The Scottish Government has commissioned an independent expert group to ‘objectively consider the evidence’ supporting the role of opiate replacement therapy in treating problematic drug use.

The panel will make recommendations to the government to ensure that ‘such medical interventions are being used appropriately and in line with the international evidence base’.

The move follows the announcement of a record number of drug-related deaths in Scotland in 2011 (DDN, September, page 4), of which methadone was ‘implicated in, or potentially contributed to’, 47 per cent. Although it was not known how many of the deaths were among people who had been prescribed the substitute medication, the Daily Record newspaper ran a number of articles highly critical of methadone prescribing and demanding a public inquiry.

The expert group will be led by chief medical officer Harry Burns, in collaboration with the independent Scottish Drugs Strategy Delivery Commission, and is expected to deliver its recommendations next spring.

‘I highly value and respect the important work being done across Scotland by clinicians and professional practitioners in treating people seeking to tackle their own drug addictions,’ said minister for community safety and legal affairs Roseanna Cunningham. While prescribed drug treatment had saved ‘many thousands of lives in Scotland’, however, it was the responsibility of professionals to ‘determine the most appropriate treatment for each person seeking medical help with addiction problems’, she added.

‘The Scottish Government is clear that prescribed drug treatment is not, and cannot be, the only treatment option available on the pathway to recovery. People have a right to a full range of treatment and support options and to decide, in consultation with professionals, what is best for them.’

The chief medical officer’s intervention could hopefully ‘help to establish a consensus’, said Scottish Drugs Forum (SDF) director David Liddell. However, it was unfortunate that methadone had become a ‘political football’, he added, with the numbers on substitute prescriptions used as evidence that Scotland’s drug strategy was not working – a ‘simplistic’ analysis. ‘We need to have our best politicians thinking more deeply about why people use substances and what responses can be made,’ he said. ‘Methadone is merely a response to a large-scale problem and it does not seek to address the cause. Politicians realise this fact in private but sadly their public utterances would sometimes suggest otherwise.’

SDF 2011/12 annual report available at www.sdf.org

Ongoing budget cuts and restructuring in the public sector are putting young people’s services at risk and could threaten progress in reducing levels of drug and alcohol use (see story, left), says a report from the UK Drug Policy Commission (UKDPC) in association with DrugScope and Mentor.

Cuts to generic services could have a knock-on effect on substance misuse problems, warns Domino effects, with young people’s services particularly vulnerable as provision often comes via ‘a patchwork of funding streams’ and a perception of them as peripheral to ‘core business’.

While many treatment services for young people have so far been protected from budget restrictions, wider youth services that play an important role in ‘drug prevention, problem identification and sustaining treatment benefits’ are being harder hit, says the report, which draws on interviews with staff members from a range of services across nine local areas.

Ongoing upheaval in the public sector also means that services aimed at young people will need to compete with adult care budgets for funding, the document points out, with many organisations already cutting or reducing specific activities and looking for efficiency gains by reducing posts or sharing staff.

‘Drug use among young people has fallen sharply over the last decade, at the same time as we saw a sustained investment in young people’s services,’ said report author and UKDPC director of policy and research, Nicola Singleton. ‘That investment helped create joined-up services that allowed early intervention before specialist drug services were needed. Now these services are threatened by a combination of financial pressure and the speed and scale of the current public service reforms.’

Many young people who need help for drug or alcohol problems are also experiencing mental health issues, difficulties at home or school or involvement with the criminal justice system, said DrugScope’s director of policy and membership, Marcus Roberts. ‘Unfortunately, we’ve been hearing concerns from DrugScope’s member agencies for some time now about the impact of local spending cuts and structural reforms on young people’s drug and alcohol treatment. This report provides evidence that significant changes in the way that services are planned and commissioned, coupled with severe budgetary pressures, are threatening to undo the progress that has been made in treatment for this group over the past decade.’

Report at www.ukdpc.org.uk

There should be a wholesale review of both the Misuse of Drugs Act and the drugs classification system, according to a report from the UK Drug Policy Commission (UKDPC).

The culmination of a six-year study, A fresh approach to drugs also calls for reduced sanctions for drug possession, more consistency in controls over all psychoactive substances, including alcohol and tobacco, and a review of penalties for all drug offences, although it recommends that the production and supply of most drugs should remain illegal.  

Much of the spending on tackling illicit drug use, which UKDPC estimates at around £3bn per year, is not based on evidence, it says, with some policies – including seizures by police and border agencies – having ‘little or no’ impact. ‘With some 42,000 people in England and Wales sentenced annually for drug possession offences and about 160,000 given cannabis warnings, this amounts to a lot of time and money for police, prosecution and courts,’ the report says. ‘On top of this comes the cost to the individual in terms of damage to employment prospects’, with people also deterred from seeking help because they are ‘doing something illegal’.

Existing drug policies have struggled to limit the damage caused by drug use, and are unable to keep pace with the ever-developing range of new substances, it says. With fewer resources available, a ‘radical rethink’ of responses is called for, says the report, which analyses how policies and interventions could be improved to create a ‘fresh approach’, with evidence taking priority and an ‘environment that works to reduce dependence’ and safeguard communities.

The report makes a range of other recommendations, including more action to tackle stigma and support families, as well as transferring responsibility for drug policy from the Home Office to the Department of Health and creating a cross-party political forum to develop dialogue about future policy direction. All drug policies should undergo ‘rigorous and continual scrutiny’ to make sure they are providing value for money, it adds, with a new independent body established to coordinate research.

DrugScope said it supported a review of the Misuse of Drugs Act, including the use of civil rather than criminal sanctions for personal possession of some drugs, and – although other recommendations were more challenging – serious public debate was welcome. ‘The media and our politicians have an important role to play in shaping this debate, which should not be reduced to a black and white adversarial argument,’ said chief executive Martin Barnes. ‘Progress in this highly emotive and politicised arena will occur when policymakers and politicians can more openly express their views without fear of opprobrium.’

Meanwhile, a report from the London School of Economics and Political Science (LSE) says that international policy drug policy needs radical reform to ‘remove outmoded, unscientific thinking’. Empirical data showing that the current system has failed is ‘overwhelming’, says The global drug wars, with the human cost of many international policies – which governments pursue through a mix of ‘bureaucratic and ideological inertia’ – rendering them ‘unjustifiable’.  

Available at www.ukdpc.org.uk and www2.lse.ac.uk

The number of young adults entering treatment for heroin or crack is at its lowest recorded level, according to figures released by the NTA.

There was a 23 per cent fall in the number of 18 to 24-year-olds seeking treatment for heroin in the last year alone, to just over 4,000, says Drug treatment 2012: progress made, challenges ahead, and down from more than 11,000 seven years ago.

Of the total treatment population, nearly 30,000 people successfully completed their treatment in 2011-12, up nearly 2,000 from the previous year and three times the number from seven years ago, while the total number of people seeking heroin treatment for the first time has fallen to just over 9,000 from nearly 48,000 in 2005-06. Heroin remains the main problem drug, with over 96,000 of the total treatment population of 197,000 seeking treatment for heroin dependency, and 63,000 for heroin and crack. Powder cocaine accounted for just 5 per cent of the treatment population, and cannabis 8 per cent.

The current recession had not produced the same levels of youth unemployment as in the 1980s, said NTA chief executive Paul Hayes – although unemployment and hopelessness among the young remained ‘fertile territory for addiction’ – and combined with this had been the scale of investment in treatment over the last ten years, something that ‘cannot be guaranteed’ in the current climate. ‘There is a risk that squeezed local authorities will disinvest, not necessarily from treatment services, but from allied services that support recovery.’

The only age group whose numbers were increasing, however, were the over-40s, who now made up almost a third of the entire treatment population and represented a ‘particular challenge’, said Hayes. ‘Some became addicted in the heroin epidemics of the ’80s and ’90s and are only coming into treatment now, and many are at risk of death as their health fails.’ There were 802 drug misuse deaths among over-40s in 2011, says the report, 300 more than a decade ago and 500 more than among the under-30s.

Methadone remained ‘an absolutely crucial first step for many people’, Hayes stated, although too often in the past it had not been used as ‘a platform for recovery’. ‘The majority of, but not all, people with an opiate problem will pass through substitute medication, and it’s important that it’s available,’ he said. ‘But it’s also important that it doesn’t become a prop.’

The challenge was to deliver ‘a truly integrated, balanced and recovery-oriented system,’ said DrugScope chief executive Martin Barnes, something the treatment sector was capable of with the necessary resources and support. ‘In difficult economic times there is a strong and compelling case for national and local investment in drug and alcohol treatment,’ he said. ‘We need to continue to make this case as the local funding and commissioning environment is changing, with the election of police and crime commissioners, the introduction of the new public health system and the establishment of Public Health England. Despite encouraging trends in declining drug use, drug and alcohol dependency continue to blight the lives of many, with harms and costs for individuals, families and communities.’

Meanwhile, a private members’ bill to make lessons on drugs, alcohol and relationships compulsory in schools (see feature, page 10) has been introduced by Diana Johnson MP under the ‘ten minute rule bill’ procedure. The Relationship, Drug and Alcohol Education (Curriculum) Bill is backed by a range of organisations including Adfam, Mentor, Alcohol Concern and Turning Point.

Report at www.nta.nhs.uk