I had a good childhood and my parents provided all that I needed. My first years at school were great and I made a lot of friends. However, things became difficult and I was diagnosed with colour blindness and dyslexia at six. Specialist help was not readily available and eventually I was sent to a special school. I left after three years and was sent to boarding school where it was thought I would be better helped.
Boarding school was like a prison to me and I was massively homesick. I did make one friend, though. She helped to make things better, but sadly passed away. This led to a suicide attempt when I was 14. The school did their best but didn’t really know how to help a troubled teenaged boy through puberty. I started drinking with my friends at 15 as we could get into pubs.
I left boarding school and went to college for about a year. There, I started smoking cannabis. This led to cocaine use, but I never felt I was addicted. I started taking pills in my late teens too, but my drinking was not an issue at that point as I was involved in the clubbing and party scene. At 20, I met a girl and fell in love. I went to work in a pub, which is when my problems with alcohol started as pub life naturally revolved around drinking.
I took a job in sales but the pressure told on me, and was reflected in my drinking. I was drinking more than two litres of vodka per day by this stage. My girlfriend broke up with me after seven years together and shortly afterwards I was made redundant. I started drinking even more heavily along with taking pills, using cocaine and anything else I could get my hands on.
I got another job and met another girl, who would later become my wife. I started to work from home and my drinking was easy to hide. I lost my job two weeks after the wedding as my drinking affected my job performance. My drinking was out of control and my wife threw me out. I became homeless and spent three weeks on the street in sub- zero temperatures.
I tried different dry houses, but they couldn’t allow me to stay as I continued to drink. I spent weeks on the streets and eventually called my parents who allowed me to move back to stay with them with the understanding that I would get help. I got involved with RISE which was helping, when my parents sold up and moved to Bournemouth. This led to me starting to drink heavily once more.
I stayed with a friend for three months but stayed drunk enough to feel stable. My wake-up call was when I had a seizure. That’s when RISE referred me to Churchfield. Here, I have one-to-one sessions and take part in activities. This has been my first period of stability in a long time. Though I still drink to maintain myself. I have been offered a detox and rehab placement in Bournemouth, which will become a reality once the funding is agreed.
I’ve spent too long destroying myself. I want to live on my own by the time I am 40 and go back to college. I want to help others who are going through some of the things that I have. My favourite quote is from The Shawshank Redemption – ‘get busy dying, or get busy living.’ I want my life back! I have hope after chaos.
Churchfield & Cherington is one of four services run by the Social Interest Group, specifically geared towards treating drug and alcohol misuse. The other services are Aspinden Wood, Brook Drive and Brighton Women’s Service.
When delivering recovery services to prisoners, demonstrating impact is a complex but vital process, says Carwyn Gravell.
Read the full article in DDN Magazine
Forward’s range of structured, abstinence-based treatment programmes (which we refer to as the ‘RAPt’ programmes) have supported thousands of people into lasting recovery. Our range and type of programmes have grown and diversified since we first began helping people from a portacabin in HMP Downview in the early ’90s. So too have the tools we use to measure their impact. Our recently launched annual Impact report includes a summary of the research on the impact of these programmes.
The first published study into the RAPt programmes was Drug treatment in prison: an evaluation of the RAPt treatment programme by Player and Martin of Kings College London in 2000. This gave the first evidence of our successful impact in reducing reoffending – a one-year rate of 25 per cent amongst the 274 completers of our programme, compared with 38 per cent for non-graduates. A second study, Effectiveness of the rehabilitation for addicted prisoners trust (RAPt) programme, published in 2014 and using data from the Police National Computer (PNC) database, showed a 31 per cent reconviction rate for graduates of our programmes in male prisons, an 18 per cent drop in reconviction rates and a 65 per cent reduction in the volume of re-offending.
The establishment of the Justice Data Lab (JDL) in 2013 has provided us with a national framework to evaluate the success of all our interventions in reducing reoffending. We have so far submitted two cohorts of data for analysis by the JDL, with our most recent results being published in October of this year. A JDL study into our Women’s Substance Dependence Treatment Programme (WSDTP) showed that women who completed the programmes reported a one-year re-offending rate of just 18 per cent, while a similar study into our less intensive Alcohol Treatment Programme reported a reoffending rate of 37 per cent.
Just how positive is this impact? There are methodological limitations in estimating the likely reoffending rate for a comparison group of drug or alcohol dependent offenders who do not access these programmes. For example, the Justice Data Lab comparison groups (with re-offending rates of between 35 and 40 per cent) are based on a criteria of frequent drug/alcohol use, rather than dependence, leading to significant underestimates. Other estimates of the reoffending rates of drug/alcohol dependent offenders range between 58 per cent (participants of all accredited drug/alcohol programmes in prison, according to an MoJ Analytical Series study from 2013) and 76 per cent for ex-prisoners who reported using class A drugs post-release (in the same study). Taking this upper-end estimate as a comparison, RAPt programmes could potentially reduce reoffending by nearly 60 per cent.
Carwyn Gravell is divisional director of business development at The Forward Trust
Yet despite this significant impact, we have seen a decline both in the number of people starting programmes (a reduction of 58 per cent over the last three years) and in programme quality. The increasingly challenging prison environment (an aggressive prison drug market, lack of space on dedicated ‘recovery wings’ to run group programmes, prison ‘lock-downs’ preventing programme delivery, and placing of inappropriate referrals onto programmes) is part of the reason. That being said, we have also realised, through consultation with staff and service users, that we need to improve the way we prepare applicants for the intensity of our programmes.
The development of our Stepping Stones courses (a shorter intervention that gives people a taster of the kinds of things covered in more intensive treatment) has helped. For example, at HMP Send –where we run WSDTP – the introduction of this stepped model has led to a 25 per cent increase in programme completion.
The process of quantifying the impact of our work is not always straightforward. Maintaining programme integrity in a hostile prison environment – and designing accurate research methodologies – remains a challenge. But it is worth it. Because proving that our work can – and has – helped thousands of people to turn their lives around is essential to building a reliable evidence base for this sector.
Sylvia’s Story
The progress of women at HMP East Sutton Park speaks for itself. DDN heard Sylvia’s story.
My mother was alcoholic as I grew up, and I was in charge of my siblings. I hated alcohol and never thought I’d be an alcoholic.
I got married and started drinking because I was lonely – my husband worked a lot. My drinking pattern progressed and I became more depressed, then hooked on antidepressants from my GP. I had my first cocaine at 30 and it got progressively worse.
I had three children when my husband asked me for a divorce. I was drinking in public toilets and was found guilty of causing grievous bodily harm with intent. I was looking at nine years.
I knew going to prison would save my life. I was taken straight to healthcare at Bronzefield, very unwell, drunk and on diazepam and suffering from pancreatitis.
When I was accepted at Send Prison, Forward couldn’t wait to get me onto their RAPt Wing.
I stayed there for five months and the peer support was amazing. I thought, ‘that’s what I want
to do.’
I didn’t trust social services and police before – I’ve been let down so much. But coming to East Sutton Park, I was able to work and build up my trust.
I volunteered and have now been on an apprenticeship for seven months. It’s hard work but I love it and I’m gaining confidence to work elsewhere. I find it amazing that I am where I am and I’m very grateful.
Forward have supported me to live out my dream. I have my own flat, my own cat. I am responsible for my children. I am needed. I’m on a licence, but I’m trusted to live my life.
‘Connecting can revise our response to a world gone mad’
THIS MONTH’S ISSUE went to press on polling day, and we brace ourselves for the result. It brings to a close months of being pounded by the same rhetoric without much hope that our opinions count.
The HIT Hot Topics conference (page 8) is familiar with this sensation. Speakers travel across the world to share frustration at opportunities for harm reduction being squandered and governments driven by greed and ignorance. It would be easy for any one of us to think our voice didn’t matter – but actually it does, how seemingly insignificant the context. Against a backdrop of world problems, ideas were sparked and it was heartening to realise that the thought of connecting – with ourselves and each other – can revise our response to a world gone mad.
There’s plenty in this issue that we hope will connect with you, not least the deeply personal stories from those finding their way through prison and treatment. And in response to your requests for more information on problem gambling, we’ve compiled an in-depth guide (centre-page pull-out) to help you support anyone affected by this devastating addiction. The Gambling and Health guide is also available here as a stand-alone publication where you can also order free printed copies.
We hope you have the festive season you wish for and we’ll see you back in print on 3 February. Please keep in touch!
The Zenalyser hand-held breathalyser is a new award-winning and cost-effective treatment for alcohol dependence is available, and your service can sign up for an introductory trial. Read about it in December DDN magazine.
It’s not often that something completely different comes along in the field of alcohol treatment. However, in October 2019 a British company won the ‘Breaking the Mould’ Future Enterprise award from Keele University for a new treatment system. If you were designing a new system from scratch, at the very least you would want it to be effective, time saving, easy to use and to offer significant cost savings. For people who are really struggling to break free from addiction perhaps you’d also like it to improve adherence to medication and offer psychological support, every day, wherever that person happens to be. Welcome to the Zenalyser.
We’re looking for clinics to try out the Zenalyser® system at a reduced rate so that we can gather feedback from as many services as possible. The cost advantages of the system are huge – three months of daily Zenalyser® treatment cost just £600, including medication and staff time. Compare that to a single one-hour consultant review, which costs the NHS more than £200, plus over £90 for a nurse and travel fares for the client. Residential rehabilitation, meanwhile, costs around £1,000 per week – much more in private units.
Has anyone used it?
The Zenalyser® has been successfully used in clinics in Shropshire, Gloucestershire and in some parts of the US, and it really shines in high-risk situations. Mothers have been able to prove to the courts that they are both abstinent and complying with treatment, and so have been able to keep their children, while military personnel in locations far from treatment centres and family help have been supported remotely. It has also been possible for alcohol-dependent medical and nursing staff under formal regulatory procedures to remain in their jobs by using the Zenalyser® every day. For people using the system, NHS post-detoxification abstinence rates were 90 per cent over a one-year follow up period, with 100 per cent relapse free (1).
So what exactly is a Zenalyser®?
A Zenalyser® is a dual sensor hand-held breathalyser that detects disulfiram (Antabuse) metabolites and alcohol on a breath sample (2). It connects to a small computer tablet that sends the sample result to a central database. The result is then analysed and automated feedback is given immediately to the client, for example a smiley emoji and the message: ‘Well done, good result’. If a daily breath sample has not been provided a reminder is sent, twice if necessary. Once the patient has blown into the Zenalyser® the result is sent to the clinician by email or SMS, and the clinician is also informed if a test sample has not been given. At any time the treatment team can access the database, view a photo of the client blowing into the Zenalyser®, and send a personalised message back – tips, encouragement, education, appointment review, whatever is helpful.
Why might you want one?
This new system can maintain abstinence from alcohol at an all-in cost of less than £50 per week. For the alcohol dependent client this can be achieved from the comfort of their home, while looking after children, or at work. The Zenalyser® system provides this mix of feedback, psychotherapeutic support, monitoring, and supervision of medication in a process that takes less than one minute per day for the user. The time required for the treating team to view results and provide personal messages of support, information and advice, is about 5-10 minutes a week. The system’s ability to work remotely also greatly reduces the need for face-to-face reviews, so taking more pressure off busy staff.
Want to give it a go?
If you would like to sign up for a trial, receive more information, or have a demonstration of the Zenalyser®, then please contact ZenaMed Ltd via their website www.zenamed.co.uk. For the trial the Zenalyser equipment will be loaned free of charge and you will simply pay £400 for 100 breath tests.
References
(1) Fletcher K. Disulfiram and the Zenalyser: teaching an old dog new tricks.
Alcohol and Alcoholism (2015)
(2) Fletcher K, Stone E, Mohammad MW et al. A breath test to assess compliance with disulfiram. Addiction. (2006)
The staff at Kenward Trust residential addiction treatment centre are dedicated to helping their residents transform their lives from the misery of addiction, homelessness and crime.
Set in fifteen acres of stunning Kent countryside, Kenward Trust provides a safe space for its residents, in many cases far from the setting of their addictions. Their skilled workforce are committed to ensuring that those most vulnerable in today’s society leave their services with the knowledge and skill set to be able to safely re-integrate into the community with a much lower risk of relapsing.
We offer a wide range of activities with both therapeutic and skills based training in our Gardens and Workshops.
At Kenward Trust we have a variety of projects dedicated to helping those affected by drugs and alcohol. Our main residential rehabilitation project, Kenward Therapeutic Community, retains many aspects of the Recovery Model of treatment delivery. Alongside our structured group programme, we also offer a wide range of activities with both therapeutic and skills based training in our Gardens and Workshops, which will allow our residents to take evidence of recognised training skills with them into the workplace. At Kenward we believe that building the confidence of our residents back up is vital in order to ensure a sustained recovery, whether this be through the rehabilitation programme itself, or through us providing education to our residents at the skill level relevant to them.
Treatment options
We have reviewed the traditional 12 or 24 week blocks of treatment and can now offer bespoke client centred programmes of between 4 and 24 weeks, dependant on the individual needs of the client. Whilst we do receive residents from the community with statutory funding, we do also take self-funded clients at Kenward. These blocks of treatment mean that those who cannot achieve funding from the community, may still be able to come use and benefit from our services for a time frame that works for them.
Our resident alpacas
Following on from our residential rehabilitation project, we have Move On houses in various locations across Kent and East Sussex. Our Move On houses provide supported, substance free accommodation within the community for those that have completed a recovery programme. Residents live independently at the Move On houses but continue to be supported by us through weekly meetings with their project manager. We find that residents benefit from continuing to live amongst a group of peers, drawing strength and support from each other and reducing the dangers of isolation which ultimately help them to sustain recovery.
Our Kenward Lodge project provides further supported accommodation for those whose lack of accommodation is preventing them from accessing drug and alcohol services and hindering their recovery. This project is based on our Yalding site, with close proximity to local services and amenities alongside access to fellowship, SMART and Aspire meetings. We encourage volunteering within the local community so that their transition back into society is a more positive experience and they have transferable skills for when they get back into the workplace.
Young people
At Kenward we believe that reaching young people at the age when they start experimenting with drugs and alcohol is a vital step in preventing future addiction. Our Think Differently project set up in 2016 goes into schools to provide education, information and relevant interventions for young people so that they can create their own informed opinion on the risks of substances. We also work with local councils to provide advice and support for young people within the community alongside raising awareness of risks of substance misuse for themselves, their family and their friends.
Our final project, Reset is a volunteer led mentor service that identifies and caters for the needs of individuals being released from prisons around the country and resettling in Kent. For many, reintegrating back into society after spending time in prison can be a very difficult and daunting time, so we aim to provide a service that reflects the challenges they face during reintegration to the community. We do this by working in partnership with existing services to help ex-prisoners become valued members of society.
To find out more about Kenward Trust and the services we provide give us a ring on 01622 812603 or visit our website www.kenwardtrust.org.uk
Andy Burford, Criminal Justice Lead at the Oxfordshire Roads to Recovery service, writes about the challenges of supporting people coming out of prison with nowhere to live.
If we’re going to talk about housing, let’s start with a pyramid.
Many of my colleagues who work within Substance Misuse will be familiar with Maslow’s ‘Hierarchy of Needs’. The humanist psychologist Abraham Maslow first introduced his concept of a hierarchy of needs in his 1943 paper ‘A theory of human motivation’. It suggests that people are motivated to fulfil basic needs before moving on to other, more advanced fulfilment in their lives, and if you do an internet search on the subject you’ll find endless variations on the theme, nearly all of them in a pyramid shape.
No prizes for guessing that right at the base, you’ll get basic physical requirements, including the need for food, water, sleep, and warmth. Being homeless is a torment in itself. If you leave prison with a long-standing drink or drug problem and move straight into NFA (i.e. ‘no fixed abode’) status, the task of staying clean and sober is a monumental one.
So how can we look to reduce the problem of homelessness for those clients who are perpetually sofa surfing or moving patch each night to keep safe?
Chris Difford of Squeeze is throwing himself into his role as the charity’s new patron
Leading treatment centre Broadway Lodge in Weston-super-Mare is delighted to announce that double Ivor Novello award-winning lyricist Chris Difford has been appointed as its patron.
Chris Difford is a founding member of British rock band Squeeze who first rose to fame in 1974 and, like Broadway Lodge, is still going strong today. Best known for hits such as Cool for Cats, Up the Junction and Labelled with Love the lyrics of their songs, written by Chris, most often refer to life around addictive behaviours and later, in recovery.
Chris is open about his own struggle with addiction and has now achieved almost 30 years in recovery. Alongside his hectic touring schedule, he is extremely passionate about supporting those struggling with addiction and working with Broadway Lodge is another part of the work that Chris undertakes. In the last two years Chris has met with clients staying at Broadway Lodge several times and presented his musical share, where he tells his life story interspersed with the songs most relevant to that time in his life. He also performed at Broadway Lodge’s annual reunion in September last year.
Dr David Sweetnam, CEO at Broadway Lodge, said ‘This is a really exciting time for the charity. By working with us, Chris is not only helping to put Broadway Lodge on the map but he is giving hope and inspiration to our clients, many of whom have reached rock bottom, and are at the beginning of a very hard but life-changing journey. His support is invaluable and we are extremely grateful to Chris for accepting our offer to become patron and we look forward to the future ahead with him as part of our team.’
Chris said ‘It’s a real honour to become a patron of Broadway Lodge. I have had many friends who have successfully been through their doors. It’s a warm and friendly rehab built around the 12-step programme and there is no other place quite like it. It’s outrageous that successive governments chose to cut back on the welfare of people with addictions, and while so many rehabs are closing down, Broadway Lodge remains firmly on the therapeutic map.’
Broadway Lodge is part of The Choices Group of Rehabs and a charity that supports individuals who are struggling with addiction and their relatives who are affected. If you would like confidential help and advice for an addiction you have or that someone close to you is suffering with, call Broadway Lodge on 01934 812319.
For many people gambling is an occasional, harmless pastime, but for others it can lead to financial ruin, relationship breakdown or even suicide. And for those who do experience gambling addiction and other problems, specialist help has too often been hard to find.
This guide on gambling addiction will help identify problems and guide you through the available treatment options.
Read the guide online here
HIDDEN IN PLAIN SIGHT Problem gambling is often called the ‘hidden addiction’, as there will frequently be no outward signs that someone is struggling with addictive behaviour. The social and financial impact of the UK’s gambling problem, however, is becoming ever more visible. Many people gamble in some form, and most without experiencing any adverse effects. In a given year almost 60 per cent of British adults will gamble, including on the National Lottery, slot machines or online betting sites – there are currently 33m active online gambling accounts in the UK.1 However according to the Gambling Commission – the government body responsible for regulating the gambling industry – there are around 2m people experiencing some level of gambling harm, and 340,000 who could be classified as problem gamblers.
WHAT IS A PROBLEM GAMBLER? A problem gambler is someone experiencing addictive behaviour defined by the World Health Organization as a gambling disorder. This is characterised as a ‘pattern of persistent or recurrent gambling behaviour’ where gambling can take precedence over other interests or daily activities and where people have impaired control over the frequency, duration or intensity of their gambling. The behaviour patterns associated with a gambling disorder can be severe enough to lead to ‘significant impairment in personal, family, social, educational, occupational or other important areas of functioning’, states WHO. The mental health issues associated with problem gambling, meanwhile, can be severe enough to result in suicide.
Read Owen Baily’s personal journey of finding treatment for his gambling addiction
COUNTING THE COST It’s not just on the individual where the impact is felt, however. An analysis by the IPPR think tank of the health, welfare, housing and criminal justice costs associated with problem gambling put the combined price tag at up to £1.16bn per year for the UK as a whole.
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One particularly concerning aspect is the number of young people who could potentially go on to experience problems. While the minimum legal age for most gambling in the UK is 18, people can buy scratch cards and lottery tickets at 16 and many gaming machines in amusement arcades and other venues have no age limit. Young people experiencing gambling issues are more likely to truant and perform poorly at school, and, crucially, are also more likely to develop a gambling disorder in adulthood.
DEVELOPING HABITS A 2019 Gambling Commission report found that almost as many 11- to 16-year-olds had spent their own money on gambling in the previous week than had drunk alcohol, taken drugs or smoked cigarettes.6 Just under 2 percent of this age group were already classified as problem gamblers. Worryingly, while problem gambling can remain hidden from family, friends and colleagues for years, the issue has also largely been unseen by addiction treatment providers, wider health professionals and policy makers. Currently less than 3 percent of people with a gambling disorder are receiving treatment for their addiction.
What does effective treatment for gambling addiction look like, and how do you access it?
Read the full guide here as printable an e-magazine (Contains option to download PDF files)
GAMBLING REGULATION AND LEGISLATION High street and online gambling providers need a licence issued by either the Gambling Commission or local authority, while gambling advertising is subject to the Advertising Standards Authority’s (ASA) primary advertising regulations and augmented by the 2007 Gambling Industry Code for Responsible Gambling. Gambling legislation recently made national headlines after the government cut the maximum stake it was possible to place on controversial fixed odds betting terminals (FOBTs) – often called the ‘crack cocaine of gambling’ – from £100 to £2, while a 2019 paper published in the BMJ argued for a revision of the 2005 Gambling Act to include a compulsory levy on the industry to support people with gambling problems.
This guide was supported by Gambleaware. Their site www.begambleaware.org provides more resources and help for people with issues around gambling.
Sixty eight per cent of 20-year-olds had participated in gambling in the last year, according to a study by GambleAware. While this fell slightly to 66 per cent for 24-year-olds, the study found that more than half of 17-year-olds had already gambled in the previous year.
Young people whose parents gambled were more likely to gamble themselves
The findings are part of an in-depth longitudinal study commissioned by the charity, which measures young people’s gambling habits at 17, 20 and 24 years of age using samples of more than 3,500 for each group, as well as survey data and interviews with parents. Regular weekly gamblers were more likely to be male and had already ‘developed habits and patterns of play’ by the time they were 20, researchers found.
Young people whose parents gambled were more likely to gamble themselves, and regular gamblers were also found to be more frequent users of social media. Regular gamblers were also likely to have lower wellbeing scores, smoke cigarettes daily and drink more alcohol, and around 7 per cent already had a gambling problem by the age of 24. Buying scratchcards, playing the lottery and placing private bets with friends were the most common forms of gambling behaviour overall, although levels of online betting activity rose sharply from 9 per cent at 17 to 35 per cent at 20 and almost 50 per cent by the age of 24.
GambleAware CEO Marc Etches
‘We are concerned to protect children and young people who are growing up in a world where technology makes gambling, and gambling-like activity, much more accessible,’ said GambleAware CEO Marc Etches. ‘One in eight 11- to 16-year-olds are reported as following gambling businesses on social media, for example.’
‘Although many young people gambled without any harm, a small minority (6-7 per cent) of males showed problem gambling behaviours associated with poor mental health and wellbeing, involvement in crime, and potentially harmful use of drugs and alcohol,’ added emeritus professor of child health at Bristol Medical School’s Centre for Academic Child Health, Alan Emond. ‘To protect these vulnerable young people from gambling harm requires a combination of education, legislation and appropriate treatment services.’
Last year saw more than 18,000 hospital admissions for poisoning by drug misuse in England, according to figures from NHS Digital, an increase of 6 per cent on the previous year and 16 per cent since 2012-13.
Admissions for drug-related mental and behavioural disorders fell by 14 per cent, however, to just over 7,300, although this is still 30 per cent higher than a decade ago. Admissions for poisoning by drug misuse were five times more likely in the most deprived areas compared to the least deprived, and six times more likely for mental or behavioural disorders.
The number of deaths in England related to poisoning by drug misuse was 2,917, up 17 per cent on 2017 and almost 50 per cent on a decade ago. Two thirds of the record high number of overall drug poisoning deaths in England and Wales were related to drug misuse (DDN, September, page 4).
The latest statistics from Public Health England (PHE), meanwhile, show a 7 per cent reduction in the number of young people in contact with alcohol and drug services, to 14,485 – down 40 per cent from a decade ago. Almost 90 per cent of young people accessing treatment did so for cannabis, with 44 per cent for alcohol, 14 per cent for ecstasy and 10 per cent for powder cocaine. Less than 1 per cent sought treatment for opiates, although the number was up from 187 to 216 compared to the previous year. A third of all young people starting treatment said they had a mental health treatment need.
Statistics on drug misuse, England, 2019 at digital.nhs.uk
Young people’s substance misuse treatment statistics 2018 to 2019 at www.gov.uk
Since I’ve adapted to recovery it’s incredible to know I can use all my life experience to give back in my own way to society.
“I’d always wanted to make a change in my life. I was born in a Christian family and I was the only one that had lost my way, so it was inevitable that it needed to happen sooner or later.
I’d been addicted for 27 years to crack cocaine, heroin and all other different substances.
Change Grow Live helped me by sending me to rehab. I was asked ‘would you like to go?’ and at first I couldn’t believe that I’d qualify. But I went along and had all the intention to get something out of this, even if it was difficult. I saw a light at the end of the tunnel and started to believe what I was being told.
Scotland’s first heroin-assisted treatment service has been launched in Glasgow, the city council has announced. The Enhanced Drug Treatment Service (EDTS) will treat people with the most severe, long-term and complex problems with ‘pharmaceutical grade diamorphine’.
The service is operated by the Glasgow Health and Social Care Partnership (GCHSCP) and has been licensed by the Home Office. Based in the city centre alongside homeless health services, the aim is to reduce rates of overdose and public injecting, as well as the spread of blood-borne viruses. Clients will receive treatment for other health conditions, and there will be a ‘holistic assessment of their social, legal and psychological needs’ as well as help in accessing other services.
The £1.2m pilot project will be open daily and is expected to treat around 20 clients per day in its first year and 40 in year two. Clients will need to attend the service twice a day, seven days a week and be ‘totally committed to the treatment’, says the council. Injectable heroin-assisted treatment will be supervised by trained nursing staff and restricted to people who are already involved with the city’s Homeless Addiction Team.
A pilot heroin-assisted treatment programme was recently launched in Middlesbrough by the police and crime commissioner (DDN, November, page 5). Glasgow’s plans to establish a drug consumption room, however, have long been stymied by the Home Office’s refusal to change legislation to allow it, despite the backing of the Scottish Government.
‘Sadly, Glasgow suffered a record number of drug-related deaths last year and there was also an increased number of non-fatal overdoses,’ said interim GCHSCP chief officer and chair of Glasgow Alcohol and Drug Partnership, Susanne Millar. ‘This challenging social issue demands innovative treatments and this Gold Standard service is leading the way in Scotland. It is aimed at people with the most chaotic lifestyles and severe addictions who have not responded to existing treatments. Not only are we are striving to save the lives of individuals themselves, we also aim to reduce the spread of HIV and to reduce the impact of addictions on Glasgow families and communities.’
The SNP is the latest political party to publish its manifesto, which repeats the party’s call for drug policy to be devolved so that the Scottish Government can ‘take all the steps needed’ to tackle drug-related deaths and harm – including the piloting of consumption rooms.
The SNP have said drug-related fatalities are a ‘public health emergency’
The country’s record high levels of drug-related fatalities are a ‘public health emergency’, says Stronger for Scotland, adding that a fresh approach is ‘desperately’ needed. ‘The Tories have displayed a shocking lack of empathy towards people struggling with addiction,’ it states. ‘If the UK government refuses to act then they must devolve the powers to Scotland so that we can step in and help to save lives.’
The Conservative party manifesto, Get Brexit done: unleash Britain’s potential, although short on detail takes a more criminal justice driven approach than the other main parties. The paragraph covering drug treatment states: ‘Drug addiction fuels crime, violence and family breakdown – and new dangerous substances are driving an increase in deaths from drug abuse. We will tackle drug-related crime, and at the same time take a new approach to treatment so we can reduce drug deaths and break the cycle of crime linked to addiction.’
The Conservatives promised to tackle drug-related crime
The one criminal justice approach specified is the use of ‘sobriety tags’ for offences relating to alcohol misuse, with the manifesto saying ‘we will expand electronic tagging for criminals serving time outside jail, including the use of sobriety tags for those whose offending is fuelled by alcohol.’
The manifesto also pledged to review The Gambling Act which the party says is increasingly becoming an analogue law in a digital age.
A Labour government would establish a Royal Commission to ‘develop a public health approach to substance misuse’, says its manifesto, It’s time for real change. This would focus on harm reduction rather than criminalisation, the document states.
A Labour government would establish a Royal Commission to ‘develop a public health approach to substance misuse’
The party would also address drug-related deaths, alcohol-related health problems and the adverse impacts of gambling as matters of public health, it continues, and treat them ‘accordingly’ – including expanded addiction support services. Alcohol labels would include clear health warnings, and the evidence around minimum pricing would be reviewed. The party would also implement a ‘tobacco control plan’ and fund smoking cessation services.
The Liberal Democrat manifesto goes further and states that the party would ‘reform access to cannabis’ via a regulated UK market. This would include a ‘robust’ approach to licensing, based on evidence from regulated markets in Canada and the US. Regulation would include limits on potency levels and only allow the drug to be sold through licensed outlets to people over 18. ‘The prohibitionist attitude to drug use of both Labour and Conservative governments over decades has been driven by fear rather than evidence, and has failed to tackle the social and medical problems that misuse of drugs can cause to individuals and their communities,’ says Stop Brexit and build a brighter future. ‘Liberal Democrats will take a different approach.’
The Liberal Democrats would ‘reform access to cannabis’
Anyone arrested for possession of drugs for personal use would be diverted into treatment, the document continues, with the imposition of civil penalties rather than imprisonment, and – ‘crucially’ – there would be more investment in addiction services. The departmental lead on drugs policy would also be moved to the Department of Health and Social Care, and the party would introduce a minimum unit price for alcohol.
Plaid Cymru promised to treat people who use drugs as ‘patients rather than criminals’.
Plaid Cymru’s manifesto, Wales, it’s us, commits to implementing a ‘long-term substance use harm reduction strategy’, which would include both services and education and focus on treating people who use drugs as ‘patients rather than criminals’.
This would help to reduce drug-related deaths, while the ‘current hardline approach’ simply serves to criminalise people who ‘do no harms to others’. The party would establish a national commission to look at reforming the country’s drug laws, it states.
The Green Party’s manifesto, If not now, when? commits to ending the ‘war on drugs, which has trapped hundreds of thousands of people into lives of crime’, and treating drug problems as a health condition. ‘The Green Party recognises that people have always and will always use drugs, including alcohol,’ it says. ‘Seeking to prevent drug use is demonstrably futile; we need a radically new system grounded in harm reduction.’
The Green Party are committed to ending the ‘war on drugs’
The party would repeal both the Misuse of Drugs Act and the Psychoactive Substances Act, and pardon – and expunge the criminal records of – anyone convicted for possession or small-scale supply. The current prohibition system would be replaced with an ‘evidence-based, legalised, regulated’ system of drug control, with production, importation and supply regulated according to specific risks to individuals, society and the environment. Heroin would be made available on prescription following a medical assessment, and safe injection facilities would also be established.
The Brexit party will tackle ‘county lines’ drug gangs.
Commercial advertising for all drugs – including alcohol – would be banned, and minimum unit pricing would be introduced. The party would also set up a new statutory body, the Advisory Council for Drug Safety, to monitor patterns of drug use and advise on sourcing ‘socially and ecologically sustainable supplies of opium and coca from the Global South’.
The Brexit Party’s Contract with the people, meanwhile, includes a pledge to ‘target the menace of county lines drug dealers, gangs and the growth of knife crime’.
Forcing everyone down the same path means losing sight of many on the way.
By Julie Breslin, Head of Drink Wise, Age Well
Walk into one of Drink Wise, Age Well’s MAP (Mutual Aid Partnership) support groups and you’ll meet a whole host of people in different situations. Some will be abstinent, others will be attempting to reduce their alcohol use and some will see themselves as ‘controlled’ drinkers. All these people support and respect what works for each other, no matter how much this varies.
Drink Wise, Age Well is a programme that helps older adults make healthier choices about their drinking. Statistics show younger generations are consuming less alcohol while older adults are drinking more. People aged 45 or over now account for 69% of hospital admissions where the main cause was due to alcohol. It’s vital we support more older adults to make healthier choices when it comes to alcohol, but promoting abstinence as the only option can often be counter-productive.
When DDN launched way back in 2004 Tony Blair was prime minister, the NTA was just three years old, and the money was flowing into drug treatment. Today the sector, and the country, are very different places.
2004 The year starts with cannabis being moved from class B to class C, a status it would manage to retain for a full five years before yo-yoing back up again. The government launches its Alcohol harm reduction strategy for England, which the BMJ quickly dismisses as the ‘dampest of squibs’. Any government serious about addressing the issue would increase the price, the journal states – ‘it’s the one measure that will reliably reduce harm.’
Read the first edition of DDN Magazine
2005 In a perhaps naïve attempt to usher in a culture of civilised, continental-style alcohol consumption, the provisions of the 2003 Licensing Act come into force, allowing theoretical 24-hour drinking and generating predictably apocalyptic headlines. The government re-classifies magic mushrooms to class A, and – not for the last time – Britons are identified as among Europe’s biggest consumers of cocaine.
2006 The government warns drugs gangs to ‘be afraid’ as it launches the Serious Organised Crime Agency (SOCA), while – in a sign of how much times have changed – the sector expresses disappointment that this year’s increase in the Pooled Treatment Budget is ‘only’ 28 per cent rather than the 40 per cent first promised. Scotland’s ban on smoking in public places comes into force, with England, Wales and Northern Ireland following the next year.
2007 The government begins consulting on its next drug strategy, pledging to focus on ‘educating the young and protecting the vulnerable’, while almost 9,000 people fill in the NTA’s user satisfaction survey, with effective care plans and ‘being treated with respect’ identified as key positives. The RSA’s Drugs – facing facts report calls for a shift from a criminal justice to a health-based approach, while the Independent Working Group on Drug Consumption Rooms recommends that UK pilot schemes be established – 12 years later not one will have been allowed.
2008 The global financial crisis hits, setting the scene for the austerity policies that would later see funding for treatment and other services slashed. The government’s ten-year Drugs: protecting families and communities strategy launches, with offers of support to people who use drugs in return for ‘responsibility’. Transform calls it a ‘miserable regurgitation of past mistakes’ while, depressingly, two thirds of respondents to a MORI poll believe that people infected with HIV through injecting drug use have ‘only themselves to blame’. The abstinence v harm reduction wars continue, with Alliance policy officer Peter McDermott branding ‘recovery’ as ‘jargon for state drugs apparatchiks’. DDN’s first service user conference, Nothing about us without us, draws 600 delegates – three times the projected number.
2009 The Scottish Government announces its plans for MUP by stating that ‘strong drink will no longer be sold for pocket money prices’, heralding the beginnings of a legal battle with the industry that will drag on for the best part of a decade. Home secretary Alan Johnson sacks ACMD chair David Nutt for stating that alcohol is more harmful than ecstasy, LSD or cannabis and, in what will become something of a familiar scenario, the government also ignores the ACMD’s recommendation to downgrade MDMA to class B.
2010 In another soon-to-be-familiar scenario the EMCDDA announces that the number of new drugs reported to it is the biggest ever. NHS figures show that Scotland’s rate of chronic liver disease has tripled in the last 15 years, and the death toll in the first ever drug-related outbreak of anthrax – the result of contaminated heroin – reaches double figures. The Drug strategy 2010 is published to a lukewarm response, with DrugScope questioning how its aims could realistically be delivered in the current economic climate.
2011 The government publishes its Health and social care bill, setting out plans to transfer responsibility for public health to local authorities and described by the King’s Fund as ‘the biggest shake-up of the NHS since its inception’. The country’s ‘heroin drought’ continues, leading to warnings of increased overdose rates when supplies become more plentiful, and the Global Commission on Drug Policy – which includes ex-presidents and a former UN secretary general – calls for an end to the ‘criminalisation, marginalisation and stigmatisation’ of people who use drugs.
2012 New synthetic drugs are now being detected in the EU at the rate of one per week, say EMCDDA and Europol, while a UNAIDS document reveals 170,000 new HIV infections in Eastern Europe, mainly via contaminated injecting equipment. Colorado and Washington become the first US states to vote to legalise cannabis, while boss of the fledgling Public Health England (PHE), Duncan Selbie, promises to ensure that drug treatment is evidence-led and says that moving public health to local government is a ‘stroke of genius’.
2013 PHE starts its work, officially taking over the NTA’s responsibilities, while outgoing UKDPC chief Roger Howard warns that people still don’t fully appreciate the ‘profound reshaping of public spending’ on the way. Signifying how the drugs landscape is changing, EMCDDA says the internet is becoming a ‘game changer’ for distribution and the National Aids Trust calls for appropriate support for people involved in the ‘chemsex’ scene.
2014 In contrast to the coming years, Scotland’s drug-related death total falls by 9 per cent, although fatalities are rising south of the border. More than a third of services questioned for a DrugScope report say their funding has been cut, while the following year the organisation itself will go into liquidation, citing the worsening financial situation.
2015 The new majority Conservative government announces its ‘landmark’ blanket NPS ban – which will become the following year’s controversial Psychoactive Substances Act – and its spending review reduces shrinking levels of local authority funding yet further. In what is to become a depressingly familiar announcement, Scotland and England both record their highest levels of drug-related deaths.
2016 The CMO revises recommended alcohol consumption levels, making them among the lowest in the world, while the bleak financial news keeps coming with 70 per cent of local directors of public health saying they expect their drug and alcohol services to face cuts. Rodrigo Duterte goes on the presidential campaign trail in the Philippines promising to kill people who sell and use drugs, and wins, while people in the UK also go to the polls – to vote on something called Brexit.
2017 The Drug strategy 2017 is published as Lifeline shuts up shop after 50 years and the ACMD says funding cuts are now the biggest threat to treatment recovery outcomes and a ‘catalyst for disaster’. The Welsh Government announces its own plans for minimum pricing, and the National Crime Agency (NCA) issues a warning about fentanyl use in the UK as America’s opioid crisis sees overdose levels quadruple since the turn of the century.
2018 The NHS sets out its plan for England to be the first place in the world to eliminate hep C, while the Royal College of Physicians comes out for decriminalisation and Canada legalises cannabis for recreational use. Minimum pricing finally comes into force in Scotland and, worryingly, the NCA says modern slavery referrals of minors are up by two thirds, mainly because of county lines gangs.
2019 County lines activity is still on the up, as is crack use, and City Roads becomes the field’s latest casualty. Prisons continue to struggle with rising NPS use and Release warns that councils are providing ‘drastically insufficient’ levels of naloxone. And 12 years after the RSA’s call for a shift from a criminal justice to a health-based approach, and with government business consumed by Brexit, the Health and Social Care Committee calls for…a shift from a criminal justice to a health-based approach. Whatever happens, however, DDN will be there to report it – thanks for sticking with us.
FIFTEEN YEARS AGO we published our first issue of DDN.
I interviewed the drugs minister Caroline Flint, who talked about the new drug intervention programme (DIP) and the recently launched Alcohol harm reduction strategy. There was a lot happening – the Home Office was pumping money into the sector to ‘break the cycle between drugs and crime’.
By our second issue we had a full letters page. Our new readers engaged with us fast and we loved becoming the new forum for debate. Ministers, service users, academics, policy makers – all joined in. We became more and more interested in our capacity to create a voice for fairer treatment and set up the annual DDN conference.
As a small, independent team we have often been very ‘hand to mouth’, particularly as the funding for the sector began to dry up. But we felt that where there’s a will there’s a way, and we have always been determined to keep DDN free of charge to readers.
Communications have changed radically and debate these days is often lurking on social media. But our readers are loyal, so onwards we go. Thank you for being part of our community. We hope you like our new design – make our day by getting in touch!
With Alcohol Awareness Week this month, Claire Carlow tells us how Forward’s alcohol pathway is revolutionising treatment in East Kent
Read the full article in DDN Magazine
When Forward took over the East Kent service in 2017 we started looking at where we could improve things. It soon became clear that one area was how we supported people whose primary substance was alcohol.
The previous treatment model lacked a specific structure so we decided to redesign the entire alcohol treatment pathway to have a more holistic approach. This included blending tailored psychosocial support for individuals and their families with clinical approaches for those who needed it.
We utilised a wide range of resources to design the pathway, including service user focus groups, feedback forms, national guidance and workshops with local staff. Once designed, we developed a comprehensive range of information guides and materials to enhance the new pathway and support both staff and service users. We also commissioned bespoke training by Kevin Flemen of KFx – all staff and volunteers, including those who might not end up directly involved in the delivery, were trained, and the new pathway was rolled out just over a year ago.
Forward Trust has five local hubs based across Kent.
Each of our five local Hubs – Ashford, Canterbury, Dover and Folkestone, Thanet and Swale – has a designated team comprising specialist alcohol workers and peer mentors. We also have a specialist alcohol detox nurse who supports community detoxes across the region.
The alcohol pathway involves several stages. Clients are assessed and decide with their key worker what they want to achieve – whether it’s reducing the amount they drink or total abstinence. Clients are then referred to one of two treatment pathways, depending on their level of drinking and eventual goal. The pathway for reducing drinking involves group sessions to understand how alcohol affects both the individual and their loved ones and clients then review whether they need further support, including whether abstinence may be a more suitable goal.
The abstinence pathway builds on this support but with additional interventions – these include a medical assessment, regular key working to address individual needs and specific structured groups to inform, plan and support abstinence. Each service now runs peer-led, abstinence-based support groups and links with local Alcoholics Anonymous groups, many of which now run meetings at our services. For clients who need it, medically assisted detox is available – service users are clinically monitored and attend structured treatment sessions, while their families are also given support to understand the challenges their loved one may face.
The pathway has been well received – completions have increased and we’ve supported more than 1,000 people with alcohol issues in the past 12 months, while staff also enjoy working with clients who are more engaged in meaningful treatment.
One of the great – and unexpected – impacts of the pathway has been more clients being able to reduce down and stop drinking entirely without the need for medically assisted detox. Of course this isn’t appropriate or safe in all cases, but it’s a huge improvement on where we were a year ago and shows the positive impact of added psychosocial support.
Claire Carlow is regional head of nursing for East Kent at The Forward Trust
We’re continually improving the pathway by asking staff and service users for feedback on what’s working well and what can be improved. During the initial stages family work wasn’t offered in Margate, but since it has we’ve come to realise that it’s a crucial part of making the pathway a success. The family work element has come on leaps and bounds since.
Claire Carlow is regional head of nursing for East Kent at The Forward Trust. For more information on Forward’s alcohol pathway email Claire.Carlow@forwardtrust.org.uk.
Finally free – Ruth’s story
In July last year, I walked out of my London flat with just a cushion, some cards and a cardholder – nothing else. I was in a bad way and wasn’t really sure where I was going. I ended up in Margate with nowhere to stay except a relative’s holiday cottage. I was at rock bottom and knew I needed help for my drinking, which was out of control.
It hadn’t always been like this. I’d had a great career in media for over 20 years, but alcohol had become part of it – taking a client out for drinks or letting off steam with friends after a hard day. Without realising I ended up reliant on alcohol – at first in social situations, then a physical dependency.
Things finally came to a head this year – I was going through a particularly tough time in my personal life and my drinking escalated. At my worst, I was drinking about a litre of vodka a day. I tried to stop on my own which resulted in me being admitted to A&E with hallucinations. The doctor told me I needed to drink, which shocked me – I didn’t understand how dangerous it is to suddenly stop when you’re physically dependent. So I went back to drinking (as instructed!) but without proper guidance and support I ended up drinking the same amount as before.
Fast forward to my journey to Margate. I’m still not quite sure how I managed to find the Hub – I didn’t know the area that well and I was quite out of it. But I’m so glad I did. I was assessed that day and assigned a key worker, who has been absolutely brilliant. They enrolled me in their new alcohol pathway initiative, which involved several stages. The first was an intensive, group-based ‘pre-detox’ week, where we met on a daily basis to prepare ourselves for the realities – both physical and emotional – of stopping drinking.
The group was great – there’s something about that kind of environment that really encourages you to open up and be vulnerable. You get the feeling that whatever surface-level differences you might have – age, gender, social status or whatever – deep down you’re all in the same boat and understand what challenges the others are going through. The next week I did a medically assisted detox lasting five days. I had to come to the Hub every morning, be breathalysed to make sure I wasn’t drinking and collect my daily medication. I also had some medical tests to check things like liver function.
I had to move back to London not long after I completed the detox, but I know that the Hub is running an abstinence group to support the people who still live locally. Importantly, they’ve given me the tools to stay strong in my recovery, particularly making sure I link into the fellowship (Alcoholics Anonymous) in London, whose meetings I attend on a regular basis. They also taught me about the importance of a strong support network, being honest – even if it means admitting a slip-up – and being compassionate to others and yourself.
I’ve been sober ever since. It’s not always plain sailing but I’m in such a better place. I have a new full-time job in retail and I’ve never taken a day off sick. My friends have been amazing, as has my new boss, who knows all about my recovery and is really supportive. I recently got promoted and to top it off I’ve started running a vintage pop-up in my spare time. Oh and I’ve lost two stone!
Before I stopped drinking, I was worried that being abstinent would take away my freedom. It’s actually been the other way around. My life revolved around alcohol and everything needed to fit in around my drinking. Now I don’t need to find ways to squeeze alcohol in – I’m free from it, and it feels great.
When prescribing regimes are preventing service users from moving on, should we be looking at new options? DDN reports
‘What makes me angry is that they’re treating every drug user as potentially stupid and can’t look after their own welfare, or potentially as a criminal because you’re going to divert your tablets.’
Marcus is talking about the frustrations of being back on supervised consumption. After giving a ‘clean’ sample at the drug service he was put straight onto a weekly pick-up of 6mg of buprenorphine, ‘which was brilliant’. But he ‘started to have a wobble’ about three months ago and began using a couple of times a week. He went back to the drug service and was honest with them: ‘I said this is happening, can I increase my dose?’
The answer was yes, but it was only when he reached the chemist that he realised he had been put back on supervised consumption, having to travel some distance each day to collect his buprenorphine. ‘I accept part of the blame for this – I should have read the script,’ he says. ‘But she should have gone through it with me, she didn’t say a word.
‘I feel as though I’m being punished for using and being honest,’ he says. ‘She’s saying it’s for my own safety. I said, “I’m a 48-year-old man, I can look after my own safety and I’ve never given anyone any reason to believe I’m diverting tablets”. But no, their policy is, “start using again and you’re back on supervised until you can give two clean samples”, and that’s it.’
It makes it very difficult for him to move out of the area, he explains, and going back to the same place brings pitfalls that he had been able to avoid. He sees the same people every day, people ‘sorting deals out’ at the drug service and the chemist. It’s very hard to get away from. ‘I’m seeing people all the time – I know it sounds pathetic, but you only need the tiniest trigger with heroin.’
So what’s going wrong when a highly articulate person feels like they can’t communicate with their drug service? ‘I don’t know whether they have hard and fast rules or guidelines, but if they’re rules then they’re wrong, and if they’re guidelines they should be flexible,’ says Marcus. ‘I don’t feel like I’m invested in my own treatment at all. They are treating me, and that’s it.’
We talk constantly about the stabilising effect of prescribing in helping service users to get back into work, but are we thinking enough about cases where it’s having exactly the opposite effect? Rebecca (not her real name) has been ‘using a bit’ on top of her script, but she can’t tell her drug service the truth about this because they’ll put her back on supervised consumption – and if this happens, she’ll lose her job and her family’s only source of income.
‘They’re putting you in a position where you can’t work,’ she says. ‘I’ve had people say to me in services, when I’ve gone in for treatment, “you need to think what your priorities are”. I’ve said I can’t come to a group every morning, I work full-time. My priorities? Well, a roof over my head to be perfectly honest with you.
‘So you’re pushed out of treatment from day one. It makes life doubly difficult. They don’t expect you to be working and they make very few concessions for you.’
It was these issues among their own service users that made WDP look at flexible dosing regimes – they have just become the first state-funded treatment provider to offer a prolonged-release version of buprenorphine in England and Wales.
According to a study by Haight, Learned, Laffont et al, published in The Lancet (February 2019) taking buprenorphine through an injection every four weeks can offer a viable treatment option for those who find it difficult to attend treatment or keep to a regular daily dose – and will also be a good option for when there are children in the home who might be at risk of taking stored medication.
Findings comments on this study that ‘extended-release injections would seem to have their greatest potential among less stable patients – those unlikely to take daily doses and perhaps even less likely to regularly attend a pharmacy or clinic for consumption to be supervised.’ They also quote Professor Sir John Strang’s comments that this could be a ‘game-changer’ in opiate addiction treatment.
A further study, published by Neale, Tompkins and Strang in the Harm Reduction Journal (April 2019), supports the idea that these prolonged-release formulations could be beneficial to patients ‘who wanted to avoid thinking about drugs and drug-using associates, wished to evade the stigma of substance use, and desired “normality” and “recovery”.’
Dr Arun Dhandayudham, WDP’s joint CEO
Dr Arun Dhandayudham, WDP’s joint CEO and medical director, and Tohel Ahmed, service manager of R3, WDP’s service in Redbridge, had keenly followed the trials in other countries, such as the USA and Australia, and felt that this could help to expand treatment options. Encouraged by the reported success of subcutaneous buprenorphine injections (depots), they established a working group, including WDP staff, Redbridge commissioners and a local pharmacist. Together they developed clinical protocols to enable the new treatment to be prescribed.
Beginning with a pilot project in the London borough of Redbridge, they recruited six service users to try the depot injections. The mixed-sex group of participants includes some who are employed or self-employed, and three of them have children.
The staff involved in the pilot have already noticed the benefits for participants in being able to carry on with their lives without being tied to visits to the chemist, with everything that that entails.
‘Stigma is something our service users experience every day, from themselves and others,’ says Dr Della Santhakumar, clinical lead at R3. ‘This option gives a break from it and offers a taste of normality. This can be a very powerful tool psychologically to move forward in their recovery journey.’
The research goes on. WDP’s Innovation and Research Unit is designing a project to evaluate the effectiveness of buprenorphine depots compared to traditional treatment regimens – but in the meantime the success of the pilot is leading to expansion of the programme to more service users, and across other locations.
‘This has been a great example of partnership working,’ says Dr Arun Dhandayudham. ‘It will support good clinical outcomes and give service users greater autonomy to focus on other aspects of their lives.’
How’s it going?
Feedback from the pilot’s participants has shown reasons for optimism. But as always, every case is complex and it’s still early days.
When Nicola, aged 42, joined the trial she felt unsettled on a sublingual dose. Living at home with two daughters, she felt that the depot dose could make life easier and three weeks on she says she feels ‘alright’ and is not tempted to use on top. While she doesn’t miss daily attendance, she has raised issues around support that management are addressing.
Paul, aged 35, also felt unsettled before the change in treatment, but has felt substantial improvement after a month. He lives with and works with his father and describes the change as ‘brilliant’.
Simon, aged 29, lives in a shared house and has occasional work. On the new dose for three months, he says he feels better for it. He hasn’t experienced withdrawals but smoked heroin twice when he had been drinking alcohol. He says he feels ‘a better person’ for the change of regime.
David, aged 43, lives in sheltered housing and was struggling before starting the new dose. Initially he was ‘not 100 per cent’, but a couple of months on he says he ‘feels fine’ and is glad not to be tied to the pharmacy every day.
Names have been changed to protect identities
This article has been produced with support from an educational grant provided by Camurus, which has not influenced the content in any way.
Change Grow Live wants its new strategy to come from staff and service users, says Mark Moody. Read the full article in DDN Magazine.
I hate the word brand – it’s more about personality.’ Mark Moody, chief executive of Change Grow Live is explaining the thought behind the charity’s new strategy. You might think we are notorious for being business-like, he says, but we haven’t been too good at telling our story, ‘describing who we really are’. Launching a new strategy right now is a ‘deliberate and real’ attempt to express the organisation’s values.
As chief executive for two and a half years, Moody had ‘a fair idea’ about some things he wanted to do. But more than 20 years in the sector, initially as a frontline worker, taught him that any new strategy had to come from the people who would be affected. ‘The principle is not to do things to people, but do things with people,’ he says. ‘If you don’t pay attention to what people want, you will fail.’
With 3,500 staff and 75,000 service users, this was going to be a major undertaking. A series of events were attended by more than 1,000 staff and hundreds of service users. ‘We looked at what’s good and bad about the organisation and the values came out of it,’ he says. His role ‘became almost administrative’ as the strategy was written by staff and service users – ‘The way we came up with it is illustrative of the way we work.’
One of the organisation’s perceived strengths was the quality of its staff and one of the main dislikes was ‘bureaucracy’. Where things like CQC should be ‘a force for good’, the strategy meetings highlighted a mindset of managing risk rather than meeting need, says Moody. The ‘well-intentioned but flawed’ national drug treatment monitoring system (NDTMS) was seen as ‘a giant data set that’s recording more stuff about a person with a substance misuse problem than a person with cancer’.
We need to make the whole thing about people, not numbers, he says. Service users wanted to be seen ‘as a person with a problem, rather than a problem on legs’. The refreshed strategy and values would involve everything and everybody across Change Grow Live’s many and varied projects and services, especially service users.
‘I’m passionate about service user involvement,’ says Moody, who relies on feedback from an active service user council. ‘The feelings and needs of our service users influence how our services are run,’ he says, while acknowledging that service user involvement doesn’t have ‘the teeth it needs’.
‘We’re in the middle of a public health disaster with drug-related deaths,’ he says. They’re called hard to engage people, but they’re not – it’s the services that are hard to engage with.’ He wants to reach the people ‘in the middle’ of their crisis and not just those who have come out the other side of treatment. The new strategy will depend on strong partnerships – internally, with service users, and across the sector. He says that Change Grow Live’s ‘story’ must involve local authorities, commissioners and everyone they work with, including service-user led organisations like Red Rose Recovery and Build on Belief, who are a vital part of the commissioning process – ‘otherwise we would be robbing the community’.
Moody believes his role as chief executive should be about creating conditions for getting answers. ‘I joined this organisation as a frontline worker and am no more likely to have a good idea now than then,’ he says. ‘Today there are potentially thousands of workers who have better ideas than I do – it’s in my self-interest to listen.’
The families of people who use substances are unforgivably overlooked when it comes to policy and service provision. With an election looming, Robert Stebbings gives Adfam’s own five-point manifesto. Read the full article in DDN Magazine.
Robert Stebbings is policy and communications officer at Adfam
We know from our latest research with YouGov that almost one in three adults in the UK have been negatively affected by the substance use of someone they know. That’s a staggering figure, especially when we consider the huge range of harms we know can result – mental health problems, violence/abuse, relationship difficulties, financial strain, isolation and stigma.
That’s why Adfam is launching our new manifesto, setting out five key points we’d like to see the government address to diminish these harms and provide families with the opportunity to thrive. We know they’re ambitious, and rightly so. These families are sorely neglected in policy and provision – a significant proportion of the population who are hidden in plain sight and often suffer in silence.
1. Funding must be made available for every local authority to provide dedicated support services for those affected by a loved one’s substance misuse.
Current provision is very patchy. Effective support in every local area will enable families to improve their health and wellbeing, stay in work, participate in society and build and maintain positive relationships.
2. Family members who assume roles as kinship carers should be supported financially to ensure they are able to fulfil their responsibilities without fear of entering poverty.
Research by Grandparents Plus has found that 50 per cent of children living in kinship care do so due to parental substance misuse. Kinship carers must be given the same rights and benefits as foster carers to provide the financial support they desperately need and to safeguard the emotional wellbeing of them and the children in their care.
3. Money should be ring-fenced for children’s social care services to identify and provide ongoing support for children affected by parental substance misuse to ensure they are given opportunities to recover and thrive.
These children can experience neglect and physical and emotional abuse, which often leads to more serious mental health problems and other negative outcomes in the future. More funding will enable children’s social care services to better identify these children and give them the support they need.
4. Central government money should be made available to start a national conversation to improve public understanding on the impact of substance misuse on others and tackle stigmatising attitudes.
Our research shows that 2m adults in the UK have experienced stigma or judgment as a result of a loved one’s substance use and this can be a barrier to them speaking out or seeking support. A national conversation is needed to change the public’s understanding and recognition of this issue.
5. Government should launch a public enquiry into how substance misuse contributes towards mental ill health and poverty in families.
Around 5.7m adults in the UK have experienced mental health problems such as anxiety or depression and 2.8m have experienced financial impacts such as debt as a result of someone else’s substance use. The government needs to take action to understand how substance use contributes to a wide range of harms to families.
Over the coming months we’ll be taking our manifesto to parliamentarians, seeking their support in turning these recommendations into practice.
Leaving drug use behind can feel like losing a lover. Christopher Robin looks at how to cope.
Christopher Robin, Enigma Drug & Alcohol Consultancy
Perhaps you need a new perspective, a new way of looking at your drug or alcohol use, I suggest to clients. Your connection with a drug is like a relationship – and relationships, as we know, come in many forms; some healthy, some unhealthy.
In a marriage, two people fall in love, decide to spend their lives together and make vows to love, honour and respect each other, forsaking all others for as long as they both live. These are huge promises that hold many challenges and changes, including the individual growth of each person.
The years pass, the love changes. The things that were once endearing may now be irritating. Desire diminishes, the ageing process takes each person in a different direction, yet both parties are reluctant to let go. They take comfort in the familiar, fear the unknown and create reasons to remain as they are – even though neither is happy. Put your substance of choice in place of a partner. Do these feelings and fears sound familiar?
Imagine this marriage now becomes undermining and destructive. Finally, one or both decide that separation and divorce is the only way forward. The separation is difficult and full of sadness. Sometimes the couple fight over belongings, only to collapse in tears and then wonder if they made the right decision. They remember the good times and wonder how it could have come to this. Sometimes they embrace, make love one more time, then feel guilty, confused and regretful. Could they have avoided divorce? Alas, they know things have gone tchrisr.
Once you’ve made the decision to separate and divorce, the transition can feel difficult and dangerous. You may want to go back, to feel the familiarity. You might feel lonely and yearn for the one who made you feel so good. You might even go back for a night and indulge yourself, even though in the morning it’s difficult to get away. If you decide ‘never again’, the loss is so great and the yearning almost overpowering, enticing you with selective memories. So how do you get through? How do you resist the yearning and craving?
At the end of any long and intense relationship, including substance misuse, you need to learn to deal with the loss and the accompanying changes. How do you spend your free time, what do you do at weekends, how do you sleep? You slowly and gradually build strength and resilience with help and support, and by doing things that perhaps you never thought you would.
It can be a long journey, yet every day can bring a lovely surprise. Just remember, some days you may have to look for it.
Mark Reid on two books that consider the restorative power of walking.
The Salt Path is available to buy in bookshops and online
In The Salt Path, Ray(nor) Winn and Moth, Cer husband of 32 years, are devastated. They’ve lost the house and farm they’d owned for over two decades and where they’d brought up their children. They’re evicted when they lose a legal battle and are liable for debts after an ill-advised investment with a once-close friend. Moth has also just been diagnosed with a life-shortening brain condition. And yet they set out to walk England’s 630-mile South West Coast Path, with just £47 per week in tax credits to live on.
At first, and for a long stretch of the walk, Ray can’t stop thinking of all they had to leave behind, and her sense of loss is colossal. Lost, they shout and argue about all their ‘wrong decisions’. Gradually – despite being ‘battered by the elements, hungry and cold’ – they adjust, and going for a swim in the sea becomes ‘an oasis of clarity, clear water, tide-rippled sand, free from time.’ Moth feels much better and comes off the pregabalin prescribed for his aches and pains. They wonder if it’s because they keep moving and ask, ‘the huge wash of oxygen, can it somehow affect the brain?’
In Praise of walking is available to buy online and in bookshops.
Shane O’Mara is a professor of neuroscience at Trinity College Dublin, and his In Praise of Walking takes us through the evolution and mechanics of walking, which he hails as ‘an astounding neuro-musculoskeletal achievement’. Among the many mental health benefits established are those of a 2014 Stanford University study in which one cohort remained more-or-less immobile while another group walked briskly outdoors. The active ones showed a marked increase in creativity and problem-solving when tested afterwards. Walking stimulates the body’s molecular growth factors to produce new brain cells and the blood vessel network is enhanced as muscle use increases.
O’Mara’s findings are paralleled in The Salt Path – he’s not saying that walking cures brain disease, but it may make it more manageable, just as it eases Ray’s harrowing thoughts. O’Mara calls it ‘mindlessness’ brought on by the body’s walking rhythms, which are set by a ‘central pattern generator’ in the spinal cord. He describes how this can then take the walker into a state in which ‘huge areas of ground are covered for what feels like minimal effort, with great enjoyment and feelings of control, of oneness, of immersion, of being in the zone’. Indeed, as Ray’s psychological wounds slowly heal in The Salt Path she ‘could feel the sky, the earth, the water and revel in being part of the elements’.
There are, though, frequent reminders along the way that they are homeless and poor.
They are often on the receiving end of other people’s bigoted perceptions of homelessness. It’s fine when they are assumed to be happy-go-lucky retired homeowners on a big adventure. But when they tell people, ‘We’re homeless, nowhere to go’ they’re met with contempt or fear. ‘One man reached out and pulled his child towards him, his wife winced and looked away’. In their one encounter with the urban homeless, Ray and Moth know immediately they have no desire to join the street drinkers and the repetitive demands of addiction. ‘I wanted to run’ writes Ray.
‘Walk without expectation’ says In Praise of Walking. The Salt Path echoes this: ‘We walk until we stop walking and maybe on the way we find some kind of future’. The wisdom Ray and Moth are granted is a triumph of the spiritual over the material: from being bereft at losing the bricks-and-mortar of home, their epiphany is that they ‘don’t need to own a piece of land’ to be content.
There is ‘no justification’ for online slot machine style games to have staking levels above £2, says a report from the Gambling Related Harm All-Party Parliamentary Group (APPG). The document, which is the result of a six-month inquiry into online gambling harms, calls for the government to ‘urgently introduce’ new gambling legislation with a focus on harm prevention.
Carolyn Harris MP: ‘Urgent review of online gambling needed’
The Gambling Commission also needs to improve its standards in the area of online gambling, the report adds, while banks should be given an ‘increased role’ in carrying out affordability checks. The use of credit cards should also be banned by online gambling sites, it says, to prevent people using debt to finance their gambling.
The sector needs to urgently adopt a ‘more responsible’ approach to advertising to protect vulnerable people and children, it continues, while the use of ‘VIP’ accounts and other inducements should also be restricted.
‘This report highlights the urgent need for a root and branch review of the regulation of online gambling,’ said APPG chair Carolyn Harris MP. ‘Stakes and prize limits online would be a major step forward in reducing the harm caused by the sector.’
See the December/January issue of DDN for a special eight-page supplement on gambling harms.
The Scottish Affairs Committee has become the latest group of MPs to call for an overhaul of the UK’s drug laws, saying that the government approach to drug use needs to be ‘substantially reformed’ and recommending decriminalisation for personal use. The Health and Social Care Committee also recently stated that UK drug policy was failing and required ‘radical change’.
MPs heard from service users, families, treatment services and others in what it is calling ‘one of the most extensive inquiries ever conducted into problem drug use in Scotland’. Last year saw drug-related deaths in Scotland reach an all-time high of 1,187 (DDN, June, page 4).
Pete Wishart MP: ‘The evidence is clear – the criminal justice approach does not work.’
The committee echoes previous calls for a public health and evidence based approach, and wants to see the Scottish Government doing more to ensure that treatment services are properly funded and supported. It also calls for legislation to allow for consumption rooms to either be brought forward or for the power to do so to be devolved to Scotland.
The report repeats previous calls for lead responsibility for drug policy to be moved from the Home Office to the Department of Health and Social Care.
‘Throughout our inquiry we heard tragic accounts of the pain and suffering that problem drug use is causing in Scotland,’ said committee chair Pete Wishart MP.
‘If this number of people were being killed by any other illness, the government would declare it as a public health issue and act accordingly. The evidence is clear – the criminal justice approach does not work. Decriminalisation is a pragmatic solution to problem drug use; reducing stigma around drug use and addiction, and encouraging people to seek treatment.
‘We’re not the only ones calling for this change. The Health and Social Care have also said the government should consider decriminalisation. It reflects the weight of evidence in support of this approach, and I hope the next government takes this recommendation seriously.’
Drug policy in the UK is ‘clearly failing’ and requires radical change, says a report from the Health and Social Care Committee. With rates of drug-related deaths now at the ‘scale of a public health emergency’ a shift from a criminal justice to a health-based approach is urgently required, it says.
A shift to a health-based report is urgently required, says the report.
The document calls on the government to consult on decriminalising possession for personal use to a civil matter, and urges it to examine the Portuguese system, which also includes improved harm reduction and treatment provision. Money saved in the criminal justice system through decriminalisation could be used for investment in treatment and prevention, the report argues. With funding levels cut by almost 30 per cent in recent years, significant investment needs to be directed into drug treatment ‘as a matter of urgency’.
New investment would need to be accompanied by a centrally coordinated clinical audit to make sure that guidelines are being followed in the best interests of service users, the report adds. The committee supported the introduction of onsite drug checking facilities at festivals and in the night-time economy, it said, while consumption room pilots should be introduced in areas with high need, with a ‘robust’ evaluation of their effectiveness. If this required changes to current legislation then they should be made ‘at the earliest opportunity’. Echoing previous calls, the committee also wants to see responsibility for drugs policy moved from the Home Office to the Department of Health and Social Care.
Sarah Woollaston: Every drug death preventable.
‘Every drug death should be regarded as preventable and yet across the UK the number of drug-related deaths continue to rise to the scale of a public health emergency,’ said committee chair Sarah Wollaston MP. ‘UK drugs policy is clearly failing. Avoidable drug deaths are increasing year on year across the UK but there has been a failure to act on the evidence. Scotland is particularly hard hit with the highest death rate in Europe.’
A holistic approach based on improving health needed to be a priority, she stated, to benefit not just people who use drugs but wider communities. ‘We have focused on the evidence and call for the Department of Health and Social Care to take responsibility for drug policy going forward instead of the Home Office. Decriminalisation alone would not be sufficient. There needs to be a radical upgrade in treatment and holistic care for those who are dependent on drugs and this should begin without delay.’
Niamh Eastwood: ‘Tough on crime rhetoric’ must change.
Release welcomed the report, with executive director Niamh Eastwood stating that the proposals went ‘some way’ to addressing the drug-related death crisis. ‘The recommendations of the report are an evidenced based approach to drug policy and should be immediately adopted by the Conservative government to ensure that our drug policy reduces harms and saves lives. However, we are concerned that the current tough on crime rhetoric from the Home Office will see a continued ideological approach to drugs rather than a pragmatic one as taken by the committee.’
Public Health England (PHE) is working to produce the first UK-wide set of clinical guidelines for alcohol treatment, the agency has announced. While the UK drug misuse treatment guidelines – widely known as the ‘orange book’ – have helped to ensure good practice in drug treatment, there has so far been no equivalent for alcohol.
A new ‘orange book’ will tackle alcohol treatment.
PHE is working in partnership with the Department for Health and Social Care (DHSC) and the governments of Scotland, Wales and Northern Ireland to publish a set of clinical guidelines to ‘provide support for alcohol treatment practice’, it says. Alongside promoting consistent good practice and improving the quality of service provision, the aim is to develop a clear consensus and help services implement interventions recommended by the National Institute for Health and Care Excellence (NICE).
The guidelines will provide a framework that commissioners can use when designing service specifications as well as a reference point for regulatory bodies when they inspect services. They will also provide guidance on managing service user pathways, such as those between hospital or prison and the community. PHE will start work on the guidelines next month using an expert group of clinicians, professionals and service users, with the aim of publishing by the end of 2020.
Rosanna O’Connor: Effective alcohol treatment can reduce the burden on health and social care.
‘Effective alcohol treatment can help to reduce the burden that is placed on health and social care services as well as reducing crime, improving health, and supporting individuals and families on the road to recovery,’ said PHE’s director of alcohol, drugs, tobacco and justice, Rosanna O’Connor. ‘Our aim is that the guidelines will help to increase the number of people in the UK receiving effective treatment for alcohol-related harm or dependence.’
Meanwhile, a study by ASH states that a million people could be lifted out of poverty by ending smoking in England. Around 1,011,000 people have been driven into poverty through the cost of tobacco addiction, says the charity, while the four largest tobacco multinationals make annual profits in the UK of more than £1.5bn.
‘Poorer smokers tend to be more addicted and find it harder to quit,’ said chief executive Deborah Arnott. ‘Worse still they are disproportionately disadvantaged if they don’t, because of their smaller incomes. That’s why it’s vital that smokers are given the support they need to quit, funded by a “polluter pays” approach. This would force the extremely profitable transnational tobacco companies to pay to end smoking.’
Smoking and poverty 2019 at ash.org.uk – read it here
A man in recovery from alcohol and cocaine addiction is preparing to launch a £7m rehab and behavioural health centre – the only purpose-built facility of its kind in the UK.
People suffering addictions and work burnout will be able to check into the private facility to benefit from a bespoke treatment programme.
Addiction specialist Mike Delaney is the clinic’s director of health and Prof Sir Cary Cooper, leading expert on wellness, sits on its advisory board. ‘What we’re creating is something exemplary, something that is different, not for the sake of being different, but because it is needed,’ said founder Martin Preston, aged 36.
‘We know how important a truly therapeutic environment is in healthcare and have therefore created what works. Rehab is an industry characterised by people who want to make a difference having to do it on a shoestring. Environment is often underinvested in, there has been little innovation and outcomes are not well reported. Delamere is here to change that.’ Martin used alcohol and drugs while battling crippling anxiety and depression, which took hold after he almost died of meningitis aged 15. By the time he went to university, aged 18, he was dependent on cannabis and drinking a bottle of spirits a day.
Martin Preston, founder of Delamere Rehab
An initial 28-day stint in rehab saw him manage to stay sober for less than five months before turning back to alcohol, cannabis, and, then, cocaine. At 21, determined to succeed, he spent a further three months in rehab, followed by 18 months devoted to AA meetings, recovery and volunteering in rehab. He has been drug free and sober since.
Martin went on to build a successful career in advertising, but had a calling to help people facing addiction. He travelled the world to meet addiction experts, therapists, psychologists, academics and doctors, visiting more than 40 rehab clinics, and spent time studying the sector in America.
Prof Sir Cary Cooper, Professor of Organisational Psychology and Health at Manchester Business School and culture change expert, said: ‘Martin has great enthusiasm and passion for what he does. Delamere is far more than just a commercial activity. He has created something different to really change people’s lives.
The new, discreetly located centre is set in six acres of green belt beside Delamere Forest in Cheshire. The building, designed to replicate a modern barn conversion with high ceilings and huge glass panel walls, but with the feel of a boutique hotel, has been informed by the Maggie Cancer Support centres with an emphasis on home comforts and away from institutionalism.
Thirteen men have been arrested as part of an investigation into what the National Crime Agency (NCA) is calling the largest UK drugs importation operation yet discovered.
They are thought to be part of the UK arm of a ‘well-established’ organised crime group that used Dutch and British front companies to import heroin, cocaine and cannabis hidden in lorries carrying vegetables and juice. The group is responsible for importing more than 50 tonnes of drugs, says the agency, with six Dutch citizens also awaiting extradition to the UK.
Heroin, cocaine and cannabis was hidden in lorries carrying vegetables and juice. Picture from NCA website
‘We suspect these men were involved in an industrial-scale operation – the biggest ever uncovered in the UK – bringing in tonnes of deadly drugs that were distributed to crime groups throughout the country,’ said NCA’s regional head of investigations, Jayne Lloyd. ‘By working closely with partners here and overseas, in particular the Dutch national police, we believe we have dismantled a well-established drug supply route.’
Meanwhile, a new briefing from Transform states that the expansion of county lines activity is partly a response to effective policing that has disrupted conventional supply routes. Sophisticated organised crime groups groom and exploit young and vulnerable people as they are ‘harder for police to detect and arrest, easier to control, and are readily replaced’, with police and social services facing an ‘impossible task’ to protect them.
‘We need to acknowledge that behind all this lies a system of drug prohibition that leads to disastrous consequences,’ says County lines drug supply – exploiting the young and vulnerable; enriching organised crime. ‘County lines is a system of supply that only exists because the trade is left completely unregulated.’
The Scottish National Party (SNP) has given ‘overwhelming support’ for the devolution of drug laws to Scotland to allow decriminalisation of drug possession.
Delegates at the party’s conference in Aberdeen unanimously passed a resolution calling the present system of drug control legislation ‘not fit for purpose’.
Map showing drug decriminalisation around the world as of August 2018. Produced by www.talkingdrugs.org
Last year once again saw Scotland record its highest ever number of drug-related deaths, at 1,187 – the fifth consecutive increase and 30 per cent higher than the previous year’s total (DDN, July/August, page 4). The Scottish Government has repeatedly clashed with Westminster over refusal to allow a pilot consumption room project in Glasgow.
The SNP’s move has been welcomed by the Scottish Drugs Forum (SDF).
Scottish Drugs Forum (SDF), CEO David Liddell
‘Decriminalisation would address several issues that cause unnecessary harm to people who use drugs and others,’ said CEO David Liddell.
‘The clandestine nature of drug use can stop people seeking information and help from treatment and other professionals. People who regard their use as non-problematic are not open with health professionals, who could otherwise link their health issues with their drug use. People who are already experiencing harms present to services later and in the face of more serious harms than they might otherwise have had. Criminalisation clearly stigmatises people and has negative effects on people’s sense of self and identity. This, for some, leads to more marginalisation and more drug use.’
As the annual event drew to a close, Turning Point celebrated being ‘stronger together’.
Every year, Recovery Month promotes the societal benefits of prevention, treatment, and recovery for mental and substance use disorders. It offers an opportunity to celebrate people in recovery and the contributions of treatment and service providers. It promotes the message that recovery, in all its forms, is possible.
This year was the 30th year of celebrating the lives of those who are in recovery from addiction, showcasing positive change – health improvements, learning new coping skills, and holistically moving forward to a better life. This might mean becoming free of drugs or alcohol or learning to get better control over their use – here at Turning Point, we believe that any change focused on enhanced wellbeing is part of that journey.
This year’s theme, ‘We are stronger together’, demonstrated that millions of people from all walks of life have found recovery. Showing visible recovery promotes widespread understanding that long-term recovery is a reality and a process that takes time and support. Ultimately, Turning Point empowers clients to find their own path to recovery, which could be through one or a combination of different routes.
On 25 and 27 September, our ROAR (Rochdale and Oldham Active Recovery) service hosted two events in Rochdale and Oldham respectively, featuring ‘Club Soda’, an alcohol-free, mindfulness-focused drinking event with mocktails, aromatherapy mists, karaoke music and board games – even bongo drums lessons! Both included inspiring recovery stories, shared in rap music style from rap artist/storyteller Ben Riley, and poetry readings and stories from those who have gone through treatment.
If you are currently struggling with alcohol or drug use issues and would like to speak to Turning Point about seeking help or advice, call us on 0300 555 0234.
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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.
A pilot heroin-assisted treatment (HAT) programme is being launched in Middlesbrough, the local police and crime commissioner (PCC) has announced. The programme will concentrate on up to 15 of the most ‘at risk’ people with entrenched drug problems.
Participants will visit a clinic twice a day where diamorphine will be administered under supervision. The aim is that with ‘the need to constantly fund street heroin removed’, clients will then be able to engage with health, housing, welfare and other agencies at the clinic and ‘get their lives back on track’.
The programme will be available to people for whom all other treatment options have failed and who are ‘causing most concern’ to criminal justice, social care and health services. It has been organised and partially funded by Cleveland PCC Barry Coppinger, with further funding from Durham Tees Valley Community Rehabilitation Company and the Tees and Wear Prisons Group.
The scheme is designed in part to ‘free up the substantial public resources’ being used to address drug issues, the PCC’s office states, as well as promote long-term recovery and reduce rates of drug-related deaths and acquisitive crime. Middlesbrough’s 20 most prolific drug-dependent offenders alone are estimated to have cost the public purse almost £800,000 over two years, ‘based only on crime detected’. The pilot will be independently evaluated with the aim of extending it for a second year with funding from the Proceeds of Crime Act (POCA).
Clinical Team Lead Daniel Ahmed
‘This treatment and recovery pilot is aimed at those for whom all other current methods have failed,’ said the project’s clinical team lead Daniel Ahmed.
‘They are on a cycle of offending, committing crime to raise funds for street heroin, being arrested and going to prison, being released and offending again. The cycle often only ends when they die, often in the street. Before joining the pilot, each of the cohort is medically assessed and the appropriate course of diamorphine is prescribed and administered under supervision daily at a specialist clinic. This removes the constant need to commit crime in order to fund street heroin addiction.’
‘The policies of the past have failed,’ added PCC Barry Coppinger. ‘If we are serious about tackling and preventing addiction we need to listen to the experts, take notice of the evidence and act decisively. By removing street heroin from the equation you remove the need to commit crime to fund addiction and the impact this has on local residents and businesses, you remove the health risks of street heroin and the associated drugs litter and you remove the drain on public services including health and police. In addition you halt the flow of funding to drugs gangs.’
Meanwhile, North Wales police will no longer automatically prosecute people caught in possession of drugs, including class A substances, according to the area’s PCC, Arfon Jones. The scheme will see people arrested undergo a needs assessment with the option of then signing a 12-month contract agreeing to undertake drug treatment. ‘If after those 12 months they haven’t reoffended then they will not get prosecuted and so will not have a criminal record’, Arfon Jones told the Guardian, adding that there was already ‘de facto decriminalisation’ of drugs by most British police forces.
A new campaign is tackling stigma head on, says Asi Panditharatna. Read the full article in DDN Magazine
Asi Panditharatna is divisional director of employment services at Forward Trust
‘We believe everyone has the ability to turn
their life around, if given the chance.’
More Than My Past is a national campaign, launched by The Forward Trust, to challenge the stigma that prevents people with difficult pasts reaching their full potential. It shows that ex-offenders and people in recovery from addiction not only want to change and succeed – they can and do.
The campaign website and social media share stories of people from all walks of life who have successfully confronted their problems and moved on to prosper in their personal and professional lives. Through sharing personal accounts of overcoming addiction and offending, they are calling on the government, employers and general public to share a belief in people’s capacity for recovery and rehabilitation. They want us to celebrate their stories of achievement over adversity while taking action to support this agenda.
Forward are also supported in the campaign by a number of employers who believe in giving people another chance as a potential new pool of talent in these challenging times.
A hidden workforce
The campaign aims to demonstrate to employers that individuals who have successfully recovered from addiction or who are rehabilitated ex-offenders are a worthy investment, if given the opportunity to prove themselves. Among the key facts it has highlighted:
• Ex-offenders and people in recovery are the two groups that organisations are least likely to employ; one in four people in recovery have been turned down for jobs three times or more when disclosing their past (Bridging the gaps, The Forward Trust, 2017).
• Seventy-five per cent of prisoners have no job on release even though having a job is the single biggest factor in reducing re-offending; 15 per cent of prisoners have never worked legally, and 47 per cent of prisoners have no qualifications.
• Those in recovery from addiction who are employed are 22 per cent more likely to be abstinent than those who are not, and having a job more than doubles the length of abstinence.
Meanwhile, with Brexit looming, evidence shows that employers may need to seek out new pools of talent to be able to meet their requirements. According to the Chartered Institute of Personnel and Development (CIPD), 70 per cent of employers with vacancies said that at least some of those were proving hard to fill in autumn 2018, compared to 51 per cent in spring 2017.
Some employers are already embracing the opportunity to work with this group of people, and know how rewarding it can be for both the business and the individuals. Catering company and food retailer Cook, leading retail service provider Timpson and transport social enterprise HCT Group are among those backing this new campaign.
‘HCT Group believes that someone’s history shouldn’t define them,’ said Dai Powell, HCT Group’s chief executive. ‘We’re proud to support the More Than My Past campaign as we believe in the potential of people whose past may not have been perfect. So many individuals still face too many barriers to employment due to a criminal past. But if they are given a chance they can – and do – turn their lives around to become valuable members of society.’
See the transformational change that ex-offenders and people in recovery can achieve at www.morethanmypast.org.uk and by joining the conversation on social media:
‘Forward has been supporting people with criminal backgrounds or drug and alcohol problems to turn their lives around for over 25 years,’ says Forward Trust CEO Mike Trace. We know that if we show a belief in their ability to make a positive change, and give them the opportunity to prove themselves, they can do amazing things.
Mike Trace, Forward Trust CEO
We back up this belief by aiming to have a high proportion of all our staff, apprentices and volunteers with ‘lived experience’ – either a history of drug/alcohol problems, or of offending. Currently, a third of our 400 salaried staff, all of our 20 apprentices, and 80 per cent of our 150 volunteers, report that they are in one of these categories.
We want the general public and employers to share our belief in this untapped potential and do something to support people to be more than their past.
‘Things are so different now…’
Andy, one of the many inspiring participants of the campaign, tells his story
Andy Apps, Forward peer mentor
It started how it does for so many: I was a social drinker. Like a lot of people, I started drinking in my mid to late teens, but it started to escalate in my early twenties. Then I started to get into drugs as well and things just spiralled out of control from there. I lost relationships and jobs because of my drinking and using. Soon I felt like I’d given up and my addiction became even more entrenched. I started committing crime and was in and out of court all the time.
I first went to rehab in 2003. I stayed completely sober for three months, but deep down I didn’t think I had a problem with drink. When I moved into my own place, I struggled to pay my bills and I soon turned back to drink, which led back to drugs. Although I was in a better place, doing my best to look after myself for the next few years, I couldn’t let go of drugs and alcohol altogether. In 2015, I moved from Sheffield down to my mum’s house in Surrey, where I was still drinking and using. She tried to help but I still wasn’t ready to change.
The grief of my dad dying in October that year made my addiction worse. I just couldn’t put drugs and alcohol down and things were getting steadily worse. Then I had one of those life-changing conversations with a friend and something inside me clicked – I knew I needed to get sober. That was in February 2016, and I haven’t touched a drug or a drink since.
Around the same time, I was introduced to Transform Housing and Support, who supported me into one of their dry houses (supported accommodation where residents must remain free from drugs and alcohol). With the support of a friend I made in the Transform house, I learned to cook and look after myself.
A month after I got sober, I started volunteering and attending fellowship meetings. I’ve found this has been so helpful to my recovery – giving me a structure and a purpose to my life. Since I found recovery, I’ve got back into things I used to like but hadn’t really had the time for – like fishing and cycling. I loved fishing as a child but in active addiction, it just fell away. Now I go whenever I can – either with a friend or by myself – it’s a really great way to have some quality thinking time.
In 2017, a friend introduced me to The Forward Trust. They supported me to start a level 2 qualification in peer mentoring and also ‘meet and greet’ training. I now do meet and greets for them – meeting a Forward prison client at the gate on the day of their release and supporting them with things like appointments and getting to rehab or supported accommodation.
I also volunteer in a charity shop and cheered on Forward fundraisers at the London to Brighton bike ride. It was such a great day and I felt really proud to be involved in the charity – plus I love cycling!
It took me a long time to get where I am today, but I’ve worked hard and things are so different now. I cycle every day, even when it’s raining cats and dogs! Once I’m on the bike, it’s like a form of meditation for me and really helps me to switch off. I’m giving back to a great organisation, learning new skills and I’m hoping to apply to do Forward’s apprenticeship scheme soon.
My mum is so proud of me and how far I’ve come, and I’m proud of me too. I’m living proof that people can change their circumstances.
For a long time now we’ve been involved in initiatives to help remove barriers for those seeking to get back into work (page 6 and page 12). Remember the UKDPC’s work on tackling stigma and getting people who have used drugs back into employment? Remember the old heated debates in DDN about the ‘two-year rule’ used by some employers to demand ‘clean’ time before people could be considered for a job? Several years ago we were involved in a recovery conference, where we invited senior staff from large organisations to outline their policies for supporting people with criminal records to begin a career with them.
But have we moved on at all? The prison door revolves as much as ever and with the exception of a few shining examples in the Timpson mould, most employers have become even more risk averse, refusing to look at the opportunities for them in unleashing the talent and skills of people who would offer so much valuable experience in return for a foothold. Let’s hope that Forward Trust’s campaign continues to gain traction as the voices of its participants get louder. It’s much needed, that’s for sure.
Unfortunately, the political situation gives little confidence to anyone – least of all those who have cause to worry that their health may be further compromised and their stability challenged in the days ahead. Nick Goldstein turns over a worrying scenario on page 8. Can we hope to be any the wiser in a few weeks? It’s anyone’s guess. Let us know how you are weathering the uncertainty.
A team of cyclists made up of staff from Humankind’s services across the country completed an epic 170-mile Ride for Recovery from Manchester to Middlesbrough. They take us through their journey. Read the full article in DDN Magazine.
Cyclists set off from Manchester
The Ride for Recovery aimed to highlight the many ways to achieve recovery from substance misuse, and to raise money for people who use Humankind services. It was also timed to arrive for the start of the FAVOR UK Recovery Walk in Middlesbrough.
The cyclists were volunteers from services in Manchester, Leeds, London, Halifax and the head office in Newton Aycliffe, and called in at Humankind-led drug and alcohol recovery services along the way. ‘Humankind is a major sponsor of the FAVOR UK Recovery Walk this year,’ said chief executive officer Paul Townsley, who was among the cyclists. ‘We wanted to show our support for this cause with this Ride for Recovery. Raising money and awareness to improve the lives of our service users will demonstrate that.’
Day one was the 43-mile journey from Manchester to Leeds. The riders were seen off by staff and residents at Redbank Recovery Accommodation, who had even baked them food for the trip. Area manager for Humankind’s North West services, Helen Hubberstey, was among those turning out to wish the cyclists well. ‘I think it’s really important we get behind causes like this to demonstrate our commitment to recovery and the journey that our residents are on,’ she said, while cyclist Rhian James from Humankind’s Manchester office said that ‘having people supporting us like this makes us feel it’s all worthwhile’.
The cyclists travelled via Humankind-led services at Calderdale Recovery Steps and 5 WAYS, the recovery hub that forms part of Forward Leeds, the city’s alcohol and drug service. The members of 5 WAYS, who are all in recovery themselves, were there to greet the riders on arrival with balloons, bunting and a home-made welcome flag. ‘It was amazing to see what the cyclists have achieved so far,’ said 5 WAYS member Stacey Vickers. ‘It made me want to get on my bike and be a part of it next year. The riders created such a brilliant atmosphere.’
‘Today has been a real struggle though hill climbs, cobbles and bad weather,’ said cyclist Claire Burns from Humankind’s HR team when she arrived. ‘But the reception we’ve been given at 5 WAYS is just amazing. Everyone has given us such a warm welcome and it was just the tonic we needed after such a long ride’. Senior practitioner at 5 WAYS Helen Mason added that the community ‘loved having them here’.
Day two was the 53-mile journey from Leeds to Northallerton, with the riders stopping off at the Headingley cricket ground before cycling via Ripon to North Yorkshire Horizons’ Northallerton hub. ‘North Yorkshire Horizons wishes all the very best to everyone taking part in the Ride for Recovery, raising money and awareness to improve the lives of our service users who we support on a daily basis,’ said Humankind assistant director Mark Vidgen.
Day three saw the team riding out of Yorkshire and into the North East for the 34-mile trip from Northallerton to Bishop Auckland. ‘It was an honour to host this event,’ said project manager at County Durham Drug and Alcohol Recovery Service, Bob Smith. ‘It gave us a chance to showcase the progress being made in County Durham, and highlight the hard work from service users, staff and volunteers which is showing definite results in advocating real recovery in individuals.’
Humankind CEO Paul Townsley
The final day was the 36-mile stretch from Bishop Auckland to Middlesbrough, with the cyclists arriving in time for the 2019 Recovery Walk.
‘The ride has been brilliant, bringing a group of staff together from different services with one aim,’ said Paul Townsley. ‘It’s been great for us all to learn about what is going on at the drug and alcohol services that we have visited along the way, and to get to chat with staff and service users.’
The implications of this political turmoil are dangerous for service users says Nick Goldstein. Read the full article in DDN magazine.
Ha! Brexit!! I can imagine eyes rolling out there, but bear with me – I promise to avoid commenting on Brexit itself or the ideology and tribal politics that propel it.
This article will just be a gentle ramble through some of the plausible short- and long-term implications of Brexit on substance misuse.
I’m afraid there will much supposition, conjecture and flat-out guess work because when it comes to Brexit there are very few definites and a mountain of intangibles. This is certainly the cause of much political uncertainty, but the coup de grace is an uninterested silence from the state, political parties, NGOs, charities and, more forgivably, from drug users themselves. More on this silence and its meaning later.
There are significant implications for substance misuse and substance misuse treatment that come from the wide variety of Brexits still possible. These range from our potentially leaving Europol with its knock-on effect on policing influencing how much and even what drugs are available, to our potentially leaving the EMCDDA – an agency that provides key data used by policy makers, which would obviously have a knock-on effect on any future politico-legal change.
Of rather more concern would be the loss of the European Convention on Human Rights and access to the European Court of Human Rights in Strasbourg. These rights (ironically put together mainly by David Maxwell Fyfe at Churchill’s behest and based on English law) are limited but offer invaluable protection to many vulnerable groups – including drug users.
One example of their worth is that they were used successfully as the legal basis of a case brought by prisoners to ensure maintenance treatment in the prison estate. I can’t prove it, but I have a feeling that it was fear of Strasbourg that curtailed many of the coalition government’s more extreme plans for substance misuse treatment, including time-limiting it – something that might become of interest to some in government again after Brexit.
In the longer term it would take a brave human to bet against the economic and social cost of a Brexit which could be a negative influence for 50 years, increasing both numbers of drug users and those seeking treatment.
A treatment system that has struggled with the removal of ring-fenced budgets and is now funded as part of public health through local authorities can only suffer as the economy struggles and business rates fall. So, there will potentially be more service users and less money for services – a turbo charging of the double whammy that has hit treatment services since 2010 and has resulted in an orgy of ‘salami slicing’.
A further worry is that there isn’t much salami left to slice, and a brave new, post-Brexit world could provide the impetus for a significant change in the structure of treatment. And while change is subjective, it would take a very brave man to see Brexit as an opportunity for positive change.
Most of these outcomes lie in the future, but drug shortages and supply chain problems are of more immediate concern. Considering the complex supply system of modern drug production, it’s distinctly possible that there will be temporary problems with the availability of some drugs. Of even more concern is the government’s response to this possibility, which amounts to quietly passing the power to pharmacists to alter both the amount of drug and even the drug itself, via an amendment to the Human Medicines Regulations.
Granted, ministers have to specifically give pharmacists this power on a drug by drug basis, despite a lack of medical training or a full assessment of the patient’s needs. Absolutely nothing in my experience suggests the unique maintenance prescribing that predominates substance misuse treatment would receive any consideration. The amendment, which takes power away from doctors and gives it to pharmacists, is a worrying sign of the government’s approach and values.
Obviously much of the above is guess work. Brexit and its impact is highly fluid with many variables and possibilities, but its impact on substance misuse is particularly hard to evaluate because an aura of silence exists around the subject and now, at the eleventh hour, we’re surrounded by what Dick Cheney would refer to as ‘known unknowns’ and ‘unknown unknowns’. Or to put it another way, we know sod all about the short- or long-term impact of any form of Brexit on substance misuse due to the state’s lack of interest or inability to research the area. After years of cuts, services are reactive and lack the ability to enact a proactive approach.
Uncertainty clouds most areas of life post-Brexit, but attempts have been made to assess risk, from Operation Yellowhammer to specific sector analysis. As an example, there are several pieces of research on Brexit’s impact on the fishing industry. Research has been done, maps have been drawn – some thought has been put into fishing post-Brexit and there are 10,000 fulltime fishermen in the UK. So the fact that so little has been done to evaluate the possible impacts of Brexit on substance misuse and substance misuse treatment – fields that have a direct impact on around 270,000 people in treatment and a damn sight more out of treatment – a little larger cohort than the fishing industry, not to mention a more vulnerable cohort, is sad if not surprising.
It’s hard to see much positive in Brexit for substance misusers. The good people at The King’s Fund have done some actual research on the impact of Brexit on general public health and social care, and although substance misuse is a unique field there are enough commonalities to make their findings disturbing. Most likely, Brexit will lead to poorer services and more suffering, but one positive outcome is that it’s highlighted the indifference of the state to the whole subject.
Brexit has made it clear that the state’s primary aim is to protect wider society from substance misusers, not help substance misusers themselves. Accepting we’re an afterthought in policy makers minds is a valuable realisation, and the gaping hole where the state’s Brexit preparation should be is a timely reminder of our role in their scheme of things.
In an open letter to MPs, The King’s Fund, the Health Foundation and Nuffield Trust summarised the four major areas where the impact of a no-deal Brexit could be felt most sharply in health and care.
Richard Murray, chief executive of The King’s Fund
1. A risk of intensifying the staffing crisis
The NHS has serious workforce shortages, with nearly 100,000 vacancies in English NHS trusts and a further 110,000 in social care. With 116,000 EU nationals working in health care and 104,000 in social care, even a small trend towards European migrants leaving the United Kingdom due to a fall in the pound or uncertainty around being granted settled status will worsen this situation.
2. Shortages and price rises for vital supplies
Despite plans for stockpiling and creating new supply routes, the large amount of new paperwork and regulatory hurdles that a no deal Brexit would create for imports is likely to increase shortages of medicines and medical devices. Although it is difficult to judge the magnitude of the problem, the leaked Operation Yellowhammer document emphasised the vulnerability of supply chains in the sector. We can be certain that these additional burdens will mean companies face higher costs to get their products into the UK – costs that will ultimately be passed on to the NHS.
3. The need to care for returning emigrants
A no deal Brexit will mean UK emigrants to the European Union do not have guaranteed rights, and they may have to return to the United Kingdom to live and receive treatment if they become ill. Around 200,000 people using the special EU scheme that guarantees health care rights to retirees abroad would face losing that protection. It is unclear how many of the roughly 800,000 other UK nationals in Europe might also be unable to access or afford care. While we would have a duty to help these individuals, it would add considerably to the already high demand pressures on the NHS and social care.
4. Funding shortfalls at a time when health and care need it most
Although an extra £20.5bn has been pledged to the day-to-day budget of the NHS in England, this does not cover other areas of spending such as investment in buildings, equipment and staff training budgets, which have been reduced in recent years. Creating real improvements for patients will also require repairs and upgrades to buildings and equipment, increased public health funding, and a stable social care system. In particular, analysis by the Health Foundation estimates that £1.0bn extra in 2020-21 and £2.1bn in 2021-22 are needed just to stabilise the adult social care system. Yet the Office for Budget Responsibility’s assessment is that the United Kingdom’s public finances would be around £30bn worse off each year in a no deal scenario of medium disruptiveness. This sum is more than the total spent on adult social care plus investment in NHS buildings and equipment across the whole of the United Kingdom in 2017-18.
Health and care services are already struggling to meet rising demand for services and maintain standards of care, not least in advance of an expected difficult winter. The potential consequences of a no deal Brexit could significantly impede services’ ability to meet the needs of the individual patients and service users who rely on them.
The impact of a no deal Brexit on health and care: an open letter to MPs at www.kingsfund.org.uk
Interpersonal group therapy has huge potential to help people in their recovery. However, ongoing supervised practice and support are critical in training effective facilitators, says Dr Tim Leighton.
Anyone going to a residential or day rehab will almost certainly be asked to participate in some form of group therapy, and there is also a place for this kind of therapy at other stages of change. Participating in group therapy can be scary but it can also be exhilarating and life changing. However, it’s vital that the staff who run the therapy know what they are doing, and have the skills to help each member get what they need from the group to build and strengthen their resources for change.
Yet there is very little training available in group therapy in this country, particularly when it comes to models suitable for people with addiction problems. At Action on Addiction we have offered introductory training in interpersonal group therapy for many years, both as part of our University of Bath degree course and as standalone CPD, and while many people have found this training invaluable, it is only introductory. To master a therapy, particularly a complex group therapy model, it takes more than a week’s basic grounding, no matter how well practitioners understand the model and its application, and no matter how enthusiastic they feel about what they have learned. What is needed is ongoing supervised practice, training and support.
Many of us who work in this field are expected to practise models of counselling and therapy with fairly minimal training in the specialist interventions, and while we may have generic counselling qualifications which form a vital foundation for the work, most of this training does not include group therapy facilitation. Our cash-strapped field seems not to be able to afford to train our practitioners to the level and for the duration required to produce really skilled, confident and qualified therapists. There is a huge amount of talent and vocational energy in the field so there are beacons of good practice in many areas, but we also know that sometimes standards fall short.
We feel that practitioners deserve more, and it has long been our ambition to create and develop a proper clinical training for people working therapeutically in the field of addiction. Our new intermediate course in interpersonal group therapy is our first offering – it’s designed to be accessible, and it will be very much practice-based. Attendance at the training group each month will focus on collaborative learning and skills building, while the academic knowledge required will be built with guided distance-learning between the sessions.
Why go for interpersonal group therapy? We believe this model has great potential to help those who are on the journey of recovery understand the way they relate to other people and learn to build fulfilling relationships that meet social and emotional needs. In problematic drug use or addiction, relationships are often impaired, and relating to others without the use of drugs can be a challenge. However, trusting relationships with others and participating in a rewarding social network are some of the strongest predictors of durable change. Feelings of belonging, and receiving and giving support to others, have been for many people the cornerstone of a recovery of confidence and self-worth.
Dr Tim Leighton is director of professional education and research at Action on Addiction
The course is designed specifically for those working with people who have alcohol, drug, gambling and related issues. It takes a great deal of skill, understanding, perseverance and confidence to facilitate therapy groups that are safe, trusting and lead to lasting change, and we hope that this course will make a contribution to the more widespread provision of this excellent model.
As soon as Harbour Housing introduced naloxone a life was saved. A decade on they are looking back on one of their best decisions, as Emily Hill explains. read it in DDN Magazine.
Emily Hill is tenancy sustainment officer: communications and research at Harbour Housing
Homeless charity Harbour Housing is celebrating a decade of its naloxone scheme, which is proving effective in saving lives from opioid overdoses. Naloxone is a competitive antagonist which, simply put, means that it is a drug that can temporarily reverse the effects of an overdose through knocking the opioids off the receptors.
It has been described by staff at Harbour as a ‘miracle drug’ as it can bring people back from the brink of death, and has been used to successfully prevent 46 cases of overdose at Harbour since it was introduced in 2009.
The drug is administered via syringe directly into the muscle and is incredibly fast acting, in most cases reviving the patient in minutes.
Jade Barron, a tenancy sustainment officer at Harbour, has intervened in several overdose situations. ‘It’s incredible how quickly the naloxone takes effect. People can be revived immediately and the great thing about it is that there are no negative side effects so it’s completely safe to use,’ she said. ‘Sometimes it acts as a wake-up call. I’ve had a resident be brought back with naloxone and the next week decide to fully commit to recovery.’
And with each naloxone kit costing as little as £30 it is clear that easier access to this life-saving drug could help to save thousands of lives, as well as taxpayers’ money.
Harbour was approached by Marion Barton, social inclusion lead for the Cornwall and Isles of Scilly Drug and Alcohol Action Team (DAAT), in 2009 and asked to pilot the scheme. At the time Harbour was tolerant to alcohol use on site but not the use of drugs, and despite this had sadly lost residents to overdose.
It was for this reason, says Chris Abbott, Harbour’s head of housing, that management decided to go ahead with the project. ‘We wanted to make things safer for our residents, and naloxone seemed like an excellent way to do this,’ he said.
‘Just after we had initiated the project we had another overdose incident and this time we were able to save their life with the naloxone. We knew then that we would do whatever we could to go ahead with this project and ensure that naloxone was available to whoever needed it.’
Naloxone was more heavily regulated back in 2009 and could only be prescribed directly to a drug user, which was not an effective way to ensure their safety as they would be unable to use it on themselves in an overdose situation. Harbour has been instrumental in developing national naloxone policy, helping to influence the change in 2015 that allowed the drug to be prescribed to a responsible person and kept in communal areas of supported accommodation facilities.
Over the last ten years naloxone has become an integral part of Harbour’s harm reduction procedure, with kits easily available across all of its properties in boxes attached directly to the walls, as well as in first-aid kits and kept in vehicles.
Kevin Flemen of KFx
After the development of the naloxone scheme, Harbour was assisted by drug and housing policy expert Kevin Flemen to adjust its own policy to become tolerant to use of drugs within the law. Through having this high tolerance to both drug and alcohol use, Harbour has been able to accept referrals from those who would otherwise have nowhere else to go.
People struggling with addiction need the right support to be able to manage their substance use, and Harbour says that their tolerant ‘eyes wide open’ approach allows for honesty and trust between staff and residents, which has a really positive impact on recovery.
Drug use is much more dangerous when it is kept hidden, and recent figures from the Office of National Statistics revealed that drug-related deaths reached an all-time high of 4,359 across England and Wales last year (DDN, September, page 4).
Naloxone distribution has become much more widespread in recent years, and thanks to the hard work of the DAAT it is now available in all supported accommodations across Cornwall. All staff, residents and volunteers at Harbour are trained in the administration of naloxone, and in recent years Harbour has also trained members of staff from other supported accommodations.
We hope that the increase in availability of this life-saving drug will reduce the harm to people struggling with addiction and stop the rise of preventable deaths.
Prescriptions for opioid-based painkillers have increased by more than 60 per cent in the past decade… With this in mind, people are inevitably comparing the situation here with the epidemic across the pond. Let’s be clear, opioid prescribing is monitored much more closely in the UK than in the US, meaning the situation here is nowhere near as severe. But that doesn’t mean we should become complacent in the face of what is clearly a growing issue.
Rachel Britton, Independent, 10 September
People who live with chronic pain can become defensive if asked to consider weaning themselves off drugs that they’re dependent on. Suggesting to someone who feels paralysed by pain that they need to get out for a walk can sound offensive, patronising and uncaring. It’s certainly not a binary choice; opioid and other pain-relieving drugs have their place. But prescribing is out of control and cannot continue at these levels. There are difficult conversations to be had at all levels of our health service, right down to the intimate exchanges that happen between GP and patient.
Ann Robinson, Guardian, 15 September
A significant source of the problem is that GPs feel both ashamed and embarrassed that patients have become hooked on medications that they have prescribed, so they simply avoid facing up to it. It’s an awkward truth that sometimes the pills we dish out can cause more problems than they ever solve. Yet doctors, increasingly left frazzled by the growing pressure they are put under, are still all-too-willing to reach for the prescription pad when confronted by a patient with complex psychological issues.
Max Pemberton, Mail, 10 September
One thing is clear: while those sitting in jail for weed may be black, when cannabis legalisation eventually hits our shores, it will be dominated by white men in suits.
Zoe Smith, Independent, 8 September
The once poorly understood phenomenon of county lines drug dealing is taking firmer shape in terms of public policy and also of awareness. The emerging picture is disturbing even to those familiar with the most destructive consequences of illegal drugs… There is no point in pretending that there is any quick fix. But a sensible first step would be for the government to put youth services on a statutory footing – and to fund councils properly to deliver them.
I was happy to see a strapline on last month’s DDN that promotes the rebirth of harm reduction activism, though who knows where the money will come from for that. And then I turn the page and read the ‘Post-its from practice’. What has happened to us in terms of truly understanding what harm reduction is? It is not only clean needles and medically assisted therapies, with the possibility of more low threshold services like safe injecting rooms and increased supervised heroin/morphine prescribing.
How many people in recovery (from addiction and mental health issues), especially the ageing cohorts, need modest doses of different mood-altering substance to live reasonable and functional lives? Think codeine, selective serotonin reuptake inhibitors (SSRIs) and so on. Without these meds prescribed responsibly by our GPs, many people would be forced back to the streets again to medicate pain or depressions, which is what many daily street-opiaphiles (and others) were doing in the first place – self medicating.
Steve Brinksman is the clinical lead at SMMGP
Steve Brinksman’s comment about the thorny issue of de-prescribing is really dangerous for a lot of people who have finally found stability in their lives because a few GPs are willing to prescribe for pain.
What do I mean?
1) It is a publicly accessible comment that can be read by a) people who know little about any of the above but generally are abstinence aficionados and have the power to prescribe or not. b) It is given respect in a magazine read by thousands.
2) In an era when harm reduction services have suffered annihilation by a government that largely doesn’t give a damn where drug users or chronic pain patients and the mentally ill live or die – many NHS patients in fact – I think we need to be extremely careful what is published in DDN.
Allowing a respected GP to advocate de-prescribing in DDN is also so mixed-messaging. On the one hand we should be willing to prescribe more to vulnerable addicts/drug users. On the other hand, we should be pushing chronic pain patients off drugs.
While I understand the need to not over-prescribe to pain patients, I think the idea of starting to coerce any of the above patients off of drugs using the increase of drug-related deaths as an excuse is highly questionable.
We do not accidentally kill ourselves because of access to drugs, otherwise tons more of us would have died during the period when increased prescribing was available to both groups of patients. We ‘accidentally’ kill ourselves because we are homeless, hungry, so lonely and depressed and cannot see a reason to live. Researchers need to be empowered to take a more detailed analysis of what those increased drug-related deaths are really about instead of simply blaming doctors who are trying to reduce people’s pain in this very dark time.
On behalf of www.usersvoice.org
Sorry state
Evidence-based treatment should always encompass a range of interventions designed to match a range of individual treatment goals (DDN, September, page 6). The problems that I have observed have often come about by expert-derived guidelines in the form of the ‘Orange Book’, together with advice from ACMD whose statutory remit is to advise governments on drug policy based on effectiveness evidence who are ignored by some politicians for perceived political expediency.
Sadly, I remember having this exact debate when the UK 2010 drug strategy was released, with abstinence-based recovery being apparently the only treatment goal allowed. Person-centred care anyone?
I don’t suppose I was alone in forecasting the tragic increase in drug-related deaths, some of which could be said to be the direct result of this policy. Whilst I wasn’t alone, I was certainly in a very small minority at the service I worked at in 2010.
There needs to be a range of interventions for different goals that individuals will have at different times in their lives – ranging from harm reduction, opiate maintenance, to abstinence-based recovery. They should all be universally available, none should take precedence, they are all equally valuable.
The sad state of affairs is, I feel, illustrated by my observation that the publication of a new UK government drug strategy is greeted by a degree of enthusiasm by managers rushing to read it that sadly doesn’t always seem to be matched by the same enthusiasm to read and study Orange Book guidelines, let alone the research referenced in the guidelines. Another beneficial change might be to move responsibility for drug control from the Home Office to Department of Health.
Paul Almond, via DDN website
Moving on:
Danny Kushlick has announced that he’s leaving Transform after 25 years.
Watch Danny reflect on his 25 years at Transform
‘I founded the organisation when I was 32, in 1994, to campaign for an end to global drug prohibition, and to replace it with an effective, just and humane system of regulation and control,’ he said on the organisation’s blog. ‘It’s been an extraordinary trip.’
Drug policy reform has now moved from an ‘NGO ghetto’ to the mainstream, he said. ‘I’m proud that Transform’s work has helped turn legal regulation from fantasy into reality.’
Have your say: DDN conference 2020
We are now planning the next DDN conference, and we need your help. We want to make 2020 an even more interactive experience for all of our delegates, and we need to know what you want to hear about and talk about.
With the fantastic exhibition area at the centre of the event and more intimate workshops and learning opportunities than ever before, this one-day event is a unique opportunity to ensure that your voice is heard. Held in Birmingham next spring, this will be a vital opportunity to share what is working, highlight what isn’t, and work together to build better and fairer treatment for all.
Please take a moment to give us some feedback on past events, and let us know what you want from the conference – what issues are important to you, speakers you’d like to see, and suggestions for presentations.
Click here to join the consultation
Let’s connect!
Extracts from DDN’s social media. Have your say by commenting on our website, Facebook page or tweeting us.
DDN: Deaths of homeless people are up. Deaths of homeless people related to drug poisoning are up. Can anyone explain why the human cost has become so unimportant?
Charlotte Hough:
Poverty-related. Mental health care decimated-related. Social housing unavailable to the most vulnerable-related. Austerity-related. Political mishandling of public finances-related.
Richard Glandfield:
Because most of these people don’t vote or consume stuff?
Robert McGregor :
If you destroy social care, public housing, benefits and health this is what you get. It can’t be a surprise. It’s an intentional policy. The deaths are drug-related? No, they are deprivation- related.
In response to ‘Agents of Change’, DDN, September, page 6
Wayne Davidson:
When released with no job, no accommodation, no purpose, but one thing they do make sure you leave with is your methadone prescription – they at least make sure you have direction. Took me 22 years to get myself out of the addiction-offending-prison-methadone cycle all against advice of drug and alcohol services.
Andreana Sutherland:
It’s not ethical for doctors to leave people suffering. Responsible prescribing can prevent a lot of misuse. Doctors rarely prescribe drugs that really help through the final stages of detox due to fears and stigma around the whole issue of addicts and addiction.
Kelly-Marie Nettleton:
Portugal set a fine example.
In response to ‘Scots drug death taskforce up and running’ (DDN website):
Glen Carpenter:
Legalise, regulate, consumption rooms and job’s a good ‘un. The millions spent on ‘harm reduction’ is being funnelled into the CJ system focusing on the supply lines which is completely ineffective and doing more harm than good.
Drug consumption rooms provide hygienic and supervised spaces for people to inject or otherwise consume illicit drugs. Is it time they were available in Britain, asks Drug and Alcohol Findings.
When counted at the end of 2018, there were 117 sanctioned drug consumption rooms in 11 countries around the world, generating an evidence base of ‘real world’ trials for scrutinising their biggest appeals and detractors’ greatest fears.
Evidence of their effectiveness is one motivation for introducing drug consumption rooms; another is that they provide a common sense solution to the suffering and risks associated with public injecting.
The Scottish Government has recognised mounting harms to the health, wellbeing, and dignity of people who use drugs, and supports trialling drug consumption rooms as part of an approach to substance use based on public health objectives and human rights principles. However, the UK Government based in Westminster (London) has repeatedly blocked any such action.
This stalemate provides the backdrop for a hot topic exploring the following questions:
In communities dealing with the consequences of public injecting, could drug consumption rooms be part of the solution?
Knowing the human cost of unsafe public injecting practices, would it be negligent for governments not to consider them at this point?
Neil was facing an uphill road back to a normal life after failed suicide attempts but broke out of his own hell with help from Turning Point’s Rochdale and Oldham staff
I was facing death before I found Turning Point. It may seem blunt to just put it out there, but I had 3 failed attempts at ending my life. The route of these attempts was a severe addiction to cocaine. I had been using some form of stimulant from the age of 16 where I was supplied with vitamins as a professional rugby player. My game of death with cocaine started around the age of 31. I was using only socially. One gram a month, if that.
Over the next 8 years that monster grew to 8-10 grams a day, 7 days a week. I was spending both mine and my soon to be ex-wife’s money (secretively) on it as well as taking money from my parents. That was my lowest ever point. My wife at the time tried to help and kept it to herself, but I had already left the building. I had lost my job and my soul mate. I was in real danger of losing my house and family. I felt that the sick, sneaky, thieving junky that I had become would be better off dead and the world would be a better place, but my parents dragged me to Turning Point. They laid down the law and offered me tough love, but supported me.
There were an estimated 726 deaths of homeless people in England and Wales registered during 2018, according to the latest figures from the Office for National Statistics (ONS) – a 22 per cent increase on the previous year. Two in five of the deaths were related to drug poisoning, representing a 55 per cent increase since 2017.
The ONS statistics include people either sleeping rough or using emergency accommodation such as homeless shelters or hostels. Almost 90 per cent of the total deaths were among men, with the mean age just 45 for males and 43 for females, compared to 76 and 81 in the general population. Suicide and alcohol-specific causes both also accounted for 12 per cent each of the estimated deaths.
A fifth of the overall deaths occurred in London, with a further 14 per cent in the North West. Among the drug-related deaths, opiates were the most frequently mentioned substances, with alcohol also mentioned on the death certificate in many cases.
‘The deaths of 726 homeless people in England and Wales recorded in 2018 represent an increase of over a fifth on the previous year. That’s the largest rise since these figures began in 2013,’ said head of health analysis and life events at ONS, Ben Humberstone. ‘A key driver of the change is the number of deaths related to drug poisoning, which are up by 55 per cent since 2017 compared to 16 per cent for the population as a whole. The ONS estimates are designed to help inform the work of everyone seeking to protect this highly vulnerable section of our community.’
Jon Sparkes: ‘Behind these statistics are human beings.’
Crisis chief executive Jon Sparkes said it was ‘heartbreaking that hundreds of people were forced to spend the last days of their lives without the dignity of a secure home. Behind these statistics are human beings, who like all of us had talents and ambitions. They shouldn’t be dying unnoticed and unaccounted for. It’s crucial that governments urgently expand the safeguarding system used to investigate the deaths of vulnerable adults to include everyone who has died while street homeless, so we can help prevent more people from dying needlessly.’
‘Years of funding cuts have devastated crucial services supporting people who are homeless,’ added CEO of St Mungo’s, Howard Sinclair. ‘The human cost is a national tragedy.’
Harm reduction is not the preserve of one community
September is a glorious opportunity to celebrate recovery month and we’re delighted to hear about the activities taking place all over the country. The Recovery Games in Doncaster (page 16) sums up the spirit of events and we’re looking forward to following what’s happening around the country.
But as we do so, let’s remember our common purpose. Harm reduction is not the preserve of one community – it’s all of our business and should be central to everything we do, whatever the drug and whatever the treatment preference. Nick Wilson’s piece (cover story, page 6) is a reminder that activism is essential, and that includes the kind of community engagement that makes recovery messages so visible and effective. The ‘culture of acceptance and engagement’ should be the unifying force that propels harm reduction to the heart of mainstream healthcare and policy. We have plenty of evidence for this, right down to the depressing year-on-year increase in drug-related deaths.
The evidence is particularly clear when looking at custody- community transitions (page 14) – an area where small changes in practice could make a vast difference to prisoners’ chances of success. As Alex Stevens points out, there’s much that can be done in the short term for a population ‘so highly vulnerable to health problems’. Meanwhile, in this month’s News Focus (page 8) we look at progress on hepatitis C and find some important messages on data sharing if we are to meet NHS England’s ambitious elimination target of 2025.
Leading drug and alcohol charity WDP and Chester Football Club are teaming up to give people who access substance misuse services the chance to obtain tickets for home matches at Swansway Chester Stadium.
Chester Football Club are donating 20 tickets to each game
This opportunity will be available through the Capital Card, a ground-breaking and award-winning reward card scheme which empowers WDP’s service users and helps them to bolster their recovery journey.
The WDP Capital Card rewards service user engagement through a simple earn-spend points system. They can earn points by attending appointments or engaging in treatment interventions, and then spend their points on positive activities in their local community, such as the cinema or gym.
From September 2019, Capital Card users in Cheshire West and Chester will be able to exchange their hard-earned points to attend Chester Football Club home games, which include: Leamington on 28 September and Alfreton Town on 9 November 2019.
Chester Football Club are donating 20 tickets to each game as part of this pilot scheme and service users can ‘pay’ for these tickets with 30 of their Capital Card points.
Yasmin Batliwala, Chair of WDP
Yasmin Batliwala, Chair of WDP, said: “We are delighted to be teaming up with Chester Football Club to give our service users such a fantastic opportunity. I welcome Chester Football Club into the Capital Card Spend Partner family and thank them for this extremely generous contribution. It will have a big impact on our service users in Cheshire West and Chester. I hope that we can continue to build on this pilot and work together to benefit not only our service users but also their local communities.”
Jim Green, Chief Executive of Chester FC Community Trust
Jim Green, Chief Executive of Chester FC Community Trust, said: ‘Chester FC is an inclusive, community club and we hope this new partnership with WDP will make a positive contribution to service users and their recovery. We are proud to be a spend partner for the Capital Card in Cheshire West and Chester and look forward to welcoming service users to a game this season.’
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
There were 4,359 deaths related to drug poisoning in England and Wales in 2018, the highest number and the highest annual increase (16%) since the time series began in 1993. (ONS 2019)
Since the ONS released the drug related death statistics on the 15th August, we have seen responses from the sector attempting to explain this continued growth in drug related deaths, and the measures that can be taken to reverse this trend.
A default narrative is that this is an ageing cohort. Indeed, those aged between 40 and 49 years had the highest age-specific drug misuse rate at 125.7 deaths per million people. However, this group clearly are not old and it begs the question of where else in the health, or any other sector, would those aged between 40-49 years be classified as ‘old’?
Others call for overdose prevention sites and heroin assisted treatment. Both are legitimate and evidenced-based suggestions, but they would require additional funding that is separate from the traditional local authority funding.
We are now more frequently hearing about better access to OST and longer duration and optimisation for those that require it. A call for increasing access to harm reduction is also being made, both to reduce deaths and the harms caused. By improving in these two areas, along with the upscaling of Naloxone provision, we can have an impact on drug related deaths.
It is worth noting that prior to 2010, the delivery of OST and harm reduction in the UK was envied by many across the world. So, what went wrong and why did these interventions go into reverse? The introduction of the 2010 Drug Strategy heralded a change in direction from the previous strategy, whereby the emphasis was on waiting lists, retention in treatment, prescribing and harm reduction.
Drug related deaths by region
In contrast, the new strategy was about supporting people to have a drug free life, freedom from dependence on drugs and alcohol. To accelerate this process, targets were set for drug free exits and payment by results was introduced in order to incentivise providers. The process of re-tendering was occurring with increased frequency and any provider bidding for these contracts had to ensure that their recovery makeover would yield results (more drug-free exits).
Why is this important? Well, to engage in this process and deliver on these targets for almost 10 years takes a significant change in workforce culture. The cultural change that has taken place cannot be underestimated in moving from a predominantly harm reduction treatment workforce to a recovery-focused one.
The evidence for accessible and optimised OST alongside well delivered harm reduction not only reduces harm, it ultimately saves lives.
Most organisations will now be encouraging this approach in the knowledge that it could have an impact on reducing drug related deaths. It will also be acknowledged that this change being directed at a strategic level is not being fully embraced on the ground. This will be a source of frustration to some but is to be expected, responsibility for organisational culture sits firmly with the organisation. The sector moved from one extreme to another, harm reduction vs. drug free exits, it now needs to be re-balanced.
We can no longer sit back as bystanders. We need to acknowledge… read more.
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.
Danniella Westbrook celebrates the launch of a new ‘breakthrough’ addiction centre in West London, and says it has given hope of recovery for many in the UK.
Former EastEnders actress Danniella Westbrook spoke out publicly about her own struggles with addiction
Help Me Stop is taking a major step to making rehab treatment accessible to all, launching their first centre last week. Branded ‘rehab in the real world’, experience in the US has shown Dayhab to keep two in three participants abstinent nine months after completing treatment.
Clients are often made to choose between long waiting times for under-funded council services, or ‘luxury’ rehab that is too expensive and demands long periods of time away from home. Help Me Stop’s non-residential treatment approach, known as Dayhab, is designed to fit around clients’ work, study and childcare. At a far lower cost than many residential rehabs, their programme makes treatment more accessible to people who are seeking help but are still not receiving the treatment they need.
Chip Somers, Clinical Director at Help Me Stop: ‘This is rehab in the real world – accessible to all and designed to fit around daily life.’
At their launch event on Wednesday, former EastEnders actress Danniella Westbrook spoke out publicly about her own struggles with addiction, and the inaccessibility of private rehab options: ‘There are people out there who want to stop, but can’t afford to spend £5,000 a week on luxury rehab.’
The TV star, who was diagnosed with womb cancer last year, believes there is a lot of work still to do in the UK to address the number of people who are unable to access treatment due to money constraints or family commitments. The mum-of-two added: ‘To come into a day centre [like Help Me Stop], and still be part of your family as opposed to just visit once a week, is an amazing thing.’
The UK’s well-deserved reputation for developing gold standard harm reduction services was the envy of many countries around the world. From modest beginnings in the 1980s and an extraordinarily passionate and committed harm reduction community, was crafted the level of activism which ultimately brought harm reduction into the UK’s healthcare mainstream.
Credit must also be given to the UK government who at this time, and faced with the emerging ‘AIDS epidemic’, committed protected funding to support the growth and roll out of harm reduction services, most notably the provision of needles and syringes for people who inject drugs. Rates of HIV in the UK today (about 1 per cent of people who inject drugs) are among the lowest in the world and testament to this partnership of activism and political pragmatism.
From the late ’80s the UK began to refine effective skills around engagement and interventions to reduce harm among people who inject drugs. The four cornerstones of harm reduction – needle and syringe provision, substitution therapy and methadone, treatment for hepatitis C and HIV and the prevention and reversal of overdose – established our role as agents of behaviour change within this inclusive, non-judgemental, low-threshold environment.
We have been effective at reducing the risks associated with injecting drug use and developing initiatives which deliver some of the most cost-effective health interventions of any kind. It is estimated that for every £1 spent on harm reduction, £4 is delivered in return in health and social gain. This was achieved by tenacity, commitment, compassion and years of activism at a time when our communities would rather see people who inject drugs locked up rather than understood, treated and supported.
However, despite achieving the inclusion of harm reduction within mainstream healthcare, the attitudes of the public have not changed towards people who inject drugs. Look beneath the thin veneer of acceptability for harm reduction in our communities and there remain the same pernicious and ignorant views about drug use which are ill-informed but ensure that people who use drugs remain some of the most marginalised in our society.
This is due in part to the UK government’s insistence that drugs and drug use remain illegal and the fear and ignorance within our society that leads many to believe people who use drugs should be locked up rather than helped. Society does not see them as worthy of compassion and healthcare and resents ‘their taxes being spent’ on injecting equipment and treatment. It’s also due to the failure of a truly representative and sustainable model of a service user involvement movement, which would have helped ensure service users’ views and rights were central to the planning, funding and commissioning process at both the political and service delivery level.
A perfect storm
Sadly, since 2010, England has systematically disinvested in harm reduction. The political firestorm debate of 2008 saw the abstinence model of intervention win out over harm reduction, and the government’s new drug policy in 2010 saw a political shift away from harm reduction. This occurred at the same time as a move in the commissioning responsibility for drug services from the then primary care trusts to local authorities, just as the authorities ran out of money. The ring-fencing of funding for HIV, which supported drug services, disappeared and harm reduction had to start competing for funding against a range of other worthy causes within public health.
There is no doubt that many people have benefited beyond their hopes from the opportunities delivered by the recovery model, but many people who use drugs are so much worse off. In the UK we are experiencing an increase in homelessness, and drug-related deaths are higher than they have ever been. We have now also had the worst HIV outbreak in 30 years, a fact which outside of Scotland hardly anyone knows or talks about.
Diminished service
Many harm reduction services that traditionally provided a front door into treatment services and, no less importantly, a safety net for people who couldn’t manage the treatment options on offer, now provide little more than the distribution of injecting equipment. The systematic disinvestment in harm reduction in England has left many people alone, isolated and vulnerable, without skilled harm reduction workers to do what they always have: engage, support and save lives.
A recent exchange on social media quoted a triage discussion with a new client registering at a needle and syringe programme provided by a large national charity: ‘Whilst going through the triage paperwork to register he was asked his preference regarding administration of substances. He told the worker he was an IV user. The worker didn’t know what that was, so he expanded saying he was an intravenous user. The worker still didn’t know what that meant.’
Does this represent what happens in most drug services? Of course not, but it does happen and it absolutely should not. So many drug services now have staff covering the needle and syringe programme who do not have the required knowledge, skills or even, in some cases, the appropriate attitudes to engage with some of the most marginalised and vulnerable people in our society.
In this environment, good quality harm reduction cannot happen and we have little hope of reducing or ending the harms and social isolation of drug users until there is enough political will to develop a drug policy which truly reflects the value of human life. Naloxone is not the answer to saving the lives of people who use drugs. Harm reduction is, of which naloxone is one important component.
The proper support
We must celebrate the commitment and compassion of those who work in our field and properly educate, train, mentor and support them. This doesn’t have to cost the earth – it’s not a financial issue, it’s a cultural one. In a world increasingly dominated by pharmacy provision of syringes, we appear to have forgotten how to like and respect people who use drugs. If we lack positive enthusiasm and optimism, what right do we have to expect this in others?
Services must properly support our amazing colleagues to once again create the culture of acceptance and engagement, save more lives and improve the health of people who inject drugs. We need to reimagine how harm reduction can work in this austere climate and, yes, maybe this also means we need to rediscover a new style of activism to once again make a difference by keeping people who inject drugs alive and well.
We must also engage with our communities in a way that encourages them to reframe their understanding of drugs and the people who use them. We have to challenge attitudes and break down the barriers that prevent society from feeling compassion, understanding and acceptance for people who make life choices that can carry risk.
We accept people who make life choices that lead to heart disease, diabetes, respiratory disease and cancer, yet condemn people who inject drugs for ‘wasting precious health resources’.
This health inequality is perverse and is perpetuated by a political policy which continues to classify people who inject drugs as criminals, fails to support harm reduction and does nothing to challenge society’s perpetual exclusion of people with genuine health needs. In the absence of any political will to address this, our only hope is that the field can become activists once more and bring about the change we need.
We did it before; we can do it again.
Nick Wilson is from Exchange Supplies, a social enterprise specialising in harm reduction equipment.
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A need for vision
Developing Health & Independence (DHI), a West of England based social exclusion charity are marking their 20th anniversary this year with The Vision Project. This series of articles, podcasts and events is exploring the question of how they can achieve their vision to ‘end social exclusion by ensuring that everyone has their basic needs met and is able to thrive by contributing to the richness and wellbeing of their community’.
Because of people like Joe it’s been the most rewarding experience of my career.
By Peter Sheath, Specialist Mental Health Link Worker
When I first met Joe* he had recently been diagnosed with HIV. My colleague had spoken to him at the local sexual health clinic and had referred him to me. He turned up with his sister because he found the thought of discussing his issues on his own absolutely terrifying. He had suffered with OCD since childhood and that day he struggled to talk at all. His sister had to frequently interject because trying to respond was causing Joe extreme anxiety.
A few years before I was on the verge of early retirement. I had worked with people who use drugs for over 15 years, both as a counsellor and a consultant. I was proud of my career but felt my enthusiasm for the job was fading. It had all become a bit monotonous and I was struggling to ignore the lure of putting my feet up.
Then I attended a lecture at Manchester University about chemsex by an amazing guy called David Stuart. Chemsex describes the practice of men having sex with other men and using particular substances, normally GHB, crystal methamphetamine and mephedrone, to enhance the experience. I found it absolutely fascinating. I felt my dulled flame re-ignite, so when I saw the position of chemsex mental health lead at Addaction in Liverpool advertised, applying was a no-brainer.
* Joe’s name has been changed to protect his identity.
As a charity Phoenix have been actively using social media for around eight years.
It offers us an opportunity to share knowledge and experience about drugs and alcohol away from the sometimes suspect agenda, or poorly informed opinions, found within more traditional forms of media. Over this time, we’ve developed a highly engaged group of followers and friends and a compassionate community of support.
However, none of us need spend long on social media before we encounter what Tim Berners-Lee, the founder of the web described on its 30th anniversary, as the ‘unintended negative consequences’ of benevolent design (of the web), such as the outraged and polarised tone and quality of online discourse.”
James Armstrong Director of Marketing and Innovation
Often the online discourse on drugs and alcohol is prompted by news stories that set the tone for outrage and conflict. Just as angry and provocative headlines stir the emotions of the public on the street in order to sell papers, there can be a similarly attention-seeking approach online. It is hard to shake the underlying feeling that this polarised online discourse of anger and outrage is driven by stigma. In response to this, late last year we started to think about how we could shed light on the stigma that is at the root of how drugs and alcohol are presented in British social media. Having a clearer idea of this would ultimately help the sector combat it effectively.
Shortness of breath, fast breathing, difficulty breathing.
Unexplained ‘bruising’ or rash.
Ways To Reduce Risk
Wash your hands before injecting.
Clean injecting sites.
Use new kit every time.
Don’t re-use filters or lick needles before using them.
Try and avoid missed hits.
Don’t inject into your groin.
Seek Medical Attention
If left untreated, these infections can get worse and can even kill. Early identification and treatment are vital. If someone has a combination of the symptoms mentioned above they should seek medical attention from their GP, call NHS 111 for advice or – if symptoms are severe – go straight to hospital. In an emergency, call 999.
My brother’s experience overcoming drug issues highlights why it’s so important families and friends don’t give up on their loved ones.
By Clare McKenny, Addaction Senior Pharmacist
As told to Rachel King.
The tipping point was in Barcelona. We were there for a Shakira concert and getting ready when my brother, Paul, found a hole in his new t-shirt. He texted our mum not to throw out the bin in his room, hoping to retrieve the tag when we got home and return it. Her reply was blunt, “There’s no tags in there. It’s just full of straws.”
I tried to be supportive. Evidence of his drug use shouldn’t be used to make him feel bad, not while we were on holiday. But our friend was shocked. “You’re still taking cocaine?” he asked.
The Office of National Statistics published the latest figures on the number of people whose death was linked to drug use, they stated “the number of deaths registered from drug use in 2018 was the highest since our record began in 1993. We have also seen the biggest year on year percentage increase’’
In the statement accompanying the report the ONS said “we produce these figures to help inform decision makers working towards protecting those at risk of dying from drug poisoning’’
Those ‘decision makers’ have, in the last 19 days, responded to the report. The Royal College of Psychiatrists, Alliance of NHS Substance Misuse Providers, The Centre for Social Justice, members of the ACMD, the Association of Directors of Public Health, academics, treatment and advocacy charities within the sector.
The commentary and analysis has been as varied as we would have expected from a sector that seeks to advocate and protect against the wide range of causes and consequences of drug use. However, there is one common universally held opinion – the cut in funding for treatment has eroded the sector’s ability to deliver a consistent level of service across the country, in line with the evidence base developed over decades.
Up to two thirds of the estimated 143,000 people in the UK living with a chronic hepatitis C infection may be unaware they have it, according to the latest figures from Public Health England (PHE). That equates to 95,000 people who could otherwise be getting life-saving treatment, the agency stresses.
The hep C virus can have devastating consequences.
PHE is renewing its call for anyone who believes they have been at risk of contracting the virus – particularly if they have ever injected drugs – to get tested. Better access to new treatments may be a factor in falling numbers of people with hep C requiring liver transplants, says the agency, which have decreased by more than 50 per cent since 2015. There has also been a 19 per cent fall in deaths from HCV-related liver disease between 2015 and 2018, from 468 to 380.
NHS England has committed to eliminate hep C as a major public health threat five years ahead of the World Health Organization’s 2030 target. However, challenges remain, says PHE, with an urgent need to identify people who are undiagnosed and to help those who have been diagnosed but remain untreated to engage with services. A recent report from the London Joint Working Group on Substance Use and Hepatitis C (LJWG) found that differing electronic patient record systems and confusion around data protection issues were hampering efficient data sharing among services engaged with people with hep C (DDN, September, page 8).
‘Hepatitis C can have devastating consequences but most cases can be cured if detected in time, which is why it’s so important to find and treat those who may be infected,’ said PHE senior scientist Dr Helen Harris. ‘Anyone who may be at risk of infection, in particular those who have ever injected drugs, even if they injected only once or in the past, should get tested. Given that new treatments provide a cure in around 95 per cent of those who take them, there has never been a better time to get tested.’
Rachel Halford: ‘Essential that we increase diagnoses.’
‘Whilst it is encouraging that the estimated number of people living with hepatitis C is coming down thanks to the successful roll-out of DAA [direct-acting antiviral] treatments, it is concerning that latest estimates suggest that around two-thirds of those remaining could be living with undiagnosed infection,’ added Hepatitis C Trust chief executive Rachel Halford. ‘It is therefore essential that we increase diagnoses to ensure we achieve elimination by 2030 at the latest.’
‘To be rated as Outstanding by the CQC is simply… fantastic.’
‘The rating is recognition of the supportive way the Sefton Park team work closely together, supporting each client to achieve the best possible outcome from their treatment.
Del Wheeler – Service Manager of Sefton Park
As a team we are absolutely delighted and proud that our service is rated as outstanding.
Among many positive comments CQC said ‘A strong recovery ethos ran throughout service delivery and all staff shared a clear definition of recovery. Staff were motivated to deliver care that is kind and foster strong therapeutic relationships with clients. They spoke with overwhelming passion about their work. Clients described staff as insightful, understanding and ‘amazing’.’
Sefton Park is a residential addictions treatment centre located by the beach in the seaside town of Weston-super-Mare.
This year the service is celebrating 27 years of helping people become free from addiction.
Our shared belief is that every individual has the right to care, respect, autonomy and choice, and that every individual should also have the opportunity to change the way they live. We provide that opportunity by helping the client to understand the causes of their addiction and gain more control over their lives. See our full DDN spotlight here.
Millions of people in England are being prescribed potentially addictive medications, according to the findings of a major review by Public Health England (PHE).
Announced last year (DDN, February 2018, page 4), the review looks at dependence and withdrawal issues associated with five commonly prescribed classes of medication – opioid pain medicine, benzodiazepines, ‘z’ drugs such as zopiclone, antidepressants and gabapentinoids. It found that one in four adults – 11.5m people – had been prescribed at least one of these in the year to March 2018, with half of those on a prescription having been continuously prescribed the drugs for at least a year and up to 32 per cent for at least three years.
Benzodiazepines are not recommended for use lasting more than a month, while opioids for chronic non-cancer pain are known to be ineffective when used over the long term. The current issue of DDN features a harrowing first-person account from someone who developed a severe addiction to prescription opioids lasting years after being prescribed them following a work-related injury (DDN, September, page 10).
Prescriptions for antidepressants and gabapentinoids are on the rise, but those for opioids, benzodiazepines and z drugs are all falling, the review found. There were, however, wide variations in prescribing rates across clinical commissioning groups (CCGs), with both prescribing levels and length of prescriptions for opioids and gabapentinoids higher in some of the country’s most deprived areas.
‘People who have been on these drugs for longer time periods should not stop taking their medication suddenly,’ PHE stresses. ‘If they are concerned they should seek the support of their GP.’ However, people who had experienced problems with the drugs reported feeling ‘uninformed’ when they started taking them and ‘unsupported’ after getting into difficulties. ‘Patients experienced barriers to accessing and engaging in treatment services,’ the report says. ‘They felt there was a lack of information on the risks of medication and that doctors did not acknowledge or recognise withdrawal symptoms.’
Among the document’s recommendations are the development of new clinical guidelines on the safe management of dependence and withdrawal problems, and improved information for patients about the benefits and risks of the medications. It also wants to see better training for clinicians to make sure their prescribing adheres to best practice, and the establishment of a national helpline for patients.
‘We know that GPs in some of the more deprived areas are under great pressure but, as this review highlights, more needs to be done to educate and support patients, as well as looking closely at prescribing practice, and what alternative treatments are available locally,’ said PHE’s director of alcohol, drugs, tobacco and justice, Rosanna O’Connor.
‘While the scale and nature of opioid prescribing does not reflect the so-called crisis in North America, the NHS needs to take action now to protect patients. Our recommendations have been developed with expert medical royal colleges, the NHS and patients that have experienced long-term problems. The practical package of measures will make a difference to help prevent problems arising and support those that are struggling on these medications.’
Why are recommendations to improve custody-community transitions being routinely ignored when so many lives are at stake? DDN reports.
Click here to read the full article in DDN Magazine
As drug-related death rates continue to rise there is one fact we can be sure of: that newly released prisoners make up a significant number of those who lose their lives – there were 955 deaths of offenders in the community in England and Wales in 2017-18. The few weeks after release pose a particularly high risk.
The reasons for this can be complicated and overlapping – tolerance to drugs has been compromised while chaos is reintroduced. Those who find themselves in custody frequently have mental and physical health problems, all kinds of background trauma, and problems relating to their housing and basic wellbeing – all mixed in with their problem drug use. Leaving prison can mean confusion, uncertainty and overwhelming difficulties with families, accommodation and day-to-day living.
These issues have been well documented over the years, with clear recommendations resulting from reviews such as The Patel report: reducing drug-related crime and Rehabilitating offenders: recovery and rehabilitation for drug users in prison and on release: recommendations for action, published by the government in 2010.
But according to the Advisory Council on the Misuse of Drugs (ACMD), the extent to which these recommendations have been implemented is unclear, with little evidence to suggest that they have led to safer practice. In their report, Custody-community transitions, released in June, they examined the existing recommendations and, with input from government departments, service providers and charities in the sector, looked at what must change (DDN, July/August, page 5).
Only 12 per cent of prisoners who were previously dependent on heroin left prison with naloxone in 2017-18
A look at the ‘substantial harms’ that contribute to the unacceptable death rate showed that many prisoners were still being released without the certainty of accommodation, increasing their risk of relapse and reoffending. The risk of death post-release was many times higher than in the general population, particularly in the first few weeks – yet naloxone was not being provided routinely to guard against fatal overdose.
Furthermore, the opportunity to reduce drug problems in custody was being squandered by the subsequent failure to provide support on release.
In the last ten years a new challenge had also emerged through widespread use of synthetic cannabinoid receptor agonists such as ‘spice’ – adding new health priorities to the continuing efforts to contain blood-borne viruses, particularly HIV and hepatitis C.
So if progress has stalled, where does the failure lie? The picture from the ACMD is of fragmented responsibility and a lack of systematic follow-up. Continuity of care appears to be missing throughout the transition period – the latest PHE data shows that only 32 per cent of people who were assessed as needing treatment on release were having treatment in the community within 21 days.
Many of the deaths resulted from overdose, yet the community policy of maximising access to naloxone (to reverse the effects of an opioid overdose) still hasn’t reached English prisons. Only 12 per cent of prisoners who were previously dependent on heroin left prison with naloxone in 2017-18 because of reluctance among NHS providers to fund it – a situation that could be resolved by funding through national NHS bodies, including NHS England.
With much to tackle, the ACMD has made key among its recommendations the need for a minister, nominated by the Drug Strategy Board, to take over-arching responsibility for improving custody-community transitions for prisoners with complex health needs.
Alex Stevens, co-chair of the ACMD
‘The fragmentation of responsibility for implementing the previous reports and recommendations in this area is one of the problems we’ve identified,’ Alex Stevens, co-chair of the ACMD told DDN.
‘This is why we’ve recommended that a single minister be made responsible for implementing these recommendations and previous ones, including the Bradley review [2009] and the Patel report [2010].’
While realistic that there could be delays in responding ‘because of all the turmoil politically’, he is hopeful that interest shown last year by Robert Buckland MP could prove useful in terms of continuity, since he has been made minister for justice.
In the meantime, there is much that could and should be done now. ‘Given that, from the spending announcements we’ve been getting from Boris Johnson, austerity seems to be officially over, there’s no reason that money shouldn’t be spent on saving people’s lives by distributing naloxone,’ he says.
Other recommendations have already been made but need renewed attention – such as the recommendation to change Friday release dates for vulnerable prisoners, to give them a fair chance of experiencing joined-up working between custody and community. ‘This is an odd one,’ says Stevens. ‘NACRO released a report last year arguing for reductions in Friday afternoon releases and the pushback they got from the Ministry of Justice was that if this was working properly, it shouldn’t make a difference what day of the week you’re released on. But all the reports from the inspectorates of both prison and probation show that we do not have a system that’s working properly.’
In some cases, the recommendations are an extension of existing initiatives, such as making sure people have access to universal credit or a chance of employment, along with help to find somewhere to live. ‘There are pilots going on and we’re arguing that these should be accelerated,’ he says. The problem – such as in the case of universal credit, where there is a partnership between the Department for Work and Pensions and the Prison Service – is that they are competing with so many other priorities.
‘We’re arguing that more priority should be given to this population because it’s so highly vulnerable to health problems, but also problematic in terms of its high level of reoffending,’ says Stevens. ‘And so there would be wins for public health and crime reduction if priority was put on meeting the needs and solving the problems of this population.’
And while we wait for the processes of government, what should the treatment community be doing? The ACMD talks about the vital need for effective community pathways and says the ‘main aim’ of the planned reforms to probation should be dealing with offenders in the community – a conclusion built on effectiveness, safety and ‘substantially cheaper’ cost.
That surely points to a highly proactive role for community drug and alcohol services?
Stevens recommends looking at the other recent report, by the Ex-Prisoners Recovering from Addiction Group, chaired by Lord Patel. ‘This has developed a blueprint for pathways between custody and community for people with various different types of drug treatment need, including those who have achieved abstinence in prison – a group that’s often let down when they leave prison,’ he says. ‘There are practical steps available in that report.’
Much is being pinned on hopes for a nominated minister, and within that person’s mandate this indicator of progress stands out: ‘reducing the numbers of people who die within four weeks of leaving custody and while under supervision of the probation services.’ Could this be the opportunity to join up the strands of research and recommendation through a clearly defined brief?
‘All I want is real help’
I’ve spent a total of 28 years in custody and over three years in isolation. For years I’ve searched out drugs to give me comfort. When I’m released I find myself scoring and telling lies. I use and it fills that void and temporarily gives me the power to be confident and feel I fit in better. Once it comes to light you’re using, the powers that be recall you and I end up again in deeper discomfort, knocked back again. My hope has gone. The jail’s chocka with drugs and I’m expected to never pick up and use. My family is gone, my mother is in a care home. I’m full of guilt and resentment and all I really want is real help and someone in my corner encouraging me, but I’m falling short of finding good people who get me and know how to help me. The truth is I contemplate suicide a lot.
Paul was prescribed OxyContin after an industrial injury. But that was just the start of his problems.
My name is Paul. I’m 51 and live in a small market town in the Peak District. I enjoyed a happy childhood and walked straight into a full-time job after school. At 18 I joined a local concrete manufacturing company and spent around ten years hand stacking very heavy paving slabs.
One morning at work I injured my back. This was in the days where awareness around health and safety issues was far lower than today, and I had some physio and returned to work a few days later. Over the following years I was promoted many times, but continually experienced problems with severe, debilitating lower back and neck pain.
Around ten years ago I was diagnosed with degenerative disc disease after MRI scans showed damage to five discs in my back and two in my neck, all believed to be caused by the heavy manual job I did for years. Numerous injections at the pain clinic offered no relief and I was eventually prescribed OxyContin.
Each time I visited the doctor the dosage was increased as it was no longer giving me any pain relief, until I was eventually prescribed 800mg per day – but taking 1,500mg per day. I would wake up around 2am then spend the rest of the night thinking of excuses for how I could collect my prescription early. OxyContin was the last thing I thought about at night and the first thing in the morning. At this point, I was no longer taking this amount of OxyContin to relieve the pain – I was taking it simply in order to function. I realised I had a serious problem.
One tablet was supposed to last a full 12 hours – I was taking my dose every couple of hours. However I kept telling myself I couldn’t possibly be an addict, as I had been prescribed this by my doctor. There were times when I would run out because my GP was on holiday and the locum or other doctors refused to prescribe such a high amount. I would then suffer full-blown withdrawal until I could pick up my next prescription.
Around this time I was involved in a car accident. While lying in the hospital bed the nurse asked me if I was taking any medication. When I told her 800mg of OxyContin per day, but actually almost double that, she said, ‘You must mean 80mg.’ I replied no, and my partner confirmed the amount.
Oxycodone 30mg is used to relieve moderate to severe pain
I got another, better-paid job but was still taking around 1,500mg per day and was eventually let go. Sitting at home wondering what I was going to do, I started to replay things in my mind – what if that car accident was actually my fault due to the amount of OxyContin I was taking? What if I believed I was doing a good job but actually wasn’t and that’s why they let me go? I decided I’d had enough and wanted my life back. I made an urgent appointment with my doctor and said I wanted off all the OxyContin.
I was then told that there had been several meetings held about me, and my doctor had been reprimanded by other GPs at the surgery over the amount of OxyContin I had been prescribed over such a long period. I was then referred to my first drug clinic, where the drug worker said they couldn’t help me as it wasn’t heroin. Another clinic told me the same thing.
I moved back to the small town I grew up in and registered at the local GP surgery.
The doctor drew up a taper plan that I was determined to follow. Over the following months I stuck to it and was doing really well, managing to reduce from the 1,500mg down to the actual prescribed level of 800mg, then gradually further until I’d dropped down to 320mg per day.
However, this is where my journey to hell began, going around in circles from doctor referrals to drug clinics and pain clinics, being told the same old story and referred back to my GP. I was suicidal at this point. I’d done so well to reduce my dose, but could no longer see any way forward. Eventually I contacted Release who got one of the drug clinics to agree to treat me, and after an agonising few months, starting on a minimum dose of 30ml of methadone that didn’t even hold me for two hours, they eventually got me to a dose of 105ml where I was stable and no longer going through horrendous withdrawals. I reduced the methadone over many months until I finally became drug-free.
However in 2016 I was diagnosed with severe ‘central’ sleep apnoea. My driving licence was revoked and I was told after blood tests that my testosterone level was zero. I also have peripheral neuropathy from pernicious anaemia, where it is painful to walk due to nerve damage in my feet, and I still have the degenerative disc disease in my back. However, I’m looking at alternative relief rather than the legal heroin I was given that almost took my life.
My main passion and purpose now is to educate everyone about how long-term opiate use destroys lives and actually makes pain so much worse in the long term. Opiates do have a very important role to play in pain relief, but only in certain situations and only for the short term, prescribed and monitored very closely. Even though I was lucky enough to beat my addiction, I am now having to deal with the long-term health effects. Not only did my addiction take everything I had, it also greatly affected the people who I love most.
If by telling my story and raising awareness of what I experienced I can save even one person from suffering what I went through, it will have been worth it.
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Findings from the 2014/15 Crime Survey for England and Wales examines the extent and trends in illicit drug use among a nationally representative sample of 16 to 59 year olds resident in households in England and Wales.
In 2014/15, for the first time the survey included questions relating to misuse of prescription painkillers (use of prescription analgesics by those for whom they are not prescribed). Findings include:
Overall, 5.4 per cent of adults aged 16 to 59 years had misused a prescription-only painkiller not prescribed to them.
7.2 per cent of 16 to 24 year olds had misused a prescription-only painkiller in the last year, while 4.9 per cent of 25 to 59 year olds had done so.
People with a long-standing illness or disability were more likely to have misused prescription-only painkillers.
Misuse of prescription painkillers is distributed more evenly across the general population than the use of illicit drugs.
Misuse of painkillers was similar in both rural and urban areas.
Post-its from practice
But doc… I’ve been on them for years
Addressing long-term prescribed opioid use requires an individualised approach, says Dr Steve Brinksman.
Steve Brinksman is a GP in Birmingham and clinical lead for SMMGP
There has been a considerable increase in the focus on prescribed opioid painkillers lately, and with good reason given the alarming statistics on overdose deaths from the US alongside massive increases in prescribing in the UK.
This has resulted in improved awareness of the risks associated with these drugs, and hopefully means that careful consideration will be given before using them for non-cancer chronic pain and fewer patients will continue them where there is no substantial benefit. However we are still left with a large number of patients who have been prescribed these drugs for many years, and that brings us to the potentially thorny issue of de-prescribing.
How do we best approach this?
Some may advocate reducing and eventually stopping these drugs for all in whom there is no sizeable reduction in pain, but how to assess that? For some patients, years of taking them have blurred the line between benefit, tolerance and dependence. Auditing prescribing data can be a good start, and writing to patients and flagging notes to discuss at medication reviews are useful tools as well.
Richard is a case in point. He is 70 and has been taking opioids for many years, originally for osteoarthritis that developed in his early 50s. He has a history of depression and anxiety, was alcohol dependent for many years, and cares for his wife who is slowly dying from severe COPD.
As well as his opioids he also takes regular diazepam, although over the years the dose of this has come down. He is currently on a 100mcg fentanyl patch, co-codamol and Oramorph. He freely admits that he is dependent on these but as they were started by a doctor, he doesn’t feel he should have to stop them. I suspect this is a common scenario.
We had a lengthy consultation and I was able to explain that medical opinion was changing, that these drugs were now felt to be less effective than we used to believe, and that decreasing liver and kidney function could mean he was at greater risk of overdose as he got older. We also discussed the impact on his wife if he wasn’t around to care for her. Following our conversation we agreed that we would reduce his fentanyl from 100 to 87mcg and in six months to 75mcg, when we would discuss the situation again.
This probably wouldn’t be enough for the aggressive de-prescribers, but as a GP I can hopefully take a pragmatic long-term approach. It would be better if the situation had never arisen. However it has, and an individualised approach agreed between the prescriber and the patient seems to my mind the best compromise.
Steve Brinksman is a GP in Birmingham, clinical lead for SMMGP and RCGP regional lead in substance misuse for the West Midlands
The increase in drug-related deaths hasn’t suddenly happened, deaths have been rising significantly for years. There has been ample opportunity to think about how to reverse this horrendous trend. And unusually, we know how to do it. The evidence has been collected and made available to ministers… So if it’s not a lack of evidence, something else must be holding back politicians from tackling the rise in drug-related mortality. It’s seductively simple to point out the failings of politicians on this issue. But they instinctively follow public opinion rather than shape it. So the uncomfortable truth might be that we, the electorate, are responsible.
Ian Hamilton, Independent, 15 August
Few experts consider that criminalising vulnerable and marginalised people who inject drugs is an appropriate response. The UK government should stop politicking about being ‘tough on drugs’ and act urgently to stop the harm to which its policy contributes. Decriminalisation of personal drug use allows interventions such as safer injecting rooms and drug testing where appropriate. It also enables gathering of evidence. What is already clear is that moralising about perceived intrinsic wrongs in taking drugs and blaming or punishing patients for having drug use disorders are not effective or ethical ways to reduce harm.
Richard Hurley, BMJ, 8 August
Most addiction services are not properly connected to wider health and care teams, so people are bounced between addiction and mental health services or fall between the gaps in both. It’s not uncommon for a patient to be excluded from mental health services due to having drug or alcohol use disorder but not be able to access addiction services because they have an untreated mental illness. This represents a lost opportunity to improve outcomes for patients, reduce the harm to individuals and their families, as well as a staggering waste of limited resources.
Julia Sinclair, BMJ, 23 August
As the sickly-sweet stench of marijuana spreads ever further across the once-civilised Western world, there is one universal result. There are more crazy people. Some of them are dangerous. Many of them are crazy because they have fried their brains with skunk. Some are crazier still because baffled doctors have added to the cocktail with various poorly understood prescription drugs. But the chances that you will meet such a person grow daily, as our leaders refuse to enforce the laws against marijuana possession. They will grow still more if they are stupid enough to bow to the billionaire campaign to legalise this poison.
NHS England’s target date to eliminate hepatitis C is 2025 – five years ahead of the World Health Organization’s 2030 target. It’s an ambitious objective, and one that the NHS is confident it can meet. ‘We are working, we are curing people, the strategy is being successful,’ its clinical lead for hep C, Dr Graham Foster, told last December’s Seven years to elimination: the road to 2025 conference (DDN, February, page 12).
Delegates at the same event, however, also heard the results of an evaluation project by King’s College’s National Addiction Centre on operational delivery networks (ODNs) meeting their hep C targets. One of the main obstacles identified was missing data, frequently the result of providers having different electronic patient record systems – an ‘endemic problem across the NHS’, according to the National Addiction Centre’s Dr Katherine Morley.
The importance of effective Data Sharing
Now a new report from the London Joint Working Group on Substance Use and Hepatitis C (LJWG) is highlighting the importance of effective data sharing processes if the elimination target is to be met. Treatment and testing for hep C has improved dramatically in recent years, but with more diagnoses happening at different locations – drugs and outreach services, GP surgeries, prisons – it’s crucial that organisations have systems in place that can process and share patient information efficiently.
Eradicating the virus will only happen if the many services engaged with people with hep C ‘join up their data systems so that people who are diagnosed can progress quickly and easily to treatment and care’, said LJWG co-chair and clinical director of South London and Maudsley NHS Foundation Trust’s Central Acute and Addictions Directorate, Dr Emily Finch.
While joining up data systems might sound fairly simple, the reality is ‘not straightforward’, the report states. Different organisations have different IT systems and different processes for sharing their diagnoses with ODNs, treatment providers and Public Health England (PHE). ‘These issues are technical but they are absolutely vital in making the system work for patients,’ it stresses.
Disengagement from treatment
Most hep C testing is still carried out by community drug and alcohol teams, and – while some providers are moving towards point-of-care testing – is usually outsourced to either hospital or commercial laboratories. While local authorities are responsible for commissioning testing in drug services, the responsibility for testing in GP services lies with clinical commissioning groups (CCGs). Responsibility for treatment, meanwhile, lies with secondary care providers and the ODNs, with NHS England responsible for commissioning the drugs used in treatment. This array of providers and commissioners means there’s no single data controller, and makes an easily navigable pathway from diagnosis to completion of treatment vital.
LJWG policy lead Dee Cunniffe
One key factor is the very real risk of disengagement from treatment, co-author and LJWG policy lead Dee Cunniffe, tells DDN, making it ‘absolutely critical’ that referral is as fast as possible. ‘People with really complex needs often find services difficult to access – that’s a given. The more complex the needs, the more difficult it is for them to navigate multiple venues, multiple appointments, different people. Really what you’re looking for is point-of-care testing and getting your results as quickly as possible at a place you attend regularly.’
Explicit consent
While all the care providers interviewed for the report had their own electronic medical record (EMR) systems in place, specific systems for storing, accessing, and updating them varied ‘even within sectors’, it says. EMR systems used by drug and alcohol teams, GPs and hospitals were all different, and even drug teams within the same umbrella organisations often used different EMRs. Data sharing is also not usually automatic between these systems – for example, between a hepatology department and a drug service.
It’s not just the systems that are the issue, however. Many people involved in testing and treatment also remain in the dark about which data can be shared, who it can be shared with, and when explicit consent is required to share it, the document states. This confusion has been exacerbated by the introduction of General Data Protection Regulation (GDPR) and the 2018 Data Protection Act.
A clear understanding of regulations
Regulations regarding data sharing were originally set out in the Health and Social Care Act 2015, which specifies that health and adult social care organisations have a legal obligation to share patient information with each other in order to provide the best care possible. While GDPR and the Data Protection Act do not actually alter the requirements of this in terms of sharing data to facilitate care, many people are unaware or unsure and tend to very much err on the side of caution.
Clinicians, information governance specialists and Caldicott Guardians – the people responsible for protecting the confidentiality of personal health and care information and ensuring that it’s used properly, and which all NHS organisations are required to have – were all interviewed for the report. While the Caldicott Guardians and information governance personnel had a clear understanding of the basis on which data could be shared, this had not ‘penetrated all levels of clinical practice’, the report found. Many people believed that obtaining written consent from patients was the ‘best’ – or only – basis on which data could be shared.
Sharing data as part of clinical practice
This is ‘at odds with’ the Health and Social Care Act and GDPR, the report points out, which ‘create an obligation to share data for patient care and provide a legal basis for doing so that does not require explicit patient consent’. This confusion and anxiety about what sharing is or isn’t permissible means that information often ends up not being shared at all, even when it would clearly be in the best interests of patients.
‘When we spoke to the Caldicott Guardians and the information governance people the overall feeling was, “We don’t understand why people are doing this,”’ says Cunniffe. ‘People need to talk to their Caldicott Guardians and IG leads and ask these questions. I think senior managers could do with doing it as much as anybody.’
The focus should not be on consent as the ‘sole legal basis for sharing and processing patient data,’ the report continues. ‘GDPR has specific allowances for sharing data as part of clinical practice, both in terms of delivering care and administrative work, that do not require explicit consent.’ LJWR wants to see the development of clear guidance and training, particularly for drug service staff, around when explicit consent is needed, which data can be shared, who it can be shared with and under what circumstances. This could be provided by PHE or the ODNs.
‘Ever since the LJWG was established there’s been times when people will say “we can’t share that”, then you’ll go to another area and they will,’ says Cunniffe.
‘When we started up our pharmacy testing project (DDN, June 2018, page 5) we found that people are just really edgy about sharing data with each other. It almost seems as if people feel it’s better not to share so you don’t get in trouble.’
Ultimately, a lot of these issues could be solved by effective training, she says. ‘I think there’s a real need for organisations to stand up and tell their staff, “Look, you’re OK – you can do this.” It wouldn’t take much to get those messages out there. But we need organisations to take a lead on it.’
The sixth annual Recovery Games were the biggest and best yet, says Stuart Green.
Read the full article in DDN Magazine
Ahead of September’s Recovery Month, people from across Britain gathered to celebrate recovery at the sixth annual Recovery Games in Doncaster last month. The games are the brainchild of Aspire drug and alcohol service, which is run in partnership with Rotherham Doncaster and South Humber NHS Foundation Trust and The Drug and Alcohol Service (ADS).
These games celebrate the achievements, personal journeys and overcoming of challenges faced by people in recovery from a drug or alcohol problem. They provide the opportunity for shared experiences and making new friends and connections with likeminded people who are in recovery themselves. The games symbolise that recovery is possible with the right support and inclusive recovery communities.
This year the demand from across the UK to take part exceeded all expectations, with 50 teams from England, Scotland and Wales registering and competing in a day of gladiator-style games and obstacle courses on the ground and in the water. Such was the demand that registrations unfortunately had to be closed early, but plans are afoot to make the 2020 Recovery Games even bigger and better. The rain couldn’t dampen the energy and enthusiasm of the competitors and spectators, with just short of 1,000 people attending on the day.
The Recovery Games represents a movement towards inclusiveness, and this year saw a push to attract more spectators from the general public. Families with young children came along and enjoyed the carnival atmosphere, and teams made their own costumes or wore fancy dress to celebrate comradery. This in turn contributed to the build-up of excitement, creating a sense of equality by giving service users, support groups and workers a shared connection and purpose.
The Recovery Games is a mix of celebration, excitement, inspiration and emotion. The minute’s silence at the middle of the day was an opportunity for everyone to show respect for the ‘fallen warriors’ who’ve lost their battle with addiction. This was followed by the spectacular ‘festival of colours’ which celebrated being alive – you can watch the film via this link
The overall winner this year was the ‘Greased Lightning’ themed team from New Beginnings, a Doncaster based rehab and detox unit run by Aspire. The games were made possible by donations and the proceeds from the sale of merchandise, especially the much-admired t-shirts which have helped secure an important step towards funding the 2020 games.
‘This year’s games were the biggest and best yet, with the recovery community being stronger and more vibrant than ever,’ said event organiser Neil Firbank of Aspire. ‘The event is about letting people know that recovery is alive and being nurtured in many towns across the region and the UK. Thank you to everyone who took part and supported this amazing event.’
Tim Young, chief executive of ADS, said the games were a ‘great day of celebration. For the first time this year the weather wasn’t kind to us and yet the rain did nothing to dampen the magic of the event. If anything this year has added ‘the year of the rain’ to the legend of the Recovery Games in the same way Glastonbury has its infamous ‘year of the mud’. A day of powerful images and emotions, the games once again brought people together to make new connections and reinforce existing ones. The message it sends is clear and loud – “recovery is possible, and fun!”’
Once again it was a fantastic day, exceeding all expectations, with hundreds of people coming together to celebrate and applaud those in recovery from an addiction. The event has become a recognised milestone in the recovery calendar. It sees people with different addictions and health conditions come together, connect, give and learn new skills, but most importantly have fun without the need for substances.
Stuart Green is service manager at Aspire drug and alcohol service
DDN welcomes your letters. Please 
The ONS statistics include people either sleeping rough or using emergency accommodation such as homeless shelters or hostels. Almost 90 per cent of the total deaths were among men, with the mean age just 45 for males and 43 for females, compared to 76 and 81 in the general population. Suicide and alcohol-specific causes both also accounted for 12 per cent each of the estimated deaths.
There were 4,359 deaths related to drug poisoning in England and Wales in 2018, the highest number and the highest annual increase (16%) since the time series began in 1993. (ONS 2019)
Media Savvy
and the skews,
in the national media
The news, and the skews, in the national media.
Prescriptions for opioid-based painkillers have increased by more than 60 per cent in the past decade… With this in mind, people are inevitably comparing the situation here with the epidemic across the pond. Let’s be clear, opioid prescribing is monitored much more closely in the UK than in the US, meaning the situation here is nowhere near as severe. But that doesn’t mean we should become complacent in the face of what is clearly a growing issue.
Rachel Britton, Independent, 10 September
People who live with chronic pain can become defensive if asked to consider weaning themselves off drugs that they’re dependent on. Suggesting to someone who feels paralysed by pain that they need to get out for a walk can sound offensive, patronising and uncaring. It’s certainly not a binary choice; opioid and other pain-relieving drugs have their place. But prescribing is out of control and cannot continue at these levels. There are difficult conversations to be had at all levels of our health service, right down to the intimate exchanges that happen between GP and patient.
Ann Robinson, Guardian, 15 September
A significant source of the problem is that GPs feel both ashamed and embarrassed that patients have become hooked on medications that they have prescribed, so they simply avoid facing up to it. It’s an awkward truth that sometimes the pills we dish out can cause more problems than they ever solve. Yet doctors, increasingly left frazzled by the growing pressure they are put under, are still all-too-willing to reach for the prescription pad when confronted by a patient with complex psychological issues.
Max Pemberton, Mail, 10 September
One thing is clear: while those sitting in jail for weed may be black, when cannabis legalisation eventually hits our shores, it will be dominated by white men in suits.
Zoe Smith, Independent, 8 September
The once poorly understood phenomenon of county lines drug dealing is taking firmer shape in terms of public policy and also of awareness. The emerging picture is disturbing even to those familiar with the most destructive consequences of illegal drugs… There is no point in pretending that there is any quick fix. But a sensible first step would be for the government to put youth services on a statutory footing – and to fund councils properly to deliver them.
Guardian editorial, 16 September