Halfway through the government’s ten-year drug strategy, a London summit, Real Voices, Real Choices invited honest discussion about the state of play.
What could save a drug policy whose progress is reflected in ever-climbing drug-related deaths? DDN reports.
LEWIS ATKINSON, MP for Sunderland Central: I was an NHS manager in 2007 and the National Treatment Agency (NTA) focused us on targets. For too many years we had ideology instead of an evidence base – and despite Dame Carol Black’s report, we are still seeing the consequences of those mistakes.
We have a system under enormous strain. Budgets can’t be confirmed and we can’t plan for continuity. Drug-related deaths are a result of policy choices. Addressing this must be an act of partnership and your input is crucial.
Our role as policymakers is to listen to you. I know that drug treatment works, but it means getting coherent policy across government. For a new minister the drugs brief can be overwhelming.
The drug sector has struggled to speak with a clear and unified voice. How do you build policy consensus across the sector? Be clear about what you need from policy. Invite MPs to visit. Be politely persistent. I want to see drug treatment as a public health issue, not a moral failing.
JOY ALLEN, PCC for Durham and APCC joint lead for substance misuse: Addiction is one of the biggest drivers of crime, ill health, and human misery. Behind the statistics is despair. Families are torn apart and communities are living in fear. Prevention is really important for us. The system is under unbearable pressure, especially prison and probation. Treatment and not punishment should be at the heart, and strategy needs to be re-energised after a decade of disinvestment.
Progress is hard-won and fragile, and recruitment and retention have lagged behind ambition. Do we have the courage to go further than From harm to hope? We need a minister for drugs – someone who appreciates the impact. And if something’s working better elsewhere, we need to learn from that.
DR LINDA HARRIS, chief executive, Spectrum CIC:
We’re witnessing a growing appetite for transformation – strength-based recovery. I no longer think of this as a clinical framework but more of a movement. We’ve got to come together and co-design minimum standards, measuring impact to make sure it’s truly recovery orientated. We need strategic buy-in to get these into a commissioning framework and create a national model with courageous leadership.
We saw shared care go to the next level before the carpet was pulled from under us. We’ve got to have skilled practitioners and investment in skills and workforce – minimum standards, including training the primary care workforce. We need to grow the basic competencies – the ‘Orange Book’ was brilliant but will need a refresh. We’ve just opened the lid on prescribed meds – pregabalin and so on. The agenda is so huge.
NIC ADAMSON, deputy chief executive, Change Grow Live: We should celebrate the collaboration in the sector, the dedication of the workforce, and the deep-rooted nature of services. However, we risk rolling backwards – a situation of looking to reduce the workforce. I would like to see our work built more into healthcare. We’re not working with people who make bad choices – this is health. Everyone knows someone.
Deaths are rising from COPD and liver disease – and over half of the latter are attributable to alcohol. These are core issues. And we need to be meeting people where they’re at. The women’s treatment group is committed to designing services with women, asking them about their preferences. For chemsex issues, we need to be as comfortable talking about sex as chem.
We need to work with regulators – what does good care look like? Let’s mainstream the agenda in health. We need long-term sustainable investment and a real driver for changing the narrative around drugs and alcohol.
KAREN BIGGS, chief executive, Phoenix Futures: The capacity of the rehab sector has reduced while demand has increased. There are empty rehab beds. We remodelled services with the confidence of the drug strategy, but last year just 0.5 per cent of people in treatment could access rehab and it’s difficult for people with complex needs. It’s one of the few areas of strategy that hasn’t seen any improvement.
We’re asking for clear leadership. When people say we can’t afford treatment, I’d say we can’t not afford it. The government isn’t saying anything and the silence is deafening, frustrating, upsetting. We’ll carry on filling gaps but we really need clear direction.
Stigma gets in the way. The drug strategy was written with the perspective that a little bit of stigma is a good thing – if you believe that, go to the Anti Stigma Network website. We need to be slow to judge and quick to understand.
KIRSTEN HORSBURGH: It feels like a deflection to say the sector needs to get it together – the government needs to be clearer.
GEORGE CHARLTON: In the North East we have a record nobody wants. We’re waiting for permission to do something.
We have the evidence base, we have the guidance, we know what works. It’s time for social disobedience – friends are dying.
PROF ADAM WINSTOCK, consultant psychiatrist and addiction medicine specialist:
We need to know how to be more successful. A business would ask, ‘What do our customers want?’ Most people who’ve died haven’t been in treatment for over five years.
NIAMH EASTWOOD, executive director, Release: We have silence from government on a public health emergency – the 14th year of the highest level of DRDs on record. It’s heartbreaking for everyone who’s lost someone and the lack of response from government is extraordinary. People are feeling the effects of extreme social neglect and we have to think about moving away from silos. There are too many services that don’t welcome you – that make you feel you’re walking into a secure facility. People who use drugs don’t need a secure facility. The fact kids aren’t allowed into facilities is extraordinary.
We can’t stop stigma until we stop treating people like criminals. When you treat someone like a criminal they will not access services.
DR CAROLINE COPELAND, senior lecturer in pharmacology and toxicology, King’s College London: The database shows drug deaths but ONS are aware they’re undercounting. Staff have been cut and they need more funding. There’s so much focus on individual drugs, but it’s rare in deaths that there’s one substance. Polydrug use is rising and it can be six or seven substances. So just focusing on drug class doesn’t have an impact on how they’re policed – dealers are dealing in various classes.
We need to focus on education, and drug use as a whole. Single substance drug policy – and treatment – doesn’t work. We need to look at the wider picture.
PROF JULIA BUXTON, professor of justice and drug policy, Liverpool John Moores University: We’re hearing about an awful situation – and it’s going to get a whole lot worse. There’s been a paradigm shift – trafficking has moved to different countries and it’s now agile, fast, violent and extremely dynamic with gang-based organisations. It’s fragmented, digitalised – and no country can isolate itself anymore. Social media dealing is one of the key platforms.
The glut of cocaine is a real problem with semi-submersibles carrying it all around Europe. Synthetics are a real challenge, but we also have over-supply of plant-based drugs. The dealers are ahead – and the police don’t have the skills to keep up.
JASON KEW, drug and alcohol public health specialist: I know how the law can harm people. ‘Hard to reach’ is a failure of the system. When DRD statistics came out, leaders were saying ‘we need’, not ‘what are we doing?’. Are people hard to reach – or are we hard to change?
PASTOR MICK FLEMMING, founder, Church on the Street: You don’t really want lived experience – people with rotting flesh. The system you’ve created is helping to kill people. You’ve based it on fairness, when fairness doesn’t exist. Your system is bollocks, it doesn’t work. We are all responsible. But at Church on the Street the first thing is a cafe, showers, a laundry room.
I have a church where 50 per cent will be dead in a year. You don’t look at outcomes from people like us. Our outcomes are remarkable despite people like you. These people matter to me because I hold their hand when they die. What are you doing with the money? Services need to become more holistic and more realistic. People in services are frightened of being outspoken and the partnership working feels false
STELLA KITYO, practitioner: I identify with the frustration. We come together to repeat conversations and are back at the same place. Why aren’t people accessing services? It’s us that make them hard to reach. Stigma hangs over everything. You need to make people feel they want to come out of the lifestyle they’re in, but we somehow think we’re on a different level to them. Sometimes neighbours have more empathy than drug services.
We need to ask our customers what they want. It’s not just tickbox exercises – they tell us what’s working. Why would people go to your service? Women often don’t get the help they need unless they’re a risk to themselves or others.
PETE YARWOOD, founder, Red Rose Recovery: I grew up in the criminal justice system and I stayed in the system for 20 years because I was conditioned that I was ‘less than’. People like me get well in communities – not in services, but communities. It took a prison officer to identify the skills in me. As an addict, I was one rung above a sex offender.
You need to start sharing power – and recognise where power dynamics are at play.
DAVID THORNE, chair, Well Up North primary care network: All day we’re trying to take complicated problems and make simple solutions – but we need complicated solutions. We oversimplify everything. We have to get into the complex and do it right.
DAVID SIDWICK, PCC for Dorset and APCC joint-lead for substance misuse: Things work well when there’s a clear focus on outcomes and measurable success. We need different ways of getting messages into schools, including true partnership and collaboration. From government we want commitment to From harm to hope – and to sort out funding so it’s secure. Give us money for primary prevention to stop our young people coming into substance misuse.
JASON KEW, drug and alcohol public health specialist: Sometimes we need to challenge the status quo – and make sure it’s evidence based. Can people acquire the medication they need? It’s a human rights issue. It’s not about one organisation over another – are we focusing enough on prevention, such as helping schools rewrite their drug policies?
VICKY MAJOR, nurse consultant, NHS Northumberland: We asked women using services for their feedback – on keeping women safe, child-friendly spaces, and how to lose the fear around treatment. The things that came out were fear, shame and guilt.
BRIAN MARTIN, advanced nurse practitioner, NHS Ayrshire and Arran: There’s lots of community activity involved in mental health support – a connection with communities. Medication is one aspect, but there’s so much more.
KIRSTEN HORSBURGH, chief executive, Scottish Drugs Forum: While we’re doing some things right, it’s clear there’s lots more to be done. We had an ‘advocates for change’ day for the national living experience group. Their statement said: ‘We are not here to be managed, fixed or saved… real change starts now, with us…’ It was about taking the power back, with a charter of rights: ‘We are not passive recipients, we are the agents of change.’ DDN
The Real Voices, Real Choices event was organised and funded by Camurus, who had no input or involvement in this article.
Through conversation with journalist and broadcaster Zoë Grünewald, three people shared lived experience of their struggles – and the things that service providers did that really made a difference. Their names have been changed to respect their privacy.
CHRISTINE: I was, from the age of 13 to 41, addicted to heroin. A security guard got me on a programme and I went on monthly injections which saved my life. Not one formula fits everybody but we need a system where you’re not passed from person to person – and they care, which makes a massive difference. You can’t just send people a letter and tick them off your list – you’d be lucky if they even open it.
Fast referral made a real difference and my service are like family now, they really care. They would hunt me down if I missed an appointment.
NATASHA: I was sexually abused and ended up on the streets of Liverpool with a £900 a day habit. I went on a script when my friend was murdered. I decided to turn my pain into power and from every little rock that was thrown at me I built a strong foundation.
I can’t really fault services – I was to blame. Someone saw something in me that I’d never seen in myself – an IPS person.
You can go through a shit time, but don’t judge a book by its cover. They saw something in me – ‘What do you like doing? Tell me a bit about you.’ We are human beings – have a little patience.
I leave little notes to look at every day, to remind me of my self-worth. How you treat other human beings says a lot and people can change with the right help and support.
STUART: I had a successful career in film and TV, but I was tortured as a child. I had terrible anxiety and debilitating trauma. I was also neurodivergent. I found drugs really early – alcohol and cocaine. When I was playing in the West End, I partied every night and was an addict for the best part of 20 years.
The treatment service was brilliant with me. They opened the clinic early and gave me privacy. I’m passionate about challenging stigma. The general public seem to have entrenched views about addiction, but they know fuck all. Always remember that nobody chooses it, nobody wants it.