing a Home Office licence, and thanks largely to the efforts of dear Dr Tom Waller – an ACMD member who batted it back every time it was put forward – it was never adopted as policy.

These trends intersected in early 1985, when a young GP in Edinburgh published a paper in the BMJ which galvanised me, and many others, into serious action. Dr Roy Robertson, (now the Queen’s physician in Scotland and professor of addiction at Edinburgh University), had been seeing drug users for some years, and maintaining some with dihydrocodeine. He was able to obtain HIV test kits in advance of their national availability, and in late ’84 had taken blood for HIV antibody assay from around 160 patients. He knew they shared used needles, and the paper showed that 51 per cent had already been infected by HIV.

The effect of this news cannot be exaggerated. Research testing in London was showing rates of under 5 per cent positive, so we realised we had a short window to make a difference if we moved fast. By the summer of 1986, teams in London, Liverpool, Edinburgh and Amsterdam and, of course, the US were working very hard to understand what they were facing, and the UK and Holland had already implemented needle exchanges to stop sharing and prescribing to reduce injecting.

But there were still battles to be fought over clean injecting equipment. I had been seconded to the Standing Conference on Drug Addiction (SCODA) from the THT to write a booklet about AIDS for drug users, but in February ‘86 I spoke at a large National Haemophiliac Society meeting in Newcastle at which I represented SCODA and called for a serious examination of supplying clean needles.

This was picked up on Newsnight, and on Monday I found myself called to the office of the director. In fact the Friday before, after six months of abstinence from opiates, I had engaged a private doctor to look after me so that I didn’t resume injecting. He strongly objected that I had supported needle exchanges. I was also told that I ‘looked stoned’ and under no circumstances could someone work in a drugs agency even on legal methadone. That same day I returned to the THT where we concentrated on reducing the risk for drug users through advocacy with politicians, speaking engagements, and writing leaflets. By 1988, the McClelland report in Scotland and the ACMD special report chaired by Ruth Runciman gave the green light to access to clean needles, setting up 15 pilot schemes in England and Scotland. These were quickly expanded when the pilots reported favourably and both reports called for an immediate re-evaluation of methadone prescribing.

GPs had also become more independent and proactive especially if they had no specialist prescriber. West Berkshire Health Authority under Ailsa Duncan, their drugs coordinator, engaged me in 1988 to train a group of around 15 GPs to prescribe methadone. It was a five-day course with a written handbook. Apart from Ailsa, none of the doctors were aware they were being trained by a methadone patient!

I have great respect for all evidence-based treatment including non-prescribing approaches when it’s what the patient seeks. But present policies that deny people such approaches are shameful and should not be tolerated. In the last part of this series, we will look at the golden age of drug services – the first eight years of 2000. And how it all collapsed and we ended up where we are now.


 

Gavin Strang MP (Edinburgh, East),
Gavin Strang MP (Edinburgh, East), House of Commons debate 31 March 1988

‘We know that the main method of transmission [of AIDs] among drug takers is the sharing of dirty needles… It was clearly documented in a paper produced by Edinburgh professionals in February 1986. The Scottish Office commissioned a report from a committee chaired by Brian McClelland published in September 1986, which recommended decisively that the government should bite the bullet and provide clean syringes at an exchange centre, where drug injectors would be able to obtain free needles and syringes.

‘The government’s response to that call has been so inadequate as to be positively irresponsible. They sat on the McClelland report for months. Eventually, they announced 15 pilot schemes, 12 in England and three in Scotland. Of course such projects involve problems – the minister may wish to comment on them – but we must make the projects work.’

 

Safeguarding Sanctuary

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The lockdown has forced services providing domestic abuse support to become even more resourceful and innovative, says Miranda Hawtrey.

Read the full article in DDN magazine

Miranda Hawtrey, support worker at Jane’s Place
Miranda Hawtrey is a support worker at Jane’s Place.

Working in a setting supporting those with addiction issues and complex needs is always a delicate balancing act. But when the coronavirus outbreak swept through the UK in March 2020, the team at Jane’s Place in Burnley had an extra challenge on their hands.

Jane’s Place is a somewhat unique service established in 2017 by SafeNet Domestic Abuse Support Services, who provide domestic abuse support to women, men and children. They are also the lead providers for Lancashire Refuges.

Jane’s Place is the only one of its kind in the North West – not only does it help to support women who are fleeing from all forms of domestic abuse, but it also breaks down barriers often posed by traditional refuge. A lack of appropriate accommodation and support for women and families with complex needs who need to escape from domestic abuse often results in outcomes such as women returning or staying with the perpetrator, escalating risk and coping strategies such as increased substance use, a lack of trust in services and sofa surfing, which often results in rough sleeping.

Jane’s Place is named in memory of Jane Clough, who was killed by her ex-partner in 2010. Jane’s parents, John and Penny Clough (pictured), are now SafeNet patrons.
Jane’s Place is named in memory of Jane Clough, who was killed by her ex-partner in 2010. Jane’s parents, John and Penny Clough (pictured), are now SafeNet patrons.

A mammoth task

The challenge of implementing safety measures and managing the extra risk posed by lockdown in this kind of specialist environment has been a mammoth task, and the team knew they had to adapt the service fast to ensure they could keep everyone involved safe and continue to support their residents.

They started by expanding and increasing their safehouse provision to provide safe spaces for those residents who were shielding, showing symptoms and needing to self-isolate. Those with serious drug and alcohol use issues and/or sex working women who found it impossible to adhere to the government guidelines had to be kept safe regardless of whether or not they were able to comply, and the team achieved this by use of separate safehouse facilities with specialist intensive floating support.

Each individual resident had an emergency COVID plan created and tailored to meet their needs. Along with various other measures, such as extra cleaning, PPE and updating residents and checking in to make sure they knew what the guidelines were, the team quickly pivoted the service to offer as much flexibility and support as possible.

This hasn’t come without its setbacks. The team have faced difficulties accessing help from outside agencies that would usually support residents, and accessing healthcare has been made much more difficult by skeleton staff in other agencies and lack of GP appointments. The residents also voiced that they were missing group work; the need for connection during their journey plays a big part in recovery.

Getting creative

Alongside the practical solutions – with staff members collecting methadone for residents daily and assisting with non-molestation orders received via court sessions over the phone with residents – the team got creative. They introduced ways for residents to connect with professionals and loved ones virtually, created online recovery groups and set up online quizzes and games to help boost morale.

With the lockdown also came a devastating rise in domestic abuse incidents, in the UK and beyond. More than ever, this highlighted the need to find other ways to reach victims who were not safe at home. The team introduced a new online chat service via their website to enable victims to safely access advice and support during periods of isolation or when they were confined at home with a perpetrator and unable to use previous routes to safety, manned by trained support workers.

What next?

So what next for Jane’s Place? No one knows how long restrictions will be in place or what the ‘new normal’ will look like, so the team are always thinking ahead and looking at new ways to engage with residents. This includes ‘walk ‘n’ talk’ sessions, encouraging communal gardening as a soothing way to pass the time and, most importantly, continuing to listen to what residents want via their ‘finding our voice’ consultations.

Case studies: Sarah and Kerry

Fleeing trauma:
Sarah, aged 34

Sarah had begun taking prescription medication and drinking alcohol at 14 years old as a way to numb the trauma of being gang raped. Both Sarah’s parents had issues with addiction and she felt unsupported in dealing with this horrific trauma. Growing up, she said she always felt ‘unloved’. During her adult life, Sarah was repeatedly subjected to sexual abuse by various males, and her drug use escalated to using heroin and crack daily.

Sarah then was in an abusive relationship and gave birth to two children. The children were subsequently removed by social care due to domestic abuse and substance abuse by both parents. Sarah became street homeless and soon got involved with another abusive male who forced her into sex work to fund substances for them both. Using heroin and crack daily, Sarah’s mental health and physical health dramatically deteriorated and she was also regularly shoplifting to fund substances. Things became too much for Sarah and she attempted to take her own life after a serious assault by her partner. She was then referred to SafeNet and accepted at Jane’s Place Recovery Refuge.

Sarah’s life dramatically changed once admitted to Jane’s Place. Her self-esteem and confidence returned as staff supported her to address health issues and receive support with her mental health. Jane’s Place referred Sarah to Inspire Wellbeing and she was allocated a key worker to help support her with substance use.

Sarah is now abstinent from all substances and back in contact with her children who live with family. She is no longer shoplifting or sex working and wants to start volunteer work after lockdown. Staff referred Sarah for specialist sexual trauma counselling and she also is supported by attending a trauma recovery group.

Sarah has said her drug use was spiralling out of control but she has dramatically changed her life with the support of staff. Sarah says the support she has received to reconnect with her children has been very important to her recovery and motivation. ‘Without Jane’s Place I would be dead,’ she says. ‘You saved my life,’

Escaping violence:
Kerry, aged 39

Upon referral, Kerry had been in a physically violent relationship for the past seven years. She had been threatened with a knife and her children had been removed for their own safety, as a result of her addiction and domestic abuse in the family home. Kerry referred herself into SafeNet’s services after trying several refuges who would not accept her as she was using alcohol and substances daily.

Kerry was drinking heavily, using crack and heroin, was on a methadone script, and was also having physical withdrawal symptoms – such as seizures – when she didn’t have alcohol. She was also a prolific shoplifter to fund her addictions, and had spent time in prison as a result.

Kerry was still having regular phone contact with the perpetrator when she arrived, who would often try to manipulate her, use controlling and coercive behaviour, give verbal abuse and threaten self-harm if she didn’t return home. SafeNet supported Kerry to stop contact and she attended domestic abuse groups at Jane’s Place. Extensive safety planning work was done as part of her support plan and as her mental health improved, Kerry was able to focus on her recovery.

While at Jane’s Place, Kerry’s anxiety reduced and she was no longer having suicidal ideation. Kerry completed RAMP (reduction and motivation programme) as part of her recovery support plan and, with the support of Jane’s Place and Inspire Wellbeing, she reduced her methadone and alcohol intake.

Kerry’s physical health greatly improved too – she gained weight, began to take pride in her appearance and was focused on getting fitter and healthier. She also began to rebuild relationships with her family and was then accepted for detox and rehab to complete her journey.

Find out more about Jane’s Place here.

 

I am a…

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Supporting people and changing lives

People work for people – whatever your job, whatever the industry, the ultimate aim is to improve people’s lives. Nowhere is this more apparent than in the substance misuse sector and related health and social care fields.

Having the right team enables treatment services to help people change their lives for the better – and in some cases can make the difference between life and death. Healthcare workers are the vital connection between people looking for help and the services and treatment they need; their interventions can transform the lives of not just the individual in treatment, but often their families and loved ones too.

I am a...

Find out more about people's experience working in the field.

Neil Ainslie is manager of the Jericho Society, a drug project in Derby. Read Neil’s story.

Carol* is a volunteer working with a community drug service in Berkshire. Read Carol’s story here.

Different strokes for different folks

People working with those experiencing problems with drugs, alcohol and other addictions do not necessarily fit into a neat category. They are likely to be based in a diverse range of settings – the inspirational youth worker; the probation officer who took the time to make a connection; or the housing support team who were able to identify problems and offer an appropriate and accessible route to help.

Substance misuse workers can be the vital link to ensuring that a person accesses the specialist treatment that they need. As well as providing the appropriate direct help, they are part of a network of specialist treatment workers operating in community, residential and, increasingly, online settings.

View the latest vacancies on 

DDN Jobs

Please tell us about your career.

How I became a substance misuse nurse, by Ishbel Straker

I never thought I would become a substance misuse nurse – law was my initial career choice. But during my training to become a barrister I worked on a dementia ward to pay for my tuition fees. That was when I began to realise that I couldn’t envisage doing anything else.

Read Ishbel’s story here

Learning from lived experience

In line with the varied settings and roles, the staff supporting people come from a range of backgrounds including medicine, social care, psychology and counselling. People with lived experience are an important component of the workforce and, with the right training and work experience opportunities, bring knowledge and empathy to many roles.

Many people have been inspired to work in the field, either by their own personal experience or those of a family member, friend or colleague. Those undergoing treatment say that seeing someone who has been in the same position as them and turned their lives around was inspiring, as well as encouraging.

DDN magazine goes to people working in all areas of the sector and is also read by many of those who are on their own treatment journey. As a free magazine there are no barriers to reading it and contributing to it, and it is the forum for everyone who is involved in addiction treatment. 

We want to hear from you!

Your experience informs what we do, so we want to hear your story about working in the sector. Let us know how you came to work in your current job – what inspired you, what is your background, and what do you find rewarding and frustrating? Do you have any advice for anyone considering a similar career? Tell us as much or as little as you want to! Your contribution will be very welcome.

Star shape featuring job titles in substance misuse field

The latest jobs online

DDN magazine is the place for recruitment for the treatment field. We have a variety of vacancies across the country from a wide selection of treatment providers.

Please visit the jobs page to view the latest vacancy, or contact ian@cjwellings.com for details of advertising for your next star!

 

 

 

Careers, training and development

Not sure where to start?

Find out about training and the career options with our

training and development guide.

Neil Ainslie is manager of the Jericho Society, a six-month residential drug project in Derby with aftercare and resettlement.

I was a resident of Jericho house in Greenock in Scotland in 2004. I came down to volunteer in 2006 and am now the project manager. We have 11 volunteers, who are all ex-residents, and four full-time staff; between us we have achieved around 45 years abstinence. 

The moment our clients arrive they agree to be completely abstinent from all mind and mood altering chemicals. We have nine residents at any given time and we support them to go through any cold turkey with understanding, empathy, one-on-ones, group therapy, chats, hot baths, identification – or whatever they need really!

We have an insight and first hand experience into every step, from when a resident arrives to when they move out. We have truly walked a mile in their shoes and they know this from day one. We understand their mindset, which people without addiction issues usually can’t quite comprehend.

People with addiction issues generally know this and find it hard to expose their irrational, fearful, compulsive and insane thinking patterns to them, so are shocked when we openly discuss this and have a massive depth and insight which brings hope to their lives – sometimes for the first time in many years. We give them hope – ‘if they can overcome this and break the cycle of addiction, then why can’t I?’

Tell us about your day…

There’s never a dull day. My latest shift was a privilege, as always. We had staff handover as always, where we discuss every resident in depth, and then I allocated the daily tasks to the appropriate staff. One of our newer guys had a family death so I had a chat with him to make sure we can all support him as best we can. 

After that I talked to one of our longer residents about the possibility of him writing a letter to his ex-partner with the hope he may at some point reconnect with his seven-year-old son. Then a chat with another resident about him deliberately lying to us about social distancing while he was on a family visit and reminding him of the importance of honesty and trust in relationships and how this was a big part of one of his previous relapses.

See the latest vacancies at DDN Jobs.

Then on to another resident who is from the Asian community, about his fears around the expectations of his family members and how hard he felt it was going to be to bring the principles of recovery back to his home. I then needed to talk to an ex-resident about how to handle a situation (and the family trauma) relating to his cousin who had overdosed and was in a really bad way. 

After that was a meeting with my business manager about expanding our service, before a chat to one of my volunteers about how to conduct himself whilst answering the Jericho House phone, as he was a little dismissive to a potential service user’s brother.

What do you find most rewarding?

I love seeing people turn their lives around, reconnecting with their families and going on to be productive members of their communities. I really love to see them helping others the way they were helped!

What would you like to change?

I would like to see more financial help available for places like ours. We are a charity and rely on volunteers to make our great work possible. We generally run at a loss and are experiencing real financial difficulties.

What’s your advice to anyone considering a similar career?

If your heart’s in it, then go for it. If you are going to work with people with addiction issues then it should be taken deadly seriously as addiction is a killer. The rewards are beautiful – but for every good story there are two not so good. Good luck in whatever you do.

—————————————————————

Carol* is a volunteer working with a community drug service in Berkshire.

I volunteer two days a week on a training placement to become a recovery worker. I do a lot of my training on e-learning in the drug service. I assist the substance misuse nurse run her weekly alcohol support group and help service users read material, and I scribe for them when needed. I also assist the recovery workers with things like phoning service users and making appointments. During lockdown I have not been at the service, and have done refresher drug and alcohol training via Zoom.

I also have another voluntary role supporting an inmate with substance misuse issues at HMP Wormwood Scrubs.

What do you find most rewarding?

Helping the service users through their recovery is very rewarding – also, learning via work shadowing the clinical recovery workers and the consultant psychiatrist in the dual diagnosis clinic. 

What would you like to change?

I’d like to be able to offer more one-to-one appointments with service users, especially for those who dislike support groups. It would be good to be able to offer more ongoing support as well, especially when service users relapse.

What’s your advice to anyone considering a similar career?

It’s an extremely interesting, challenging and rewarding career.

*Not real name

 

 

 

A quarter of drinkers consuming more during lockdown

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More than a quarter of people who have ever drunk alcohol think they have been drinking more during lockdown, according to research commissioned by Alcohol Change UK. Almost half said they expected to continue drinking at the same rate as the lockdown eases and pubs reopen, while 17 per cent said they anticipated drinking more.  

Richard Piper: ‘We were right to worry’ about the impact of lockdown on people’s drinking.

The figures are based on a survey of more than 2,000 people, around 1,600 of whom were current or former drinkers. Just under 20 per cent of this group said they had been drinking to cope with stress or anxiety, with parents of under-18s more likely to cite this as a reason than non-parents or parents of adult children. Although one in five drinkers had been drinking more often, the number of units consumed on an average drinking day ‘does not seem to have changed significantly’, says the charity, with 13 per cent drinking more units and 12 per cent drinking fewer. Of people who typically drank seven or more units a day, however, 38 per cent said they were now drinking more.

Just under 20 per cent of drinkers said they intended to visit a pub within two weeks of lockdown easing, but 7 per cent had stopped drinking altogether during the lockdown –equating to more than 3m people – with younger people more likely to have cut out alcohol. More than one in three people had also been taking ‘active steps’ to manage their alcohol consumption, including having alcohol-free days or looking for advice online. Traffic to the ‘get help’ section of Alcohol Change UK’s website from March to June was almost 250 per cent higher than during the same period last year, the charity says.

‘From the very start of lockdown, charities and treatment services have warned of the impact on people’s drinking,’ said chief executive Richard Piper. ‘This research shows that we were right to worry. One in five of us has drunk more often than usual over the past three months, and this research suggests that those drinking more often during lockdown are less likely than others to cut back as it eases. But the good news is that one in three of us are acknowledging that drinking is a concern and taking active steps to manage our drinking during lockdown. One in three are also planning to manage our drinking actively as the pubs reopen and lockdown eases, putting in place plans like drink-free days, keeping an eye on the amount of alcohol we buy, and getting support online or from our GPs.’

Government launches second phase of Carol Black review

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The second part of Professor Dame Carol Black’s independent review into illegal drug use in England has now been launched, the government has announced. While the initial phase looked at drug supply and demand, the second will study treatment provision, recovery services and prevention.

Prof Carol Black: An opportunity to correct ‘a decade-long erosion’.

The review will look at how drug treatment interacts with housing, employment, mental health and criminal justice services, with the overarching aim of ensuring that vulnerable people get the right support to ‘recover and turn their lives around in the community and in prison’. The final document will contain policy recommendations to government, including around funding, commissioning and how local bodies are held accountable to ‘ensure they are effective’. The review’s first phase concluded that even if more money were made available for drug treatment, there would still be ‘a lot of work to do’ to build up capacity and expertise in the sector (DDN, March, page 4).

The second phase will engage with a ‘wide range of stakeholders’ including service users and people with ‘lived experience of drug addiction’ to build a detailed picture of treatment, recovery and prevention, the government states. Professor Black will be supported by government recovery champion Dr Ed Day (DDN, June 2019, page 8) and former drug policy adviser to president Obama, Dr Keith Humphreys (DDN, June 2012, page 16).

‘In my foreword to part one I said that behind the thorough analysis of the market for illicit drugs that we had just completed lay a very tragic human story – about the effect on individuals, their families, youngsters caught up in the trade, and the economy,’ said Professor Black. ‘We showed a decade-long erosion, under previous governments, in almost every aspect of drug addiction, prevention, treatment and recovery. We now have the opportunity to correct this and build a better world. To do this many stakeholders and government departments must work together as never before.’

‘The findings of Dame Carol’s first review set out the scale of the challenge,’ added health minister Jo Churchill. ‘Now our focus must shift to ensuring the appropriate services are in place to support the treatment and recovery of drug users, as well as preventing drug use in our communities in the first place.’

More than 120 children slain in Duterte’s ‘war on drugs’

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OCT report on child killings in the PhilippinesMore than 120 killings of children and young people were carried out in the Philippines between July 2016 and December 2019, according to a report by the Geneva-based World Organisation Against Torture (OMCT) and the Philippine Children’s Legal Rights and Development Center. Just under 40 per cent of the killings were carried out by the police, with the remainder by ‘unknown individuals, often masked or hooded assailants, some of them with direct links to the police’.

The document – which is based on interviews with families, witnesses and local authorities, as well as official documents – states that the children’s ages ranged from just 20 months up to 17. In one case a seven-year-old boy was killed simply because he had witnessed the murder of an adult. The organisations estimate that the total number of extrajudicial killings since the country began its ‘war on drugs’ under president Duterte four years ago is just under 30,000 – with just one police officer convicted – while at least seven children have been killed in the first three months of this year.

The children’s deaths documented in the report were either the result of direct targeting, mistaken identity, ‘collateral damage’ or ‘as proxies when the real targets could not be found’. Almost all of those interviewed for the report asked not to be named, and most did not even file a case for the murder of their children through fear of reprisals. ‘With parents often too afraid to testify, even anonymously, it is likely that the actual numbers of children killed are higher than the 122 documented in the report’, states OMCT.

There has also been a sharp increase in the arrest and detention of children on drug-related charges since Duterte came to power, says the document, leading to the ‘overcrowding of detention centres where abuse, ill-treatment and even torture are rife. This increasingly brutal policy has spilled over during the recent COVID-19 related lockdown, with numerous children arrested for curfew violations, sometimes threatened with being shot and detained in dog cages or inside a coffin’.  

The report’s revelations must be a wake-up call for the international community, which has been ‘largely absent as the Philippine government has kept trampling human rights’, said OMCT secretary general Gerald Staberock. ‘Over the past four years we have hardly seen any meaningful reaction to the wanton killing of thousands of people under the pretext of the “war on drugs”, the targeting of the poorest and most marginalised citizens of the Philippines, and the persecution of human rights defenders, many of whom are in prison for their legitimate work. It is the total lack of accountability that feeds the cycle of violence, including the war on children we are witnessing.’

How could they do this to my child? Extrajudicial killings of children during the ‘war on drugs’ in the Philippines at www.omct.org read the report here

Gambling oversight ‘complacent’ and ‘weak’, says Commons committee

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Read DDN’s guide to help for gambling addiction at https://www.drinkanddrugsnews.com/gambling-addiction-guide/

The bodies overseeing gambling are failing to protect people who are vulnerable to gambling harms, says a report from the House of Commons Public Accounts Committee. The Department for Digital, Culture, Media & Sport (DCMS) and the Gambling Commission – which it oversees – have an ‘unacceptably weak understanding’ of the impact of gambling harms and lack measurable targets to reduce them, says the document, which follows a report from a separate parliamentary group calling for a complete overhaul of gambling regulation (read about that here).

The public accounts committee found the pace of change to ensure effective regulation to be ‘slow’ and the penalties imposed on companies that do too little to  address problem gambling ‘weak’. ‘Where gambling operators fail to act responsibly, consumers do not have the same rights to redress as in other sectors’ it says. As gambling increasingly moves online DCMS and the Gambling Commission have failed to adequately protect consumers, even when problems such as increased risk of gambling harm during the COVID-19 lockdown have been identified.

The committee is calling for a published league table of gambling operators’ behaviour towards customers, with ‘naming and shaming’ of poor performers and it also wants to see DCMS embark on a review of the Gambling Act within the next three months.

Meg Hillier: Evidence shows a ‘torpid toothless regulator’

‘What has emerged in evidence is a picture of a torpid, toothless regulator that doesn’t seem terribly interested in either the harms it exists to reduce or the means it might use to achieve that,’ said committee chair Meg Hillier. ‘The commission needs a radical overhaul – it must be quicker at responding to problems, update company licence conditions to protect vulnerable consumers and beef up those consumers’ rights to redress when it fails. The issue of gambling harm is not high enough up the government’s agenda.’

The review of the Gambling Act was ‘long overdue’, she added, and an opportunity to see a ‘step change’ in the treatment of problem gambling. ‘The department must not keep dragging its feet – we need to see urgent moves on the badly needed overhaul of the system. Regulatory failure this comprehensive needs a quick pincer movement to expose the miscreants and strengthen those they harm.’

Gambling regulation: problem gambling and protecting vulnerable people at www.parliament.uk. Read it here

Urgent action needed to address lockdown ‘time bomb’, warns Adfam

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People coping with a loved one’s drug use, drinking or gambling have been hard hit by the COVID-19 lockdown, according to a new survey from Adfam.

Families are often overlooked when it comes to discussions of problematic alcohol or drug use. However, half of the respondents to Families in lockdown said the situation had had a negative impact on their own mental health, while 28 per cent said they were experiencing more verbal abuse than usual and 13 per cent admitted to being concerned for their safety. Nearly 5 per cent said they had been experiencing more physical abuse during lockdown.

Almost half also stated that their loved one’s substance use or gambling had increased during the lockdown period, while just under a third reported that the person had either relapsed or their recovery was at risk.

Vivienne Evans: Lockdown is making feelings of isolation even worse

Around 5m people are thought to be dealing with the negative effects of loved one’s alcohol or drug use in the UK, with 85 per cent of respondents to the survey saying the lockdown had made a ‘bad situation worse’. Many of these people will need urgent additional support as lockdown conditions ease, warns the charity.

‘At least one in ten of us are currently affected by a loved one’s drinking, drug taking or gambling problem,’ said Adfam chief executive Vivienne Evans. ‘Our survey shows that this unrecognised and hidden problem has been made worse by the lockdown. When you are already isolated, fearful or in poor mental and physical health, lockdown takes an even bigger toll. Even when restrictions ease, people will need help and support to recover. Now more than ever, we need a national conversation about how we can help people to cope with the life-long impacts of a loved one’s alcohol, drug or gambling problem.’

Meanwhile, UNODC’s latest World drug report has highlighted the increased prices and reduced purity of many drugs as a result of COVID-19 lockdown measures. The economic fallout from the pandemic is also likely to disproportionately affect the poorest and make them more vulnerable to problem drug use, it warns.

If governments react in the same way they did in the aftermath of the 2008 financial crisis, then reduced budgets for drug treatment could mean severe impact on vital areas like naloxone provision and prevention measures.

‘Vulnerable and marginalised groups, youth, women and the poor pay the price for the world drug problem,’ said UNODC executive director Ghada Waly. ‘The COVID-19 crisis and economic downturn threaten to compound drug dangers further still, when our health and social systems have been brought to the brink and our societies are struggling to cope. We need all governments to show greater solidarity and provide support, to developing countries most of all, to tackle illicit drug trafficking and offer evidence-based services for drug use disorders and related diseases.’

 Families in lockdown at adfam.org.uk

World drug report 2020 at www.unodc.org

Government announces interim housing plans for rough sleepers

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New funding from the Treasury will provide ‘interim support’ for 15,000 vulnerable people placed in temporary accommodation during the COVID-19 pandemic, the government has announced. The £105m package will be used to help rough sleepers secure their own tenancies and provide short-term housing in the meantime, it says.

The £105m is made up of £85m of new funding and £20m from ‘refocusing’ existing homelessness and rough sleeping budgets. The money will provide help with deposits and secure ‘thousands of alternative rooms already available’ – such as student accommodation – and is part of the government’s commitment to ‘end rough sleeping for good’. Partnership working between government, local authorities, charities and the hospitality sector has seen thousands of people temporarily housed in hotels during the outbreak (DDN, May, page 5).

A further £16m is being made available to help people in emergency accommodation access substance misuse support – money already announced but brought forward because of the pandemic. 

Robert Jenrick: ‘An unprecidented commitment’ to ending rough sleeping.

‘In recent months, I have seen a huge effort across the country to keep almost 15,000 vulnerable people off the streets,’ said housing secretary Robert Jenrick. ‘This has been vital to ensure their safety during the peak of the pandemic and has changed the lives of thousands for the better. The additional funding announced today will allow us to continue to support these individuals – giving them access to the accommodation and support they need now while we continue with plans to deliver thousands of long-term homes in the coming months. Together, this takes the funding provided by government for vulnerable rough sleepers and those at risk of becoming homeless to over half a billion this year – an unprecedented commitment as we move towards ending rough sleeping for good.’

Dame Louise Casey: ‘There can be no going back to the streets.’

‘I am clear that there can now be no going back to the streets as people begin to move on from the emergency accommodation that has been put in place,’ added chair of the COVID-19 rough sleeping taskforce, Dame Louise Casey. ‘The government is committed to ending rough sleeping by the the end of this parliament, and has taken unprecedented steps to protect thousands of vulnerable rough sleepers and those at risk of becoming homeless.’

‘This a great news but support in England is patchy with councils often uncertain who they should be helping,’ stated homelessness charity Crisis. ‘We need emergency legislation to ensure that every local council can provide housing support to everyone experiencing homelessness.’

Listening to people who use our services during the coronavirus pandemic

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Service user involvement is about making sure people can influence decisions that will affect them. To influence, people need the opportunity to speak and be heard. The voice of people using services provides valuable feedback and we need to make sure we always acknowledge and consider it.

By Chris Barnes, National Service User Involvement Coordinator at Change Grow Live.

Through my role as service user involvement coordinator, I have continually been impressed by the way people adapt and work collaboratively to overcome adversity and achieve incredible things.

Coronavirus has impacted on every aspect of our lives, including the way we deliver our services. Back in March, as changes to our ways of working started happening, we quickly noticed that our approach to hearing the voices of people who use our services needed to change.

It is critical that we continue to listen to the people who use our services.

Read the full article here.

If you are getting support from us, we have heard you. We now want to know more about your experiences. Please click here to share your story and your experience through our survey.  


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content first appeared on Change Grow Live’s website

 

 

 

 

 

Time to ban all gambling ads, say MPs

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The All Party Parliamentary Group (APPG) for Gambling Related Harm has called for a ban on all gambling advertising as well as a complete overhaul of the UK’s system of gambling regulation. ‘The Gambling Commission is not fit for purpose,’ it states. 

APPG chair Carolyn Harris
APPG chair Carolyn Harris

The recommendations are among more than 30 set out in the APPG’s final report into online gambling-related harms, following a year-long enquiry. The group, which comprises more than 50 MPs, is also calling for a ban on all ‘VIP’ schemes and inducements – a ‘cynical tool to incentivise problem gamblers’ – and for the stake limits for online slot machine style games to be capped at £2, ‘given the potential to cause harm’. The APPG has previously called for a £2 stake limit in its interim report (DDN, November 2019, page 5). 

The group’s final report is based more than ten evidence sessions, as well as submissions from a wide range of stakeholders. Other recommendations include a new Gambling Act to reflect the realities of the digital age, as well as affordability limits to be set and imposed by the Gambling Commission. According to the commission, there almost 400,000 problem gamblers in the UK, with at least 1.8m more considered ‘at risk’. A recent report from GambleAware found that just under half of people with a gambling disorder had never accessed support (DDN, June, page 5). 

The COVID-19 pandemic has underlined the need for greater protection for people who can ‘gamble with ease from home, at any time of day and at any level, via a mobile phone’, says the APPG, which also refutes claims that it is prohibitionist or anti-gambling. ‘This is to debase what is an important discussion to protect vulnerable people and children and prevent online gambling harm,’ it says. 

DDN Guide to gambling addiction
The DDN guide on gambling addiction helps identify problems and the available treatment options.

This multi-million pound industry has destroyed people’s lives,’ said APPG chair Carolyn Harris.They resist change at every turn and claim to be reforming themselves but put forward limited changes. Their primary motive is profit. During the COVID pandemic they said they would end TV and radio advertising (DDN, May, page 4) but just ended up replacing ads with ads – that none of us want to see. They have shown time and again that they will not effectively self-regulate. We cannot ignore this any longer. Urgent change is needed to stop this industry riding roughshod over people’s lives.’ 

Report from the Gambling Related Harm All Party Parliamentary Group: online gambling harm inquiry, final report at www.grh-appg.com

Bill Nelles – Doctor Wars (part one)

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In the first part of his two part series ‘Doctor Wars’ Bill Nelles describes how the running battles between substance misuse clinicians in the ’70s and ’80s helped to shape today’s treatment landscape.

Bill Nelles
Bill Nelles is an advocate and activist, now in Canada. He founded The (Methadone) Alliance in the UK

What to do about opiate use and users has been discussed, argued, and shouted about for more than a century now to relatively little positive change. It’s like the opening song in The Sound of Music – ‘how do you solve a problem like Maria?’ Only no one ever does solve the problem of Maria (although I think it has something to do with finding love and, of course, climbing every mountain – a familiar metaphor for any users).

The same seems true for opiate users. We dutifully sing the songs asking for help, but too often leave disappointed. There are still hundreds and even thousands of opiate-dependent users in the UK and around the world who want and deserve a safe supply of that medicine under medical oversight, and finally some are getting it. And I use the word oversight for a reason. It should mean ensuring services are providing empathic access to a safe supply with all the social support, trauma therapies and help with housing that we know are essential to settling down to a life of quality without the poisons on our streets. Having all these is what saved me for nearly 40 years. All were necessary for me and there should be widespread shame at the lack of this joined-up care today.

It wasn’t until the late ’60s that serious prohibition started in the UK – largely because young people, not elderly users and dependent doctors, were now using heroin and getting it from doctors famous for their unusual prescribing locales like coffee bars and street corners. Some changes were understandable as the system was anarchic and largely unregulated.

But the ‘classic’ NHS clinics born around 1969 all had differing attitudes with little agreement on what to do within the teams formed to run them. Thus the era of the ‘doctor wars’ broke out – psychiatry came to dominate treatment in the UK, leading to psychotherapy becoming the approach, and in London high quality Chinese heroin replaced the state gear. So people voted with their veins.

This was in direct contrast to Dr Vincent Dole and Marie Nyswander’s approach in New York that saw opiate use as a physically mediated condition that was treatable but not curable, and not always responsive to psychotherapy. Opiate receptors were identified soon afterwards, and real research started uncovering just what was going on.

But the UK’s NHS drug dependency units were taken over by psychiatrists, not medical doctors. With some notable exceptions, their goals were abstinence through withdrawal and therapy. All these psychiatrists who held the new licences needed to prescribe heroin hardly used them, with a few notable exceptions. People were moved onto oral methadone or nothing if your particular clinician wouldn’t prescribe, or you only had access to a non-medical community drug team – tea and sympathy (of little use) if you were ‘lucky’, but confrontation if you weren’t.

The fights at the monthly meetings held at the Home Office Drugs Branch during the ’70s to mid ’80s brought together psychiatrists who hated prescribing, some of the private doctors who could still prescribe some opiates and opioids (but not heroin or cocaine), and the very few doctors who did still prescribe injectables to the few. They were often vicious and sometimes very personal – some moderating influence came from the presence and later letters and testimony of dear Bing Spear, head of the Home Office Drugs Branch the until the early ’70s. He was replaced by a warrior who did his best to shut down even oral methadone.

By 1983 even getting methadone for more than a short period became very rare in the NHS clinics and unheard of in Scotland. One of the heads of the Royal College of Psychiatrists held that ‘no one needs more than 40mg of methadone a day’ – which was a big reason so many people had such poor outcomes and used on top. Most were expected to and that’s why their methadone was kept so low. There were no objective medical tests or practices used in the UK to ensure patients had adequate doses to minimise fluctuation of methadone levels.

Prescribing anything opiate-like through the NHS to those dependent had almost completely stopped by 1983. But events were about to take an unprecedented shift, and that changed how everything would be done. I’ll explore this further in the next edition.

Read Part two here

Scottish off-sales down 5 per cent in year after MUP

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Sales of alcohol from supermarkets and off-licences in Scotland fell between 4 and 5 per cent in the year after minimum unit pricing (MUP) was introduced, compared to England and Wales.  

The analysis, from Public Health Scotland in partnership with the University of Glasgow, was controlled for seasonal fluctuations, underlying trends such as household income and other factors, the researchers say, meaning it is ‘reasonable to conclude that the reductions in volume of alcohol sold were due to the introduction of MUP’. 

The biggest relative net reductions were seen in the products whose price increased  most after the introduction of MUP, such as high-strength cider, with smaller reductions recorded for beer and spirits. MUP was introduced in Scotland in May 2018, following a lengthy legal battle with the drinks industry. Public Health Scotland says it will publish a three-year analysis of post-MUP sales in 2022. 

‘The methods used in this study allow us to be much more confident that the reduction we have seen in per adult off-trade sales is as a result of the introduction of MUP, rather than some other factor,’ said professor of medical statistics at the University of Glasgow’s Institute of Health and Wellbeing, Jim Lewsey. ‘Incorporating data from England and Wales into our analysis controls for any changes in sales in a neighbouring region where the legislation was not introduced. We’ve also been able to adjust for other factors, such as household income, sales of alcohol through pubs and clubs and of other drink types.’

However the reductions were partly offset by off-trade sales of wine, fortified wine and ready-to-drink beverages, which the analysis ‘found to have increased in the year post-MUP’, said public health intelligence principal at Public Health Scotland, Lucie Giles. 

Alison Douglas, chief executive of Alcohol Focus Scotland.
Alison Douglas, chief executive of Alcohol Focus Scotland.

‘It’s very encouraging to see further evidence that minimum unit pricing for alcohol seems to be changing our drinking habits for the better,’ added chief executive of Alcohol Focus Scotland, Alison Douglas. ‘A reduction of between 4 and 5 per cent in off-sales in the 12 months following the introduction of MUP is really significant. It is also clear that it is the high-strength, low-cost drinks, favoured by heavier drinkers, which we are drinking less of. This gives real cause for optimism that MUP is having the intended effect and that it will improve – and save – many people’s lives.’

It was important not to become complacent, however, as Scotland was still drinking enough for every adult to exceed the CMO guidelines by a third every week, she said. ‘For some of us the pressure of lockdown and social distancing may mean we are drinking more.’

Delphi Medical

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Delphi Medical are a leading provider of drug and alcohol addiction treatment in the UK

Delphi Medical have an outstanding reputation as one of the leading providers of recovery-focused drug and alcohol treatment in the UK. The team offers excellent care on a pathway that supports and facilitates patients engaging in genuine recovery.

 

Delphi Medical’s services include:

Rethink detox – a private community-based alcohol detox service based in Lancaster. 

Pavilion – a residential drug and alcohol detox treatment centre on the outskirts of Lancaster.

Horizon Alcohol, Drugs and Sexual Health Support – a service offering free, confidential and non-judgemental support for all Blackpool residents.

Drug & Alcohol Services in Prisons – providing confidential help and support, and a range of life-saving clinical and psychosocial programmes.

 

Delphi Medical provide flexible solutions to recovery by working with individuals to better understand the traumas linked to their addiction.

As part of their service delivery, Delphi Medical recognise that they have a wider role in changing cultures and social support. The service works with multiple partners and communities to make real improvements. As part of The Calico Group and Syncora, Delphi Medical are in a unique position to provide bespoke services that fit the most complex needs.

With passion and excellence, Delphi Medical make a difference to people’s lives by providing innovative and specialist addiction services that lead the way from dependence to freedom.

Find out more at www.delphimedical.co.uk

Telephone – 01524 39375 Email – contact@delphimedical.co.uk

Delphi Services

A residential Detox Nurse
The Nursing Team are on duty 24 hours a day to support patients and monitor any changes in physical health during detox.

Delphi Pavilion Detox

The Pavilion is a residential drug and alcohol detox treatment centre on the outskirts of Lancaster, run by Delphi Medical. As part of a not-for-profit organisation, we endeavour to make detox and addiction treatment as affordable as possible.

The Pavilion team – made up of doctors, independent prescribers, therapist, nurses, support workers and volunteers – prides itself on delivering care to the highest standard with a focus on supporting patients into recovery.

The Pavilion is accessible to patients aged 18 years and over, delivering personalised and structured detoxification programmes, personally tailored to each individual.

Health, wellbeing, and personal empowerment are at the forefront of every programme, delivered in individual and group settings by trained medical and therapeutic professionals, with all services reflecting best practice, meeting CQC standards.

A combination of clinical and therapeutic services are delivered to safely support patients’ detox, whilst also addressing the contributing factors that have led to their dependence.

Detox is the first step into abstinence from drugs or alcohol, and can be a daunting decision for patients. The Pavilion provides a safe and effective in-patient detox from both drugs and alcohol, through medically assisted withdrawal.

Single and multiple detoxification services are available for the following substances:

  • Illicit drugs (opiate and non-opiate based)
  • Alcohol
  • Psychoactive substances
  • Over the counter medication
  • Prescription medication

Find out more at www.delphipavilion.co.uk

Telephone – 01524 39375 Email – enquiries@delphipavilion.co.uk

Kenward Trust rises to the challenge 

Kenward Trust rises to the challenge 

COVID-19 has proven to be an incredibly challenging time for the addiction rehabilitation sector, with community services having to limit face-to-face meetings where possible and lockdown forcing residential units to rethink their admissions process or close altogether. However, Kenward Trust, a residential alcohol and drug rehabilitation centre based in Yalding, Kent, are proud to say they are still open and taking admissions.

Kenward TrustThe Trust, situated in 15 acres of stunning Kent countryside has a variety of services to provide support to those affected by addiction, homelessness and crime. The core service of Kenward Trust is their residential rehabilitation programme which provides support to those affected by alcohol and drug addiction from for to 24 weeks. They also have Kenward Lodge based on their site in Yalding, which provides supported accommodation to those who are struggling to access drug and alcohol treatment due to not having accommodation, whether this be because they are street homeless or living in unsuitable housing. 

Increased demand

‘We are currently facing a significant increase in demand for our residential services during lockdown, so have managed to repurpose some of our accommodation to allow two isolation areas for new arrivals to the project,’ said Penny Williams, CEO of Kenward Trust. ‘We have ensured that during isolation, any residents can still partake of the programme through remote connection, so they are benefitting from all the time they have with us. I am incredibly proud of our team for keeping COVID-19 off our site and for ensuring that we can safely help those who really need it and that this is being recognised by our referrers.’

Kenward Trust Logo
Kenward Trust are currently recruiting for a Residential Resettlement Manager (closing date 19.6.20) Click here to find out more

The Trust has Move On accommodation across Kent and East Sussex, which are quickly filling up due to the increase in demand. Residents live independently in the Move On accommodation but have support from a dedicated Kenward staff team member to help them reintegrate back into the community whilst sustaining their recovery. The typical length of stay is up to two years while they find longer term accommodation and employment or volunteering opportunities.

Penny Williams, CEO of Kenward Trust
Kenward Trust CEO, Penny Williams

‘Due to this increase in demand we are looking at finding more Move On accommodation within the Maidstone area, so it is closer to our Yalding base,’ explained Penny Williams. ‘We are currently getting in contact with the council and surrounding housing associations to see how we can start this process, however if anyone could provide support with this please do get in touch. We are passionate about helping as many vulnerable members of society that we can, so any support would be greatly appreciated.’

 

Statutory funding

While demand for the Trust’s services is increasing, the statutory funding for residential rehabilitation is continuing to decline. Additionally, as a charity which relies on donations and grants to help fund the services, we are in a challenging time with lockdown. Therefore, to help provide support to those who either cannot afford the residential treatment privately or cannot take the four to 24 weeks needed off work, the Trust is launching a Day Treatment Service. This service can be run remotely during lockdown with confidential counselling via Zoom, but will also feature Evening and Weekend groups when lockdown is over.

To find out more about the services Kenward Trust provides, or to find out how you can support their life changing work visit kenwardtrust.org.uk or give them a ring on 01622 814187.

Would you like to learn how to save a life?

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Peer distribution of naloxone is the best way to get the opioid overdose reversal drug where it’s needed.

Naloxone distribution

by Nye Jones, We Are With You

Andy struts through Redcar town centre, his bright blue naloxone hoody protecting him from the fierce north sea breeze. He bellows hello to a woman across the street and fist bumps a guy he knows from his childhood. Then he sees a man he recognises from picking up his methadone script and it’s all systems go. Andy asks if he’s heard of naloxone. He hasn’t. He asks if he’d like to learn how to save a life. He would. The two sit together on a bench outside Sports Direct. In just eight minutes Andy expertly takes him through how to respond if someone has taken an opiate overdose. With a slap on the back, he hands the man a naloxone pack to keep and waves him on his way.

Hands with a naloxone kit
Read more DDN articles on naloxone.

It seems like he’s been doing this for years, but just three months before the programme started Andy knew very little about naloxone — “I’d never seen a pack before, I never had a clue.” Drug related deaths are at record levels in the UK, with the north east recording the highest rate of deaths in England. Now, Andy is part of a team of peers proactively taking naloxone out into the community in the coastal area of Redcar and Cleveland.

Read the full article on the We Are With You Blog.


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by We Are With You, and first appeared on

https://medium.com/we-are-with-you

‘Resilient’ organised crime groups adapting to pandemic conditions

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EMCDDA Report on covid impact on drug markets
Report available at www.emcdda.europa.eu

‘Active and resilient’ organised crime groups have been successfully adapting their drug trafficking routes, transportation models and concealment methods during the COVID-19 pandemic, according to a report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. While the pandemic has led to local shortages, higher prices and reduced purity of some drugs, crime groups are continuing to thrive and make ‘huge profits’, it says.

Disruption of the drug supply chain has been seen ‘mostly at the distribution level’, the document states, as lockdown and social distancing measures have made street deals more difficult. While dealers and customers are increasingly turning to encrypted communication apps, social media platforms and the dark web to buy and sell substances, the ‘continued commercial transportation of goods across Europe’ has enabled the ongoing movement of bulk quantities of drugs between countries.

Trafficking via maritime shipping remains at pre-pandemic levels, say the agencies, although there has been ‘marked disruption’ in smuggling via passenger planes, echoing the findings of a recent UNODC report (DDN, June, page 4). Violent incidents related to drug trafficking have also continued during the pandemic, the document says.

Alexis Goosdeel: We are likely to see ‘greater volatility’ in the drug trade.

‘The economic effect of the crisis is likely to make some in our communities more vulnerable to both drug problems and drug market involvement,’ said EMCDDA Director Alexis Goosdeel. ‘Furthermore, the growth of online dealing and encrypted communication will place greater strains on law enforcement. In the post-pandemic period we are likely to see greater volatility, competition and violence associated with the drug trade. By anticipating these developments now, we will be better prepared to respond quickly and effectively to the new challenges we are likely to face.’

EU drug markets: impact of COVID-19 at www.emcdda.europa.euread it here

The Benzo Trap

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Improving our understanding of benzodiazepines would save many lives, says Kevin Flemen.

Non-medical use of benzodiazepines creates big challenges for treatment services. There need to be significant changes in how we respond if we are to reduce dependency and fatalities related to this family of drugs.

The extent of non-prescribed benzo use is poorly understood. The Crime Survey for England and Wales (CSEW) reports a drop in use, but anecdotal information from drug services, including young people’s services, suggests the opposite is true.

The CSEW data is highly suspect in relation to benzos, and this may be because it misses key using populations. Questions to identify benzo use need to be carefully framed too – would young people taking ‘Xans’ automatically know that this is alprazolam, a benzodiazepine? If not, standard screening questions such as ‘have you used benzodiazepines in the past six months?’ are liable to under-count actual use.

Further, not all our benzo-type drugs will show up on urine screens, possibly because the stronger ones produce effect at very low doses – producing lower levels of metabolites below the detection threshold. And some of the drugs, such as etizolam, are thienodiazepines not benzodiazepines, so won’t produce metabolites that show up on a standard screen.

Mousetrap with pills on it
Click to download a printable PDF of this article
Young people

Young people’s benzo use appears to have increased. Some of this is recreational, influenced by popular culture, including a new generation of rappers whose image and lyrics have popularised Xanax. For others, use may be self-medicating for trauma, anxiety or other negative mental health conditions.

The trap here is the slow access that too many young people encounter when seeking help from child and adolescent mental health services (CAMHS). Long waiting lists or failure to meet the threshold to access services mean young people may be waiting months for access to CAMHS, if they can access the service at all.

In the meantime, some will find benzos and start to self-medicate. When and if the young person does access mental health services there is a good chance – in classic ‘dual diagnosis ping pong’ – that they will be told they have a primary presenting drug problem and therefore should be referred to a drug service. In turn, when they present to the drug service they may well find a paucity of treatment options to assist with their benzo dependency.

The benzo backlash

The increase in the use of Xanax may have started among young people, but the wider pattern of non-prescribed benzo use has been an ongoing issue and has morphed over time. Initial benzo dependency was largely driven by massive over-prescribing and long-term prescribing, something that has been addressed but remains an issue.

The path to hell is, however, paved with good intentions. The ongoing guidance to GPs to carefully consider the need for benzo prescribing and review existing patients has certainly reduced the extent of benzos being prescribed in the UK. But without measures to address the underlying reasons why people feel they need tranquillisers, people ended up seeking these drugs first from online pharmacies, then via the NPS market off the dark web and, ultimately, off the streets. This has allowed people to build up tolerance to novel benzos at far higher doses than they would have obtained on the NHS. These same patients, when presenting to GPs for treatment, may encounter the same reluctance to prescribe benzos that pushed them to the street market in the first place.

Prescribing trap

The NICE BNF guidance on benzos for the treatment of anxiety allows for doses up to 30mg a day. For someone who has a significant street-acquired strong benzo habit, the BNF upper limit may be well below that person’s current dose. The dose equivalence for someone using four 2mg alprazolam a day (8mg x 20) would be 160mg diazepam – more than five times the BNF upper limit for treating anxiety.

Where services do have a benzo-prescribing pathway it typically requires a person to reduce themselves off their own illicit benzos to a level where drug services or GPs could take over prescribing. This approach effectively directs a person to continue purchasing off the illicit market, with all the risks that this entails. It is the equivalent of having an arbitrary maximum dose of 30ml methadone and saying to heroin users they should reduce themselves off street heroin until they get to this level.

This situation also assumes that the person has continued access to illicit benzos that they can taper off. If a person has been purchasing off a dark web site which is then shut down, they could be left without any access to drugs, withdrawing off a high dose with no access to legal substitutes. This brings with it huge risks, including psychosis and life-threatening convulsions.

Ashton Manual

Many professionals and people seeking help online will find the Ashton Manual, a guide to benzo reduction and withdrawal by Professor C Heather Ashton. A helpful resource for many, the manual and related resources create two key challenges. First, for some people, reading the manual could reinforce fear and anxiety of withdrawal symptoms. There is a risk that people will anticipate and expect symptoms and could therefore experience a wider range of symptoms and with greater severity.

Second, the withdrawal schedules suggested by Ashton typically reflect people reducing off NHS-prescribed dose ranges. Where people have built up dependency on stronger novel benzos, and built up high tolerance on street drugs, following the sort of slow tapers proposed by Ashton could take one to two years or longer to complete. While on the one hand very slow tapers as described by Ashton minimise risks of unpleasant or dangerous symptoms, they can prove prohibitively and unnecessarily slow for people who have been using at high doses. Minute dose reductions can lead to people fixating on each reduction, and losing motivation over a protracted reduction programme.

Unknown tablets

Efforts to accurately substitute prescribe for illicitly acquired benzo habits are further confounded by our uncertainty as to the specific drug and specific dose that the person is actually taking.

A significant amount of the tablets sold as Xanax could contain one or more other compounds. Alprazolam may or may not be present – weaker or stronger benzos could be present, and these could be shorter or longer acting than alprazolam. Dose may be higher or lower than the claimed strength, and there may be other psychoactive compounds present such as quetiapine.

While drug testing websites such as WEDINOS are invaluable in highlighting trends in pill composition they are less helpful when considering tapers and withdrawal protocols – even if pills held by the client are submitted for analysis. The analysis doesn’t show the amount of each psychoactive compound in a pill, and without testing several pills from a batch, no certainty can be derived from testing a single pill.

This uncertainty about drug, dose and strength makes it impossible to accurately assess:

  • what level of substitute prescribing is required
  • how fast or slow a taper should be applied – some novel benzos have a very long duration of effect (100-200 hours) and so slower tapers may be required.

In lieu of accurate and rapid pill testing, the only practical way of substitute prescribing and tapering is to prescribe symptomatically, increasing dose and slowing withdrawal where there are clinical indicators of unmanageable withdrawal symptoms combined with careful assessment of the patient’s self-reported symptoms.

Escaping the trap

Services need to urgently develop new pathways and treatment protocols for people using benzodiazepines outside of clinical and prescribed settings. These need to include:

  • screening tools to assess for patterns and nature of
    benzo use
  • research into the extent of non-prescribed benzo use
    in the UK
  • protocols to test clients’ pills for content and potency
  • appropriate levels of substitute prescribing with tapers
  • rapid access for children experiencing anxiety to CAMHS to reduce self-medicating with benzos
  • staff training and training for GPs about addressing the use of prescribed benzos without driving people towards illicit markets.

www.kfx.org.uk workshops have moved online during the current lockdown.

Email kevin@kfx.org.uk for joining instructions.

Commissioning Quality

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The new national substance misuse commissioner forum will play a vital role in responding to future challenges, say Chris Lee and Prof Jim McManus.

Even through these unprecedented times, councils are absolutely committed to ensuring that people seeking help with substance misuse get the right treatment and support, as part of their public health and other wider responsibilities. This includes helping vulnerable people being given another chance to find work, rebuild relationships, improve their physical and mental health and find safe and secure accommodation.

Chris Lee is, public health specialist at Lancashire County Council
Chris Lee is a public health specialist at Lancashire County Council

But more must be done. Only a fifth of dependent drinkers are currently accessing treatment, while the success rates of drug services vary five-fold from place to place. What’s more, new threats are emerging all the time – one only needs to look at the drug-related death statistics to see that. We must not be complacent. Councils know more needs to be done in close collaboration with local partners to ensure everyone gets the support they need wherever possible.

Covid-19

The COVID-19 emergency comes after a lengthy period of financial and policy upheaval for the drug and alcohol sector. For example, those of us in local government have long argued that reductions to councils’ public health grant – used to fund drug and alcohol prevention and treatment services – is a false economy that will only compound acute pressures for criminal justice, NHS and social care services further down the line.

The Local Government Association (LGA) and the Association of Directors of Public Health (ADPH) have jointly agreed to support the establishment of a national forum for substance misuse commissioners in England. While there are strong regional support networks across England, coordinated by Public Health England regional teams, the purpose of this new forum is to provide a strategic national space in which to bring together those with commissioning responsibility in local government, and enable a representative commissioner voice.

Prof Jim McManus, director of public health at Hertfordshire County Council
Prof Jim McManus is director of public health at Hertfordshire County Council

With many people currently finding new ways to work, this development will be a timely opportunity adding structure and support around the alcohol and drug agenda in England. It will provide a dedicated space to address the issues and concerns of those commissioning substance misuse related services and the opportunity to share ideas and experience or even just support colleagues.

‘The new national network comes at an important time,’ said director of public health at Hertfordshire County Council, Prof Jim McManus. ‘Bringing commissioners together to learn and share good practice is core to the improvement ethos of local government known as sector-led improvement, and will seek to bring some structured support to an area which has been neglected in recent years. Part of this will be ensuring we develop the best possible services and best commissioning practices. This is just one plank of ensuring we have a response to drug and alcohol issues and the need of our populations. But it is an important plank.’

With physical meetings unlikely to happen for the foreseeable future, the intention is to initially develop an online forum to bring people together and use Knowledge Hub as a central platform – it’s hoped we can physically bring people together at a future date!

Key objectives

  • To support the development of good practice and effective commissioning approaches
  • To enable commissioners to share information, intelligence, challenges, ideas, and to support problem-solving
  • To represent commissioner views on relevant current and emerging policy and strategy
  • To influence legislation and policy at a local, regional and national level
  • To enable national representation of substance misuse commissioners in relation to other sector organisations.

While planning is at an early stage, we would welcome expressions of interest to join this emerging forum. If you have any ideas to support this development or wish to register interest in joining, please contact: enyal.lani@adph.org.uk

 

 

DDN June 2020

‘We need to be proactive and responsive’

INNOVATIVE DEVELOPMENTS and impressive collaboration have characterised our sector’s response to the crisis (page 8).

But what we also need to keep up with are the changes in the drugs market and regional trends that could tip the drug-related deaths crisis into further catastrophe. One of the trends identified by Release’s new drug monitoring network is increased use of benzodiazepines, so our cover story looks at how we can respond to this by developing urgent new pathways and treatment protocols. It’s essential that we remain proactive and responsive at the same time as making so many other adjustments to routine.

Commissioners have been thinking along the same lines and there’s an invitation to join a new national forum on page 11. As we’re all particularly concerned about diminishing resources and the threat of services being decommissioned, it’s the right time to create a space for clear strategy and a representative commissioner voice.

Collective Voice are working hard for the treatment sector and invite your involvement in rising to important challenges (p14). When we emerge from this crisis let’s not forget the many gains we’ve discovered from working more closely together.

Claire Brown Editor of DDN magazine
Claire Brown, editor

Keep in touch claire@cjwellings.com and @DDNmagazine

Read the issue as an online magazine or download the PDF

Gender imbalance

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The lockdown may be having a disproportionate effect on female service users, warns Gordon Hay.

Gordon Hay is a reader at the Public Health Institute, Liverpool John Moores University
Gordon Hay is a reader at the Public Health Institute, Liverpool John Moores University

The coronavirus pandemic and the subsequent lockdown impacts on all society, and is likely to be impacting more on groups such as those in contact with drug or alcohol services. Research studies are being launched to explore how COVID-19 and lockdown impact on people who use drugs, and there is a wider discussion about how levels of alcohol use within the general population have changed over the last few months (DDN, May, page 5) and issues such as the relationship between domestic abuse and alcohol use during the current crisis. While new research studies are being set up, existing monitoring and surveillance systems can quickly be augmented to highlight emerging issues facing those in contact with drug or alcohol services.

The Public Health Institute at Liverpool John Moores University has, since 2013, hosted the Integrated Monitoring System (IMS) which records activity at a range of primarily low-threshold drug and alcohol services across Merseyside and Cheshire. Just as the UK entered lockdown, six additional questions were added to the monitoring system to enable services and commissioners to identify additional issues facing their clients.

As services were not mandated to ask the additional questions, the numbers are relatively small but large enough to highlight the impact of gender. Two months from lockdown, emerging findings from 1,435 contacts with services involving 468 clients suggest that female clients are impacted more than males. Overall, very few clients (about 1 per cent) report concerns about having symptoms of coronavirus. Interestingly, only a similarly small amount reported problems accessing medicines, healthcare or harm-reduction supplies – however this finding is unlikely to be representative of all people who use drugs or have problems with alcohol, as the monitoring is being undertaken in healthcare, particularly harm-reduction, settings.

Woman looking through window
Click here to download a printable PDF version

 

More clients report difficulties in social distancing and accessing basic needs such as food. While social distancing was reported as an issue for 22 per cent of female clients, only about 10 per cent of male clients reported difficulties. For accessing basic needs, 6 per cent of female clients as opposed to 2 per cent of male clients reported issues.

Behavioural change

Changes in the clients’ alcohol, drug or tobacco use were explored. Although it cannot be assumed that any changes are increases or decreases, 15 per cent of female clients reported a change compared to 6 per cent of male clients. While all of these differences are seen to be statistically significant, the starkest gender difference occurred when considering mental health, with 23 per cent of female clients reporting that their mental health had been affected by the current environment, compared to 10 per cent of male clients.

Research typically shows that women who use drugs face additional challenges, for example the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) suggests that women are particularly likely to experience stigma and social disadvantage and to have less social support. They may be likely to come from families with substance use problems and have a substance-using partner, have faced Adverse Childhood Experiences (ACEs) and may have co-occurring mental disorders.

Information monitoring

The emerging information from this monitoring system is not a replacement for more detailed research, as we can only highlight that there are differences and would only be able to speculate on why these differences are occurring, and research is needed to examine why females are experiencing lockdown differently to males. Those working in drug and alcohol services, and commissioners of these and similar services, should be alert to any additional difficulties faced by female clients and seek to explore them in more detail during contacts with female clients.

 

In the Picture

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The parliamentary group discussion moved to Zoom for its first meeting since the crisis hit services, as DDN reports.

UK Houses of parliament
Click here to download a printable PDF of the article

The issue around deprivation and inequality is going to come out really strongly.’ Speaking at the Drugs, Alcohol and Justice Cross-Party Parliamentary Group’s first Zoom meeting, Karen Tyrell, executive director of Humankind, was the first of the treatment providers to give an update on the situation since COVID-19 had turned ways of working upside down.

Karen Tyrell, executive director of Humankind
Karen Tyrell, executive director of Humankind

With two-thirds of clients falling into the ‘vulnerable’ category, the organisation was pleased with the way many had switched readily to online support. Staff and commissioning teams had risen to the challenge, but one of the main worries was the drop-off in people coming into treatment – Humankind had seen a third fewer people entering services, and exits were also down as the organisation was trying to keep people in treatment during this unpredictable time.

Laura Bunt, deputy chief executive at We Are With you echoed that the move to remote working overnight had been ‘astonishing’, but that many people who weren’t accessing support were deterred by fear of putting pressure on the NHS as well as contracting COVID. There had been impressive collaboration within the sector, and some innovative developments including trialling a ‘click and collect’ model for needles and other essential harm reduction equipment. But there was also an increase in mental health issues from the boredom, loneliness and a situation that ‘has been really tough for everybody’.

‘We’ve had to put our thinking caps on,’ said WDP’s chair Yasmin Batliwala. Collaboration and communication – between staff, service users, commissioners and other services – had been key to carrying on, including more training through webinars. ‘We’re speaking more to each other than we ever did,’ she said. The crisis had shown that there were opportunities to do more online in the longer term.

Beyond the immediate crisis all the organisations were deeply worried about funding, redirection of resources and the threat of services being decommissioned.

The vital need for sector funding was underlined by Niamh Eastwood, executive director of Release, which had set up a monitoring network to hear about changes in the drugs market.

Niamh Eastwood, executive director of Release
Niamh Eastwood, executive director of Release

‘We’ve already had a public health crisis with drug-related deaths,’ she said. ‘If fentanyl arrives it will be a catastrophe.’ The network had been identifying regional issues, such as fluctuations in heroin purity in the north and north east of England and reports of ‘really poor’ quality ketamine.

There was increased use of Xanax, especially among young people, increased use of psychedelics, and a reduction in MDMA use (‘not a drug for physical distancing’).

Diversion was not happening, as ‘people are holding onto their meds’ (mainly methadone) during the crisis. The move to longer-term prescribing had been helpful in making people ‘feel more in control of their treatment’.

A reduction in opportunities for shoplifting and begging had led to increased use of benzodiazepines to replace other drugs. Meanwhile patterns of policing ‘were not proportionate in lockdown’, she said, with an increase in stop and search for low level offences.

Dr Richard Piper, chief executive of Alcohol Change UK, gave a snapshot of the effect on drinking culture. A national survey on lockdown drinking had tested the hypothesis that people would be drinking more, but findings contradicted this. While 21 per cent of people were drinking a greater volume of alcohol (‘binge drinkers’ continuing to binge), many (35 per cent) were found to be drinking less (DDN, May, page 5).

‘Some have decided to protect their immunity, take care of themselves and only drink when out,’ he said, adding that the disruption had enabled people to break drinking routines. There were five times as many people coming to Alcohol Change UK’s website looking for information and five times as many searches around alcohol and health on Google, suggesting that people were receptive to the opportunity to make healthier choices.

UK Recovery Champion, Dr Ed Day
UK Recovery Champion, Dr Ed Day

Participating in the group discussion, most felt that there were lessons for working smarter after the crisis, particularly around more intelligent prescribing options, tech solutions and web-based support.

But there was also a note of caution about moving to a world of teleconferences and losing face to face contact.

‘The recovery community has responded very strongly with some great web-based support,’ commented Dr Ed Day. ‘But it is no replacement for real face-to-face contact and some people must be falling through the cracks.’

Staying Alert

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The sector has risen admirably to the challenges of COVID-19. But it needs to remain vigilant when it comes to what happens next, says Peter Keeling.

If the current emergency has demonstrated anything, it’s the importance of having a robust healthcare system. Drug and alcohol treatment and recovery services form an absolutely essential part of this, but like so many others our sector is facing incredible challenges because of COVID-19.

Hand blocking Covid-19
Click to read the full article in DDN magazine and download a printable PDF.

The fact that services from community treatment to residential rehab have been able to find solutions is testament to both the sector’s innovative strength and the dedication of its key workers. And it’s these qualities that are keeping people safe. But now we need to ask ourselves about the next steps for drug and alcohol treatment, and what lies ahead for the people who rely on our support.

Over the past few months, Collective Voice has been working hard to bring together people and organisations from across the sector, so we can identify key challenges and find solutions that work for everybody. We’ve seen unprecedented levels of collaboration across third sector providers, NHS trusts and commissioners, who have all brought their expertise to bear on what is possible when it comes to provision of OST, face-to-face interventions, supported housing, and many other areas of our work.

It’s far too early to assess the longer-term impacts of changes to these core aspects of treatment and recovery. But even at this early stage it’s clear that many in our field are asking themselves the hard questions of ‘what do we keep?’ and ‘what do we lose?’ The sector has always been a champion of innovation and flexibility when it comes to designing services around people’s needs, and this flexibility has been crucial in recent months. It has allowed us to keep people supplied with life-saving OST medication and food, helped us create safe spaces for women and children fleeing abuse and violence and, almost overnight, allowed the sector to shift to digital ways of working so frontline staff can maintain crucial relationships with their clients and support them in their recovery.

The crisis has also highlighted our sector’s ability to collaborate; not just at national policy level, but also at local levels. Because it’s at these levels that drug and alcohol services have established themselves as key partners in cross-sector initiatives that support some of the most vulnerable people in society. The London Homeless Hotels Drug and Alcohol Support Service (HDAS), brought together to provide treatment for people living in hotels under the government’s rough sleeping initiative, is a perfect example of the kind of innovative, collaborative response the sector is capable of. Similarly in Dorset, Avon and Wiltshire Mental Health Partnership NHS Trust is working with drug and alcohol partners and the local public health team so that council delivery drivers can provide vulnerable service users with OST medications. Across the country, there are many other examples of such collaboration.

These local and national relationships have helped the sector support itself during an extremely turbulent period where quick decisions have had to be made to keep people safe. Areas that already had strong relationships across sectors tell us they’ve been well placed to respond quickly, and councils which already had good relationships with the voluntary sector have stated how critical these relationships have been when mobilising the local response.

The sector has proven itself entirely capable of meeting the immediate challenges of COVID-19, but what comes next? Because as we look to how services will operate in the ‘new normal’, there are a number of issues that are already causing concern.

1. Increased alcohol consumption

The effects of social isolation during the COVID-19 lockdown appear to be having a noticeable effect on the country’s alcohol consumption. Recent research from Alcohol Change UK, while highlighting some positive indications of a segment of the population who are actually drinking less during lockdown, nonetheless showed that around one in five drinkers are drinking more frequently (DDN, May, page 5). The longer-terms effect of such a substantial portion of the population negatively changing their relationship with alcohol could create a potential new cohort of people seeking treatment as they begin to recognise their consumption has changed for the worse. If there is an increase how will it be paid for? None of us have a crystal ball but it seems fair to say there may well be questions over the level of public spending the country can afford and we know that people with drug or alcohol problems are a frequently discriminated-against group.

2. Rough sleeping exit strategy

The move to swiftly house people in hotels and other temporary accommodation during the COVID-19 emergency has, in many ways, been a success story. It has taken enormous energy across different systems from local authority workers to homelessness, mental health and drug and alcohol workers, but as the COVID-19 emergency enters its second phase, the contracts with hotels to accommodate people previously sleeping rough will end. This leaves our sector, and the many other connected parts of the system, with a significant challenge to continue providing support. But it is also an important (possibly never-before-seen) opportunity for services to create pathways into long-term meaningful support for people who have historically sometimes been difficult to engage (see news, page 4). Ensuring continued accommodation obviously needs to be at the heart of the planning for this group, but it will be a wasted effort for many people if the building blocks of wider support are not also put in place – especially access to drug and alcohol treatment.

3. Local government funding

We welcome the £3.2bn commitment by the Ministry of Housing, Communities and Local Government to support people in the most vulnerable of circumstances during this unprecedented crisis. Local authorities have already distributed some of this funding to fortify services that support people experiencing multiple disadvantage, particularly around rough sleeping, and it is testament to the strength of collaboration between local government and treatment providers that our service users have been kept as safe as possible. But since the funding lacks protection, we are concerned that some public health services – including drug and alcohol treatment – will not benefit from its distribution. This funding is needed by a sector that has been forced to take on unexpected emergency costs around PPE procurement, and payment of locum and bank staff to cover staff sickness.

4. Unforeseen consequences of service adaptation

Services have mobilised quickly and effectively to adapt, while both managing risk and maintaining effective support. But there will soon be a need for the sector to properly assess the consequences of these changes and their effects on service users’ treatment and recovery. The remote (and particularly digital) delivery of assessment, key working and more structured interventions has undoubtedly made services more accessible for some people, and the forced changes to OST provision are likely to provide benefits going forward. But there will still be people in desperate need of treatment for whom online services will not be appropriate, and it is vital that these changes are seen as a welcome addition to the range of available services, not as a replacement. At a time when investment in drug and alcohol services may become challenging, and where digital services could be seen to be a cost-saving exercise, the sector must be vigilant as to the effects of service adaptation and ensure an appropriate balance is found.

Peter Keeling, campaigns officer at Collective Voice
Peter Keeling is campaigns officer at Collective Voice

Finally… We want to pay tribute to the thousands of workers across the country providing essential treatment and support to people with drug and alcohol problems. COVID-19 has shone a light on the extreme vulnerability of many of our citizens, from rough sleeping to domestic violence, and we will continue to push for our sector, and its many unsung heroes, to receive the same level of recognition. But we can only do this with your help and expertise, which is why we’ve launched some new ways to communicate with the field, including a weekly bulletin and an open source Slack community (all details at www.collectivevoice.org.uk). We want to hear from you about how we can best support the sector, so please do get in touch: Peter@collectivevoice.org.uk

 

June Letters and Comment

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DDN welcomes your letters Please email the editor, claire@cjwellings.com, or post them to DDN, CJ Wellings Ltd, Romney House, School Road, Ashford, Kent TN27 0LT.

Letters may be edited for space or clarity.

Serious stress

I was pleased to read Victoria Hancock’s article about secondary traumatic stress (DDN, May, page 14), especially her call for this to be taken more seriously by senior management. I must confess that although it’s an issue that’s concerned me for a long time, I wasn’t even aware that it had an official name.

I’ve worked in this sector and associated fields like homelessness and mental health Ð for close to two decades, and some of the stories I’ve heard from clients have been truly horrific. Hearing about this kind of trauma and abuse, and witnessing its often still-raw effects on clients, is something that can be extremely difficult to switch off from or forget Ð and I’m not sure what it would say about me if I was easily able to do that.

In my experience it’s not something that necessarily gets any easier, either. I remember asking a colleague how they coped with it early on in my career and being light-heartedly assured that I’d soon ‘toughen up’ Ð the implication being that if I didn’t then I’d probably be better off in some other line of work. Obviously things have moved on since then, but this is still an under-discussed issue and it’s good to see it getting some attention.

Name and address supplied

Best buddies

I read with interest the article about Lancashire’s Recovery communities working together during COVID-19 (DDN, May, page 8) and thought you may be interested in our ‘sobriety buddy’ initiative.

For members of any detox community meetings are a cornerstone of recovery, but this is just not an option for anyone leaving a detox facility right now. So at our Birchwood residential detox centre community in Birkenhead we’ve created a new initiative – each member can have their own personal ‘sobriety buddy’ (see news, page 5). The idea is to provide support for people while they undertake a detox programme, so that support can continue when they return home too.

We realised extra support is needed under current conditions, and so we set about finding volunteers to help service users in this difficult time and be that person on the other end of the telephone with some good sobriety time under their belt.

Research shows that coping with stress and isolation can make a relapse more likely, especially in the early stages of sobriety. When our coping skills are tried, we often revert back to behaviours that are not necessarily serving us.

We offer people this service before they arrive for their detox. During their first telephone consultation with our office we ask if they would like a sobriety buddy to support them. Their buddy will then text first to introduce themselves, and they can move onto talking daily if that support is wanted. There is no better way to learn than from someone who has been there and is happy to share their experience; we are able to guide people on how to deal with difficult life events without resorting to past behaviours and it’s been getting great results.

It’s already been such a success we are going to continue running this after lockdown as the support people have received has made all the difference.

Jo Moore, manager at Birchwood (a Kaleidoscope Project facility), Birkenhead

In solidarity

When I was at school I always thought that I’d make something of my life, do something exciting and follow my dream of helping others. However, it turned out I’d end up on a different path.

I joined the ambulance service the day after my 18th birthday and worked for them for over ten years as a paramedic. Six years ago I developed a brain problem and ended up needing multiple surgeries over the following two years and during this time I was prescribed Oramorph. It turned out that I’d become addicted to it and I never thought I’d end up becoming one of the people I previously cared for. I then began injecting the Oramorph when taking it orally wasn’t working quickly enough. When my prescription was abruptly cut off I went into withdrawals and ended up swapping to injecting heroin and crack cocaine.

After getting myself clean I decided to start a blog to help those who are in my previous shoes and the family and friends of those with an addiction. The blog can be found here at: www.drink-n-drugs.com or on Facebook and Twitter ‘Drink ‘n’ Drugs’. I hope it helps others as writing it helps me!

Dave Richens, by email

In memory of Kevin Knott

It is with great sadness that Bradford Drug Services report the passing of our colleague Kevin Knott after a short illness. Kevin was a drug worker in the Bradford and Airedale district. Kevin was a big supporter of service user influence and involvement and he frequently attended the DDN service user conferences.

Kevin was a great guy who was very popular and loved by all – such an inspirational, funny, caring and genuine individual, fantastic at his job and able to instil confidence in anyone he met. He was a proper character who loved a laugh and was a true legend. It was such a pleasure to have known him over the years and his legacy and treasured memories will last forever.

Gerard Smyth and all his colleagues in Bradford

Zooming in

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Technology is helping to make sure that recovery workers and clients stay connected. While it can never take the place of face-to-face working we should retain the best parts of the ‘Zoom boom’, says Charlotte Hadaway

The lockdown has changed my working day. As an outreach worker in Devon I can travel up to 60 miles a day to see my clients. We’re a very rural county, so I work from a number of Together/EDP hubs as well as GP surgeries and community locations.

Before lockdown, technology enabled me to do simple things like keep an online diary so everyone knew where I was and who I was seeing, or write up my notes on the hoof using Wi-Fi and phone tethering. When lockdown hit, all this changed. We had to adapt quickly to be able to offer a safe and secure service, and I have to say Together/EDP have been brilliant at supporting us during the changes. We have daily virtual meetings with managers and team members, we’re kept really well informed of developments and what we need to do to keep everyone safe, and we’ve been encouraged to use virtual groups utilising Microsoft Teams, WhatsApp, Zoom and other technologies. I think it’s fair to say that we’ve adapted well and changed the way we work – we continuously share the experience, reflect on what’s working, and keep each other going.

When we started setting up Zoom meetings we didn’t know how tech savvy people were, but I was really surprised that clients jumped at the chance of joining an online group. They really wanted to see each other and know how they were getting on in their recovery. It’s never quite the same as being in the same room, but it’s a great alternative. I don’t think you can beat human contact because you see people’s expressions, you see their movements, you can look into people’s eyes and you can see behaviours better up close. You can still see that on Zoom, but it’s not as powerful as face-to-face.

We are very clear about our meeting rules with Zoom, especially around respecting each other and confidentiality. I find that when people do share their feelings, others still connect well with them – they are very respectful, they are listening to that person and that person feels held by everybody in the virtual group. The online meetings have kept clients in contact with each other. It’s often just talking about the little things that makes people feel they’re part of something. Just knowing they’re being heard is really important.

Charlotte Hadaway EDP
Charlotte Hadaway is an outreach recovery worker at Together, part of EDP Drug & Alcohol Services (EDP is a subsidiary of the Humankind charity).

What will happen beyond lockdown is hard to tell, but I would like to offer an evening virtual meeting going forward. It will be easier for some clients who experience high anxiety or who are trying to work full-time and manage their recovery. I know that just getting to an appointment can be quite stressful for some people, so these digital solutions are a great way for people to have more choice in treatment. I’ve also learnt that it is important to be patient while clients are setting up Zoom accounts, as tech can be daunting for those not used to it.

It’s fair to say that most agree there is a new place for virtual groups post lockdown. Of course, nothing beats face-to-face group work. The interaction between clients can mean everything, especially in early recovery. A hug, a conversation over a cup of tea, a chat in the break – it’s bonding, friendship and fellowship all rolled into one. But to meet online is the next best thing, and I’m looking forward to keeping the best bits as we move forward and offer more choice and variety to our clients.

 

Grow a little kindness

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Samantha Smith shares the Roots project’s successful campaign for Mental Health Awareness Week.SIG Penrose Roots is a garden-based community recovery project that provides a therapeutic growing space for service users, members, volunteers and the wider community. Through work in the garden, we equip people with new skills, help reduce social isolation, and promote positive mental, emotional and physical wellbeing.

After weeks working from home in lockdown, while the Roots staff are busy supporting the community, my mind started to turn to what we would have been doing if life was still ‘normal’. For the past four years we have put on our annual Walk and Talk (adding cycling in 2019) to mark Mental Health Awareness Week. We would go for a leisurely walk around the Luton area, with service users and local partners, to discuss the important topic of mental health in a more relaxed and open way.

This year the pandemic meant this could not happen and we had to come up with another plan. The 2020 theme is kindness, which is very close to the heart of all who attend our various projects. So I thought about how we could make a campaign with the theme of kindness to tie in with what we currently do at our community garden – and the ‘Lettuce be kind’ campaign was born.

The team of staff and volunteers got to work planting 50 lettuce seeds to grow and nurture into something that we could give out to the community. By 18 May, the team had grown the lettuces, made care labels and were ready to start randomly placing the lettuces across Luton. They went to bus stops, parks and green spaces, doorsteps and various residential streets. All carried the message: #lettucebekind – perhaps the roots to kindness can start with yourself. Be kind to this lettuce and it will repay your kindness.

The campaign was a huge success and had many tweets and messages from excited community members who had found one of the lettuces. The campaign also got a mention on the BBC East Twitter live update and the team was invited to talk about the campaign on BBC Three Counties Radio.

We will be following up with other campaigns over the coming months. It was a huge effort by the whole team and helped to get the message of kindness out there as a gentle reminder that in these days of supposed disconnection we have never been more connected.

Follow the campaign on twitter

 

SIG launches newly designed website

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User-friendly site gives clear signposts to all the services on offer.

New Social interest group websiteThe Social Interest Group (SIG) is excited to announce the launch of their newly designed, consolidated website, www.socialinterestgroup.org.uk. After six months of development, the launch of the new site was officially announced today, Tuesday 26 May 2020. The new site is faster, easier to navigate, and more user-friendly.

Previously, the main SIG website consisted of details about the charity and overall strategic information. Alongside this, there were individual websites for the subsidiaries, Penrose Options and Equinox Care, where visitors could find information on the individual charities and the services they offer. 

There is now one single SIG website incorporating the Equinox Care, Penrose Options and SIG investments information. This provides a seamless integration of the group brand as a whole and includes information on the services offered. 

Breakdown of Social interest group activities‘I am pleased that we have achieved this in the time that we have,’ said group chief executive Gill Arukpe. The site was built in-house and was a collaboration between our IT and communications teams. It is particularly exciting that instead of three disparate websites of differing quality, look and feel, there is now one single site where visitors can find out about the wonderful work we do to support our service users.’

The new site provides visitors with an easier way to learn about SIG’s services, including who they are, how they work, service user stories, staff blogs and careers pages. It also features integrated social media buttons for Facebook, Twitter, Instagram and LinkedIn to foster improved communication with stakeholders and visitors.

www.socialinterestgroup.org.uk

  


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content also appeared on The Social Interest Group’s site.

 

 

 

 

 

Don’t squander chance to end rough sleeping, urge parliamentarians

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The government needs to establish a £100m housing support fund to avoid losing a ‘golden opportunity’ to put an end to rough sleeping, says a report from the Housing, Communities and Local Government Committee. 

Around 90 per cent of rough sleepers have been housed in temporary accommodation in response to COVID-19, providing a ‘unique opportunity to eradicate rough sleeping in England for once and for all’, says the committee. It wants to see at least £100m a year dedicated to long-term housing support to avoid the thousands of people in temporary accommodation ending up back on the streets, and warns of a ‘looming homelessness crisis’ as more tenants struggle to pay their rent and the three-month ban on evictions expires. 

The government needs to work quickly to put in place a housing-based exit strategy and the funding to support it, the committee urges. This should be in the form of a dedicated funding stream to allow local authorities to make sure people are securely housed, as well as provide for additional support services for rough sleepers. The government recently denied press reports that it was about to stop funding the scheme to provide emergency accommodation for rough sleepers in hotels.

‘We must praise the efforts of all those who have done so much to help take people of the streets during the current health emergency, but what happens next is crucial,’ said committee chair Clive Betts. ‘It is simply not good enough for anyone to leave temporary accommodation and end up back on the streets. This isn’t just about protecting vulnerable people from COVID-19. It is not safe to live on the streets in any circumstances, and it is not acceptable to allow it to return once the health crisis abates.
 
‘In our report we have called on the government to grasp the golden opportunity that has presented itself,’ he continued. ‘For the first time in over a decade rough sleepers have been comprehensively taken off the streets and given accommodation. This must become the new norm.’

 

Protecting rough sleepers and renters: interim report available here.

Early Day Motion salutes vital role of treatment services

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An Early Day Motion has been tabled to recognise the essential role of treatment services and thank the ‘unsung heroes’ on the frontline of drug and alcohol service provision.

It also calls for MPs to ensure treatment providers are involved in post-pandemic public health plans.

The statement reads:

That this House acknowledges the vital role being performed by drug and alcohol treatment services throughout the country during the COVID-19 outbreak; recognises that key workers on the frontline of critical service provision are among the unsung heroes who rarely receive the recognition they deserve; commends the dedication with which they have maintained crucial support for a most vulnerable section of our society; expresses its gratitude for the flexibility shown in adapting to meet the needs of service users in these most difficult current circumstances; recognises that the work has been achieved after a decade of depleted resources as a result of austerity and funding cuts; notes that a surge in mental health issues can be anticipated in the wake of such crises; recommends that to help people stay safe, protect the NHS and save lives, future funding for this often-overlooked sector should be safeguarded; and calls on the Government to ensure drug and alcohol treatment providers are involved in shaping plans for post-pandemic public health provision.

Statement, with signatories, here: https://edm.parliament.uk/early-day-motion/56995/treatment-services-during-the-covid19-outbreak

Half of people with gambling disorders have not accessed support

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Just under half of people with a gambling disorder have not accessed treatment or support, according to a study by GambleAware. Of those scoring above eight on the Problem Gambling Severity Index (PGSI) – considered ‘high risk’ – 46 per cent had not accessed support. 

DDN Gambling and Health guide
DDN’s guide on gambling addiction will help identify problems and guide you through the available treatment options.

The research, which included a YouGov survey, found that up to 61 per cent of the population had gambled in the last 12 months. Overall, 17 per cent of gamblers experiencing harm at any level had accessed support over the last year, with barriers to seeking treatment including stigma, reluctance to admit having a problem and lack of awareness of available services. Perceived stigma or shame was cited as a reason for not accessing support by 27 per cent of problem gamblers. 

In particular, women and people from BAME communities and lower socio-economic backgrounds may ‘not be having their treatment and support needs adequately met’, says GambleAware. Just under a fifth of gamblers from lower socio-economic backgrounds were ‘likely to report that nothing would motivate them to seek support’, researchers said, while women were three times more likely than men to cite practical barriers like time, cost or location as reasons for not accessing treatment. Around 7 per cent of respondents said other people had also been affected by their gambling. 

GambleAware is calling for services tailored to the needs of groups less likely to access services, as well as campaigns to increase awareness and reduce stigma.  

‘This research has shown that there is a clear need to further strengthen and improve the existing treatment and support on offer, to develop routes into treatment and to reduce barriers to accessing help,’ said GambleAware chief executive Marc Etches. 

GambleAware chief executive Marc Etches
GambleAware chief executive Marc Etches

‘Services have to be flexible to meet the needs of individuals and easy to access. Meeting the needs highlighted in this report will require partnerships between the statutory and voluntary sectors, both those services specific to gambling treatment and other health and support provisions. Working with those with lived experiences is essential in designing and promoting access to services, as well as helping to prevent relapse. It is important to engage community institutions including faith groups, to help make more people aware of the options available to them and ensure no one feels excluded from services.’

Treatment needs and gap analysis in Great Britain: synthesis of findings from a programme of studies available here.

Be kind to yourself

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Kindness is all around us lately. But how do we be kind to ourselves?

As a cognitive behavioural therapist I see kindness in the people I work with and support every day

by Beth Marr, cognitive behavioural therapist

Kindness is everywhere at present. We hear stories about acts of kindness on the news, be it frontline staff putting their lives on the line to protect sufferers, or people delivering food and goods to neighbours in need. We see it in the pictures of rainbows on windows, a warm and comforting image depicting hope through the scrawl of a child’s crayon. We can even wear it courtesy of the numerous t-shirts available bearing slogans such as ‘Be kind’ and ‘Keep talking’.

As a cognitive behavioural therapist, much of my working day is spent in the company of people’s hopes and fears. I get to know who they feel they are, who they would like to be, but something that is very often missing is kindness.

I hear of loved ones, I hear of the people who have become their second heartbeat in a way, helping them to breathe through life’s darkest moments, but when we come to look at their own self-image, the words on my notepad take a decidedly harsher tone. ‘Useless’, ‘embarrassment’, ‘ugly’, ‘inadequate’. These words pepper the pages with a sense of resignation – as much a part of the individual’s identity as the blood that flows through their veins.

Read the full article on the We Are With You Blog.


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by We Are With You, and first appeared on

https://medium.com/we-are-with-you

Government denies imminent end to rough sleeper funding

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The Ministry of Housing, Communities and Local Government (MHCLG) has denied claims that it will no longer be funding the scheme to provide emergency accommodation for rough sleepers in hotels (DDN, May, page 5). A story in the Manchester Evening News on 14 May stated that civil servants had told Greater Manchester Combined Authority officials that the scheme was ‘no longer being funded by central government’, that March’s original COVID guidance to local authorities had ‘been scrapped’, and that a leaked report said that MHCLG had now ‘drawn a line’ under the programme.

MHCLG has since responded via Twitter stating that ‘any suggestion that the government is reneging on the commitment set out at the start of this national emergency is entirely wrong’, and that the department had been clear that councils ‘must continue to provide safe accommodation for those that need it’. Suggestions that funding is being withdrawn or that people are being asked to leave hotels are ‘unfounded’, it says.  

More than 90 per cent of rough sleepers known to councils at the beginning of the COVID-19 crisis – around 5,400 people – had now been ‘made offers of safe accommodation’, the ministry added, stating that it would ‘work with partners to ensure rough sleepers can move into long-term, safe accommodation once the immediate crisis is over’.

The government came in for significant criticism from homelessness organisations at the start of the outbreak for failing to provide them with adequate guidance or explain how people sleeping rough or in hostels were expected to self isolate. It later instructed all local authorities to find emergency accommodation for rough sleepers by the end of March.

St Mungo’s has launched a campaign, No going back, which is calling for funding to be put in place for local authorities to ensure that no one is made to leave emergency accommodation without being offered suitable alternative housing. It also wants to see more housing and support for people with complex needs, and more safe and secure housing for women and survivors of sexual abuse. ‘The government now needs to ensure that everyone isolating in a hotel can move into specialist hostels or permanent housing – depending on their needs,’ it says. ‘And that no one is forced out without the right support to stay off the streets for good. If the government takes action now thousands of people can be helped off the streets permanently.’ 

 Details of No going back campaign at www.mungos.org read it here

Tsunami of Need

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Phoenix Chief Exec Karen Biggs blogs about the impact of COVID-19 on the people who rely on drug and alcohol treatment services.

Man staring at a Fjord
Isolation is the enemy of recovery

The COVID-19 pandemic has brought many people in society to a crisis point. People who were already struggling to access the health and social care they desperately need. When society opens its doors again it will reveal a tsunami of need which we should be ready to meet.

Many people use drugs and alcohol to try to numb pain and smother deeply traumatic experiences. Many more of us would too, if faced with similar circumstances. People who use drugs have always been invisible; labelled as ‘hard to reach’ or ‘too complex’.

They are not; the reality is that decision-makers and funders haven’t spent the time and money required to reach out, understand and help. There are many reasons for that – poverty, entrenched stigma across society and the sense of some people are more deserving than others. What is clear now that is that we don’t need to argue anymore about whether or not that is true. It is fact, proven, accepted and understood – no matter how hard it is to stomach.

‘Funding reductions are exacerbating gaps in treatment provision. As funding pressures have increased some services have disappeared altogether (such as outreach service targeting newer users), whilst others have been rationed (such as inpatient detoxification for people with complex and multiple problems heroin assisted treatment and residential rehabilitation.)’
Professor Dame Carol Black

So, what happens when people who are already struggling to stay alive lose the fragile links to the support they have? Lose the opportunity to be with others with the same shared experiences of life? When people lose their sense of belonging? The answer: negative thoughts, relapse, self-harm, overdose, suicide and death.

Read the article at

www.phoenix-futures.org.uk

———–

DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by Phoenix Futures, and first appeared on their site. Read this and more article like it on

www.phoenix-futures.org.uk

Why COVID-19 will change social care for good

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From claps for our carers to government recognition that funding for adult social care is a top priority, something is finally changing.

It would have seemed unimaginable a year ago that neighbours would come together at 8pm every Thursday night to join a chorus of thanks and appreciation for everyone working hard throughout the NHS and in social care. The cheering and saucepan banging is wonderful recognition for those going out on the frontline every day to treat those in great need and to support the rest of us to keep safe.

Giving credit to hard working doctors, nurses and all NHS staff in the direct path of this virus is, of course, extremely important. Alongside this, valuing the role of care staff and other public sector key workers marks a significant change.

Read the full article at www.turning-point.co.uk

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DDN magazine is a free publication self-funded through advertising.

 

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

 

This content first appeared in the Turning Point blog

 

WDP and Hermes deliver essential items to Capital Card users during COVID-19 pandemic

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Leading drug and alcohol charity WDP has partnered with Hermes, one of the UK’s largest parcel delivery companies, to provide its most vulnerable Capital Card users access to essential items during the coronavirus pandemic through a home delivery service.

Hermes electric vanUsers of the WDP Capital Card earn points by engaging in drug and alcohol treatment and can then spend their points on positive activities and products in their local community at Spend Partners, such as cinemas, gyms or eateries. However, many Capital Card Spend Partners are closed due to the current lockdown.

This innovative partnership means that service users who are currently unable to leave their place of residence, whether because of self-isolating or mobility issues, can place orders for essential items that they would usually ‘buy’ in their local WDP service’s pop-up shops, such as toiletries and non-perishable items. Hermes will then deliver these orders to the service user’s door within one week, as part of the Capital Card ‘Shop on Wheels’ initiative. While WDP services remain fully operational, social distancing guidelines dictate that the pop-up shops cannot currently open on-site.

Hermes is generously providing delivery options in 11 different WDP service locations across Greater London and Cheshire West and Chester, meaning ten packages per week per location can be delivered to service user homes.

WDP chair Yasmin Batliwala
WDP chair Yasmin Batliwala

Yasmin Batliwala, Chair of WDP, said: ‘We are excited to be partnering with Hermes to support our service users during these difficult times. Our Capital Card team are doing everything they can to find new and innovative ways to support our service users, and this news is yet another example of their hard work and dedication and exemplifies everything that WDP is about. We welcome Hermes into the Spend Partner family and thank them wholeheartedly for enabling us to provide safe and secure access to essential everyday items for our most vulnerable service users without them needing to leave their homes.’

Sasha Law, head of internal comms and engagement at Hermes, said: ‘We’re proud to be able to support the Shop on Wheels initiative, which is a great cause, and we’re pleased to be able to use our network to support some of the most vulnerable in society. Hopefully this support will help make a positive impact and enable WDP to continue their valuable work.’

Read the full article and find out more about the Capital Card on www.wdp.org.uk/news


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content was created by WDP, and first appeared on www.wdp.org.uk

 

New helpline for prisoners released during pandemic

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A new free-phone helpline has opened for men and women in the North East who are being released from prison during the coronavirus crisis.

The helpline is provided by the Humankind charity from 10am to 4pm, Monday to Friday, on 0800 731 2072. It can also be accessed through the website.

‘Changes community based services have had to make alongside the Ministry of Justice initiative to release some people from prison early have prompted us to launch this additional support for drug and alcohol recovery clients leaving North East prisons,’ said Amy Levy, of Humankind, which is based in Bowburn, Co. Durham. ‘We hope to provide information and guided signposting to services and support which is already available across each local authority area in the North East.

She added, ‘There’s considerable evidence that confirms the first few weeks following release as being a critical period during which men and women face a range of increased risks.’

The helpline will point callers to community drug and alcohol service provision, local pharmacy information, local authority housing support and support hubs for vulnerable people, Job Centre Plus and a wide range of community support projects. Links to Probation will also be key for those men and women released on any form of licence, including those released under the early release scheme.

Humankind provides the non-clinical drug and alcohol recovery service element of the new Reconnected to Health service led by Spectrum Community Health CIC.

The Reconnected to Health partnership, which also includes Tees, Esk & Wear Valleys NHS Foundation Trust (TEWV) provides integrated healthcare to men and women resident across the region’s seven prison establishments – Durham, Frankland, Holme House, Low Newton, Northumberland, Kirklevington Grange and Deerbolt. The service is commissioned by NHS England. 

All drug and alcohol recovery clients leaving prison in the North East will get details of the helpline in their release packs. Information about local services, including links and telephone numbers, will be held on a dedicated page on the Humankind website.

 

 

Weathering the storm

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While COVID-19 is wreaking havoc on the vulnerable, the economy and society as a whole, it is also generating – by necessity – some new and innovative ways of working. DDN reports.

With the UK’s lockdown now in its second month, everyone has had to adjust to the ‘new normal’. However, in much the same way that COVID-19 can be far more damaging to people with weakened immune systems or pre-existing conditions, so it has the potential to cause disproportionate damage to sectors already depleted by year after year of shrinking budgets. Whether the inevitable recession that comes in its wake will lead to greater austerity, or whether renewed respect for health services and – perhaps – a different attitude to society’s most vulnerable might see the drug and alcohol sector get off relatively lightly (DDN, April, page 7) is yet to be seen.

In the meantime treatment services, like everyone else, are having to get by as best they can. Substance misuse staff have been designated as key workers eligible for COVID-19 testing if they display symptoms and for school-based care for their children, which means the sector is able to function better than most. Arrangements have also been made to try to ensure people can get their substitute medication, and organisations have also been able to move elements of their support online.

Guidance

director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill.
Director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill.

The government published its guidance for treatment services and commissioners on 15 April (see news, page 4) which – alongside instructions to minimise face-to-face contact, scale back hep C testing and defer detoxes – recommends increasing provision of harm reduction measures including naloxone, and encourages services to increase stock held by NSPs and allow people to take more equipment. The guidance also advocates new ways of working, such as by phone or video call, something most organisations were already doing.

‘I do think that the drug and alcohol sector were getting on with it ourselves because of the very nature of what we do,’ director of health, care and wellbeing at the Calico Group, Nicola Crompton-Hill, tells DDN. ‘But I think what the guidance did was offer reassurance. One example was that staff were recognised as key workers. That alone really helped me and the management teams realise we’d be able to manage staffing levels and safeguarding better.’

WDP chair Yasmin Batliwala
WDP chair Yasmin Batliwala

‘We were heartened to read the guidance, especially as WDP had already implemented the overwhelming majority of it,’ agrees WDP chair Yasmin Batliwala. ‘The guidance is sensible and comprehensive but will of course need to be updated to suit the ever-changing situation, particularly as lockdown restrictions are eased and we begin the return towards normal service operation – albeit with stringent protection measures in place.’

WDP has moved support to online resources, videoconferencing facilities and phone appointments where it’s considered safe for the service user, although it also continues to safely operate in-person appointments. ‘Our IT department has also rolled out a large amount of equipment and support in a short space of time, for example a desktop phone system used on tablets to allow staff to make and receive calls using the usual service number,’ she says.

Bath: A volunteer PPE manufacturing initiative set up in a school sports hall during the coronavirus pandemic. Credit: Andrew Lloyd/Alamy
Bath: A volunteer PPE manufacturing initiative set up in a school sports hall during the coronavirus pandemic. Credit: Andrew Lloyd/Alamy

It’s possible that one of the long-term impacts of all of this might be a shift towards more online support and counselling generally, although clearly there are areas where this will be far from ideal. ‘We’ve been adapting the model and the programme where we can to offer virtual support and virtual counselling,’ says Crompton-Hill. ‘Some staff in our residentials aren’t used to working digitally so I’m really proud of how quickly that culture’s been adapted, and we’re starting to think about how we can enhance services going forward. Given that when we come out of the actual crisis we may be left with a reduction in funding, can we do more in the style that we’ve had to adapt to? But there are lots of mutual aid groups operating virtually at the moment and what’s key to mutual aid is actually going out there and socialising with people in similar situations – having that connectedness and those one-to-one chats. So although people have done their very, very best, those sort of things will be really impacted, so it’s just trying to get the balance right. I think we’ve just got to hope as a sector – and fight a bit – to try to get back to where we were in terms of our offer and delivery.’

Unprecedented

The unprecedented operating environment has meant that organisations have needed to come up with other alternative ways of working. While the lockdown has inevitably forced the partners who provide the rewards for WDP’s Capital Card scheme (DDN, February 2019, page 6) to close, the organisation is securing a free-of-charge arrangement with a national delivery company to deliver essentials like clothing and hygiene products from Capital Card shops – normally located in services – direct to service users’ doors. While keen to return to normal operating models, WDP will ‘certainly be able to boost our offer with a lot more home participation for service users in the future,’ says Batliwala. ‘This should really help the momentum of recovery journeys between in-service appointments.

Support

Although it’s been a period of rapid change, the local authorities commissioning WDP’s services have been ‘extremely supportive, which has been a big help’, she adds. ‘It’s been a real two-way process – there’s been a real sense of really wanting to help us with PPE, for example, which has been really welcome,’ agrees Crompton-Hill.

‘We’re proud of the way all WDP staff have risen to the challenge with both dedication and innovation,’ says Batliwala. ‘To say thank you to them doesn’t seem nearly enough. The fact that we’ve managed to still provide both an in-person and remote service in all areas has been a huge success. We’ve maintained very regular communication, guidance and encouragement to staff throughout, and have done whatever we can to boost morale in small ways such as pizza lunch deliveries and ‘fresh fruit Mondays’. We have also vastly expanded our online support for staff, including workouts, weekly wellbeing webinars and tips for effective home-working and coping with lockdown in general.’

Long-term impact

What no one knows, of course, is what the long-term financial impact of all this is going to be on the sector. ‘A lot of the work we’re doing at the moment is looking at the “what if?” and factoring in the financial implications of that as a business,’ says Crompton-Hill. ‘I think what we need to try to do as a sector is use what we’ve learnt over the last month to see if we can step up to what those financial challenges might be, for example can we do more digitally so we can see more people? We don’t want to have to do that because a lot of our services run on being able to come together, but we may have to.

London: A space underneath Tottenham Hotspur Stadium is used as a food hub for delivery of pre- packaged meals to the homeless and vulnerable. Credit: Simon King/Alamy
London: A space underneath Tottenham Hotspur Stadium is used as a food hub for delivery of pre- packaged meals to the homeless and vulnerable. Credit: Simon King/Alamy

‘One of the things I’m proud of is the staff and their resilience, and their ability within a very short time frame to adapt their everyday practice,’ she continues. ‘We’ve been specifically helping with homelessness. We looked at all the beds we had available and with every service that had a bed it was, “can we help?” Everyone mucking in together has been a real theme over the last month.’

Another thing that the crisis has reinforced is the vital importance of effective communication. ‘Really open and transparent communication has been key,’ she states. ‘I’ve had that from the local authorities we work with, and we’ve done that with all of our clients in treatment, all of our staff, partners – it’s really helped us through this. I’ve never had as much communication coming through, and I’ve never sent as much out. But I think that helps people feel fully informed, and it’s been a real key thing for me. You’ve not felt alone in the process.’

Scots widen availability of naloxone

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The Scottish Government has widened the availability of naloxone as part of a package of support for people affected by drug use during the COVID-19 pandemic.

Other measures include £1.9m to support people on OST while in prison to switch to a prolonged release injection of buprenorphine (Buvidal), and an ‘enhanced offer of residential rehab’ for people leaving prison during the outbreak in order to reduce pressure on local services. 

Under current UK regulations, only drug treatment services are allowed to supply take-home naloxone kits. However, Scotland’s lord advocate has confirmed that it would ‘not be in the public interest’ to prosecute anyone working for a service registered with the Scottish Government – for example, a homelessness organisation – who supplies naloxone for use in an emergency during the crisis. Non drug treatment services will need to register with the Scottish Government to become a naloxone provider.  

‘While this public health crisis is ongoing, we must not lose sight of the fact there continues to be a significant number of highly vulnerable individuals who are at great risk of harm as a result of alcohol and drug use, who continue to need a wide range of help and support,’ said public health minister Joe FitzPatrick.

public health minister Joe FitzPatrick.
Scottish public health minister Joe FitzPatrick.

‘Buvidal is an alternative to methadone or buprenorphine tablets which is administered by a seven or 28-day injectable dose, rather than daily administration. By making this available to people in prisons, we will support continuity of care, while reducing the need for daily contact and reducing pressure on our frontline prison officers and NHS staff.

‘I welcome the lord advocate’s statement of prosecution policy in respect of the distribution of naloxone during the period of disruption caused by COVID-19,’ he added. ‘This will help to ensure that we can continue to support those affected by drug use and keep them safe.’

A new normal

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Within days of lockdown being announced, Lancashire’s recovery communities had transformed their way of life on a grand scale, as Chris Lee explains.

LUF Lounge
Read the full feature in DDN Magazine

We are all living with significant changes as a result of the threat posed by COVID-19. For some this is just another factor in busy lives, for others it’s a real threat to a safe and functioning lifestyle. The pressures of isolation, worries about money, housing, food, keeping children occupied and all of us safe will be creating untold pressures and risks for some.

The UK recovery movement might have drifted from the popular narrative, however in parts of the country, thriving, diverse recovery communities are adapting to the ‘new normal’. We wanted to highlight how two organisations, Red Rose Recovery/Lancashire User Forum (LUF) and The Well Communities are adapting to support those in recovery and beyond.

Lancashire has had a sustainable and thriving recovery scene for well over a decade. This had led to well-developed peer support structures, training, employment, group work, activities, volunteering and more. All of this is delivered very much as an asset-based community development approach – local people with lived experience supporting other local people with lived experience.

LUF Live LoungeThe Old Normal

In the current circumstances, some ‘normal’ work is still ongoing, albeit under the guidance of physical distancing, use of appropriate protective equipment and essential journeys:

  • In the early days of lockdown donations of food and toiletries from high street retailers were delivered to the elderly, homeless and vulnerable, along with packs from Lancashire Fire and Rescue Service.
  • Volunteers have been supporting the delivery of more than 600 meals a day to feed individuals who are vulnerable, isolated, quarantined or shielded in local communities; information about digital support is distributed through the food parcels.
  • Local treatment providers have been supported to deliver naloxone and safe storage boxes
  • Support has been given to individuals in recovery housing.

However, with no face-to-face mutual aid running and normal peer support ‘suspended’, a dramatic shift to digital provision has been implemented locally to do all we can to ensure no one is left behind. Both Red Rose Recovery and The Well Communities have rapidly embraced digital tools and shifted support online within days of the UK lockdown coming into force. This emphasises the flexibility of community organisations and the principle of building delivery around those who use them.

This isn’t perfect, but sharing the learning has been key to the success of recovery communities locally. One simple issue has been to try to buy mobile phones and credit for those with no resource and therefore at risk of isolation, or to actively support people to download software and give tutorials to support access.

The New Normal

Employed workers and volunteers in the recovery communities are desperate to help those in need in any way they can. It took a while to get them to recognise the severity of the situation, the risks involved and to adapt to new ways of working. However, now as always, they have proved how they adapt quickly and develop new skills to enable work to continue safely.

The ‘new normal’ is being supported with daily team Zoom meetings (other platforms are available), and regular outreach is now via telephone and social media platforms and tools – WhatsApp and Facebook. This aims to replicate as far as possible the principles of pre-COVID delivery but with the added bonus that group work is now open to all without geographical restrictions.

Since the lockdown began:

  • more than 15 online support groups are running each week with regular participation
  • live exercise classes (weekly) achieve around 100 views per session and active participation
  • recovery shares (weekly) are viewed by up to 500 people
  • live topic broadcast (with field experts) are viewed by up to 700 people

Both organisations have also inadvertently created ‘flagship’ broadcasts. Red Rose Recovery and the Lancashire User Forum developed the ‘LUF Lounge’ on Saturday evenings at 5pm – hosted on Zoom and broadcast to Facebook as a live stream. The Well have been using Facebook to live stream for broadcasts on Monday and Friday each week at 12 noon. Both events have drawn in both local and national figures to update, educate, support and entertain our recovery communities.

Both organisations have been collaborating to share experience of the technology, to support each other’s approaches in reaching out and provide meaningful content for the local recovery communities – and beyond. Digital delivery has meant reaching recovery communities in Wales, Australia and New York!

New partnerships are appearing as a result of the new digital world, for example working with local housing providers to support delivery of food parcels in the physical world and support them to access the online offer.

LUF Live LoungeThe Lessons

What are we learning as a result of all this?

  • Isolation and mental health have been key issues raised, especially from those in supported housing as they are almost confined to their bedrooms (although we know that not all are keeping to lockdown rules and meeting up with friends etc).
  • People are struggling when they are unable to see their children and other family members; this is also undermining some people’s mental health.
  • There is a perceived increase in relapse; local treatment provision has seen an increase in referrals.
  • Another key concern is that those who have experienced crime, assault or dispute are desperate for personal contact, something no digital transformation can ever overcome.
  • Facebook and Twitter followers are rapidly increasing alongside significant increases in requests for support.
  • The beauty of digital is that the analytics are available to help inform reach. We can see an unprecedented surge in views with a global reach from the broadcast events so far.

The future

This has yet again highlighted the inherent value of community organisations and community participation. It has shone a light on the need to address digital inclusion and ensure people have access to the right tools to enable participation, alongside other existing social, economic and health inequalities.

Plans are currently being developed to build on these early developments and to bring along other groups who wish to join in, to build digital inclusion, develop the new digital skills and embrace what technology has to offer. This will include technical, social and policy development needs.

The future is clearly unknown. When will lockdown measures begin to ease, how will that happen and what restrictions will remain? All are questions that society as a whole will be grappling with. What is certain is that the digital shift in delivery for recovery communities locally is here to stay. Yes, the physical world is important and digital cannot replace much of ‘normal’ recovery activity. However the ability to reach out beyond borders (of whatever sort), to share stories, experiences, music and thought in times of crisis is aided by digital platforms. The increased connectivity is making a difference, for example people who suffer with anxiety or those living in rural communities. We can’t just go back to ‘normal’.


FIND OUT MORE

Chris Lee is public health specialist at Lancashire County Council

chris.lee@lancashire.gov.uk

Peter Yarwood, strategic engagement lead, Red Rose Recovery, peter@RedRoseRecovery.org.uk

David Higham, CEO, The Well Communities, dave@thewell2.co.uk

LUF Lounge: www.facebook.com/groups/279396408828996

The Well Communities: www.facebook.com/groups/thewellcommunities/

DDN May 2020

‘We’re learning about new versions of outreach’

WE’VE HAD TO CHANGE OUR PLAN for this issue several times this month as your news and survival tips have been coming in.

DDN May 2020The good thing is, it’s not just about business as usual – it’s become about being better than usual. Not only are we hearing about swift action to keep essential services maintained – we’re also learning about new, enhanced versions of outreach, where service users are an essential part of developing and maintaining the model.

Tweeting their invitation to the LUF Lounge on a Saturday night, Red Rose Recovery offer ‘community and connection with a whole heap of compassion’ and this spirit is playing out through the Lancashire recovery communities, with their ‘dramatic shift to digital provision’ (page 8). Particularly exciting are the partnerships that are forming from this ‘new digital world’.

Last month we raised the issue of delayed scripts through a ‘plea from the pharmacy queue’ and there’s been a lot of hard work going on to improve the situation. The clinical and prescribing team at Humankind are among those working round the clock to ensure no one is ever without medication (page 13).

Carry on the great work and new ideas – and share them with us! Community means more than ever right now.

Claire Brown Editor of DDN magazine
Claire Brown, editor

Keep in touch claire@cjwellings.com and @DDNmagazine

Read the issue as an online magazine or download the PDF

Staying on track

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What does COVID-19 mean for hepatitis C elimination plans in London? Dee Cunniffe gives an update.

Dee Cunniffe, LJWG project lead
Dee Cunniffe is LJWG project lead

Two months ago, on 2 March, senior leaders from across the NHS, addictions sector and public health in London came together at City Hall to kick start work on a new routemap to eliminate hepatitis C in the capital. The World Hepatitis Alliance hailed the partnership as ‘an example of best practice that could be replicated in cities across the world’ and support for this initiative from every connected sector in London has been impressive.

However, just days after our ‘kick start’ event, the enormity of the impact of COVID-19 started to unfold. That seems like a lifetime ago now, and since then the NHS has completely reconfigured to create capacity for coronavirus patients, and all outreach and addictions support services have had to adapt to supporting people remotely.

So, where does that leave our plans for eliminating hepatitis C? While people who had started treatment are being supported to complete it and become hepatitis C free, outreach testing and treatment initiations have paused in most places, and some hepatologists have been redeployed to COVID wards.

We know this is not forever and Matt Hancock has already started talking about the restoration of other NHS services. This will require substantial service reconfiguration in many places and will take several weeks, maybe months for some areas.

Reception for Routemap to Eliminate Hepatitis C in London
Reception for Routemap to Eliminate Hepatitis C in London

Creativity and fresh thinking will be required to ensure that healthcare challenges, such as finding the undiagnosed people who are living with hepatitis C, are not worsened in the long term due to this crisis. For example, we will need to think more creatively about how we raise awareness and provide information and support online, and whether self-testing could be used, as it has for HIV.

The steering group for the routemap brings together senior representatives from Public Health England, local government, NHS England, addictions service providers, homeless services, CCGs and The Hepatitis C Trust. While many of these people and their organisations are completely focused on combatting COVID-19 at the moment, they are all also deeply committed to the goal of eliminating hepatitis C. No one wants progress made in addressing hepatitis C to be another victim of COVID-19.

There is one thing that has been constant in my experience of working in the hepatitis C field for the last ten years: progress has always been built on the passion and dedication of an army of incredible people, from people with experience of living with hepatitis C to nurses, consultants, addictions support workers, and many more. I know that we will all rise to the new challenges and, as a ‘new normal’ develops, ensure we continue to make progress to our goal of eliminating hepatitis C.

Key Areas for Action

Five Key Areas for Action

The routemap to eliminating hepatitis C in London has five key areas for action – raising awareness, engaging with people who are under-served by traditional health systems, working with GPs to find the undiagnosed, making pathways as quick and easy as possible, and aligning hepatitis C and HIV Fast Track Cities Initiatives.

Read more at www.ljwg.org.uk/news

More reports and updates from DDN on the work of the LJWG

Remembering Simon

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Tributes have been paid to Simon Morgan; Change Grow Live recovery worker, DDN volunteer, and a much-loved member of the Stratford-upon-Avon music scene, who was an inspiration to family, friends and colleagues.

Simon Morgan, 57, from Norton Lindsey, Warwickshire, died after a road accident on Friday 3 April. He was out cycling when the accident involving a tractor happened, near Balsall Common. He was taken to hospital but died later that evening.

Simon was much loved by his friends and colleagues. His closest friend and his colleague Chris Jennings gave us an insight into the ‘real’ Simon.

They became friends in teenage years and stayed close ever since. Chris was a member of The Fragiles at the time Simon was in Domestic Bliss and the pair properly joined forces in The Suspects, a band that featured in the Easter 1982 edition of The Herald’s Focus magazine.

Simon and Chris formed The Hop in 1983 and early work features Chris on vocals. Chris would then move to London, but the pair kept in frequent touch. Chris recalls: ‘He would visit, call me and send letters with home-made mix tapes on cassette. Over the years we’ve been through everything together, holidays, good times, bad times and played at some of the most dubious venues in London.

Domestic Bliss - Simon Morgan
Hear Domestic Bliss on Youtube

‘He was a prolific songwriter, still putting down ideas shortly before the accident. He was one of the most intelligent and articulate people I’ve ever met. He was a prolific journalist with exceptional literary skills, widely recognised as an expert in his field with the ability to produce thousands of words effortlessly. He was also interested in and highly knowledgeable about art, politics, ancient history, megalithic remains and their surroundings – indeed, there wasn’t much he didn’t know about, and his energy and output was unreal.

‘He was a musical expert and was still listening to everything from avant-garde jazz, pan pipes and punk to reggae, French hip hop and more recently, the sounds of Bristol’s Ossia and Young Echo.’

Alongside the shared love of music, they had been working together in recent years for Change Grow Live, with people recovering from drug and alcohol issues. Simon’s previous roles had included being part of his father’s firm working on exhibition electrics but he then went late to university and graduated as a social worker, quickly moving into recovery work.

‘He was a key player in treatment services and he was a pioneer,’ says Chris. ‘He was a champion of the underdog and was never afraid to challenge authority.’ But at the same time other enduring qualities shone through to all who knew him. ‘He was also one of the most loyal, sensitive and caring human beings I have ever known,’ he said.

‘As Simon’s manager, I only knew him for six months, but I was enormously impressed by his contagious passion,’ added Change Grow Live team leader, Paul Woods. ‘What a wonderful guy, who had a profound impact on me in the short time I knew him.’

DDN adds…

For years we have been indebted to our team of volunteers for helping us stage the DDN Conference. Whenever we think about this role we will always remember with gratitude and affection the star that was Simon Morgan, who cheerily, competently and without fuss coordinated a superb effort on our behalf, meeting and greeting delegates, then helping them find their way around throughout the day. Simon’s cheery band of colleagues was a credit to his ‘can-do’ style and charisma. The picture was taken in March, on a visit to The Glee Club, when Simon brought some of his group to look around the venue and go through logistics for the conference. We larked about not knowing that the event would be postponed – Simon was going to compere the entertainment programme and sing with his guitar.

Simon felt like one of our team members and we will miss him very much. We know how hard it will be for those who called him ‘the heart of the recovery community in Coventry’. Our sympathies to his family and many friends. DDN

Home from home

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Keeping the home ties strong is one important way that Phoenix Futures keeps their residents’ motivation high, says Liam Ward

Aligned with government guidance – and as with other registered care homes – our residents are currently unable to receive visits from their loved ones. We know that these connections are really important; in a recent study, more than 60 per cent of our residents told us that repairing relationships with loved ones is one of the most important and motivating factors behind their recovery. 

Evidence confirms that visits are conducive to improved outcomes throughout treatment and emphasises how a regular structure of contact with loved ones can provide a welcome balance to the hard work required throughout residential treatment. 

COVID-19

COVID-19 has meant that elements within our programme have had to be adapted to ensure the continued safety of everyone in our care. Without visits we wanted to ensure we supported our residents to keep connected with their loved ones, and our services have certainly done that! 

Access to WhatsApp, FaceTime and Skype video calling software has been increased as well as the availability of the service telephone and, where appropriate, residents’ own personal devices too. Additional time is given for those wishing to contact families and children. 

family look at tablet
Mobile apps help to keep residents in touch with their families.

Further to this, services are being innovative and finding ways to keep families updated, connected and reassured that their loved ones are being cared for. 

Our Wirral Residential’s choir has been singing and sharing videos on social media, including their closed community group on Facebook. This has allowed family members to watch their loved ones looking well and enjoying activities. Family members commented that it was amazing, and that they were proud. They also said how good it was to see them doing so well. 

The residential community responded by creating video messages that were shared, and in turn received heart-warming and motivating messages such as ‘you’re doing great’, ‘love and miss you’ and ‘keep up the good work’, which were passed onto them by staff. 

Sense of achievement

Lee B has been with us in our Wirral Residential since January and told me how he FaceTimes his son twice a week but misses having visits. ‘I can’t wait for the restrictions to be lifted so he, my mum and my nan can come,’ he said. ‘They’ve been going on the Facebook site and writing comments. It makes me feel really proud of myself. It gives a sense of achievement and reminds me why I’m here.’

Phoenix Wirral Choir
Wirral Residential’s choir has been singing and sharing videos on social media

 

I asked how Lee felt after hearing from his family. ‘I feel sad for a short time because I’m missing them,’ he said. ‘But after I reflect on it, reflect on the reasons I’m here, it makes me feel good seeing them smile and feeling like I’m achieving something with my life. 

‘If I was still out there, I’d be dead,’ he added. ‘I used to be isolated, I suffered from anxiety, I was paranoid. I would have spiralled. I was out of control. Now I’m healthier. I’ve got colour back in my skin and colour back in my life.’

Lee A was admitted in late March after the lockdown had been announced by the government. He spoke about his initial feelings upon entering rehab during this time, and spending his first few days separate from the community as part of our screening process for new admissions. 

‘It was the way it had to be,’ he said. ‘I had company with the other new admissions, and we all kept a social distance. Staff were fantastic. They kept us engaged, kept us entertained. When that was over I was excited to go into my first meeting, but I hadn’t mentally prepared myself. The community were so welcoming and understanding though, I warmed to everybody.’

Lee A went on to discuss his relationship with his family, and his feelings around being away from them. ‘I hear from my mother, my grandparents and my sister about two or three times a week. It’s strange for me to hear them say things about me like “I’m proud” or “well done”. I pushed these people to the ends of their tethers. It’s been hard to explain to people what I’m feeling, but here (in rehab) we can all relate to each other.

‘Yes, I want to see them, but we all respect the rules, it’s for our safety and for others. [When we were addicted] we were selfish, we didn’t care, but now we feel empathy, we worry about other people,’ he said. ‘Now more than ever we understand these rules, we don’t want to hurt anybody. It’s beautiful to have that part of us back, something missing all those years.’

Lee A continued ‘My family notice a difference in me. They hear it over the phone. I didn’t make sense in the past when I spoke. I’d go too fast and lose my point but now I’m concise and well mannered, I have confidence in my voice. My family have told me it’s lovely.’

‘We’re in the best place’

Dave C arrived with us in December. He spoke about those he misses most and gave his thoughts on the impact of COVID-19 on his and their lives. ‘It’s been tough because my mother has no immune system. She visited me before the lockdown. I can’t help worrying it was the last time I’m going to see her. It’s always in the back of my mind.’

Dave speaks on the phone to his mother several times a week, as well as other members of his family, who keep him abreast of their activity – or lack of it, in some cases. ‘People outside are bored. We’re in the best place because we’ve got the community. The boredom can’t set in,’ he said. ‘I love being here. It’s one big happy family.’

Dave went on to speak about the impact of the staff team on his experience whilst being in rehab, particularly at this difficult time. ‘The staff are fantastic. What they’ve done for us is above and beyond. Loads of services are closed down and can’t take admissions. They’re a fantastic bunch of people. After I leave, I want to get my health and social care education. I want to be part of this team.’

His feelings were echoed by his peers. ‘I’m so grateful to the staff here. They’re doing everything they can – putting on activities for us, making plans for families to visit once restrictions are lifted. I respect them for putting their lives at risk,’ said Lee B.

‘I speak to my family every night’

David F, a resident at our Scottish Residential service in Glasgow, added, ‘Staff have been brilliant. They’re worse off than us out there. They’re out there on their days off, some of them alone, then they come in and they’re positive, encouraging and determined.’

David is the most senior member of the community in Glasgow, having been with us since September 2019. As a result, he is looked to as a role model for other residents and is allowed certain privileges to reflect his progress. One is more regular access to his phone, which he uses to call his family.

‘Before treatment, communication with family was terrible. They’ve always been supportive, but we never really talked. Now I speak to different members of my family every night. I speak to my mum, my aunt, my daughter, and even my brother who lives in Australia,’ he said.

‘They tell me it’s hard, but they don’t tell me how they’re feeling. They might have a sense of making me feel like I need to go. They tell me a bit but just encourage me mostly.’

David went on to reflect on his feelings towards the current situation around coronavirus, and the effect it has had on him and his programme. ‘We get updates on how it’s going on, but because we aren’t out there and experiencing it I think we’re a little sheltered, so maybe we don’t realise the gravity of the effect on the rest of the world. We see it on the news but we’re not living it.

I was going on home visits before all of this and having face-to-face contact. My mum was coming to family support groups. Even though that’s been taken away, I’m trying to take a positive out of it. It’s time to build up more strength and have more chance of recovery.’ 

Liam Ward residential marketing manager for Phoenix futures
Liam Ward is residential marketing manager for Phoenix

Across the country, the feelings in our services follow a consistent thread. Times are hard, but those with us are in a safe place and are supported by others in their residential communities. There is a tremendous sense of cohesion and unity between those in treatment and the dedicated staff teams supporting them. 

Dave C likened the feeling to the mantra of his beloved football team, Liverpool – ‘This means more’. ‘It runs through this house,’ he said. ‘You can see it in the faces of all these amazing people around you.

 

Gambling firms suspend TV ads during lockdown

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British betting firms will voluntarily remove their TV and radio advertising during the COVID-19 lockdown, the Betting and Gaming Council (BGC) has announced.

Existing advertising slots will be replaced by ‘safer gambling messages’, donated to charity or removed, says the council – the industry body representing betting shops, casinos and online gambling companies. 

Ray Winstone
Actor Ray Winstone is the face of Bet365’s TV advertising campaign

The changes will come into force no later than 7 May and stay in place until at least 5 June, and will only be reviewed when lockdown restrictions are relaxed. BGC members account for around half of all gambling advertising on TV and radio, and the council says it hopes other operators will follow suit. Direct marketing via social media, text or email by its members has also dropped, the council says, with members committing to ‘further increases in safer gambling messages online’.

Overall gambling levels have fallen since the lockdown began as a result of betting shops and casinos closing and the suspension of live sporting events, says BGC.  

‘This major announcement by our members will result in the removal of half of all product advertising on TV and radio,’ said BGC chief executive Michael Dugher. ‘I hope now that other major gambling operators like the National Lottery follow our lead. We have been working closely with our member companies since this crisis began to monitor the impact of betting and gaming. There hasn’t been an explosion in people betting online as some had predicted – in fact, the opposite is true with total revenue down by up to 60 per cent.’

DDN Gambling and Health
DDN’s guide on gambling addiction helps identify problems and guides you through the available treatment options.

 

RSPH Survey

Meanwhile, the Gambling Commission has issued advice on how gambling companies should keep consumers safe during the COVID-19 outbreak, and the Royal Society for Public Health has designed a confidential survey on behalf of the Gambling Health Alliance to help understand what impact the lockdown is having on those vulnerable to gambling related harm. 

 

 

Gambling Commission guidance at http://www.gamblingcommission.gov.uk/home.aspx

Survey at

https://www.surveymonkey.co.uk/r/L9HBYBT

Online COVID-19 support tool launched in Scotland

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A new online tool to help people stay up to date with changes to treatment and pharmacy services during the COVID-19 outbreak has been launched by the Scottish Drugs Forum (SDF), We Are With You and Scottish Families Affected by Alcohol and Drugs.

Pharmacies and treatment services can submit weekly updates, which are then shared through the lead organisations’ websites and social media channels. The database can also be accessed in the form of a user-friendly map, to allow people to see what is available close to them.

‘It has been a real team effort to create a map of all Scotland’s drug and alcohol services’ revised arrangements during the COVID-19 lockdown,’ said We Are With You Executive Director Andrew Horne. ‘People can now see, at the click of a button, which services are being delivered across the country. Whether it’s new arrangements for emergency one-to-one support, or injecting equipment delivery services, people can get accurate information from a central source. We can all get through these times if we work together and look out for each other.’

The tool would complement the Scottish Drug Service and Needle Exchange Directory websites, added SDF CEO David Liddell. ‘It has been a cause of great concern to hear that some of the most vulnerable people in our society have not been able to access basic support with their drug problems during a particularly challenging time for all of us. This tool will ensure that services and people with drug problems have access to real-time information on current service provision.’

Tool available at www.sdf.org.ukview it here

Substance misuse staff eligible for testing

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People working in drug and alcohol treatment are among those now eligible for coronavirus testing if they develop symptoms, the government has announced.

While testing patients remains the government’s priority, the Department of Health and Social Care (DHSC) has expanded the list of professionals who can be tested to include all NHS, social care and community pharmacy staff, as well as people working in voluntary sector organisations providing substance misuse support, prison and probation staff, and people working with the homeless, rough sleepers, vulnerable children or vulnerable adults.

Testing will allow people unable to return to work because either they or a member of their household have symptoms ‘to know whether they do have the virus’, says DHSC, and advises any worker on the list who would like to be tested to speak to their employer. ‘The list is not exhaustive and local and regional areas can refer other frontline workers in their area for testing as determined by need and available capacity,’ it adds. The categories only apply to England, and the lists for devolved administrations may vary.

Matt Hancock: Allowing vital workers to return to the front line

The scale of testing in the UK has been a controversial issue throughout the COVID-19 crisis, with the government’s target of carrying out 100,000 tests a day by the end of the month deemed ‘impossible to reach’ by some scientists.

‘I am determined to ensure that everyone who needs a coronavirus test should be able to have access to one,’ said health secretary Matt Hancock. ‘Today’s expansion of testing will allow even more vital workers to return to the front line. We have built up capacity in the system with new testing and diagnostic facilities backed by Britain’s world-class scientists and industry partners. This means we are now able to give even more workers who support and protect us the ability to know if they have coronavirus if they have been demonstrating symptoms.’

 More information at www.gov.uk/guidance/coronavirus-covid-19-getting-tested

Coronavirus guidance issued for providers and commissioners

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New guidance for commissioners and treatment providers during the COVID-19 outbreak has been issued by Public Health England (PHE) and the Department for Health and Social Care (DHDC).

While services don’t need to close they should be taking steps to ‘keep face-to-face contacts between staff and service users to a minimum’ and minimising use of biological drug testing, it says. 

naloxone kit
Provision of harm reduction measures and take-home naloxone, should be increased where possible

Given the pressure the on NHS and other services it will ‘mostly be necessary to defer drug detoxes, especially inpatient’, the guidance states, as well as scaling back testing for hep C. Provision of harm reduction measures such as NSP and take-home naloxone, however, should be increased where possible, while arrangements for prescribing and dispensing will need to change to take account of social distancing, pharmacy closures and staff unavailability. 

Providers, commissioners and pharmacies should be as ‘flexible as possible, within the legal framework, to support the safe delivery of OST’, it states. Services should be transferring ‘most, if not all’ patients from supervised consumption to take-home doses, and providing them with up to two weeks’ worth of take-home supply where possible. Anyone advised to self-isolate asked to nominate someone to collect medicines on their behalf. 

Services should also be increasing the amount of stock held by NSPs, allowing people to take more equipment or ‘providing packs with more equipment in them’, it says, as well as increasing outreach and peer-to-peer supply ‘with appropriate social distancing’. The ‘usual expectations’ on services for monitoring, reporting, performance management and contract re-tendering, meanwhile, should be scaled back to focus on delivery.

Service users should be told not to turn up without an appointment, and staff should contact them before their appointments to check if they’ve developed symptoms. Providers should also liaise with local hospitals to ‘ensure they are aware the symptoms of COVID-19 may be confused with withdrawal symptoms in a dependent drug or alcohol user’, the guidance adds. ‘It is important that anyone taken to hospital and showing symptoms that could be either alcohol or drug withdrawal or COVID-19 is managed as if they have COVID-19, unless and until the results of testing show otherwise.’

New ways of working during the outbreak, such as contacting service users by phone or video call, may also ‘bring to light new information about a service user’s home life’, it says. ‘If staff discover a service user is living with children, or see that a service user with children is now struggling to cope, they should consider whether the family would benefit from further support from their local Early Help service, community food banks and other resources.’ Staff should also be monitoring safeguarding issues, and note that referrals to children’s social care services may be appropriate in cases where children are having to take on ‘inappropriate caring roles’. 

Providers should also be monitoring reports of adulterated or unusually strong drugs or any unexpected effects, the document stresses. ‘If usual drug supply routes are affected, there is a risk that alternative substances will be sourced and sold. Cases should be reported to drug.alerts@phe.gov.uk.’

COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol at www.gov.uk 

 

Regular drinkers consuming more during lockdown

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Almost 20 per cent of daily drinkers are consuming more alcohol during the coronavirus lockdown, according to research commissioned by Alcohol Change UK.

However, while more than a fifth of drinkers overall are now drinking more often, one in three are either drinking less frequently or have stopped completely, with the lockdown changing the way people drink ‘at both ends of the scale’. 

pic by www.quotecatalog.com

The survey, of more than 2,000 people, suggests that 14m UK adults are either drinking less often or not at all, while just under 9m are drinking more frequently. Almost 40 per cent of current or past drinkers said they were taking steps to manage their drinking, suggesting ‘an awareness that lockdown might lead us to drink more frequently or heavily and that many are keen to keep their drinking healthy’, the charity says. 

Reduced consumption

People who were already drinking the least are more likely to have reduced their consumption, the survey found – almost half who drank once a week or less have cut down or stopped, compared to 27 per cent of those who drank between two and six times a week and 17 per cent of daily drinkers. ‘Worryingly’, 18 per cent of daily drinkers are now drinking more, it states. 

DDN alcohol and Health
DDN Alcohol and Health provides a clear and detailed overview of the risks of excessive drinking.

Around 7 per cent of respondents also said they were living in a household where drinking – either their own or someone else’s – had worsened tensions, rising to 14 per cent of those living with children. The figures supported what Adfam had ‘been hearing from families,’ said its chief executive Vivienne Evans. ‘Family and household members are largely unrecognised victims of the harm alcohol can cause; at the best of times they suffer emotional and physical distress, and feel isolated because it’s not easy to own up to having a heavy drinker in the household.’

Just under 10 per cent of the survey’s respondents said they were being ‘careful’ with the amounts of alcohol they bought, 14 per cent were making sure they had drink-free days and 6 per cent were not drinking at all. People were also turning to online support, with 4 per cent seeking advice, 3 per cent accessing remote support groups or receiving one-to-one counselling and 2 per cent using apps to monitor their consumption. 

Extensive research

‘This is the most extensive research yet into drinking during lockdown and it shows that this unprecedented period is having a significant impact on the way the UK drinks,’ said Alcohol Change UK chief executive Dr Richard Piper. ‘More than one in five of us are finding ourselves drinking more frequently in lockdown; many of us use alcohol as our go-to stress reliever, and in this very stressful time it’s not surprising that we might find ourselves reaching for a drink more often. But at the same time people across the UK are rising to the challenge by taking steps to manage our drinking. More than a third of us are putting in place ways to keep our drinking in hand, ranging from taking drink-free days to using online support groups. We want to come out of lockdown as mentally and physically healthy as we possibly can, and managing our drinking is an important part of that.’

Professor Ian Gilmore


The lockdown period would be difficult for many dependent drinkers and those in recovery, added chair of Alcohol Health Alliance UK, Professor Sir Ian Gilmore. ‘If you are concerned about your drinking or the alcohol consumption of someone you know, make sure you reach out for help.’

 

London rough sleepers housed in hotels

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More than 1,000 homeless people in London are now self-isolating in hotels and other locations during the COVID-19 outbreak, according to the mayor’s office.

Homeless person.

City Hall has been working with the government and charities to block-book rooms across hotel chains including Best Western, Travelodge, InterContinental and Accor. Specialist rough sleeper support is being overseen by St Mungo’s, while Change Grow Live is providing substance misuse support for those who need it. Anyone developing symptoms of COVID-19 will be referred to a specialist facility in a hotel in east London. 

The operation is being funded by a £10.5m grant from the mayor and the Ministry for Housing, Communities and Local Government. The government had previously written to all local authorities instructing them to find emergency accommodation for rough sleepers by the end of March (DDN, April, page 4).  

Official figures from three years ago put the number of rough sleepers in London at just under 1,000, although the Combined Homelessness and Information Network (CHAIN) – which is managed by St Mungo’s – said the total number of people seen sleeping rough in the capital by outreach workers was closer to 8,000 (DDN, February 2017, page 4). 

Sadiq Khan

Sadiq Khan
London mayor Sadiq Khan

‘As we approach the peak of the coronavirus pandemic it is more important than ever to ensure the most vulnerable Londoners are supported in clean, secure accommodation,’ said mayor Sadiq Khan. ‘I’m proud that this outstanding coalition of compassionate organisations, charities and individuals have stepped up to the challenge. The speed with which we have acted, and the willingness of multinational companies to work with us at this critical time, is testament to what can be achieved when we work together.’ There was however, more to do, he stated. ‘More money, volunteers and hotel rooms will be required.’

Round the clock support

‘Our teams are working round the clock to support over 1,000 people who were living on the streets or in emergency hubs into hotel accommodation in London,’ added St Mungo’s chief executive Howard Sinclair. ‘Thanks to the GLA and other partners, these vulnerable people are now in a place where they can self-isolate in safety, and are out of harm’s way. We begin to look beyond the crisis and work out next options for people when they have to leave their crisis accommodation. This will enable us to ensure that support and housing is available to anyone at risk of sleeping rough so people have a home for good.’ 

SIG Joins the Fight Against Coronavirus

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In partnership with Guys and St Thomas’s Hospital, the Social Interest Group through SIG Equinox joins the direct fight to help people recover from COVID-19.

Until the Pandemic is over, we will be welcoming people who are being discharged from Guys and St Thomas hospital and are recovering from COVID-19 into our Brook Drive service. These patients, who are deemed medically fit for discharge but are either homeless or vulnerable, will be supported to get well, and have the necessary arrangements put in place for them to safely return home or into stable accommodation. 

This is a temporary change to our normal service at Brook Drive and we will still provide limited residential detox where it is critical to life.

Speaking about this change, Gill Arukpe, CEO of the Social Interest group said, ‘The Board and I made one of the toughest ethical decisions we have had to make together.’

Gill Arukpe, CEO of the Social Interest group
Gill Arukpe, CEO of the Social Interest group

‘We decided it was ethically right to ask the staff team at Brook Drive to temporarily change who they worked with in response to the biggest public health issue we, as a country, have faced in our lifetime. The staff in Brook Drive, working together with our partner, Villa Street GP practice, are amongst the most professional and dedicated team of nurses, recovery workers, cleaners, admin workers and cooks any CEO could wish for.

They save lives daily and I know they will continue to do so in the coming weeks and months. It is an extraordinary day for the SIG Equinox staff team and I am so proud of everyone within the Social Interest Group for stepping up and proactively fighting back against this devastating virus. We are stronger together and I hope anyone reading this will join me in celebrating our teams of dedicated staff during this crisis.’

socialinterestgroup.org.uk


DDN magazine is a free publication self-funded through advertising.

We are proud to work in partnership with many of the leading charities and treatment providers in the sector.

This content also appeared on The Social Interest Group’s site.

 

 

 

 

 

Pharmacists allowed to dispense methadone without prescription

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Pharmacists are to be allowed to give out methadone, buprenorphine and other medicines containing controlled substances such as opioids or barbiturates without a prescription during the COVID-19 pandemic. The home secretary wrote to the Advisory Council on the Misuse of Drugs (ACMD) earlier this month asking them to urgently review emergency measures that would ‘ensure patients continue to have access to medicines, build resilience and help relieve pressure elsewhere in the health system caused by COVID-19’, the government states.

Priti Patel: Asked the ACMD for an urgent review

The proposed measures, which were developed by the Department of Health and Social Care (DHSC) and the Home Office, are to enable registered pharmacies to supply controlled drugs without a prescription where patients have been receiving the medicines as part of ongoing treatment, allow them to vary the frequency of dispensing for an instalment prescription, and extend the Serious Shortage Protocols (SSPs) to include controlled drugs in Schedules 2, 3 and 4 (Part I) of the Misuse of Drugs Regulations 2001.

The government has assured the ACMD that the measures will only relate to NHS services and that controlled drugs would only be supplied by registered pharmacies regulated by the General Pharmaceutical Council and at the pharmacists’ ‘professional discretion’. Cases where there is ‘insufficient information available to dispense safely’ would be referred back to the original prescribing service. The National Crime Agency (NCA), National Police Chiefs Council (NPCC) and HM Prison and Probation Service have been consulted and view the risks of diversion as ‘outweighed by the need to continue to supply medicines to those in need’.

The ACMD is ‘generally supportive’ of the measures, says the reply from its chair Dr Owen Bowden-Jones, given the exceptional circumstances and the potential risk of discontinuity of supply. ‘However, pharmacists will require additional support and guidance, as they will be working outside of the scope of their usual practice,’ the letter states. The ACMD has recommended that national-level guidance be issued in consultation with the relevant royal colleges and professional bodies, and notes that the measure ‘would be associated with a greater risk of misuse and diversion’ for patient groups requiring OST or opioid pain medicines.

Owen Bowden-Jones: Pharmacists will need support to work outside normal scope

‘Patients with substance misuse issues might attempt to place pressure on a pharmacist to dispense in accordance with this measure, or might visit a range of pharmacists in an attempt to locate and exploit weaknesses in any of their practices in order to be supplied with medicines against best practice,’ the letter states. Risk assessments by pharmacists will need to be documented and recorded, the prescribing service notified and ‘rigorous’ ID checks carried out, it stresses.

People will need to be able to safely store medicines in locked boxes and have access to take-home naloxone, the document adds, as well as be able to maintain regular contact with the professionals responsible for their prescriptions. ‘Pharmacists will also need to be supported by the original prescribing service to minimise the risks associated with this measure, which include the possible increase in risk of drug-related death,’ it states, and stresses the importance of ensuring that the measures ‘do not extend any longer than is necessary’.

Shared perspectives

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Having had to postpone his trip to the DDN conference, Bill Nelles reflects on the differences in drug policy between the UK and his Canadian home.

Bill Nelles harm reduction activist
Bill Nelles is an advocate and activist, now in Canada. He founded The (Methadone) Alliance in the UK

Sometimes things happen in life that force us to change our plans, but it’s especially hard to miss a planned journey. I’m writing, of course, about the COVID-19 virus that forced the postponement of the DDN conference, which I was planning to attend in order to talk about the ‘overdose crisis’ in Western Canada where I now live. I was particularly annoyed because I was looking forward to being back home in the UK and seeing dear friends and colleagues.

I’m never sure how many UK users and drug workers remember me when I lived and worked in London, but there’s a good chance that if you were working or using from the mid ‘80s to 2004, you heard me training about AIDS, drug treatments, overdoses and user involvement.

Here in Canada we don’t have any national publication like DDN that gets to users and professionals alike. DDN’s February editorial, and its article about Vancouver, reminded me how good it is to read sound and unambiguous editorials and articles that say what they mean and don’t pull their punches. The issue had excellent content on the increasing level of danger to users from contaminated supplies. Jussi Grut’s article described the five-fold rise there has been in fatal overdoses in British Columbia (BC) since the street supply has become contaminated by cheap and often poorly made synthetic opioids like fentanyl and carfentanyl. The already high number of overdose deaths here suddenly climbed steeply from just over 400 in 2014 to 1,600 in 2018, in a province with only 3m people.

2016: Vancouver’s Downtown Eastside neighbourhood, a mural highlighting fentanyl-related drug deaths Credit: Gerry Rousseau/Alamy
2016: Vancouver’s Downtown Eastside neighbourhood, a mural highlighting fentanyl-related drug deaths Credit: Gerry Rousseau/Alamy

I also wanted to express the same fears that I felt in 1985 that something bad was on the horizon. Something that could, and should, change the balancing trick we cling to when keeping a safe drug supply just out of reach of the people who need it, and who may live or die depending on reaching such services. Nowhere is this more evident than in the cohort of around 500 people in Vancouver who have access to clean pharmaceutical heroin, or hydromorphone. Hydromorphone isn’t used a lot in the UK but it’s kind of like North America’s legal heroin. It’s also much cheaper than importing heroin from Holland.

This group has had no direct overdose deaths, because of course they don’t need to use the poison on our streets. Massive publicity and easy availability of naloxone kits have also helped hundreds to reverse their overdose and stay alive. I planned to outline the differences between UK and Canadian services. I remembered DATs and DAATs, which we have never had here, but which are often envied. Then I heard they have gone the way of the dodo, with no ring-fenced drug funds any longer. My reaction was like Charlton Heston’s at the end of Planet of the Apes: ‘You fools, you went ahead and did it!’

One thing that is very evident here is the absence of any arguing about whose treatment is better. Users are much more united here. BC has had comprehensive availability of opioid treatments to rival any European programme for five years now, and peer educators are employed by health providers to educate, encourage trust and provide advocacy. The challenge is to scale these services down for people using in rural settings – including many First Nations people, who were living here when Europeans settled in their lands.

There are certainly some shafts of light to mark our progress. Last year saw the first reduction in overdose deaths since 2012, dropping from 1,600 to 1,000. While they remain far above the 400 a year before the crisis, we are getting much better at responding to them.

 

Uncharted territory

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The coronavirus outbreak has transformed almost every aspect of our society at dizzying speed. DDN looks at the impact so far on treatment services and their vulnerable client groups.

Public health experts had been saying for years that a pandemic on the scale of ‘Spanish flu’ in 1918 was long overdue, and there were fears that it had arrived with avian flu and later with the SARS coronavirus in the early 2000s. When COVID-19 hit, however, it was the real deal. The final impact may prove to be far less deadly than 1918, but only time will tell. In the meantime the situation is changing at breakneck speed, with society’s most vulnerable – as always – at particular risk.

The long-term impact on the drug and alcohol treatment sector also remains unknown. The fallout from the financial crash of 2008 led to the prolonged austerity policies that decimated the treatment field, and there is no doubt that COVID-19 will cause a recession – it’s just a matter of how deep and how long. And no one in the field needs reminding that when decisions are made about which groups to spend scarce resources on, their clients tend not to be near the top of the list.face mask and hand wash

But for now there’s an urgent health crisis to deal with. Services know that their older clients are an extremely vulnerable population, and many will have long-term respiratory issues as well as weakened immune systems and overall poor health – both physical and mental. One of the most vulnerable populations of all, of course, is people sleeping rough. Homelessness charities were issuing increasingly urgent messages about the need for clear guidance and warning they would be forced to turn people away from shelters if they presented with symptoms.

When official guidance did come it was swiftly branded inadequate, as it failed to set out how those sleeping rough would be able to self-isolate. The government subsequently instructed local authorities to provide accommodation for all rough sleepers by the evening of 29 March, but days later it was still unclear how many homeless people had yet to be housed.

Treatment agencies meanwhile are acting on government and PHE advice as well as drawing up their own action plans. Peer-led charity Build on Belief (BoB) felt it had no choice but to close in order to protect the health of volunteers, staff and service users. ‘It was an extremely difficult decision,’ chief executive Tim Sampey tells DDN.

‘All our services are London-based so we’re up to our necks in this – Kensington and Chelsea was a hotspot from the start. We’ve always recruited from our volunteer teams, so of course people have underlying health issues across the board. We figured out that two thirds of everybody either volunteering or working for this organisation has an underlying health problem that would put them at risk, and at that point we had no choice but to shut. In many cases we beat our providers to the punch by a day or so – a lot of the messages I got back were, “We were just about to ask you to do that anyway.” I don’t know what it’s like outside London but here it’s just prescribing, basically.’

Covid-19 share
Click for updates from services and the latest news and information on Covid-19

Executive operations director for Humankind, Anna Headley, tells DDN that while staff will self-isolate if they – or family members – have symptoms her biggest worry is the service users. ‘How are they accessing their treatment, whether that be prescribed treatment or an adjunct to that?’ she says. ‘We run a lot of hep C clinics, so their hep C medication for example. And then services are closing down. Everybody’s trying to reduce the footfall into their premises, which is absolutely the right thing to do, but of course you have to manage the risk of that if you’ve had service users on daily supervised consumption. Some pharmacies are no longer offering that service, so what’s the alternative to that?’

BoB intends to offer as much support to people as it can via phone or social media, and is working out how best to make that work. ‘We’re looking at what the rules will be around that,’ says Tim Sampey. ‘I don’t want to put staff in the position where they’re being rung 12 hours a day, seven days a week. But we’re going to try to do what we can remotely.’

‘A lot of our guys who are in recovery rely on our groups and social gatherings that we do to keep sober,’ says Anna Headley. ‘Some group workers who can’t run groups any more have made little videos, anything to try to keep that interaction with service users. We’ve got an amazing team and we’ve set up webinars to train staff in doing remote one-to-one consultations. We also have online counselling with DrinkCoach and we’ve been able to adapt that into regular psychosocial interventions, so that’s working really well, and obviously phone contact. We’re mobilising staff who’ve traditionally worked in big offices and are suddenly home workers.’bus driver wearing a facemask

One significant concern, however, is that many of the people who need support the most – and may already have significant mental health issues that will be compounded by further isolation – will not be able to access it. ‘Lots of people don’t have internet access at home, don’t have a computer or in some cases even a smartphone,’ says Tim Sampey. ‘A lot of our client group are going to be incredibly isolated.’

There are also concerns that over-stretched emergency services may be slow to respond to overdose situations, while anyone who has the infection could be more at risk of respiratory failure during an overdose, and some people have expressed fears that reduced supplies of street drugs as a result of restrictions on movement could lead to potentially harmful substances such as synthetic opioids being added to supplies.

Overall, people who use drugs are being advised to adopt common-sense precautions such as not to share pipes, joints or snorting equipment and make sure they prepare any drugs they take themselves. ‘We’ve tried getting information out to vulnerable groups in a number of ways, including social media, but it’s often the people who are most in need of that information who aren’t accessing it,’ says Anna Headley. ‘That’s the worry.’

There are also the simple day-to-day practicalities of how to get by in a situation like this. For most people, their lives are facing huge disruption and they may be frequently confronted with empty supermarket shelves, but they will be able to cope. That’s not going to be the case for many service users, however. ‘Some people are really vulnerable and don’t have the option of driving around to different shops,’ says Anna Headley.

‘We can buy our way out of this problem, they can’t. If they have a disability and impaired mobility they may find it difficult to access alternatives for their food. It is also a sad reality for some within our client group that, with fewer people out and about, clients begging will have less opportunity for charity in the form of cash donations or food brought to them. This is at a time when local support groups have also closed due to the virus.’

One huge issue for treatment services – as with other organisations up to and including the government – is simply trying to keep ahead of all this. ‘It’s the speed things are changing that caught everybody out,’ says Anna Headley. ‘We had a full business continuity plan set up on the afternoon the prime minister did his first big announcement, and it was out of date within an hour.’

When it comes to the long-term financial impact on a sector that’s already been cut to the bone, however, it’s impossible to predict. ‘We’ve just had the public health grant announcement, which does give me a bit of hope,’ she says. ‘With governments it’s always cyclical, and I hope that they do realise people are at a very low ebb and that they do have to invest. I do try to have a glass-half-full attitude.’

‘I think the wider sector might not be too bad per se, because they’re working with a vulnerable client group,’ says Tim Sampey. ‘I think politically there’s going to be a real pushback on looking after the homeless and people with addiction problems, so I think the wider sector may be a little better protected than we might think. From a BoB perspective it’s going to be tricky for us if we’re not able to open for three or four months. At the moment we’re asking our staff to go and help out at our providers to see what we can do together collectively, but ultimately what can you do? It’s all so far out of your control that I’m trying not to think about it too much.’ 

 

‘Aspirational’ treatment standards published by WHO and UNODC

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A revised edition of the International standards for the treatment of drug use disorders has been published by the World Health Organization (WHO) and United Nations Office on Drugs and Crime (UNODC). All UN member states have signed up to the document, which incorporates the results of extensive field testing.

Originally published in 2016, the aim of the document is to ‘develop and expand effective, evidence-based and ethical treatment for drug use disorders’, with the updated version containing input from service user and advocacy groups. The publication stresses the importance of joint working with health, social care, criminal justice and housing bodies, as well provision across community, in-patient and residential rehab settings. It also promotes the use of evidence-based interventions, provision of trauma-informed women-only services and the importance of using non-stigmatising language.

While the standards are ‘aspirational’ and national or local treatment systems need not attempt to meet the recommendations ‘all at once’, over time ‘progressive quality improvement with evidence-based and ethical practice as an objective, can and should be expected to achieve better organised, more effective and ethical systems and services’, it says.

‘A remarkable achievement’, says Annette Dale-Perera, who was ‘honoured’ to work on the 2020 version.

‘UNODC and WHO invite those responsible for local or national policy development, planning, funding, delivery and monitoring, and for the evaluation of treatment for drug use disorders, to measure up local systems and services for the treatment of such disorders against the standards,’ the document states. ‘The aim is to identify gaps and areas that fall short of the standards and work with the appropriate stakeholders’ to improve them.

‘All 192 UN member states have signed up to this document,’ said Annette Dale-Perera, who was ‘honoured’ to work on the 2020 version. ‘This is a remarkable achievement, given their different views.’

Available to download here

Dame Carol Black Review – Next Steps

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Dame Black has spoken loud and clear. How policy makers respond will be crucial, says Oliver Standing.

Report from DDN magazine on the Carol Black review
Read it in DDN Magazine

At the recent Glasgow drugs summit Dame Carol Black shared a number of truths many readers will be sadly all too familiar with. Drug problems spring up in areas of poverty and social exclusion; successful treatment and recovery is contingent on effective, coordinated support around housing, mental health and criminal justice; and when people leave prison they often miss out on the vital support they need. She also reminded delegates that our world-class treatment and recovery has been eroded and fragmented by austerity and localism.

Some commentators may look at the Glasgow summits and conclude that no concrete political outputs were agreed. At a time when drug-related deaths and other visible manifestations of extreme inequality such as rough sleeping are on the rise this is understandable, as is the perception that ongoing increases in drug-related deaths constitute a serious failure of public policy and/or political leadership. We must harness the sense of outrage and urgency that many of us feel to bring about change.

Positive developments

So, in that spirit, I want to point to some more positive policy developments that may help build the necessary momentum to make that change happen. Though the last Conservative manifesto was light on detail around drug and alcohol treatment, a subsequent addendum was published laying out plans to tackle addiction. This included two crucial pledges – to introduce a combined addictions strategy and a ‘dedicated monitoring unit at the heart of government’. Collective Voice welcomes both commitments.

The addictions strategy should address the public health emergency of drug-related deaths by outlining a clear plan to enable local authorities to fund and deliver effective, evidence-based and person-centred support. The 2017 strategy was not gripped firmly enough by government to bring about transformational change. This strategy should be driven by an effective inter-departmental approach, united behind a shared vision.

Dame Carol Black
Dame Carol Black: ‘The illegal drug market has long existed but has never caused greater harm than now.’

The monitoring unit could bring some welcome political attention to a field that has been fundamentally shaped in the past decade by the twin challenges of austerity and localism. Austerity has seen more than a quarter of our funding lost and localism has meant that loss has not been evenly distributed.

Challenges

It would be wrong to directly link all our challenges with the move of drugs and alcohol to local authority control. But there is an unquestionable issue over priority. Funding evidence-based and life-saving drug and alcohol services will never be the first thing on the list for local politicians dealing with substantial funding pressures.

However, a successful central unit will require a careful balancing between the local and the national. The unit should have sufficient powers to encourage local areas into action where appropriate, reducing the local variation in support and working effectively with Public Health England with clearly delineated roles and responsibilities. Most importantly, the development of the unit must be supported by sufficient new funding and political investment to ensure its long-term potency.

While more money is not the answer to all of our questions it is a good response to a great many, as the unprecedented scale of the cuts has forced local authorities to make very difficult decisions. Increases in public spending could enable the support of a greater number of people. There are over 314,000 people in England who use heroin or crack problematically, and 586,000 with an alcohol problem. Many aren’t currently receiving help. More support means an increase in family stability, fewer children taken into care, fewer blue light call outs, fewer emergency admissions to hospital and fewer people caught up in the criminal justice system.

The prime minister has spoken extensively about his commitment to the areas represented by new Conservative MPs. These areas