The DDN letters page, where you can have your say.
The August issue of DDN will be out on 5 August — make sure you send letters and comments to email@example.com by Wednesday 31 July to be included.
Open letter from Dr Chris Ford to Anna Soubry MP
Dear Anna Soubry,
I would like to continue our discussion begun at the 18th RCGP working with people who use drugs and alcohol conference, Joining the Dots in Birmingham in May, when you took questions from the stage.
I said I felt it was vital that drug use is treated as a health issue, not as a criminal issue and I was truly shocked to hear you say that you are in complete disagreement with this. Your view is at odds with the recent BMA report Drugs of Dependence: The role of the medical professionals which clearly states the that the emphasis on health has been lost as the focus instead has been on the legal and criminal justice aspects of drug misuse. With the report, the BMA aims to refocus the debate on this as a health issue, led by the medical profession, which is well placed to take such a key role. To quote Professor Mansfield, ‘The medical profession should look squarely at the issue and debate it as a medical problem’. Professor Mansfield adds: ‘The BMA believes that drug users are patients first. That’s why we want health to be at the heart of the debate about drugs policy’.
This view is also supported by the chief medical officer, Professor Dame Sally Davies, who said that at present illegal use of drugs was treated mainly as a law and order issue. She says the research suggests the focus on criminalisation is ‘deterring drug users from seeking medical help’ and ‘I think we have a health problem, and we would do well as a nation to look at is as a health problem. I think there’s quite a lot of evidence from other countries, and science, about how you could go about that.’
We know that the criminalisation of people who use drugs leads to increased stigmatisation and marginalisation, limiting the potential effectiveness of health interventions, particularly for problematic users. Criminalisation tends to maximise the risks associated with use, such as unsafe products, behaviours and using environments; increase the health harms created or fuelled directly by drug law enforcement, or indirectly through the wider social impacts of the violent illegal trade it creates, as well as creating political and practical obstacles for us as health professionals in doing our job addressing drug-related health problems and reducing harms, and how they are obliged to work within a legal and policy framework that is often in direct conflict with fundamental medical ethics – not least the commitment to ‘first, do no harm’.
I could continue ad infinitum with quoting from the evidence but I ask you to consider the above and give you the chance to respond to this letter.
Thank you in anticipation.
Dr Chris Ford, clinical director, IDHDP,
www.idhdp.com, Twitter: @idhdp
Response from Anna Soubry MP
Dear Chris Ford,
I am grateful for the opportunity to continue our discussion on this key issue. Of course, I agree there are serious health issues concerning drugs misuse
As a government, we set out our position in the response to the report on drugs by the Home Affairs Select Committee.
Within the overall drug strategy the Home Office leads on action to protect society by stopping the supply of drugs, and tackling the organised crime that is associated with the drugs trade. Crime is a major component of the social and economic costs of class A drug use. Current estimates suggest that crime accounts for 90 per cent of the total cost – and the UK’s response relies on the crime fighting capabilities coordinated by the Home Office.
Treatment forms a very important part of our drugs strategy and the UK has consistently sought to help individuals who are dependent on drugs by treatment rather than the application of criminal sanctions. Healthcare is the responsibility of the four UK administrations’ health departments. In England, the Department of Health leads the delivery of the drug strategy’s ambition for more and more individuals each year to achieve and sustain recovery.
This shared responsibility for preventing and tackling the problems caused by drugs is also reflected in the structures at a local level. We have introduced police and crime commissioners, who will take responsibility for local action to drive down drug-related crime and anti-social behaviour, and Public Health England, which will support local authorities to tackle drug and alcohol misuse as a core part of their work, including supporting recovery-orientated drug and alcohol treatment services and delivery of prevention and other health services.
GPs who help their patients to tackle dependence are well placed to play an important role in the new local structures. With their understanding of public health issues and through their participation in clinical commissioning groups, they can help ensure that the planning and delivery of services are joined up in a way which meets all the support needs of people who are dependent on drugs or alcohol.
Anna Soubry, MP
Lessons in localism
In your last issue you said doctors at this year’s GPs’ conference were concerned about how localism could affect healthcare. While public health minister Anna Soubry had faith in local authorities, talking about the ‘robust partnerships between stakeholders’, delegates gave a ‘messy picture’ in reality, with ‘massively reduced commissioning teams in some areas’, disintegration of shared care in other areas and ‘conflicts of interest everywhere’ (DDN, June, page 8). Then in a recent DDN Bitesize, you asked readers about what’s happening in our area and what our experience has been.
I work in northern Alberta, Canada as an addictions counsellor in a 60-bed residential treatment centre. I began work here in 1998 when we were under the jurisdiction of the Alberta Alcohol and Drug Abuse Commission and our province-wide service had around 600 employees. The commission was merged into Alberta Health Services in 2009. The purpose was good – to integrate addiction and mental health services with all other medical services. Other regional boards and local authorities were merged as well. Since then we have belonged to a single organisation that employs 90,000 workers to provide access to quality health care services for 3.9m people in Alberta.
As a frontline worker I didn’t notice a lot of change at first. The most immediate ones were that all staff in my classification had to switch unions and pension provider. Our hours of work went from 7.25 hours a day to 7.75 hours per day. Then our software for human resources and training changed.
I think that in the long run it is for the best that we merged. I support the idea of eliminating some of the duplication of effort. We don’t really need to reinvent the wheel and we can all use the same policies on infection control, use of computers, ethics, etc. Many people want to go for substance abuse treatment away from their home community and that is simplified by a single organisation. However we had a province-wide addictions treatment service since the ’50s.
Now, however, a new service is in our building. Mental health workers run groups on anxiety, relationship issues, depression etc here. We can pop down the hall and discuss with them how they work with their clients. We’re slowly learning from each other. I’m willing to keep working at it.
In the next ten years I hope I see a common database covering all of our clients that we can access. Right now, only our nurses can access the medical database, and I have no problem with that. However only addiction staff province-wide can access the database of the clients we see. I can enter notes on that database and anywhere in the province where a client sees an addictions counsellor who works for Alberta Health Services; a staff member can read notes from the treatment the client got here.
Trish Wright, addictions counsellor, Business and Industry Clinic, Northern Addictions Centre, Alberta
Out of touch
Mark Gilman’s recent interview in The Guardian (11 June), declaring 12 steps are best for addicts, demonstrates how out of touch his view of UK recovery movement is. I found the article divisive and if his beliefs are shared by PHE then that saddens me. What happened to choice and empowering people? Frog-marching people to a meeting may be OK in the US, but not in UK.
Carl Cundall, trustee, SMART Recovery UK
I live in East Yorkshire and run three self-help groups. We have recently had our funding for room hire withdrawn at short notice for no obvious reason. We find that some of the treatment providers see voluntary groups as a threat, and instead of working together, block our attempts to reach out to users who are desperate for help. We only exist to help people, but find obstacles put in our way. The provision for alcohol abuse intervention in our area is abysmal. Have other areas of the country come across this?
Stephen Keane, leader, East Riding Alcohol Support Group
Help sight loss project
Researchers from the University of Bedfordshire, Glyndwr University and the University of Lancaster have recently been commissioned (by Thomas Pocklington Trust and Alcohol Research UK) to undertake some exploratory research about substance use and sight loss. They are interested in understanding more about the prevalence and experiences of those people living with a combination of both. The project also seeks to acquire more knowledge about the nature of service provision to such individuals.
It is anticipated that the findings of the project will be able to inform future policy, research, service developments and support for those working within these arenas. The research team would like to hear from any service users, carers, practitioners or organisations that may have specific experience of working with the duality of these subjects, and have information or direct experiences you may wish to share.
For further information about the project, to express an interest in supporting it or be interviewed for the project, please contact me on 01978 293471 or firstname.lastname@example.org
Wulf Livingston, senior lecturer in social work, Glyndŵr University Wrexham
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