Sixty per cent of England’s opioid users are now in treatment – one of the highest reported international rates – according to an evidence review by Public Health England (PHE) which compares international research literature on treatment effectiveness to the English system. Rates of HIV infection among injecting drug users remain at just 1 per cent, it says, while 97 per cent of drug users are able to start their treatment within three weeks.
The areas where the English system were ‘not doing so well’, however, were the record rates of drug-related deaths (DDN, October, page 4) and the number of people who continue to use opiates after beginning treatment. Rates of abstinence from illicit opiates after three and six months of treatment in England stood at 46 and 48 per cent respectively, a ‘relatively poorer performance’ internationally, while the drug-related death rate was ‘substantially lower than in the USA but considerably higher than elsewhere in Europe’.
The report reiterates the importance of factors such as housing, employment and good social networks in remaining drug-free, along with properly integrated services, and states that increases in drug-related harms are largely among a ‘small but growing number of vulnerable, older entrenched heroin users’ who experience poor physical and mental health. ‘The number of drug misuse deaths has increased over the past 20 years, with a significant rise in the last three years, to the highest number on record,’ it says. ‘In the next four years, PHE estimates that there will be an increase in the proportion of people in treatment for opiate dependence who die from long-term health conditions and overdose.’
‘Local areas increasingly have to meet the complex needs of older long-term heroin users, often in poor health, with other problems – particularly housing, poor social networks and unemployment, which are vital to successful recovery,’ said PHE’s national director of health and wellbeing, Professor Kevin Fenton. ‘Services will also need to be flexible, ensuring appropriate treatment to those seeking help for the first time, particularly with emerging issues such as new psychoactive substances or the problematic use of medication.’
An evidence review of the outcomes that can be expected of drug misuse treatment in England at www.gov.uk