May 6, 2016

Dr Chris Ford on the importance of keeping up the momentum…

With some excitement and a good helping of scepticism I set off to Vienna for my first Commission on Narcotic Drugs (CND), which occurs annually and is the central drug policy-making body within the United Nations system. It was the event that was going to draft proposals for the UNGASS, which we had been working towards for the past three years.

I decided to try and soak up the experience, but when adding the term ‘abuse’ to a UN document was seen as a success, I knew it was going to be a long week.

The main purpose of the meeting was to create an outcome document that would be ‘short, substantive, concise and action-oriented’. It was an opportunity for a detailed examination of the linkages between prohibition, violence and organised crime, the corrosive impact of corruption on many countries, to explore new distribution systems and revisit the ‘world drug problem’.

Proposals had also been tabled to ensure that drug control measures were in harmony with treaties safeguarding human rights and to push back against countries applying the death penalty for drug offences.

Sadly none of this happened. After the week the consensus statement simply reaffirmed the three existing drug control conventions with no admission of flaw, fault or contradiction.

I didn’t get it – how could so many countries not fight for the end of the death penalty, or insist all countries provide humane evidence-based treatment for drug problems? Why did so many allow international diplomacy to miss the opportunity for real change around drug control?

But there were some rays of hope. For the first time ‘access to controlled medications for medical use’ was added. Many palliative care and pain organisations had been striving for this for many years and we had focused on this in our campaign leading up to the UNGASS (DDN, February, page 17).

The ‘outcome document’ signed off in Vienna was immediately adopted in New York, meaning there was no room for change – people found this deeply frustrating. The document didn’t acknowledge the comprehensive failure of the current drug control regime to reduce drug supply and demand, or the damaging effects of outdated policies on violence and corruption as well as on population health, human rights and wellbeing.

UNGASS did not address the critical flaws of international drug policy, call for an end to the criminalisation and incarceration of drug users or even urge states to abolish capital punishment for drug-related offences! Had we hoped for too much? Perhaps we need to accept and celebrate the great work many governments and civil society groups have achieved and the many positive drug policy reforms already underway around the world. This is going to be the way forward – individual countries making changes.

The next international opportunity to address this will be in 2019 when the UN plan of action that calls for a ‘drug-free world’ will be reviewed. We must continue to fight for health and human rights to be at the centre of all future drug policy.

Dr Chris Ford is clinical director of IDHDP.

Damp Squib?

Features

DDN

May 6, 2016

You wait nearly 20 years for an UNGASS on global drug policy and then… well, not much. See below for the sector’s reactions to last month’s event in New York, but first DDN hears from one of the architects of President Obama’s drug policy

When UNODC executive director Yury Fedotov told the closing of the 2016 UN General Assembly special session (UNGASS) on the world drug problem that ‘We must take advantage of the momentum provided by UNGASS to strengthen cooperation and advance comprehensive, balanced, integrated rights-based approaches’, people could be forgiven for asking how much momentum there really was.

Reactions have ranged from cautiously optimistic to uninspired, disappointed to enraged – particularly around the content of the session’s ‘outcome document’. This, according to the Global Commission on Drug Policy, serves merely to sustain an ‘unacceptable and outdated legal status quo’.

The document has been attacked for its failure to address capital punishment, sufficiently advocate harm reduction approaches or acknowledge the ongoing process of drug policy reform occurring across the world. It also talks about ‘a society free of drug abuse’, something that the International HIV/AIDS Alliance called ‘a dangerous and distorting fantasy’, while Transform branded it a ‘shocking betrayal’ of the countries that had most wanted the UNGASS to take place – Colombia, Mexico, and Guatemala.

Although the session did see Canada’s health minister announce plans to introduce a legalised, regulated cannabis market, the main source of disappointment with the document was its failure to offer proposals to, in the words of the Global Commission, ‘regulate drugs and put governments – rather than criminals – in control’. In other words, a significant move towards decriminalisation or legalisation.

That, according to former senior drug policy advisor at the White House and now professor of psychiatry at Stanford University, Keith Humphreys (DDN, June 2012, page 16), was never really on the cards. ‘I think it was a fantasy to think there would be big change,’ he tells DDN. ‘I think some groups may have convinced people in fundraising, and maybe convinced themselves, that the world was going to legalise drugs in New York, and that was ludicrous. For years it was said, “Everyone wants to legalise drugs and it’s just the big mean United States standing in the way”.

The United States didn’t stand in the way and it turns out nobody wants to do that, except for cannabis – and not all countries want to with cannabis.’

Rather than the UN, the real obstacle to legalisation is ‘popular opinion in all the nations of the world,’ he argues. ‘In the US the majority of people want to legalise cannabis, but less than 10 per cent want to legalise heroin or cocaine – there’s been no general spreading of that sentiment. If you look at polls of young people in Europe, they don’t want to; if you look at polls of people in the Latin countries that are being hammered, they don’t want to legalise drugs other than cannabis. So it isn’t surprising, and it isn’t this evil thing being imposed on the world.’

But doesn’t the roster of ex-presidents and prime ministers calling for reform represent something of a groundswell of opinion? ‘The Global Commission, I think, actually shows how unaccepted those views are,’ he says. ‘I know a number of these people are ex-leaders, but when former leaders call for something the question you should always ask is, “Why didn’t they run for office on this platform?” You didn’t run for this and you didn’t do it when you were in office because you knew the public wouldn’t like it. You can get 100 NGOs or whatever, but how many funders are there for those 100 NGOs? Are there really 100 different funders, or are there a couple of wealthy people who care about this? And that’s fine, but it’s not a constituency. The checkout line at Waitrose, plus George Soros, is not a constituency.’

Those advocating legalisation tend to ‘live in a bubble, and talk to each other a lot’, he says. So are they being naïve or disingenuous, in that case? ‘I think there’s a third option, which is that they don’t care, and I don’t mean that as an insult. Someone told me recently, “Yes, use will go up – who cares?” and I respect that. What they’re saying is, it’s worth it. “Yes, there’ll be a lot more drug use, a lot more addiction, but that’s not my problem – I’m fighting for human rights”, or “I’m fighting for the free market, for business peoples’ right to make a living”.’

Legalisation arguments can be persuasive, he says, because it’s a case of the grass is always greener. ‘Doing things differently often sounds good when things aren’t going well, but still it seems that most people just don’t buy it, in part because we have a pretty good experience of how sales and capitalism work – not just with tobacco and alcohol, but for anything.

‘If you got rid of the UN treaties and held a plebiscite in any nation on earth – including the Latin American countries – and said, “Do you want this to be a legal, corporate industry?” people would say no. What’s standing in the way is democracy, and what’s making cannabis legal is also democracy. If you have the popular will, then these things are not a barrier.’

It may not have delivered any major shifts, but the mood remains cautiously optimistic. DDN hears what some key players thought of the UNGASS

‘To have the document adopted in just two minutes, prior to any serious debate, underscores a key question – what, indeed, was the purpose of the meeting other than theatre? Having said that, what followed the adoption was encouraging since a number of countries openly lamented the failures of the document, from no call to abolish the death penalty to a lack of mention for the terms ‘harm reduction’ and ‘decriminalisation’, and complete refusal to acknowledge emerging regulated markets for cannabis. This in turn raises another question – why did these countries sign up to the document only to criticise it immediately after?’

– Niamh Eastwood

‘Our expectations for UNGASS were always modest, and we never anticipated the kind of transformational event that some were hoping for. Our main priorities were always to ensure that pre-existing commitments on harm reduction were defended and not rolled back, so that the UNGASS resolution could provide a foundation to build towards real progress at the UN high-level meeting on HIV in June. This must now move forward and tackle the global funding crisis for harm reduction, and address the fact that we have failed to meet the 2015 target of halving HIV infections among people who inject drugs by a staggering 80 per cent.’

– Rick Lines

‘I never thought anything would happen at UNGASS. They vote on the resolution at the beginning of the meeting and then it’s all speeches, so it really is a talking shop.’

– Keith Humphreys

‘The mood of civil society organisations has been positive overall. Of course there are frustrations with the outcome document because it doesn’t acknowledge that punitive drug control has been catastrophically damaging and unfortunately reaffirms a commitment to society free of drug abuse. However, there is some progress that was hard won which we must acknowledge, around improving access to controlled medicines and the need for proportionate sentencing for drug offences.’

– Ann Fordham

‘The outcome document had some welcome language on human rights, harm reduction and access to essential medicines but was generally a huge disappointment because it was watered down and heavily caveated by the need for consensus – any really challenging content or progressive language was vetoed by the more conservative member states. This was probably most obvious with an issue like the death penalty for drug offences – clearly illegal under international law to which all member states are party to, and already subject to a General Assembly moratorium – yet the states that are still doing it vetoed any mention of it in the document. Utterly ridiculous. Consensus policy-making can seem like a nice idea but can also be profoundly undemocratic, and favour the status quo by default – achieving change in that environment can be almost impossible.’

– Steve Rolles

‘The main and most important difference was the huge shift in the debate. Serious discussions of drug reform, decriminalisation, regulation etcetera, are all now a legitimate part of the debate among UN member states, and the tone of those discussions is so different than what was the case even five years ago at the UN. While this is not sufficient, clearly policy change will only come when these issues enter the mainstream of policy discourse, and this is clearly happening.’

– Rick Lines

‘The debate on the floor in the plenary and side events was very dynamic and positive. Country after country stood up and criticised the outcome document’s shortcomings, and many raised key current issues like decriminalisation and legalisation, and structural reform of the UN treaty system, which the outcome document did not engage with at all. The narrative was very much moving away from a punitive approach towards one of health and human rights, and when old-school drug warrior rhetoric emerged it seemed from another time.’

– Steve Rolles

If we look at other difficult policy areas, whether that be the refugee crisis, global warming or the war in Syria, the UN does not generally show leadership largely because of individual member states’ own views. It must be remembered that the UN is the sum of its parts, not an individual entity in and of itself. Multi-lateral agencies are not the best places to sow the seeds for regional or international reform, largely because of individual member states’ own views and interests generally being paramount. This was evidenced by the statements made by Russia and many of the Asian countries, who continue to push for punitive responses to drug use and supply, despite the human rights abuses that are apparent in many of these states.’

– Niamh Eastwood

‘The last shreds of the pretence of a global consensus were ripped away as countries completely disagreed with one another via their country statements, with some explicitly stating that global drug policy had failed while others – and this group is getting smaller, although still includes powerful states like Russia – talked of the need to intensify the war on drugs.’

– Ann Fordham

‘We were very pleased by the high profile given to the death penalty debate, and the large number of member states voicing explicit opposition to the practice. Despite its weaknesses, the outcome document does contain the strongest human rights provision ever agreed in a UN drug control resolution. So that is also progress.’

– Rick Lines

‘Probably one of the most depressing moments was when Indonesia said that their drug laws – which involve the use of the death penalty – were compliant with international human rights. This was moments after a colleague from an Indonesian NGO who represents those sentenced to the death penalty had eloquently outlined the horror faced by those who have been, or are waiting to be, executed by firing squad for low-level drug offences.’

– Niamh Eastwood

‘After a week of listening to the debates in New York, it’s clear that things have shifted. More and more governments are openly voicing their displeasure with the dominant punitive approach to drugs. Having the UNGASS this year has helped to build important momentum for change, bringing many new voices calling for reform, such as other UN agencies and new actors, into the reform community – from criminal justice, development, peace building, palliative care, human rights, racial justice and religious groups.’

– Ann Fordham

‘Nine countries stood up in front of the world and called for legalisation. That may not be many, but it’s nine more than last time and shows how far we’ve come. It’s not a taboo any more, and if the UN system doesn’t show some flexibility they will continue to implement the reforms anyway and the UN drug control system will drift into irrelevance. It’s a case of reform or die really.’

– Steve Rolles

‘It is reform nationally that will ultimately change the international regime.’

– Niamh Eastwood

‘The UK government’s message to the UN is right – robust investment and light-touch enforcement is the path forward – but those words will ring hollow if we fail to heed them at home.’

– Paul Hayes, head, Collective Voice

‘It is clear that new metrics and indicators should be developed in the sphere of drug policy, aligning global policy with the sustainable development goals, and that guidelines should be produced that reflect the socio-economic foundations of involvement in the drugs trade. In this way, the UNGASS can make moves towards effectively dealing with the challenges posed by drug usage and mend some of the damage caused by a costly and failed war on drugs.’

– Yasmin Batliwala

‘This UNGASS was a success when looking outside of the UN itself as it served as a key opportunity to publicly scrutinise failed drug policies, something which the mainstream media did reasonably well, by and large.’

– Niamh Eastwood

‘The countries seeking change didn’t get what they wanted at UNGASS but their resolve has only stiffened, along with the solidarity between reform-minded states, and with the growing reform momentum and change on the ground they will doubtless regroup and come back stronger – with an emboldened and empowered civil society supporting them all the way. Progress can happen at multiple levels – public debate, national reforms and in multilateral agencies, and is mutually supportive. So we need to keep pushing on all those fronts.’

– Steve Rolles

False economies

Features

DDN

May 6, 2016

Is the focus on recovery undermining a highly skilled workforce? As Neil McKeganey said in 2010 (in Controversies in Drugs Policy and Practice), if you need to visit a doctor you can rest assured the person you are seeing will have had a medical education. If you want to buy a house you know that the solicitor has been educated to degree level, and if you take your dog or cat to the vet you know that they will be one of the most highly trained professionals around. But if you see a drug worker you will probably be seen by someone who has not been to university, does not have a professional or postgraduate qualification, and who may have only just entered the field. At a conference on Workforce development: challenges, opportunities and the way forward, speakers from different specialisms painted a picture of a sector in danger of paying the price of undervaluing essential skills, and asked, are we compromising service users’ safety by ‘doing it on the cheap’?

The nurse: ‘We need to find our voice’

‘There are half a million nurses working in this country, but I’m not sure where our voice is’, said Dr Carmel Clancy, head of department of mental health, social work and integrative medicine at Middlesex University, who is also chair of the Association of Nurses in Substance Abuse (ANSA).

In the 1960s nurses were working in regional drug dependency units (DDUs) and the 1980s saw an increase of nurse specialists in community drug and alcohol teams. In the 1990s nurses were central to harm minimisation and there were nurse consultant roles – but the title of nurse was now becoming interchangeable with key worker and drug worker.

‘Non specialists are taking over nursing roles,’ she said. ‘Nurses are there, but are not as visible. How do we claim a stake at the table?’

The sector had ‘no idea’ of the number of nurses working in addiction, with many falling into it by default, through promotion or changing location. Despite nurses seeing addiction as a specialism, they did not receive any undergraduate training on it and felt they were starting again when they came into addiction, said Clancy.

Changes were afoot however, with ANSA’s proposed merger with the International Nurses Society on Addictions (IntNSA) in July, which would strengthen the nurses’ voice and raise their profile in the addiction workforce.

The law change on ‘non-medical prescribing’ in 2012 (extending the right of a professionally qualified person to prescribe) had resulted in a growing number of nurse prescribers, added Mike Flanagan, consultant nurse and clinical lead for substance misuse services at Surrey Borders Partnership NHS Foundation Trust and chair of the National Substance Misuse Non-Medical Prescribing Forum.

The changing landscape of the last ten years had seen drug and alcohol treatment more performance monitored than any area of health and social care, he said. When commissioning moved to local authorities in 2013, the sector had been subjected to repeated cycles of retendering with diminishing budgets, all of which had contributed to making specialist addiction treatment a less attractive career option.

So what had been the impact on nursing? Medical roles were increasingly provided by non-medical prescribers – which was fine if properly supervised, said Flanagan. But with nursing posts increasingly provided by drug workers, there was ‘a risk that commissioners and managers may fail to fully appreciate the impact on quality.’

The psychologist: ‘Everyone does psychosocial interventions’

Many of the barriers and facilitators to change were psychological, but ‘absolutely everyone’ did psychosocial interventions now, including staff and service users, said Dr Christopher Whiteley, consultant clinical psychologist at South London and Maudsley NHS Foundation Trust.

The ‘recovery juggernaut’ had involved everyone in ‘building recovery capital’ – human, physical, cultural and social – which had helped to address issues of confidence, joining in meaningful occupations, maintaining accommodation and staying in recovery.

But there were challenges: with many of the psychosocial interventions being undertaken by people who were not psychologists, outcomes were greatly affected by the quality of the working alliance.

Organisations were prone to heavy caseloads, high turnover of clients and a lack of resources for training. To be effective there needed to be synergy between leadership, a culture of innovation, training and supervision, he said, while more could be done with families, peers and community networks.

Addiction doctors: ‘We’re an endangered species’

Addiction specialist doctors were becoming an endangered species, according to Dr Kostas Agath, medical director at Addaction. Decreased availability of addiction psychiatry training posts brought with it disappearance of skills. ‘Once my generation has expired you cannot download us from the internet,’ he said.

Throughout the disruptive environment of retendering we needed to make sure training plans were robust, he said. The way forward in preserving the disappearing specialism relied on a national sphere of influence, but also local sustainable solutions.

‘Localism shapes the context – one size does not fit all,’ he said. Future-proofing psychiatrists’ roles involved effective integration with GPs, non-medical prescribers, pharmacists and psychologists.

Social workers: ‘We need specialist knowledge’

‘Of 90,000 social workers in the UK we have no idea how many specialise in alcohol and drug use’, said Dr Sarah Galvani, professor of adult social care at Manchester Metropolitan University’s department of social care and social work, who had ‘more than 30 years of identifying the lack of drug and alcohol knowledge in social workers’.

Alcohol or drug problems were identified as criminal justice or health problems, which explained the lack of engagement with social workers.

‘But the vast majority say alcohol or drug education is very or extremely important to their practice,’ she said. ‘Most social workers can talk – but they have a problem talking about substance misuse as they don’t know what to ask.’

Social workers could have three key roles – to engage with people about the topic of substance misuse; to motivate people to change and support them in doing this; and to offer follow-up support to maintain changes.

The challenges included political constraints and direct government intervention into social work education, with the devaluing of specialist practice on substance misuse. There was dissolution of specialist teams and roles, with whole services being cut and others going to the cheapest bidder.

But there were also clear opportunities, said Galvani, including the move of specialist services towards holistic and recovery-oriented approaches and embracing the wider health and wellbeing agenda, which was ‘social workers’ bread and butter’.

We were lucky to have a strong evidence base, new teaching partnerships and an increasing number of resources relating to social work and substance use, she said. ‘We need to take the opportunities.’

A long and winding road

With a clear set of challenges ahead, the Scottish Drugs Forum is learning lessons from the past in developing its workforce programme, said George Burton

‘Scotland has had a long-standing alcohol and other drug problem and has been disproportionately affected,’ said Burton. Drug-related deaths were stubbornly high and had increased again, with last year’s figure of 613 the highest ever recorded.

Looking back, policy responses in the 1980s had been rooted in harm reduction and methadone, until the newly elected SNP introduced a strategy of ‘drug- free recovery’ in 2008 (and a ‘new hostility to methadone’). Drug services began changing their names to take on recovery, with drug workers becoming recovery workers.

But the quality of services depended on the quality of professionals. How much was the ‘strategic objective’ to recruit people in recovery about money and levels of pay?, he asked.

A two-tier workforce had meant that agreements on outcomes between the health service and voluntary drug and alcohol services were ‘difficult to develop, when one half of the workforce [the NHS] was paid considerably more’ and there was ‘such disparity across providers’.

Alcohol and drug partnerships (ADPs) across Scotland were aligned to local authorities, and support teams included officers for different functions, such as development, policy and research, some of whom ‘had no knowledge of drugs and alcohol but were responsible for big commissioning decisions’.

The Scottish Drugs Forum (SDF) provided training, which covered an introduction to the field, motivational interviewing, stigma, recovery outcomes and new drugs, as well as offering strategic support to ADPs for quality development.

A survey of service users also suggested the workforce needed local knowledge, flexibility and non-judgmental practice, and some suggested they benefited from ‘lived experience’.

‘Workforce development is becoming understood as more than just training, but it’s taking time and it’s still early days,’ said Burton.

Among the SDF’s current priorities were the national naloxone programme, work on quality development and service improvement, strong user involvement including a programme to train people in recovery to join the workforce, programmes on hepatitis and needle exchange, and work with the Scottish Prison Service, including dealing with NPS in prisons.

The absence of a clear pathway to the drug and alcohol field meant there was a rich mix of people with a range of experience, ‘but we need to pay properly – this race to the bottom is not acceptable,’ he said.

‘It’s important to recognise that most people can’t do this type of job,’ he said. ‘But being in recovery does not make you a recovery worker.’

George Burton is workforce development programme manager at the Scottish Drugs Forum

Barriers to work

Features

DDN

May 6, 2016

Last July the government asked Dame Carol Black to conduct an independent review into the challenges of getting and staying in work for people with drug and alcohol problems, or who are obese. With her report imminent, she gave a preview to the Drugs, Alcohol and Justice Parliamentary Group. DDN reports

‘I’ve put drugs and alcohol in part one of the report and obesity in part two, as the challenges are quite different,’ Dame Carol Black told the parliamentary group. ‘We looked internationally, talked to as many stakeholders as possible and visited prisons and treatment centres.’

The first job was to get a handle on numbers, as we often didn’t hear about people having problems until they were in the benefit system with another problem, such as mental health issues or anxiety, she explained.

‘People worry that a specific problem might disadvantage them, so they may have something else as the primary diagnosis from their GP, such as mild depression,’ she said. Many people with addiction might have other problems such as diabetes, which needed attention before they could work.

So the first problem was identification and sharing data, and the review would contain recommendations on improving this.

One of the motives for the review was to find out if there was a viable case for a mandatory route to treatment, carrying a penalty of reduced benefits. This was rejected by Black, as ‘there is no evidence that being in treatment gets you anywhere nearer to the labour market’. We needed to have conversations about barriers to work, so that work became a part of treatment, she said.

The report would also identify lack of activity as terrifying for those in recovery who had been permanently busy finding their next fix of drugs. Environment was another problem, said Black: ‘After treatment they would go back to friends and the environment they’re trying to get away from. They need to be housed away from addicts, but taking them away from former friends and family is very difficult.’

Many wanted ‘a home, partner, work and, if possible children, – but they know how difficult that is’.

The report would make recommendations about getting work into the treatment environment – and also about employers, who were ‘the last part of the jigsaw’.

‘Employers told us that the government needs to de-risk it for them,’ she said. ‘They wanted a support person on the end of the phone, so we’ve made recommendations on how the government might work with employers… unless we can get employers on board, it won’t matter how good treatment is.’

Reactions from the group…

‘Help people test the water’

‘Taking a holistic view of people’s lives is important. People aren’t necessarily going to be ready for employment if they have health or housing issues. Practical things that can be done are helping people to get to and from interviews and meetings and help with building life skills. It’s hard to provide time to do this in the treatment sector.

‘We’d also like to see support pre and post employment, so there’s a much more joined-up connection. We’re keen on any support that could be made with local employers to move people through the system and help them test the water.’

Karen Tyrell, Addaction

‘We will seize the opportunity’

‘The treatment system will commit to you and DWP to do our best. The focus has been on crime, harm reduction, then recovery. Then there was the crash, and the agenda moved on. We will try to seize this opportunity to make this work.’

Paul Hayes, Collective Voice

‘Will information sharing be safe?’

‘One of the things that was concerning me was the information sharing. How would you educate people that they wouldn’t be at a disadvantage, and that if they did disclose, it would go in their favour?’

Kirstie Douse, Release

Dame Carol Black replied: ‘We can’t go on as we are – in a safe and secure way we need to get that data and know what people’s health problems are. If we continue with a mismatch of data we’re not going anywhere. People think it might affect their benefits, but there has to be a safe way of doing this.’

‘The system is set up to blame people’

‘Stigma is one of the biggest barriers to employment. People who are stigmatised start to believe the message themselves. The whole system is set up to blame people for not being in work. Two thirds of employers would be unwilling to help them.

‘It can be a slow journey, with personality or behavioural disorders and a wide range of physical and mental health illnesses. We did a survey and the barriers to getting back to work included lack of confidence, lack of computer skills and poor health. Age was also a factor for many.

‘We need specialist help and in-reach, and unless you get these right, nothing’s going to happen.’

John Jolly, Blenheim

Capturing Quality

Features

DDN

May 6, 2016

ISO9001 is an internationally recognised, universal quality assurance standard most often associated with the manufacturing industries. So how can a system designed to ensure the quality of car parts help us in the substance misuse sector?

ISO 9001 requires an organisation to identify, define, document, implement, measure, and continually improve the effectiveness of its processes. It offers a disciplined and systematic approach that can be applied to any sector, and is being increasingly adopted in health care systems. Here at Kaleidoscope, we have considered introducing a formal ISO9001 quality management system for a number of years.

With the support of regional commissioners and the Welsh Government, we finally took the plunge with our Powys adult services in Mid Wales. Having a certified quality management system is an expectation that is increasingly being specified in tenders. More importantly, we wanted to establish a system that would help us to optimise the quality of the services that we deliver.

Powys is a large rural chunk of Wales, taking up a quarter of the country, but with a sparse population of just over 133,000 people. With a staff team operating from four primary sites and additional satellite venues, introducing a system to assist us monitor, maintain and improve service delivery and demonstrate quality was attractive to both us and our commissioners.

We of course had apprehensions. We recognise the passion and skills of our employees and trust them to work with our clients in a person-centred way in order to achieve positive, client-defined outcomes. However, we also want them to follow treatment manuals, specific interventions protocols and defined service procedures, so that we deliver a service that is tangible and consistent.

We’d already decided that ISO9001 was the most robust, recognised and trusted quality standard, so in May 2015 we engaged the services of a quality management consultancy to guide us through building our system.

The first big questions for us were ‘what does quality look like?’ and ‘how do we know when we are doing things really well?’ Given that every client has unique needs and goals, how do we uniformly measure to see that what we have delivered constituted ‘quality’?

As a precursor to the ISO9001 project, we had mapped out what we delivered within our services, and defined it in operating manuals. Every key part of the treatment journey featured in the manual, and served to clarify procedures and expectations for staff.

This work actually gave us the basis of our quality management system. We took our Powys operating manual and chopped it up into a range of procedures. We concluded that quality could be defined by regularly auditing these procedures to ensure they were being followed correctly against quantitative and qualitative measures. This in turn should result in service users reporting satisfaction with the service and achieving positive outcomes.

After mapping out the main parts of the treatment journey as low-level process maps, we held a ‘procedure speed-dating’ style event in which each member of staff had a procedure, and five minutes to explain it to a colleague before moving to the next. Four hours and 28 procedures later, our long-suffering team had effectively undertaken a consultation to check through the procedures, refine them and start to understand them. Training sessions and team meetings further helped to embed the procedures into the working life of our teams.So what does our ISO9001 quality management system actually look like? To borrow a software engineering term, I would describe it as having a front end and a back end.

At the front end, we have flow chart procedures that outline the core aspects of what we deliver, such as what an initial client meeting should include and how a care planning session should be approached, right through to how a client should be discharged. These are kept electronically in a folder structure that includes all of the approved documents that are used as part of the treatment system; letter templates and written client information.

At the back end, we have documents and procedures that are less important for staff to understand. These define how the system works, including a quality policy, quality manual, controlled records log and other system-based procedures which describe how quality assurance and continual improvement is demonstrated.

Straddling the two is an audit schedule, which defines which parts of the system are audited when. Typically, audits run monthly. There are some core procedures that are audited each month, such as those looking at referral, assessment and care planning. Others are run quarterly, six monthly or annually.

All of the key aspects of what we deliver as a service are defined by the system, and this in turn gives us control, consistency and a way of defining and measuring quality.

This may sound like an incredibly restrictive and formal approach to delivering a service, but in my view we can still embrace innovation and creativity in our work, because the system is ever evolving in response to service user and staff feedback, and the results of our audits.

Last November we had our second stage external compliance audit and successfully achieved ISO9001 compliance. We are still very much at the start of our quality management system adventure but continuous improvement is of course a journey and not a destination. We continue to develop and refine our system, and we still have some particular areas concerning staff training and demonstrating competence that we want to improve. However we feel that we’ve made a great start and I’m really proud of the benchmark that has been set by our Powys team.

We plan to use these early experiences to embed quality management system principles within our other services. I’ll leave the final words to one of our Powys team members, Ben Chaffey, who says: ‘The QMS helps us to work consistently with procedures, assessment and therapeutic tools. It has taken some time to get used to, but we can see the benefit.’

James Varty is head of development and quality improvement at Kaleidoscope Project, www.kaleidoscopeproject.org.uk

Complex Care

Features

DDN

May 5, 2016

Have you noticed the world is getting more complicated? It’s not just technology that’s stretching our capabilities but, in the addictions field, it’s the increasing complexity of our clients challenging us on a daily basis. The traditional ‘street’ addiction service was never set up to work with clients with learning disabilities, chronic pain disorders, personality disorders, over 75s – and so many more issues. In fact, these comorbidities are often exclusion criteria for many treatment services but then their substance misuse excludes them from the health services able to deal with their comorbidity. They can get stuck in a loop of rejection with no one prepared to take on their treatment for fear that they lack the necessary skills.

Some have suggested that the answer is the development of highly specialised comorbidity services but these would be costly, numerous and likely to increase the level of exclusion and stigmatisation felt by their service users. The reality is, though, that in order to address their substance misuse needs you do not require an ‘expert’ level of experience in both issues. The expertise is in the ability to adapt substance misuse interventions to fit the needs of the individual in front of you. To do that you do need an understanding of how the comorbid condition influences use and treatment for substance misuse but you also need enough confidence in your own approach to be able to adapt it in a person-centred way.

Addiction services are beginning to recognise their need to improve their ability to manage more complex service users. Cwm Taf University Health Board’s substance misuse service (RISMS) saw an increase in referrals for individuals with a learning disability (LD) and neurodevelopmental disorders and wanted to enhance their knowledge and skills to engage with these service users more effectively. Although they linked with their local LD team, neither group of staff felt equipped to deal effectively with this group, so they approached Pulse Addictions for training.

Using our knowledgable trainers with their wealth of experience working within the complex needs addictions field, we were able to design and deliver tailored training, focussing directly on the needs of the service. From general considerations such as allowing service users to wait in quiet rooms away from the main waiting areas and avoiding the use of jargon and metaphor through to how to adapt specific psychosocial interventions for use in those with cognitive impairment, the course took the findings of the limited research in this area and turned it into tangible techniques appropriate for day to day use. The training provided staff at all levels with a balance of evidence-based knowledge and skills-based practice, empowering them to be able to work with service users with LD and neurodevelopmental disorders with confidence.

Pulse Addictions provides tailored training, consultancy and clinical management in the field of substance misuse and associated areas to organisations across the UK. With a proven track record of enhancing and developing services whether community based, NHS, third sector, private sector, residential or secure, they have the expertise to meet the most demanding of briefs with a personal touch. For details of their services visit www.pulseaddictions.com

May 2016

DDN

May 5, 2016

There was plenty of expectation around UNGASS – result of a 20- year wait for a global drug policy summit meeting – with a lot at stake and real hope of reform (page 6). What actually took place makes you question the value of such processes, watered down by the need for consensus. What is the point, if there’s no movement on abolishing the death penalty and little progress on harm reduction?

Virtual Mag / PDF Version

‘Put people first,’ Fedotov tells UNGASS

News

DDN

April 21, 2016

The world needs global drug policies that ‘put people first’, UNODC executive director Yury Fedotov told the opening session of the UN General Assembly Special Session (UNGASS) on drugs. The session also saw the official adoption of an ‘outcome document’ that has been greeted with dismay by drugs campaigners, who have branded it ‘disconnected from reality’.

UNODC was committed to promoting approaches to prevention, treatment, rehabilitation and reintegration that were ‘rooted in evidence, science, public health and human rights’, Fedotov stated, adding that it would work to ‘ensure access to controlled drugs to relieve pain and suffering’.

‘Putting people first means balanced approaches that attend to health and human rights, and promote the safety and security of all our societies,’ he told the session, adding that the founding purpose of the existing international drug control conventions had been the ‘health and welfare of human kind’.

The outcome document, Our joint commitment to effectively addressing and countering the world drug problem, contains the reaffirmation by UN member states of the goals and objectives of these conventions, as well as a commitment to ‘tackle the world drug problem and actively promote a society free of drug abuse’.

The document – which was finalised at the UN Commission on Narcotic Drugs (CND) in March rather than at UNGASS itself – has been branded ‘a turgid restatement of “business as usual”’ and a ‘profound betrayal for the many stakeholders across the world who were promised real dialogue, new thinking and change’ by Transform’s senior policy analyst Steve Rolles.

While campaigners have welcomed the inclusion of sections on alternatives to prison, access to essential medicines and overdose prevention, the statement could have been ‘very different’ if ‘more progressive inputs’ had been included, says Transform.

‘The UNGASS was called for by three Latin American countries who are desperate for a critical evaluation of the failings of the global war on drugs, and an open and honest exploration of the alternatives,’ said IDPC executive director Ann Fordham. ‘But the outcome document does not do this. Instead it reflects the lowest common denominator consensus position that is almost entirely disconnected from reality.’

IDPC was one of more than 200 civil society groups to sign a statement condemning governments for ‘failing to acknowledge the devastating consequences of punitive and repressive’ drug policies in the run up to the UNGASS.

www.unodc.org/ungass2016

April 2016 DDN

DDN

April 11, 2016

Thirty years after his graphic harm reduction campaigns burst onto the scene, Michael Linnell’s work still has the capacity to shock. Is it the graphic drawings? Is it the confrontation of difficult and taboo subject matter? Or is it the fact that he refused to be deterred in creating campaigns for ‘the most marginalised and stigmatised’ in society? How many of us would have given up at the threat of prosecution, the press attacks, the repeated obstruction?

Read about the results that spurred him on – such as the wider provision of injecting equipment at needle exchanges – and ask whether ‘crossing the line’ can sometimes be worth the controversy when it takes away a barrier to public health.

PDF version

Hepatitis C : new hope, old problems

Features

DDN

April 11, 2016

PROMOTIONAL FEATURE

People with hepatitis C in the UK have a greater chance of being cured now than at any other point in the history of the disease. Recent advances in medicines mean that for many people they work better than before, treatment times are shorter and the drugs have fewer side effects and are easier on the body. However, while treatment for hepatitis C is changing fast, the eventual impact this will have on the societal burden of hepatitis C may be a great deal slower.

To understand why it may be harder for new advances to help communities, we need to understand the unique hepatitis C environment as it can be very complicated, especially for people also living with addiction issues.

A complex picture

Around 214,000 people are infected with hepatitis C in the UK. Injecting drugs continues to be the most common way to contract hepatitis C, with half of people who inject drugs (PWID) in England and Wales thought to have been infected. In addition, about half of those again are not aware that they have the virus.

While testing and diagnosis numbers have increased over the last five years, the number of people with hepatitis C being treated is still low.1 Historically a number of barriers and challenges have existed preventing people living with the virus from being treated successfully. These range from:

clinical barriers like the effectiveness

of treatment and side effects

environmental barriers like suitable services for people dealing with addiction issues
personal barriers, such as low awareness about the seriousness of hepatitis C and care options available.

Shifting barriers

With the recent developments in treatment giving hope that clinical barriers to care will shift, the differences that exist among the population that suffer from hepatitis C mean other barriers are not so easily fixed. Stigma linked with hepatitis C infection and substance use is just one of the many complex challenges people face which may stop them from getting the care and services that they deserve.

As available treatments will get rid of the virus in about nine out of ten hepatitis C patients, depending on their type of hepatitis C, there is a worry that vulnerable groups with complicated needs won’t be in a position to take advantage of these advances which could potentially transform their health.

Over the coming months and years, services will need to be restructured to create better pathways to treatment; however an urgent need remains to motivate people living with hepatitis C to access care and services. We need to help patients realise that they are worth the best care and treatment: it doesn’t matter how someone got hepatitis C, no one deserves to live with a life-threatening virus when today’s treatments offer a better chance of cure.

Better support

In response to many of these issues the I’m Worth… campaign has been created to support people living with hepatitis C. It aims to address the stigma that many people with the virus face, encouraging and empowering people living with hepatitis C to access care and services no matter how or when they were infected. The campaign includes a web resource, materials and activities to help people feel comfortable and motivated to access NHS services, which may increase their chance of cure.

In a series of promotional features in DDN over the coming months, we will look in detail at many of the challenges that the hepatitis C community faces and explore the role of professionals in the drug and alcohol field in supporting them.

1PHE. Hepatitis C in the UK 2015. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448710/NEW_FINAL_HCV_2015_IN_THE_UK_REPORT_28072015_v2.pdf (Accessed April 2016)

The I’m Worth… campaign is supported by several patient groups with an interest in hepatitis C in the UK. The campaign, including this promotional feature, is sponsored and developed by Gilead Sciences, a science-based pharmaceutical company.

April 2016, HCV/UK/16-03/CI/1335a

For more information on the campaign and to access materials designed to support people living with hepatitis C please visit www.imworth.co.uk

Emotional rollercoaster

Features

DDN

April 11, 2016

Offering support to families affected by addiction means acknowledging the ups and downs of a close bond, says John Taylor

Recently I made a film for Turning Point’s recovery and wellbeing friends and families service, a London-based service supporting people affected by someone else’s substance misuse. The film tells the stories of clients who have suffered from active addiction and the trauma they have experienced as a result. It also portrays their journey to recovery through the service and how they have pulled through from their ordeal.

When I was asked to lead on supporting friends and families at this service at the beginning of last year I agreed because this kind of support is essential, but can often be ignored. For much of the nine years I have been working in the substance misuse field, I have supported people affected by someone else’s substance misuse – whether a relative, or friend. If you really want to know the price of addiction and what its impacts are, ask those I call the ‘affected others’.

As a friends and family worker at HMP Pentonville in 2011, I met clients coming to visit their loved ones from all around the country. They would meet me before or after visits, and I would often intervene to put them in touch with drug services in their local area to find support. What I found challenging at the time was how little support there was for people indirectly affected by substance misuse.

I am pleased to say that five years on, more support is now available for this client group – but there is still more to be done. According to Adfam, an estimated one in five people is affected by someone else’s substance misuse. Many of these people do not use substances themselves, and it is unfair that they have limited access to support when needed. It is very important that we understand the emotional rollercoaster that active addiction can bring to friends and families, affecting their physical and emotional well-being.

Where support is available, many are unaware of it. When I talk to other professionals in the field, only a small number recognise the difficulties faced by friends and families, exposing the need for an extension of the support that is already provided.

At our recovery and wellbeing friends and family service we aim to provide some of that crucial support by offering one-to-one counselling, group work, telephone support, and complementary therapies such as ear acupuncture and shiatsu. We also refer to our counselling service for ongoing therapeutic support if needed.

One of our most popular schemes is the Education, Training and Employment (ETE) service. The ETE team can help friends and families look for work opportunities, college courses, and voluntary placements, or help with writing CVs and building up people’s confidence.

We provide links to local support groups in the community such as Al-Anon, Families Anonymous (FA) or Co-Dependants Anonymous (CODA). These self-help groups not only offer support, but can also help people to explore the co-dependency that addiction may bring.

The biggest challenge we face is preventing friends and families from becoming too enmeshed in the problems affecting their loved one, which can cause them to forget about their own wellbeing.

We also explore specific behaviours displayed by people suffering from addiction. Manipulation can lead friends and families to become involved in enabling addictive behaviour out of fear or guilt. An exploration of enabling, implementing and setting boundaries therefore underpins some of the work I do with my clients.

I believe it is important for every professional in the country working in the social care sector to have an awareness of the impact that active addiction has on others, and to know that there are services out there supporting this client group. Once more people are aware of what’s on offer, we can further the possibilities of providing better support.

John Taylor is friends and families lead at Turning Point South Westminster, www.turning-point.co.uk. Watch his film at www.youtube.com/watch?v=YuiF6fhbji4

View from the coalface

Letters and Comment

DDN

April 11, 2016

The work can be demanding and draining – so why do it? Keith Stevenson shares the highs and lows of working at the Mulberry Community Project

I have had two conversations today with ex-residents of Mulberry who left us because they were seeking something other than what we offered. One wanted to drink, and because we are abstinent based he could not do his drinking within our project. The other wanted to live with his boyfriend who was a drinker, and again he could not do that while being with us. Today I talked with two people who were both in tears, both drinking copious amounts of alcohol and both at the end of their tether. As they are in very different parts of the country to where we are, personal contact is impossible but sometimes, just someone on the end of a phone helps. This ‘coalface’ work can be extremely demanding and can leave you exhausted by the end of the day. So why does anyone do it?

Let’s rewind nearly five years to when I first opened a recovery house in Blackpool under the charity Mulberry Community Project. I opened it after seeing so many people going through treatment and trying to get out of the chaos that is addiction. It can involve a lot of money, time and thought to take the road to recovery. It may happen after some stabilisation on a script, or it may have been a ‘lightbulb’ moment; a realisation that changing one’s life is the only way forward. The problem was there was very little, if any, post-treatment support for the individual beyond the 12-step approach – which, alongside other recovery programmes such as SMART, work for many people around the world.

But this approach could not cover other needs such as housing, education and volunteering and I saw the need to provide safe secure housing with a support package where relapse and addiction could be explored.

I did lots of research while working for Inward House, an excellent charity in Lancashire that encouraged me to look into this. I talked to the commissioner for services in Blackpool and, being the very forward-thinking man he was, he encouraged us to tie treatment and recovery together as the benefits are so obvious. Others helped greatly, such as The Basement Project on the other side of the Pennines, and people such as Cormac Russell whose ABCD talk convinced me that I was on the right track.

Nearly five years and eight houses later we are helping people find their recovery. Two people have left the project in the last three weeks, and between them they have got four years recovery time and are looking forward to rich, fulfilling lives. Both have flats of their own, are in employment, and are enjoying an abstinence-based life. We look around and see other projects getting lots of money, and others getting awards, yet we just carry on doing what we are doing.

Would we have liked the money? Yes of course, as it would have meant that we could have helped more people. But Mulberry started with £150 in the bank and a lot of faith. What we like most is seeing people leaving our project and going into independent living, being abstinent and holding fulltime work. That is a true reward.

Not everything is plain sailing and we do have our problems – but that’s the nature of the beast. When I have to take phone calls from people I have worked with and they sound really bad and suicidal, it breaks your heart. We have had two deaths in the project in five years and they bring home just how important what we do actually is. Life on the ‘coalface’ is both rewarding and painful – often at the same time – but we will never give up, as we are told that we literally save lives.

Keith Stevenson is founder and CEO of the Mulberry Community Project, www.mulberrycompro.co.uk

‘No slowdown’ in new psychoactive substances, says EMCDDA

News

DDN

April 11, 2016

There are ‘no signs of a slowdown’ in the development and discovery of new psychoactive substances (NPS), according to the European Monitoring Centre for Drugs and Drug Addiction’s (EMCDDA) latest report on the continent’s drug markets. A hundred new substances were reported for the first time in 2015, and the EU’s early warning system is now monitoring close to 600.

As the UK government delays the implementation of its beleaguered Psychoactive Substances Act (see below), the report also warns that, given the nature of the market and the ‘continuous stream’ of new substances, it is ‘unfeasible’ that all of them could be controlled. ‘It is unlikely that any regulatory system can be designed to sufficiently limit the stream of new substances being manufactured without resorting to a ban on a huge range of chemicals,’ it states.

Europeans spend at least EUR 24bn a year on illicit drugs, says the document, with evidence of increasing links between drug trafficking and other criminal activities, including terrorism. Criminals have also been quick to exploit the opportunities presented by the internet and increased globalisation, it says, and warns that instability in regions neighbouring the EU could also have a ‘profound’ effect on Europe’s drug market.

Cannabis is estimated to account for 38 per cent of the entire retail market for illicit drugs, while cocaine is the continent’s most commonly used illicit stimulant, with a market estimated to be worth at least EUR 5.7bn per year. The heroin market, meanwhile, is estimated at EUR 6.8bn a year, with recent signs of increasing availability that ‘may signal increased harms’. Levels of opium production in Afghanistan have remained high, and there is evidence of ‘increasingly flexible and dynamic’ production techniques and trafficking routes, says the report, including via the Southern Caucasus, Africa, Iraq and Syria.

‘The EU drug market is driven by two simple motives: profit and power,’ said EMCDDA director Alexis Goosdeel. ‘Understanding this, and the wider impacts of drug markets on society, is critical if we are to reduce drug-related harm.’

2016 EU drug markets report at www.emcdda.europa.eu

Services continue to feel cuts pain

News

DDN

April 11, 2016

Nearly 60 per cent of residential treatment services have reported a decrease in funding to the Recovery Partnership’s latest State of the sector report, along with nearly 40 per cent of community services. Just ten and eleven per cent respectively reported an increase, the document states.

Produced by Adfam, the report is based on an online survey and telephone interviews carried out in the last quarter of 2015, with more than a quarter of all services reporting an increase of ten per cent or more in the number of clients accessing them. Meanwhile, 44 per cent had been through either tendering or contract re-negotiation in the previous year, and half expected to do so in the year ahead.

A fifth of respondents felt that access to mental health services and/or housing support had worsened, suggesting that ‘better joined-up support for people with dual diagnosis and multiple and complex needs’ was necessary, the report states. Just under 70 per cent reported actively recruiting ex-service users as paid employees, while almost all said they recruited them as volunteers.

More than half also felt that funding changes had had a negative effect on both workers’ caseloads and workforce development, and more than 40 per cent said there had been a negative impact on core services. However, ‘passion, innovation and resilience’ remained evident despite the challenges, the report stresses. The report revealed a system ‘struggling to support some of our most vulnerable citizens’, said Adfam chief executive Vivienne Evans. ‘It provides vital intelligence on how services are coping, or not coping, and contains worrying findings on the impacts of funding changes to the delivery of core services. As ever, highly committed staff and innovative practice were also uncovered.’

State of the sector 2015 at www.recovery-partnership.org

Recovery Capital

Letters and Comment

DDN

April 11, 2016

New government funding of £10m has just been awarded to drug and alcohol services ‘committed towards improving recovery outcomes’ across England – capital funding that was distributed by PHE via local authorities. ESH Community Works were among the successful bidders and have been awarded £545,000 to purchase property for a local, peer-supported residential rehabilitation unit. CEO Paul Urmston gives their reaction.

How does it feel to have secured the funding? We’re excited about the opportunity but we also recognise the effort that’s going to be required to make this a reality.

What does it mean for ESH? This funded initiative will give us the opportunity to expand our current peer-led support. It will give us the ability to bring clients into a safe and peaceful environment allowing us to work more closely with them and their families to focus on their sustained recovery in the local community.

What does it mean for service users in Warwickshire? People with addiction problems in Warwickshire who have been assessed as needing drug and alcohol rehabilitation support would currently get a placement approved at a rehab unit somewhere outside of the county because we don’t have one locally. While the clients are away for around three months they build up a network of mutual support and many of the clients actually relocate because they’re comfortable in the recovery network that they’ve established. The problem is that they do not return to Warwickshire with their own recovery, and we lose the value of their recovery and the enthusiasm they have to help others.

Feedback from service users who had been out of county to a residential rehab and who came back to Warwickshire was that they actually felt there was no continuity for themselves or their families when they returned. A local residential rehab facility in Warwickshire will provide that continuity and stability for clients and families during their stay and, perhaps more importantly, when the clients leave the rehab it can provide the local aftercare and support to sustain their recovery.

Have you identified a site yet? We have looked at several sites, mainly residential properties, but we’re looking for somewhere with land and potential to expand the facility so we can eventually provide other activities and premises for clients to start their own small businesses.

When could the centre be up and running? It will take several months to complete a purchase and we then have to go through the process to register with the Care Quality Commission, so it could actually be six months or more before we are operational.

Were you successful in your capital bid? Tell us your plans for the money – email claire@cjwellings.com

Voice on the stairwell

Letters and Comment

DDN

April 11, 2016

The launch of Collective Voice saw the group emphasising their commitment to service users.

‘It’s Important that our Service Users inform our services,’ said Lord Victor Adebowale, at the recent ‘official’ launch of Collective Voice at the House of Lords. The group of voluntary sector organisations came together to provide a coherent voice from the drug and alcohol treatment sector.

‘We’ve certainly got our work cut out. When the environment gets tough, we can retrench, take a defensive approach – or come together and represent the interests of people we seek to help,’ said Karen Biggs, the group’s chair.

‘We knew we were about to face a reduction in public spend but the needs of our service users are high,’ she said.

‘As providers we had never worked together before… Yes we fight like cat and dog over tenders – but on important stuff we’re all agreed. We’ve proved we speak with a collective voice.’

The group’s chair Paul Hayes agreed that the objective was to improve the lives of service users: ‘We’re not set up to just exist,’ he said. ‘We’re set up because real things need to be done.’ This included trying to influence the drug strategy, the Dame Carol Black review, and the spending review.

‘The drug strategy is still not published and we’re concerned it might edge away from 2010 strategy – we won’t know until it’s published,’ he said. ‘There are people in government that believe in abstinence only – and that methadone is the spawn of the devil.

‘Reductions in public health grants mean it will be challenging,’ he added. ‘But there’s widespread acknowledgement in government that if they want the benefits that accrue from drug treatment in tackling crime, they need to invest.’

The group needed to ‘keep up pressure’ and also engage in other conversations, such as with Mind, the Royal College of Psychiatrists and the NHS, he said, and to pay as much attention to alcohol as drugs.

Hayes emphasised that the group was ‘not pretending to represent service users, but needs to be informed by them and have the service users’ take in a meaningful and responsive way.’

‘We cannot do everything and we don’t want to spend time reading perfectly crafted response documents,’ said Hayes. ‘It’s the two-minute conversation on the stairwell that makes a difference. We need to be able to grandstand – but we also need to be able to have a quiet word.

‘In the end we will be judged by: is the world a better place for Service Users? Is the taxpayer getting better value for money? Is there still a drug treatment sector – and are we all willing to work in it?’

Collective Voice is made up of Addaction,Blenheim, cgl, Cranstoun, DISC, Lifeline Project, Phoenix Futures, Swanswell and Turning Point.

Different wavelengths

Features

DDN

April 11, 2016

The countdown to the Psychoactive Substances Act has been marked by controversy. Kit Caless shares debate from Addaction’s recent conference

Last month, the Psychoactive Substances Act formed the focus of Addaction’s NPS conference, No longer a novelty: the expert view. More than 200 clinicians, practitioners, key workers, managers and many others heard a wide variety of views on both the coming legislation and approaches to NPS treatment. Ranging from the thought provoking to the outright provocative, there were almost as many opinions on the topic as there are psychoactive substances.

Met police commander Simon Bray kicked off the day discussing the implementation and enforcement of the Psychoactive Substances Act. To date, he explained, there have been ‘a small number of successes but they’ve been hard won and they’ve been expensive’, going on to stress that the police were able and ready to enforce the law, ‘as soon as the act begins.’ Bray also said that ‘poppers’ may not be included in the act ‘in a few months’ time’, foreshadowing subsequent Home Office confirmation to this effect.

Professor David Nutt took to the lectern next. Creating a febrile atmosphere, Nutt spoke about his opposition to the act and the myths he saw that surround NPS. In his trademark forthright way, he questioned the scientific validity of the act as it exempts substances on precedence rather than on harm, leading to a lively question and answer session afterwards.

Later on, minister for prisons, Andrew Selous discussed NPS use in prisons, citing a rise in violence related to NPS use as a serious problem. Selous informed delegates that ‘NPS testing is currently underway in 34 prisons [and] will be rolled out to all other prisons shortly.’ He spoke candidly on the difficulties posed by the explosion in NPS use, and left the audience in no doubt as to how seriously the trend was viewed.

In the second session, Majella Pearce from HM Inspectorate of Prisons returned to this topic, acknowledging the difficulties the prison system has had getting a handle on NPS use. She spoke specifically of spice (a synthetic cannabinoid) in prisons: ‘it’s very linked to violence, bullying, to debt’ and ‘for prison officers it really has been a huge change in the behaviours they are experiencing.’ She also added that the rise in synthetic cannabinoid use ‘really took a lot of people by surprise’.

Addaction’s Fern Hensley presented case studies on managing NPS in prisons. She told the audience that ‘one NPS-using prisoner said he wouldn’t access services because “spice isn’t a drug”’. Fern went on to showcase the Trans4orm drug treatment programme in HMP Lincoln, which has a 90 per cent completion rate. Dr Mark Piper, from Randox Testing, then took the delegates through the scientific process of testing and how difficult it is to stay on top of the ever-changing chemical make-up of NPS.

The afternoon session was chaired by Jan King from the Angelus Foundation. She spoke about their campaigning and then introduced Professor Harry Sumnall, whose compelling talk highlighted the problem of NPS in vulnerable populations, such as looked-after children and people experiencing homelessness. Sumnall said ‘levels of harm are not likely to be affected by the new Pychoactive Substances Act.’

Addaction’s Rick Bradley spoke about how NPS has affected young people. Guiding delegates through the history of NPS use he said, ‘there was a huge amount of confusion around the different products’ in 2010 when mephedrone became illegal. The mainstream media also came in for criticism – not for the first time over the course of the conference – as Bradley suggested coverage of NPS ‘really dilutes what we’re trying to put across, and that’s a real concern.’

Dr Owen Bowden Jones appeared via live video link and spoke about the Neptune Project, which is developing clinical best practice for treatment groups. But he also warned of a lack of data around NPS use: ‘We don’t know the long-term effects of five years of NPS use, we just don’t have the data yet.’ He advised clinicians to focus on the drugs’ effects, rather than their names.

Dr Ben Sessa gave an entertaining talk on prohibition – ‘the elephant in the room’, as he put it. He spoke of visiting around local head shops in Weston-super-Mare and asking what drugs were on the market and how you took them, noting that store employees would refuse to offer potentially useful harm minimisation advice for fear of prosecution.

Finally, Addaction’s Kostas Agath rounded things off to discuss how we move forward on this tricky issue. He said that services need to make potential service users feel welcome, speaking to them factually and with authenticity, and that it is paramount that NPS users can see that there are services out there for them.

The conference produced opposing views, case studies and evidence, dialogue, debate and a great deal of discussion. NPS use is likely to remain a controversial issue in the substance misuse sector over the coming years, so it’s essential that the conversation continues.

Kit Caless is Addaction’s communications officer for London and the South East

Put on the spot

Columnists

DDN

April 11, 2016

Launching his new monthly Behind the stats column for DDN, Russell Webster looks at the inventive business of getting drugs into prison

I always remember John Grieve, the Metropolitan Police Commander who was a moving force behind one of the early drug strategies, passionately calling for an end to the war on drugs because: ‘A war on drugs is a war on our own young people.’

Although his argument was a moral one, he backed it up with the practical argument that it was impossible to prevent drugs being available, citing as an example the large-scale heroin problem in post-war East Berlin despite the fact that the city was surrounded by a somewhat notorious wall and four occupying armies.

It might be a cliché, but necessity has always been the mother of invention.

In 2005, I was part of a team that undertook a study into prison drug markets which found a wide range of ways of getting drugs into prison, including:

concealed in mail and parcels
thrown over the prison wall in oranges and dead pigeons
brought in by visitors
brought in by prisoners themselves, usually concealed in their anus, and
occasionally, allegedly, smuggled in by corrupt prison staff.

There is currently widespread concern about the increased availability of legal highs – especially synthetic cannabinoids – in most prisons, revealed by a series of prison inspection reports and a briefing by the prison drug treatment provider, RAPt. Admission to both prison health care and local accident and emergency departments, assaults on fellow prisoners and staff and self-harm are all common consequences.

This made me wonder whether prison drug smuggling approaches have evolved over the last decade.

It appears they have. A recent Freedom of Information request by the Press Association revealed that there were 33 recorded incidents of drones being discovered in English and Welsh prisons in 2015 (up from two in 2014).

Drones are now very cheap and very low risk for the operator and if you’re wondering how prisoners manage to get to the ‘payload’ before prison staff, prison inspectors have also pointed out how the easy access to illicit mobile phones makes planning deliveries a relatively straightforward matter.

Adherents of the war on drugs are coming up with their own responses – more searches, new machinery to screen incoming post and people, even training eagles to intercept drones (yes, really).

I know what John Grieve would say, though. He would say we should focus on providing advice, information and treatment, and encourage drug-using prisoners to look for a better life on release.

Further reading: HMIP (2015) Changing patterns of substance misuse in adult prisons and service responses; RAPt (2015) Tackling the issue of new psychoactive substances in prisons; Penfold, Turnbull & Webster (2005) Tackling prison drug markets: an exploratory qualitative study. Home Office online report 39/05.

Russell Webster is a consultant and researcher specialising in alcohol, drugs, crime and payment by results and runs a blog which aims to keep readers up to date on these issues at www.russellwebster.com

Be inspired

Uncategorized

DDN

April 11, 2016

We need easy access to material that will challenge us, says our new columnist George Allan

A confession: during a lengthy career as both a practitioner and manager in criminal justice and substance problems services, I didn’t read! That’s not quite true – I read enough reports and policy documents to last a lifetime, but rarely lost myself in the type of material that would have encouraged me to reflect more fully on the quality of my practice or challenges in the wider and shifting landscape. Journals I subscribed to piled up in a corner, unopened.

The situation changed when I became a lecturer delivering substance problems modules to social work students. Not only did I suddenly have the time to ferret out material; it became an obvious necessity of the job. There is, of course, an irony here: I was reflecting on best practice at a point in my career when I was furthest away from directly impacting on people with problems.

I’m sure my experience will ring bells with busy practitioners struggling with excessive caseloads and harassed managers trying to maintain quality in the face of conflicting demands and reducing resources. All too often continuing professional development consists of the occasional, short skills input or attendance at day conferences. The latter is great for networking, but how often is the content quickly forgotten? In addition, continuing professional development is usually the first casualty of funding cuts.

Having spent the last few years accessing material, both for teaching purposes and for writing a text book on substance problems, I thought that it would be good if I could pass on some of what I have found most helpful, so I’m delighted to be writing Resources Corner for DDN, every other month.

So what will my new column cover? Well, books will be in there, but websites, podcasts, interviews and research summaries will be in the mix too. I intend to apply two overarching criteria when considering material. Firstly, it must be either challenging or inspiring: I hope the reader will come away wanting to access the material. Secondly, it must be easy to find and easy to digest, so that busy workers will gain the benefit without large demands on precious time.

I’m really looking forward to getting started.

George Allan is chair of the Scottish Drugs Forum. He is the author of Working with Substance Users: a Guide to Effective Interventions (2014; Palgrave)

Get real

Letters and Comment

DDN

April 11, 2016

Losing her daughter to an accidental overdose made Anne-Marie Cockburn determined to campaign for the realistic drugs education that could have saved Martha. She spoke powerfully to a recent meeting of the Drugs, Alcohol and Justice Parliamentary Group

My 15-year-old daughter, Martha Fernback, died of an accidental overdose in 2013 after swallowing half a gram of MDMA powder that turned out to be 91 per cent pure. After her death, I found that she had been searching online for ways to do it safely – but sadly what she took in one go was enough for five to ten people. My naturally curious teenager wanted to get high; she didn’t want to die. No parent wants to think of their child taking drugs, but I’d choose high over dead any day.

I’ve been regularly visiting schools to have an open dialogue with 15 to 18-year-olds. When I asked a group of 19 Oxford students how many have been offered drugs, 18 hands went up; I then asked how many of them knew where to get drugs from and 19 hands went up. With each school I visit, this is the consistent picture and it worries me greatly. They comment that the schools just tell them not to do it, but that there is no advice or education on the alternatives – despite harm reduction being the most obvious and sensible one. I liken harm reduction education to age-appropriate sex education, which empowers young people and helps them to make more informed decisions. Harm reduction isn’t about being for or against drugs – it’s the responsible reaction based on what’s actually needed.

I remember searching on the Frank website when I found out Martha had taken ecstasy for the first time and it did nothing to quell my feelings of helplessness and inadequacy – it merely offered symptoms and possible reactions, rather than harm reduction. I therefore remained terrified as I couldn’t find good information to equip me with the answers based on the fact that the ‘just say no’ strategy wasn’t working for my child.

The divide between the easy access young people have to drugs and the inadequate education they receive is alarming. The dialogue I have with them shows me how genuinely baffled they are, due to so much misleading information and the stigma embedded within this subject. For some youngsters the easy access to drugs has, in part, normalised drug taking. They see their friends not dying from taking drugs and may have had a good experience on drugs. They tell me that drug taking isn’t always widespread at parties, but there’s always a handful who are partaking. They say that drug taking at gigs and music festivals is widespread and seems to go with the territory.

Parents and children need to know where they can access good, solid information that isn’t based on judgement or idealism.

Learn more about Anne-Marie’s campaign at www.whatmarthadidnext.org

A smack in the eye — Michael Linnell’s graphic harm reduction campaigns

DDN

April 11, 2016

Thirty years after Michael Linnell’s first graphic harm reduction campaigns burst onto the scene he recalls the outrage – and the results – that spurred him on

In March 1985 I answered an advert in The Guardian. A small drugs charity called Lifeline was looking for an artist, and they gave the job to me. Over the next 30 years I created a range of internationally acclaimed, and at times notorious, drug campaigns for the most marginalised and stigmatised sections of society.

In the mid-1980s, information aimed at drug users consisted of primary prevention campaigns of the ‘drugs are bad’ ilk and a handful of advice leaflets. The emergence of HIV (then called HTLV III) required a new public health response. Tossed like a harm reduction hand grenade into the primary prevention trenches came the rudest drug campaign anyone had ever seen.

Smack in the Eye was based on speaking to drug users (a novelty back then) and asking them what they wanted, found funny and were likely to read, rather than what was least likely to cause offence. It had quite an impact. It had been banned by the probation service, reviewed by The Times Educational Supplement and had featured on BBC 1 before the 500 pilot copies of the comic were even distributed. By the time we had been interviewed by the director of public prosecutions (twice), it had been discussed in the House of Lords and commended by the WHO. It was called ‘grossly offensive and pornographic’ and accused of just about every ‘ism’ and ‘obia’ around at the time.

Not only did it contain explicit information on safer drug use and safer sex, it critiqued many aspects of the drugs field – from some of the more pretentious extremes of therapy to mass methadone prescribing. We even highlighted one of the little known but most dreadful consequences of heroin addiction – the delusion that you can write poetry when you give up!

We had expected to be attacked by the press, but surprisingly this came many years later (the Daily Mail dubbed us a ‘threat to the youth of Britain’). It was our fellow professionals who both asked the police to arrest us (nobody was really sure which laws we were breaking but were sure we must be doing something illegal) and occasionally wrote to us complaining. However, these complaints were far outnumbered by the ‘fan mail’ we started to get from drug users.

By 1990 the ‘acid house’ (rave) scene was flourishing among a group of young people using LSD, amphetamine and ecstasy to get off their trumpet and dance all night to electronic music. We recognised that there was an urgent, unmet need for accurate harm reduction advice for this group and Peanut Pete was designed to change the image of drug services that were perceived to be ‘just for junkies’.

The leaflets were originally distributed at record shops and hairdressers in Manchester. They became an instant success with drug users, so we started to sell them nationally to other services and they sold in their millions, funding our work and allowing us to keep our editorial independence. They also attracted considerable national press interest and we were even (briefly) in the government’s good books when in 1992 the Peanut Pete campaign was described by the European Parliament as ‘by far the best in Europe’ and chosen to represent the UK at the “European Drug Prevention Week” conference.

One of the first people in Britain to die from ecstasy use was a young girl in a nightclub in a Manchester, which was at the time christened ‘Madchester’ by the press. Nobody really knew why the handful of tragic deaths had occurred until we heard that a toxicologist, Dr John Henry, thought the deaths were due to overheating. We managed to get hold of his (at the time unpublished) research and produced Too Damn Hot – a leaflet containing the first ever advice to ecstasy users about heatstroke.

In the early 1990s, we had leaflets distributed by drug workers and volunteers who worked in nightclubs (such as The Hacienda) and at “raves”. This led to a campaign of harm reduction information, policy and training around nightclub drug use we called Safer Dancing. It was hugely influential, despite a serious lack of funds, and became the blueprint for the many initiatives that sprang up, both in the UK and internationally.

All the publications in the archive were aimed at specific populations of drug users as diverse as children groomed by paedophiles to professional footballers (commissioned by the PFA). They were all based on extensive research with these target populations and we used their expertise. Although there is a long tradition of drug users writing about drugs going back to Thomas De Quincey, it still raised a few eyebrows when in the early 1990s we commissioned a drug user to write about drugs. McDermott’s Guides were designed to be credible and entertaining enough for experienced users to want to pick them up and read them.

However, it was often the pictures that got us into more trouble than the words. An example of this is On the Beat, a booklet based on research with female street sex workers. The ‘sexy’ and ‘glamorous’ images of the women caused some controversy, but that is the way the women we spoke to wanted to be represented, so that is how I drew them.

As the new millennium dawned I was managing a research and communications project on homeless populations of injectors. The project had initially been going well and had led to an overdose leaflet, involving police and ambulance services in a joint overdose protocol. The police would now only be called if there was a death or an under-16 involved.

It was when we tried to do something about this unhygienic places where the homeless population were injecting that the project ran into a bit of trouble. We produced an injection box designed as a ‘safe space’ and filled this with all the injection equipment needed for a day – an initiative that led to us being threatened with arrest under section 9a of the Misuse of Drugs Act.
By the end of the project we were under siege, and still under threat of arrest when the Home Affairs Select Committee (HASC) report came out. The Committee (including future prime minister David Cameron) had visited and taken me to dinner to talk about the work. But when the report came out, our publications were accused of ‘crossing a line’ and promoting drug use. This led to the government trying (illegally) to stop anybody buying them with public money: we were under investigation by the Charity Commission and the National Lottery; we had complaints from Prison Officers Association sent to the Prime Minister’s Office and were under attack by the entire national right wing press. The Daily Mail (bless!) called us ‘groovy right-on activists’.

The box was never put out, but the subsequent furore and media storm created by us refusing to kowtow led to the Misuse of Drugs Act being amended to allow for the wider provision of injection equipment at needle exchanges. We survived the onslaught and had the most financially successful sales year in our history.
The work in the archive was produced for a national drugs charity, through setting up a publications department that survived for nearly 30 years just from sales of the publications. That we did this by producing such uncompromising and challenging works is (I think) quite remarkable.

Although many of the publications in the archive rely on the use of humour, I always took the work seriously. I never assumed that information alone would lead to behaviour change and never attempted to tell people that they shouldn’t use drugs, as I never believed this would prevent anybody from using them. The work was first and foremost an attempt to communicate with the target audience of drug users and to show them as people, with all the strengths and weaknesses that make us all human.
Enjoy, but be warned – many of the publications in the archive are still as gloriously rude, vulgar and likely to offend as when they were first created.

Hot off the press! Biffo the clown’s guide to the PSA is now available in the ‘new work’ section at http://michaellinnell.org.uk

Painful inheritance – NACOA’s annual lecture 2016

Features

DDN

April 11, 2016

NACOA’s (the National Association for Children of Alcoholics) annual lecture at the House of Commons set out an action plan to give the issue the public profile it deserves. DDN reports

The children of alcoholics were ‘the innocent victims of booze, who never ask for the pain they suffer’, chair of the All Party Parliamentary Group (APPG) on Children of Alcoholics, Liam Byrne MP, told delegates at NACOA’s David Stafford Memorial Lecture.

All children of alcoholics grew up experiencing insecurity, shame, guilt and worry, he said, as well as ‘the instinct to try to create order, build armour plating, and never take it off’.

When his own father died he’d thought ‘finally he’s in a place where no one can hurt him, and where he can’t hurt himself’, he said. His father had been idealistic and driven, eventually becoming leader of Harlow council, but ‘as he rose up the ranks his dependence on alcohol deepened’, particularly after the death of his wife. ‘I struggled for a long time with whether I should speak out,’ said Byrne, ‘with the worry that I might be dishonouring my dad. But my dad was the child of an alcoholic too.’

Many of the stories he’d heard since he took the decision to speak out were ‘hard to listen to’, he said, with people describing loneliness, abuse, violence, or ‘special occasions like birthdays and Christmas that were more crisis than celebration’. However, these were stories that people ‘need to hear about’, he stressed. ‘If we can begin to break the silence and end the stigma, then we can help to break the cycle for those children experiencing a hell on earth.’ Children of alcoholics were three times more likely to become alcoholics themselves and three times more likely to attempt suicide, he told the event.

The aim of the APPG, which launched in February, was to ‘make a difference’, he said. ‘Public support is, frankly, a shambles.’ No local authority had a specific strategy in place to support the children of alcoholics, he pointed out, while referral rates for treatment varied widely between areas and many treatment budgets were facing cuts. ‘We have to join together and say that this is unacceptable.’

The group was calling for more investment in helplines, as well as public information films aimed at parents to ‘bring the message home of how much damage they’re doing’, he said. ‘We need to have an adult conversation about this.’

The APPG had also published a proposal for a new law, the Children with Alcoholic Parents (Support) Bill, which called for a national strategy as well as the appointment of a minister with national responsibility to support those affected and coordinate services. The law would also require councils and the NHS to set out the scale of the challenge in their local area, and to publish details of their budgets for support and treatment. This would form part of a national league table ‘to show which local authorities are doing good work, and which aren’t’, he said.

‘I had no idea that the support was as shambolic as it is,’ he stated. ‘There’s a lot of people doing good things, and a lot of effective models, but there’s obviously a need to put in place more research, so we can really see what works.’ The APPG was planning an event that would allow those affected by the issues, as well as charities and other organisations, to give evidence about ‘what needs to change’, he said, with the findings forming part of a manifesto to be taken to the party conferences in the autumn.

The biggest challenge, however, remained ‘getting it to the top of the list’, he said. ‘People are only really waking up to the scale of the problem now. We’ve deliberately set our initial campaign asks as something it will be easy for the government to deliver, and that’s why we’re asking for transparency about what’s going on locally. Once you’ve got that comparable data it becomes easy to say, “this needs to change”.’

The way that the conversation around mental health had evolved over the last few years had provided an inspiring example of what could be achieved, he said, but there were clearly major barriers to overcome. ‘When Sally Davies published the new drinking guidelines you had this slightly hysterical reaction in parts of the media, and we really need to get over that.’ It was unlikely that the current government would make ‘big changes’ around alcohol policy, he acknowledged, but smoking campaigns were proof that a strategy framed around the impact on children could have a genuine impact.

‘Every revolution starts with a few people in a room,’ he said. ‘We couldn’t fix things for our parents, but we can fix things for our children. Recovery is a place we can all get to if we choose.’ DDN

Thank you for your interest in this position

Uncategorized

DDN

April 1, 2016

CRI have now rebranded to CGL – Change, Grow, Live.

Their jobs page is currently being updated, please check back again on Monday 4th April to apply.

Local news from the substance misuse field

Uncategorized

DDN

April 1, 2016

Yes you can!

bob Build on Belief (BoB) recently held their eighth annual award ceremony and celebrated their ten-year anniversary through an evening of entertainment and celebration at Kensington and Chelsea Town Hall.

One of BoB’s volunteers, Kelly, explained how helping other service users got her back on track: ‘I had a rocky few years. Volunteering really helped and supported me – being able to be myself and share my experience.’

Among the award winners, collecting the Kevin Plunkett-Gibney Memorial Award, Linda Chan said: ‘I had 32 years of drug use. Getting off them wasn’t a problem – staying off them was. Tim [Sampey] explained how I could use my skills in that world and put them to good use. Coming off drugs is one thing – building a life is another. BoB gave me that.’

Amelia runs marathon for her RAPt journey

Amelia Barber will be among the runners in the London marathon this year, fundraising for the Rehabilitation of Addicted Prisoners Trust (RAPt). Now working as a nurse on an oncology ward at Guy’s Hospital, she is running to ‘give back’ to the charity that helped her to change her life.

‘I struggled with drug and alcohol addiction for several years and it caused me to lose my home, my family, my job, my values, my health and my self-respect,’ she said. ‘At my worst I was homeless, drinking and using drugs every day to block out the pain of living.’

Joining RAPt’s Island Day Programme in Tower Hamlets brought her in contact with counselling, structure and support. ‘I will always be grateful to RAPt for helping me when I couldn’t help myself,’ she said. ‘I wouldn’t have wanted to do the marathon for anyone else – I know that money will make a real difference to RAPt, and most importantly to the people whose lives it helps to change.’

Nottinghamshire service users show their spirit

Life-changing contributions to recovery across Nottingham and Nottinghamshire were recognised at Double Impact’s Spirit of Recovery Awards.

Celebrations were held at the charity’s flagship social enterprise Café Sobar, with an opening address from Professor David Best, professor of criminology, development and society at Sheffield Hallam University. Service users from the Recovery in Nottingham’s creative writing group then gave readings of their own poetry, introduced by Miggy James, winner of the Exceptional Recovery Worker award.

Sixteen award categories attracted entries from individuals and organisations across the county, with votes made by service users, staff, peer mentors and volunteers.

‘I can’t believe that within a year of finishing the mentoring diploma I am now in fulltime employment with New Directions Nottinghamshire,’ said winner of the Extraordinary Achievement Award, Sandra Platten. ‘I am so grateful to everyone at Double Impact Academy.’

The award ceremony was followed by music from Rob Green and Gallery 47 – part of Café Sobar’s monthly music event to showcase talent from Nottingham’s live music scene.

New booklet helps young people with psychosis

A booklet has been produced by Greater Manchester West Mental Health NHS Foundation Trust to help young people who are experiencing psychosis for the first time, helping them look after their physical health and maintain a healthy lifestyle.

Right from the start: keeping your body in mind includes useful questions for young people to ask their healthcare professional so they can get help with stopping smoking, reducing their alcohol consumption and making positive adjustments to diet and lifestyle. The need for routine checks such as blood pressure, weight and cholesterol are also covered, to help with detecting symptoms of physical conditions earlier.

‘It has been my mission over the last eight years to tackle the premature mortality of people with psychosis,’ said Dr David Shiers, honorary research consultant for the Psychosis Research Unit at GMW. ‘There needs to be a more holistic awareness of the condition and its potential impact on physical health and quality of life.’ www.gmw.nhs.uk

Musical challenge

A series of music workshops have been supporting women to make changes to help them out of drug addiction, prostitution, physical abuse and homelessness.

Award-winning charity Create teamed up with the U-Turn Women’s Project and international law firm Reed Smith LLP to deliver the creative: u-turn programme, led by Create’s professional musician, John Webb.

Women from East London’s U-Turn Project were involved in experimenting with instrumentation to create films that echoed their personal experiences.

‘It offers a chance to explore creativity, an effective and cathartic way to channel emotions and feelings that can be difficult to verbalise,’ said Create’s chief executive, Nicky Goulder. ‘The project also endeavours to nurture new relationships, creating support networks for those who have shared similar challenges in life.’

Beau takes the lead at Kenward

Beau the labradoodle has joined the team at Kenward Trust. Since arriving at 13 weeks old, he has shown himself to be a calming influence, building trust, while being walked, groomed, taught and spoiled by residents.

‘We hope that he will encourage exercise and responsibility but we really feel he will come into his own when a resident is struggling and can’t open up to staff or even peers,’ said project manager Nicola Boniface. ‘He will be the third medium and through stroking him and trusting him, staff and residents may be able to make psychological contact during those really vulnerable times and work on the issues the individuals are struggling with.’

Decriminalisation would mean global gains, say medics

News

DDN

March 31, 2016

Drugs should be decriminalised across the globe as existing policies are directly contributing to ‘many of today’s most urgent public health crises’, according to a commission of medical experts.

The commission, which was set up by the Lancet and Johns Hopkins University in the US, also wants to see better access to harm reduction measures, policies that ‘reduce violence and discrimination’ in drug policing and an end to aerial spraying of drug crops with toxic pesticides. The report has been published to coincide with the UN General Assembly Special Session (UNGASS) on the world drug problem.

All ‘minor and non-violent drug use, possession and petty sale’ should be decriminalised, says the document, and coupled with much greater investment in health and social services for drug users. The report is based on a review of existing evidence as well as new research into drug-related violence, imprisonment and infectious disease.

‘The idea of reducing harm is central to public policy in so many areas from tobacco and alcohol regulation to food or traffic safety, but when it comes to drugs standard public health and scientific approaches have been rejected,’ said Joanne Csete of New York’s Columbia University. ‘Worse still, by dismissing extensive evidence of the health and human rights harms of drug policies, countries are neglecting their legal responsibilities to their citizens. Decriminalisation of non-violent minor drug offences is a first and urgent step in a longer process of fundamentally re-thinking and re-orienting drug policies at a national and international level. As long as prohibition continues, parallel criminal markets, violence and repression will continue.’

‘The case for reform has always been compelling, but who is making the argument is crucial,’ according to Transform policy officer George Murkin. ‘When arguably the world’s most respected medical school and medical journal speak out so emphatically on an issue like this, there can be no excuse for inaction.’

Meanwhile, a report from Release states that decriminalising drugs leads to fewer drug-related deaths, lower HIV transmission rates, improved opportunities for drug users and substantial savings to the state. Fears that decriminalisation leads to a surge in drug use are ‘simply not borne out by the evidence’, adds A quiet revolution: drug decriminalisation across the globe. More than 200 civil society groups have also signed a statement condemning governments for ‘failing to acknowledge the devastating consequences of punitive and repressive’ drug policies in the run up to the UNGASS.

Public health and international drug policy at www.thelancet.com
A quiet revolution: drug decriminalisation across the globe at www.release.org.uk
The UNGASS outcome: diplomacy or denialism? at idpc.net

Lib Dems make legal cannabis case

News

DDN

March 8, 2016

A report setting out what a regulated cannabis market in the UK could look like has been published by the Liberal Democrats. The document is the work of an expert panel commissioned by the party last year, and chaired by Transform’s Steve Rolles (DDN, November 2015, page 4).

The sale of cannabis should be allowed to people aged over 18 from ‘specialist, licensed’ stores, says A framework for a regulated market for cannabis in the UK. Modelled on pharmacies, these would be single-purpose premises with the drug sold over the counter by licensed, trained staff, and with ‘clear health and risk reduction information’ available. The cannabis would be sold in mandatory plain packaging, featuring non-branded designs similar to prescription drugs and with strict guidelines around price and potency.

The market would need to be overseen by a ‘cannabis regulatory agency’, the report states, ‘informed by evidence and best practice’ in tobacco and alcohol regulation. Home cultivation for personal use, as well as small-scale licensed cannabis social clubs, would also be permitted.

The criminalising of cannabis use is an ‘unjust and disproportionate sanction for a consenting adult behaviour’, says the report, as well as being expensive and an ineffective deterrent to use. Instead of ‘fuelling a vast and socially corrosive criminal market’, regulation would also help to manage and minimise the ‘well-documented’ health risks associated with heavy use of the drug, the document claims, and could raise up to £1bn per year in taxes.

‘The reality is that millions of people use cannabis in the UK and there is a pressing need for government to take control of the trade from gangsters and unregulated dealers,’ said panel chair Steve Rolles. ‘Legal regulation is now working well – despite the fear-mongering – in Colorado and Washington and will roll out across the US over the coming years. A regulatory framework is in place in Uruguay and the Canadian government will legally regulate cannabis soon. This is no longer a theoretical debate – and the emerging evidence is only pointing in one direction.’

Report at www.libdems.org.uk

Too much at stake

Uncategorized

DDN

March 8, 2016

We’re seeing the unwelcome return of the ‘postcode lottery’, says Dr Steve Brinksman

My practice has long had a reputation in Birmingham for working with people who use drugs and alcohol, and who are much more complex than those seen in most shared care practices. We were recently approached by the newly commissioned service to see if we would treat a man who – for a variety of reasons – wasn’t engaging with the main drug service. This has happened before and no doubt will again; as while a commissioned service is designed to deliver a good level of service to the majority of its clients, by virtue of commissioning arrangements it has to work within defined parameters.

So what happens when a client falls out with a service, or a service falls out with a client? It is a fact of life that we don’t see eye to eye with everyone and sometimes irreconcilable differences develop. In my experience, within drug and alcohol treatment this is frequently due to intransigence in both parties. However the service user can’t fall back on or blame ‘procedures’, ‘staff shortages’ or ‘we aren’t commissioned to do that’ statements.

Previously when drug and alcohol treatment was part of health services, a service user would usually be placed in an alternative treatment system, bearing in mind that access to NHS treatments should be fair, equitable and available to all. However since public health has moved into the realm of local government this seems to have changed.

All councils will commission drug and alcohol services but I suspect they are less willing to fund the ‘square pegs’ that may need to be sent to a different service. I have come across a number of clients now who simply fall through the cracks and, due to a breakdown in the relationship with the ‘only show in town’ are outside of treatment and, despite wanting help, they can no longer access it.

We are fortunate in Birmingham to have a number of highly skilled GP practices as well as the central service for drug and alcohol treatment, so it is usually possible to accommodate most clients who have a problem with one provider in an alternative service – albeit that a client may need to embrace change within themselves too, for the arrangement to work.

I worry about what may happen elsewhere in the country if this diversity isn’t available, how many people are excluded from their local treatment provider (for whatever reason) and are simply not able to find an alternative? And what should we do about it?

Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP, www.smmgp.org.uk. He is also the RCGP regional lead in substance misuse for the West Midlands.

Public health directors voice cuts concerns

News

DDN

March 7, 2016

More than 70 per cent of directors of public health say that drug and alcohol services in their area are likely to be reduced in the coming financial year, according to a survey by their membership body, the Association of Directors of Public Health (ADPH).

ADPH members were asked about the likely impact of the government’s £200m cut in its public health grants to local authorities (DDN, September 2015, page 4). Overall, 78 per cent of directors said that the reduced funding would ‘have a detrimental impact on health’ in their area, with all services likely to suffer reductions next year, although none of the respondents said they expected the cuts to mean drug or alcohol services being completely decommissioned. The reductions are a further blow in the context of ‘wider local authority cuts and NHS financial difficulties’, says ADPH, with 75 per cent of directors saying there would be an increase in health inequalities.

More than 90 per cent of the directors stated that they were ‘centrally involved’ in any decisions about cuts themselves, with the criteria a combination of ‘politics, statutory requirements, evidence, need and pragmatism’. Almost 60 per cent of respondents also said they expected to lose staff.

‘Devolving public health to local government was a positive step, and councils have embraced these new responsibilities,’ said the Local Government Association’s (LGA) community wellbeing spokesperson, Izzi Seccombe. ‘However, as ADPH’s analysis shows, the significant cuts to public health grants will have a major impact on the many prevention and early intervention services carried out by councils. These include combating the nation’s obesity problem, helping people to stop smoking and tackling alcohol and drug abuse.

‘Given that much of councils’ public health budget goes to pay for NHS services like sexual health, public health nursing, drug and alcohol treatment and health checks, these are cuts to the NHS in all but name. And it will put further pressure on other NHS services.’

‘Devolving public health to local government was a positive step… However… the significant cuts to public health grants will have a major impact on the many prevention and early intervention services carried out by councils.

Prison staff overwhelmed by NPS crisis

News

DDN

March 7, 2016

Health staff at a large Nottinghamshire prison risk being ‘overwhelmed’ by the demands of treating people seriously affected by use of new psychoactive substances (NPS), according to a report by HM Inspectorate of Prisons.

Based on inspections carried out in August and September last year, the report says that safety at the large category C HMP Ranby is a ‘major concern’, with existing problems exacerbated by a surge in the availability of NPS. ‘As we walked round the prison, we saw a number of prisoners who were clearly under the influence of NPS; some had been left with other prisoners to check they did not deteriorate, because there were no available health care services or other staff to do so,’ it states.

In addition to the health issues, the wide availability of NPS was leading to serious problems around drug debts and associated violence, says the report, with almost 60 per cent of prisoners telling the inspectors that drugs were ‘easy’ to get hold of in the prison.

Assaults on staff had increased significantly – including ‘very serious’ incidents – and on one occasion prisoners had forcibly entered an office to take back a package of drugs intercepted by staff after it was thrown over a wall. Self-harm levels were also higher than in similar prisons, with four self-inflicted deaths since April 2015, while another death earlier this year was being treated as murder. ‘NPS and the associated debt and bullying had been cited as a significant factor in some of these events,’ the document states.
Urgent action is needed to stabilise the prison and to make it safer, urges the report, including an effective, whole-prison strategy to reduce violence ‘and its contributory causes’, although it does acknowledge that the prison is ‘attempting to respond to these challenges’ and that there were signs of improvement in some areas.
NPS, particularly synthetic cannabinoids, are an area of increasing concern for prison authorities, with the recent HMP Inspectorate of Prisons Changing patterns of substance misuse in adult prisons report labelling them the ‘most serious’ threat to safety and security in British jails, and calling for a national committee to address the issue (DDN, February, page 4).
Meanwhile, new guidance on the prevention, diagnosis and treatment of hepatitis C in prisons has been issued by the Hepatitis C Trust. The document aims to provide commissioners and staff with advice on testing and treatment that can be used by ‘any prison that needs to develop, revise or update their services’.
‘The prevalence of hepatitis C amongst people in prison is so high that healthcare teams can’t address it alone – it needs to be everybody’s business,’ says hepatitis specialist nurse Jayne Dodd. ‘The governor, senior staff, prison officers, healthcare team and substance misuse staff all need to understand what hepatitis C is, the transmission risks and the fact that it is curable. Through training and education, we can end the stigma that too often puts people off getting tested or treated.’
Report on an announced inspection of HMP Ranby by HM chief inspector of prisons at www.justiceinspectorates.gov.uk
Guidance: hepatitis C prevention, diagnosis and treatment in prisons in England at www.hepctrust.org.uk

Meet Oscar, the DDN baby!

Features

DDN

March 7, 2016

Jason and Elizabeth met at a DDN conference and brought little Oscar to meet us at this year’s event

Four years ago I was at the DDN conference, at the NEC in Birmingham, Jason tells us. I had a stand to promote my community interest company, iSore Media, which does film production and media training. I was busy networking, when a lovely lady called Elizabeth Holding from the East Sussex Recovery Alliance walked past and caught my eye. At lunchtime we met again over a vegetable curry and cupid fired his arrow!

We kept in touch through text messages and eventually we got together and dated for a couple of years. We got married on 21 July 2014, which also happened to be my ‘clean time’ date – I’d been drug-free for six years. Elizabeth suggested it so that I’d never forget our anniversary, as it’s tattooed on my arm!

We got married in Solihull Register Office, with a reception at the Coach and Horses, attended by half of Birmingham’s recovery community.

We’ve been happily married for two years. We have our ups and downs like anyone else – more ups than downs – but the language of recovery is important to us, such as remembering to live with humility.

Thirteen months ago little Oscar Turner came into our lives and has made us so happy. He’s become quite a Facebook celebrity!

DDN magazine has been getting out information about addiction all over the country for years. Who would have thought that they would have made two recovering addicts very happy indeed.

iSore Media is at www.isoremedia.org

Are you involved?

Features

DDN

March 7, 2016

Asking delegates from all over the country for a picture of service user involvement brought forth some distressing stories of groups being dissolved, dysfunctional partnerships – and frustratingly, fear of talking about the situation against a backdrop of threatened redundancies. Here members of the Nottingham team tell us about a system they believe is working well. We’re relying on you to let us know what’s happening in your area.

Lee Collingham, service user activist and advocate:

Nottingham city has that rare commodity so often missing these days within local drug commissioning teams – a full-time user involvement worker. Over the last decade these roles have gradually disappeared around the country despite, as is shown by the Nottingham model, user involvement being integral to successful drug and alcohol treatment – be it with an individual’s care plan or the planning of what services need to provide, as well as assisting in delivering those specialist services.

Even companies like Tesco and Facebook talk and work with their customers, something that seems to have been lost in most areas within drug treatment in the light of funding cuts, localisation, and the demise of specialist commissioning teams and the NTA.

By working closely with service users, both providers and commissioners can better shape services to meet local needs and achieve successful outcomes.

Glen Jarvis, service user involvement officer, Nottingham City Council Crime and Drugs Partnership:

The Crime and Drugs Partnership (CDP) has a long-standing commitment to involvement and consultation going back more than ten years. At that time the partnership commissioned mostly treatment services, with NHS funding, so our involvement and consultation structures were built upon guidance and duties around health-related legislation and the NHS constitution.

Service user and carer involvement is embedded within treatment and support services. We expect that service users are listened to, involved and consulted on decisions about their treatment and support, and ensure that both they and carers are involved in the planning, development and delivery of services.

This commitment is to give opportunities for our service users and carers to be involved at all levels.

At an individual level, we want service users to be actively involved in their own treatment and support, specifically through their relationship with workers in devising care/support plans.

At a service level, they should be consulted and involved in the decisions about the running of those services. Meaningful involvement is a contractual obligation and services should be able to give evidence of measures they have used to obtain the views of the patients/clients about their treatment experience, the running of the service and any proposed changes to how that service is delivered.

At a strategic level, we are committed to involving people in the planning, evaluation and development of future provision. We run long-standing service user forums for those with issues around drug and alcohol use and mental health, which provides a continuous consultation function.

At a policy level, we work with Public Health England to promote good practice through regional forums for service users and carers. Some of our service users attend national conferences and events and get involved in national strategy and policy.

We also undertake consultation on specific themes and issues with these groups and do joined-up consultation activities with partners in the CCG, local authority and public health.

All of this is enshrined in the treatment system charter, and the commissioners, in partnership with previous and existing service users, providers and wider stakeholders, have established a set of locally agreed values, which underpin local drug and alcohol treatment.

We believe that involvement means better services, better commissioning and better outcomes for people seeking help. All of these people need to remember that involvement isn’t an optional extra or just a nice thing to do – it is a right.

Details, including the charter, are in the service user and carer involvement section of the CDP website, www.nottinghamcdp.com

Body and soul

Features

DDN

March 7, 2016

Therapists Lois Skilleter and colleague Sal Crosland gave free tasters of their energy-balancing treatments to delegates throughout the day. Lois explains some of the benefits

What an amazing day we had at the DDN conference! Sal and I did nine treatments each, and introduced several people to Indian head massage, hand massage/reflexology and reiki they were blown away. What a privilege to meet such lovely people and to share the love of therapies with them.

As the volunteer therapists, we offered 20-minute tasters of the treatments, all of which can be carried out with the client seated and fully clothed, and using the minimum of equipment – an important consideration when we’re coming by train from Yorkshire! A word of explanation: reflexology and reiki, and to an extent, Indian head massage, are energy-balancing therapies where the therapist facilitates the client doing their own healing – very empowering for them, and an example of what we can do for ourselves in the right circumstances.

Some of our clients had already experienced these therapies and were keen to have them again. We also had the privilege of introducing several people who had never had therapies before to their benefits, and of seeing them completely overwhelmed by the relaxation and rebalancing which took place. Everyone left the room feeling better, and they had done it for themselves with our help.

In the modern world with all its stresses, I believe that so called ‘alternative’ therapies although as an article I read the other day pointed out, they have been around for a lot longer than ‘conventional’ medicine – offer a real help to people who are open to their possibilities. They are ‘complementary’ to medical treatment and while they can’t always cure, they can help people to cope more effectively with symptoms and emotions. I have volunteered in a couple of hospices and although the patients knew our therapies wouldn’t cure them, they so appreciated the relaxation and peace that they brought.

Therapies have few or no side effects, they empower the client and they help us to reconnect with our inner self. I’ve seen so many of my students and clients gain in confidence and positivity when practising or receiving therapies, and although it can never be guaranteed, physical symptoms often improve too. Experiencing this easy and accessible relaxation in a non-judgemental situation lends itself perfectly to service users in treatment or rehab, and I would advise anyone to give it a try if the opportunity arises.

Lois is a holistic therapist and tutor and is always happy to discuss training or treatments. Contact her at www.eartherealofyorkshire.co.uk

Frugal feast

A cookery demonstration by Hope North East gave delegates the opportunity to learn about cooking on a budget

‘Our cooking on a budget demonstration went really well,’ Miranda Yare, recovery support worker at Hope North East, told DDN. ‘We spoke to a lot of people about our set menu, which showed how to cook a three-course meal for under £3 per head – winter veg soup, pasta carbonara and coconut rice pudding.

‘Hope North East runs cooking on a budget every Monday, and we teach clients about where to source cheap fresh produce and easy cooking methods. We are looking to further the initiative and roll it out into the communities around Middlesbrough.

‘We all loved the conference.We found it very useful and loved networking with other services around the country.’

Congratulations to Miranda, who was also the lucky winner in Ladbrook Insurance’s prize draw during the exhibition, winning a Kindle. Ladbrook are specialist insurance advisors for the third sector.

News in brief

News

DDN

March 7, 2016

POPPING OUT

The implementation of the Psychoactive Substances Act 2016, which was due to come into force last week, has been temporarily postponed by the government. Alkyl nitrites (‘poppers’) have also been exempted from the controversial legislation after the ACMD wrote to drugs minister Karen Bradley to say that, in its view, they did not fall within the scope of the act’s current definition of ‘psychoactive substances’. A proposed amendment to exempt poppers from the legislation was defeated earlier this year (DDN, February, page 4).

CHANGING TIMES

CRI has changed its name to change, grow, live, the organisation has announced. ‘Our priority is to work with service users, who are some of the most vulnerable people in society, and help them to make the changes they need to make to live independent and purposeful lives,’ said chief executive David Biddle. ‘We believe that everyone is capable of positive and lasting change and we wanted to have a charity name that more closely reflects this vision.’

TAKE IT TO THE LIMIT

Nine per cent of drinkers in the UK had drunk more than the new recommended weekly limit in a single day, according to the latest alcohol figures from ONS. While the proportion of 16-24 year olds who had drunk in the previous week had fallen from 60 per cent in 2005 to less than half, those young people who did drink were the most likely to have consumed their weekly recommended limit in one day, and almost three in five adults reported drinking some alcohol in a typical week. ‘It’s clear from these figures that although there are now more people, especially younger ones, who don’t drink alcohol at all, there is still a significant group of other people who are drinking well in excess of the latest health advice,’ said ONS statistician Jamie Jenkins.

Figures at www.ons.gov.uk

BUDGET BLUES

The chancellor’s decision to freeze duty rates on beer, cider and spirits as part of his controversial budget last month has been criticised by alcohol health bodies. The budget did ‘nothing to protect young people from the devastating harms of the cheapest, strongest alcohol’ said campaign group Balance North East.

TAX TALK

The Local Government Association (LGA) is calling on the government to extend tax breaks on beer to lower-strength ciders, wines and spirits. This would encourage the industry to widen the availability of low-strength drinks and help combat the annual £3.5bn cost of dealing with alcohol-related ill health, it says. ‘The drinks industry and several retailers have gone some way to make and sell lower strength drinks but we want them to go much further,’ said LGA spokesperson Tony Page.

SPENDING POWER

HIV-related deaths and new HIV infections among people who use drugs could be almost entirely eliminated by 2030 with ‘just a tiny shift in global drug control spending’, according to a report from Harm Reduction International. Redirecting 7.5 per cent of the US $100bn spent on drug enforcement and control to harm reduction measures would cut deaths by 93 per cent, says The case for a harm reduction decade: progress, potential and paradigm shifts. Document at www.ihra.net

LOW-PRICED LIMITS

The revised weekly limit of alcohol units can be bought for as little as £2, according to a report from Alcohol Concern Cymru. A ‘snapshot’ survey of supermarkets and off-licences in six towns and cities across Wales found alcohol on sale for as little as 15.5p per unit. ‘Typically, it’s heavy drinkers who favour low-price alcohol, meaning that it is the cheapest alcohol on the market that is bought and consumed in the greatest quantities and which causes the greatest harm,’ said spokesperson Mark Leyshon.

www.alcoholconcern.org.uk

WELSH ON THE DEAL

A proposed ban on the use of e-cigarettes in public places in Wales (DDN, May 2014, page 4) has been defeated by a single vote. Although Plaid Cymru had originally planned to allow its assembly members a free vote on the public health bill of which the proposals were part, it ultimately voted against, meaning the bill failed to pass.

COLLECTIVE ACTION

Collective Voice has become an associate of the Making Every Adult Matter (MEAM) coalition, which works to improve policy and services for people with multiple needs. ‘The majority of individuals using substance misuse services have a wide range of other needs,’ said Collective Voice chair Karen Biggs. ‘To support them we need to influence policy and services across different sectors, and MEAM will provide excellent links across criminal justice, homelessness and mental health.’

ONE YOU

A new national campaign to help address preventable illnesses caused by lifestyle factors such as drinking or smoking has been launched by PHE. One You aims to encourage adults to ‘take control’ of their health to avoid problems in later life.

BUSINESS WINS

Non-expert in-house legal advice and fear of expensive appeals mean many local authorities are failing to use licensing ‘to its full potential’, according to a report from the Institute of Alcohol Studies. The 2003 Licensing Act is ‘commonly interpreted to the advantage of the licensed trade’, says The Licensing Act (2003): its uses and abuses 10 years on, with any health concerns addressed likely to be those related to street drinking or domestic violence. ‘Local councils could help themselves more by paying closer attention to the act and case law in order use licensing more assertively, but there is also a need for the government to better support councils against challenges from the licensed trade,’ said lead author Jon Foster.

Report at www.ias.org.uk

Get the Picture

Features

DDN

March 7, 2016

State of the Nation: One of the day’s lunchtime sessions heard delegates debate the current state of English drug policy

‘The subtitle of this session is “have we lost our duty of care”, and that’s something that really worries me,’ Chris Ford told delegates. Many services now had a ‘one size fits all’ agenda, or ‘to be more accurate, one size fits nobody,’ she said. ‘They’re concerned about their PbRs or whatever. As the Archbishop of Canterbury said, the way a society is measured is by how we care for our most vulnerable’.

The ‘deafening silence’ around the fact that drug-related deaths had risen by more than 60 per cent in two years was a ‘real indictment’, agreed Alex Boyt. ‘Imagine if that was in any other part of society. I’m not anti-recovery, but I am worried that it pulls some people forward but leaves others behind. Service users in Camden, where I work, create newsletters that have now become just pages and pages of obituaries.’
Wales and Northern Ireland had actually seen death rates fall in the last two years, he pointed out, while Scotland had experienced an increase and in England it varied according to region. ‘Naloxone by itself is not going to reverse the trend.’ When people arrived at services now they were ‘shattered, tired, broken’, he said. ‘They need to be held by services, but increasingly they’re subject to recovery-based criteria. One service manager said to me recently that, “These days we have to get them in and out before we even get to know them”.’
Recovery also now meant so many different things to so many different people that ‘it seems to me that when we use it we’re not communicating properly’, he argued. ‘I think it’s important that when you celebrate recovery you’re aware that what works for you may not work for other people.’
Indicative of the overall problem was that one current target was for hepatitis C testing, he said. ‘So you can say you’ve offered testing to 99 per cent of your clients, but only 1 per cent are treated, which is obscene.’
‘Thirty years ago I started going to a drug service in Paddington, and my main feeling was fear,’ Beryl Poole told the session. ‘Now those elements of fear are creeping in again, and I never thought they would. You have drug workers talking to you about recovery with these fixed, rictus smiles. We used to diss the NTA but now that we don’t have them we miss them. Who’s going to advocate on our behalf now?’
‘A lot’s been said about service user involvement having a voice, but it’s lost its way,’ said Steve Freer. ‘In the days of the NTA it was statutory, but service users are feeling totally disillusioned now, and they’re being crushed underfoot.
On the key question of how to create a meaningful voice for service users it was vital that ‘we should all be on the same side’, said Ford, but one delegate argued that ‘we have lost our voice. It’s all being muddied by money, and we’re losing our passion.’
Organisations had a vested interest in not promoting service user involvement, argued another. ‘It’s a bit of a monster once it’s let out of the cage – they don’t want service users to have that power. I’m a service user representative but I’m not listened to, not really. Once you let that monster out of the cage how do you control it, what do you do next?’
What it amounted to was a ‘divide and conquer’ process, said another delegate. ‘What we have to do is be fighting this top-down inequality. There’s too much arguing about the minutiae.’ Poverty was by far the biggest driver of drug-related deaths, said Ford. ‘In the 1980s, the most deaths were in the North East and the North West. It’s poverty.’
While there was undoubtedly a need for a social movement, it shouldn’t be based around drugs, argued Alistair Sinclair. ‘We need to be talking to people in mental health, in homelessness.’
‘When the service user voice has really been heard, it works well,’ stated Ford. ‘It’s a win-win situation. I think this the beginning of a rallying call. We have to get together – united we stand, divided we fall.’

Throughout the conference, Philippe Bonnet gave practical training sessions on administering naloxone. Distributing kits made an important difference, he told DDN

Another year, another DDN SU conference in sunny Birmingham. This year, however, I was allowed to not only train people but give them take-home naloxone kits too!

The legislative changes made in October 2015 have made a real difference in kit distribution – to some parts of the country at least. Although I trained around 45 individuals last year, I could not provide them with kits there and then. This year everyone left with a kit.

This year was also a reminder of how blessed we are in Birmingham. To date, we have issued around 3,000 kits and we witness successful reversals on a monthly basis. My organisation’s national naloxone strategy, launched last year the day after the DDN conference, has had a tremendous impact. Naloxone sure saves lives.

Phillippe Bonnet is an outreach worker and activist

Big Business

Features

DDN

March 7, 2016

‘Don’t let anyone tell you that you don’t have valuable skills,’ Big Issue founder John Bird told delegates in the day’s powerful final session

‘Get money. It doesn’t matter how you get it, or where you get it from,’ Bird urged delegates in the day’s rousing final presentation. ‘Tell people whatever they want to hear. Get money – then bring about social change,’

‘I saw [the Body Shop Foundation’s] Gordon Roddick on TV, saying how it was important not just to have a business but to put something back into the community, so I rang him up. He said, “Are you one of those people who crawl out of the woodwork when someone’s made a shedload of money?” I said, “Yes”.’

The two became friends, and one day in 1990 Roddick was walking down the street in New York when he was approached by a ‘huge bloke who said, “would you like to buy a copy of my street paper?” He explained how it worked – “I’m making money so I don’t have to go and steal.” Gordon thought this was brilliant.’

Roddick returned to the UK with the idea of launching a similar product in London, where at the time there were ‘about 10,000 people sleeping rough,’ said Bird. Many had become homeless through drink and drugs, or developed drink and drug problems while homeless.

The Body Shop Foundation decided to conduct a feasibility study, which involved getting in touch with the UK’s homeless organisations, of which there were ‘501 in London at that time,’ he said.

‘There is no one in the world who can be divided between the deserving poor and the undeserving poor,’ Bird told delegates. ‘But these homeless organisations were doing that. They all said, “Why would you give homeless people the means of making their own money?” So the Body Shop went on to do something else.’

At the time Bird was running a print business, which was struggling financially, he told the conference. ‘So Gordon said to me, “Why don’t you do this street paper? You don’t cry over the poor.” If you’re going to get real about poverty, then get real and get it in your nostrils.’

Bird’s idea of a feasibility study was different to Roddick’s, he explained. ‘I went out and just talked to the police and people on the street. Most of them just told me to piss off, but some of them said, “Anything’s better than begging, stealing, breaking into cars or selling my arse”. And the police got behind me 100 per cent, because I would get to the people who were feeding their habits by coming into the West End and committing crime.’

The magazine launched in 1991, but immediately ran into a ‘huge problem’, he told delegates. ‘When we said to homeless people that they’d have to buy the paper to sell it they went nuts. They said, “But we’re homeless, we’ve always been given stuff for nothing”. I said, “That’s why you’re still homeless. It’s a way of walling you off, keeping you helpless, keeping you a child.”’

He then decided to approach some of the biggest and most intimidating rough sleepers and ‘buy them off’, he explained. ‘So they became our police force, and it really took off. Everyone got involved – it was an absolute change. A hand up, not a hand out – not a moralistic telling off of people.’

And that ethos extended to those who got into real trouble, he said. One of the magazine’s best vendors relapsed and robbed the safe from a Big Issue office to buy drugs, but was given his job back after leaving prison. ‘What someone needs when they fall down is help.’

Bird was to make his maiden speech in the House of Lords the following day, he told the conference. ‘I’m there to do our work, about how do we keep communities together, help people when they fall down, and turn social security into social opportunity, which is what it was intended for in the first place. It was about giving people succour and help, but all that changed under Thatcher.

‘The house I came from was hard working people who fell into poverty,’ he continued, adding that he’d once told a service user meeting, ‘I’m always meeting people who define themselves by the failures of others – every last one of us has to stop and put effort into our own lives.’ The way he’d survived homelessness and prison himself – ‘and being beaten shitless by the police and my father’ – had been to constantly pick himself up and have self-esteem, he stated.

He’d learned to read in a young offenders’ institute, he said. ‘I was educated by the prison system, doing a “short, sharp shock” at Oxford Detention Centre. Now young people go in bad and come out worse. I’m very, very hard on poverty – I hate to see poor people treated almost as if they’re another species. And the way the government, the media, the public, even some charities, talk about the poor is as if they are another species.’

There were also too many impediments to getting people out of poverty, he warned. ‘We need to give users, ex-users and others the chance to develop themselves as individuals. We have to have an intellectual revolution.’

Around ten years ago he’d had the idea to start a finance business, he said. It began as Social Brokers before becoming Big Issue Invest, and had so far invested money from high net worth individuals into 320 social enterprises. ‘I call it “preventing the next generation of Big Issue sellers”,’ he explained.

Existing alongside this was his concept of PECC, which stood for Prevention, Emergency, Coping and Cure, he told the conference. ‘Ninety per cent of all social money invested in the world goes in when the shit has already hit the fan and you need to stabilise the situation – not into prevention, or cure.’

‘I’m not an idealist,’ he stated. ‘I’m sure I’m going to be thrown out of the House of Lords. What we really need to do is understand people, give them help and encouragement and create social justice for those who fall on hard times and there’s no one there for them.

‘There are transferable skills you learn as a homeless person – use them. We are all full of talent and skill. The skills you use to score and beg – use them. You learn skills and abilities – don’t kid yourself that you haven’t picked up enormous skills when you’ve been down that you can use on the way up. All you need is a hand up, not a hand out.’

Giving Voice

Features

DDN

March 7, 2016

The morning’s second session, chaired by Peter Hunter, allowed audience members to put their concerns to some of the sector’s key players

The new drug strategy is one of my key priorities,’ minister for preventing abuse, exploitation and crime, Karen Bradley, told delegates via video, and the government was looking for meaningful input to make sure it was implemented effectively.

‘The government recognises that drug use is a complex, evolving issue,’ she said. While it was ‘dedicated to ensuring that fewer people use drugs in the first place,’ the support was also in place for those who did, she said, with action needed at local, international and individual level. ‘We need more targeted action for the most vulnerable’, as there were strong links between substance misuse and other vulnerabilities.

This meant that effective partnership working was essential, and recovery-orientated systems of care needed to be far broader than ‘just treatment’ alone. ‘I do not underestimate your vital role in peer support and motivating others in their recovery,’ she told the audience.

Delegates then heard from Karen Biggs, chair of the Collective Voice umbrella group of some of the sector’s largest providers. Its aim was to ensure that the sector had a voice, she said, with the group already having input into Professor Dame Carol Black’s benefits review and the new drug strategy.

The sector as a whole had made very good progress in understanding how the service user voice could have an impact, she stated. ‘How do we develop a service user voice that can impact national decision-making? We want to create a model that gives the service user voice an input into policy influencing what goes into the drug strategy, not just how it’s implemented in local services.’

However, there were no illusions about the current situation, she stated. There had been significant funding cuts across the country, and there would be more, ‘And we aren’t naïve enough to think that cuts in the general public sector aren’t going to affect drug services – of course they are. But we’re keen to see that they’re proportionate, and that the harms are minimised and contained.’

It was also essential to make sure that services were responsive, she said, with evidence-based commissioning and delivery to address evolving challenges such as new psychoactive substances. ‘And as the pressure on other services hits, we’re going to see much higher presentation rates of people with complex needs. It’s not hard to see that the risk of stigma will increase as local authorities have to make tough decisions about the services they fund.’

The money for drug services was now the responsibility of local authorities, Rosanna O’Connor of Public Health England (PHE) reminded delegates. ‘They’re responsible for what happens in their own patch. The money transferred to them was a huge pot, but there are also huge pressures on local authorities, so it’s not surprising if that funding begins to shrink. That’s why making your voice heard is vital.’

The recent increase in drug-related deaths was also a ‘massive concern’, she said, and a major PHE work stream had been implemented around it. ‘There’s been something like a 64 per cent increase in heroin-related deaths over the last couple of years, but most of those people had not been in treatment for four or five years. I know some people think that people are being pushed out of treatment to meet recovery targets, but if you look at the figures the increases in deaths aren’t among the people in services – the people who have that safety net.’

One real concern was cuts to other associated services, however, such as wider social support. ‘As that network that’s wider than services themselves begins to fall away – and these are often services that are easy to cut – it’s possible that that is having an impact.’

FDAP chief executive Carole Sharma then explained how her organisation – the professional body for the paid and unpaid drug sector workforce – was trying to improve quality and make sure everyone was working to an ethical framework and code of conduct. ‘As service users, your voice is essential to that,’ she said.

Many delegates expressed concern about custody of children and other parental issues, and O’Connor reassured them that there was an increased focus on substance-using parents across government departments. ‘What this government is particularly interested in is improving the life chances of drug-using parents. I recognise that there is a huge amount of extra pressure on service users who have parental responsibility, and I think the way local services link with safeguarding and children’s services is hugely important. When it comes to that, the voice of service users is much more important than mine.’

There was, however, a difference between being listened to and being heard, some delegates argued. ‘It’s about how meaningful it is,’ said one, while another stated that ‘it’s all about recovery now – if you’re not jumping through those hoops then you’re really in trouble’.

‘In the South West we’ve not had any consultation about cuts or the impact of cuts,’ said a representative from Badsuf (Bournemouth Alcohol and Drug Service User Forum). ‘If ever there was a time for service user consultation, it’s now. Consultation and representation is meaningful only if it’s genuinely listened to and acted upon.’

‘That it’s getting harder to have meaningful consultation and input because of the cuts is absolutely right,’ agreed Karen Biggs. However, Chris Ford argued that the ‘main concern’ of Collective Voice – as a ‘collection of eight of the biggest providers’ – was ‘keeping hold of the part of the sector they’ve got, because the NHS has been pushed out’.

‘I think we collectively have to work at making sure that service users have a voice,’ stressed O’Connor. ‘It isn’t Karen and her colleagues that have pushed the NHS out – that has been a decision of commissioners and policy makers, and it’s at local level that service users need to have a voice. It’s absolutely vital.’

One Coventry-based delegate stated that his organisation had ‘moved past service user involvement now – we’re about recovery visibility. We’re part of the community, and we sit down with commissioners to shape services. The point is that we don’t need anyone’s permission. We just get up and make it happen.’

Just a ‘tiny amount of the money that’s being wasted on everything else’ could have a huge impact if it ‘went to the right place’, he told the panel. ‘It would change all your statistics.’

On the question of the growing problem of gambling addiction, O’Connor told the conference that it was ‘absolutely shocking how it’s mushroomed in front of us, with advertising on every TV and billboard. But although it’s a massive problem, the last thing we want to do at the moment is take any more money out of drug and alcohol treatment. So it’s been pushed back to the industry to fund that treatment.’

‘I came to a DDN conference and thought, “I could do that”,’ Red Rose Recovery CEO Peter Yarwood told the conference’s closing session. ‘So I took that inspiration back to Lancashire and found people who believed in me.’

Trying to get his life back together after 20 years dominated by drugs and prison, he became ‘massively demotivated’ after attempts to find work were thwarted by his criminal record. ‘Society will stigmatise you, but I took that stumbling block and made it into a building block,’ he told delegates.

Lancashire User Forum was now a limited company, he said, and in the last year alone its volunteers had contributed more than 15,000 hours of valuable work in the county. ‘That’s social, economic value that we’re returning to the community. We focus our energies on what’s positive, not what’s wrong – I’m bigger than my treatment.’ The organisation now had almost 30 employees, he said, ‘and we’ve got a philanthropist who’s investing not just money but providing technology as well.’

‘You’re more than people tell you,’ said his colleague Steve Watson. ‘It’s about hope, not thinking, “I can’t do it”.’

‘Red Rose Recovery saw something in me,’ added another colleague, Mark. ‘I was fresh out of treatment but they but they believed in me. If I’d stayed in the box I was told I had to, I would have gone crazy. Treatment is essential, but it won’t keep you clean. It’s about purpose, worth, belonging. Believe in each other.’

Picture This

Features

DDN

March 7, 2016

The day’s opening session heard a range of passionate presentations on the theme of getting your message across

‘I didn’t know how long I’d had hep C. I could have contracted it at any time in 30 years of active drug use,’ Phil Spalding of the Hep C Positive support group told delegates at Get The Picture’s opening session. ‘But the one thing that struck me when I first came out of rehab was that no one I came across professionally knew anything about it.’

This was ‘no fault of theirs’, he said, adding that there was also a great deal of fear around the subject. ‘I thought, “Why is no one talking about this?”’ He began doing voluntary work and attending 12-step groups but was keen to find out what he could do about his condition. ‘I had it about as bad as you can have it, with a very high viral load. I was pretty much ill all the time, and I didn’t want to die from something I could do something about.’

He got in touch with the Hepatitis C Trust – ‘who were great’ – and they helped point him towards a treatment pathway. Once on this, he and a friend from rehab began offering each other mutual support, out of which grew a very small support network based in his home town.

However he still wanted to know ‘what the big issue with talking about hep C was’, he said. ‘And we still have this issue where, if you have hep C, people will say, “Are you a drug addict?” Is that helpful? No, it’s bollocks. If someone has hep C we call them a patient, not a service user or a drug addict. We’re all patients, we all go to the doctor. As soon as I started to see myself as a patient then I started to feel more like part of the community.’

When he set up the support group one major issue he found he had to address was how to ‘get people to perceive it as a group where you could come safely, and not get your purse nicked’ he said. ‘It was a real opportunity to educate people.’ The group also provided a vital chance to have informed discussions about treatment and therapy options, he stressed. ‘People would say, “The treatment’s terrible – my mate told me”. I’d say, “When did your mate qualify as a doctor?” People didn’t even know the difference between screening and testing.’

The first thing the group did was to make sure that it was inclusive, he told the conference, open to patients, professionals, family members, carers and friends – ‘because our belief is that these issues affect us all’ – and with no barriers based on where people lived.

The group was now also working closely with a partner organisation in France, he said. ‘They have a shop in Strasbourg, right in the centre – no one has to creep around – and we’ve got plans to do something similar here. Why should this thing be a secret?’

He’d been determined to hold on to his voluntary principles and ‘stay independent for a purpose’, he said, but the value of the organisation’s work had led to it being commissioned. ‘We’ll come to your region,’ he told delegates. ‘We’ll support, educate, use the local media and television. The best thing we’ve found you can do is to talk about it.’

Next up were two more support group representatives, Lanre Babalola and Lindsay Oliver of Bubic (Bringing Unity Back Into The Community). Based in north London, the group was mainly aimed at ex-crack users, explained Babalola, and provided peer support, group sessions, family and friends workshops, volunteering, outreach and more.

It used a wide range of techniques including drama and role-play, he said, as well as a variety of different therapy disciplines, taking aspects of each and tailoring them to the group’s needs. Group and individual advice sessions included issues like relationships and co-dependency, families, boundaries and self-awareness, with all new members invited to attend group sessions aimed at challenging unhelpful ways of thinking. ‘Even if people don’t particularly care about the harm they’re doing to themselves, you can get them to look at the harm they’re doing to their community and their family,’ he said.

This was followed by a second phase of support that shifted the emphasis from drugs to improving self-awareness and self-esteem and developing emotional intelligence. ‘As an ex-crack and heroin user, I know from personal experience that the most important step in life is the one you take when you start to give back,’ he said, with the third phase designed to give service users the skills they needed to do that. This included opportunities for volunteering and working alongside members of the community, with Bubic gaining awarding centre status from Gateway Qualifications in late 2014.

‘We like to make sure all our clients feel included,’ said Oliver. ‘Everything’s accessible, even for people who’ve been disengaged from education for a long time. It helps people to maintain their motivation and their self-esteem.’

The organisation’s assertive outreach work also enabled it to access any part of the community, said Babalola, providing information, guidance, support and signposting to relevant services. ‘We walk on the street, we go and meet people – our own personal experiences have allowed us to recognise the importance of late-night outreach.’

Bubic also carried out inreach work in prisons, he said, with a particular focus on trying to ‘encourage emotional intelligence and self-awareness’ prior to release. ‘People get “gate happy” and the risk is they’ll go and use,’ he said. ‘But it doesn’t have to be that way.’

The next presentation was from Nigel Brunsdon of Injecting Advice, on the importance of photography in helping to get a message across. ‘We’ve got people who’ve died,’ he said. ‘We’ve also got our own heroes, people who are doing great things. We can use photography to highlight our achievements, celebrate the big personalities in our community, raise awareness of events and important issues – like the availability of naloxone – and promote change.

‘But it has to be us doing it,’ he stressed. ‘No one is knocking down our door wanting to take pictures of harm reduction, recovery, anything. We have to do it ourselves.’

The media, when it did use photographs, wanted images of people ‘overdosing in doorways’, he said. ‘We need to capture the narrative, and not allow the media to dictate it. You don’t need expensive equipment – everyone’s got a mobile phone, so you’ve got a camera on you all the time.’

Henri Cartier-Bresson had once said that ‘your first 10,000 photographs are your worst,’ he pointed out. ‘So keep taking photographs, and share them. Let’s make sure we’ve got a history for the next generation that’s coming along.’

The session’s final presentation was from three representatives of the Anyone’s Child and Recovering Justice campaigns, Jane Slater, Fiona Gilbertson and Suzanne Sharkey. The latter campaign aimed to create a voice for policy change, Gilbertson told the conference. ‘The war on drugs was never a war on drugs. It was a war on people.’

When she had been a 16-year-old heroin user in Edinburgh, the police attitude had been to ‘criminalise us’ while the media attitude ‘was that we should be left to die, or be put on islands’, she said. There had been no needle exchange facilities, and the three pharmacists in the city that had provided needles eventually stopped as a result of police pressure.

Edinburgh’s reputation as an Aids capital in the 1980s came about as a ‘direct result of bad policy’, she stated. ‘My partner died of Aids. I said to him, “you don’t deserve this”. He said, “I’m a junkie. I deserve everything I get.” That’s what happens when you treat people this way.

‘Our stories have power, and they’re not often heard,’ she continued. ‘Never underestimate the power of people to change policy.’ Current policies were inadequate and were killing people, she said, and her organisation had been working closely with Transform to show the harms the war on drugs was causing ‘to people like us and our families’. The war on drugs was not a ‘fair fight’ and never had been, she said. ‘People like us all over the world are caught up in this.’

‘I’m actually an ex-police officer,’ Suzanne Sharkey told the session. ‘I joined the police in Newcastle and was doing my bit, or so I thought – getting drug users and dealers off the streets. I thought that if we got you all off the streets there’d be less drugs, less crime. But I was naïve. I wasn’t helping the community, I was harming it.’

Her own drug use eventually led to her being arrested, she told delegates. ‘But it wasn’t the arrest that helped me, it was the people I met in recovery. We need to change policy, and we need your experiences, your voice. Because without reform people are going to continue to be stigmatised and marginalised.’

‘We’re wasting a hell of a lot of money on a counter-productive and futile policy,’ agreed Jane Slater of the Anyone’s Child campaign. ‘I work for Transform and we tend to produce a lot of heavy, evidence-based texts. But what we need to do is tell the human stories.’

The campaign had been mounting events and trying to get media attention and engage with politicians, she said. ‘We’re also going international, because this is a global issue. Prohibition is not the solution. We urgently need a new approach.’

March DDN 2016

DDN

March 3, 2016

Our speakers at Get the Picture, our ninth service user involvement conference, underlined how engagement was everything. You can read all about the event – and get the picture! – in this issue of the magazine. We had John Bird from the Big Issue using his tough life lessons to offer a ‘hand up not a handout’; Phil Spalding of Hep C Positive countering fear and isolation; Bubic giving their story of outreach alongside peer support; Recovering Justice and the Anyone’s Child campaigns reaching out to families; and Red Rose Recovery showing the power of mutual support.

There was so much about the day that was galvanising – yet we are under no illusions that all in the garden is rosy. In an interactive session our speakers representing policy, treatment, and the profession, acknowledged a squeezed and struggling sector, with more pain to come.

So it’s over to you now to give us the true picture – we want to make sure the service user voice is heard and we’ll communicate with every group and strategy that needs to hear it. An active group began to form at the conference, with the will and the momentum to campaign and carry things forward. Get involved now – you can tweet us and like our Facebook page. We want to hear from you!

PDF Version

Promotional feature : An honest relationship

Features

DDN

February 10, 2016

It’s time to stop relying on outdated treatment models and offer clients an approach they can relate to, says Kenneth Robinson

One of the most challenging things an individual, group, or organisation can do is to look at itself and how it operates. For the substance use field, this means asking: how do you engage and work with this client group?

The overarching response to substance use has always been to use labels – addiction, dependent, sick, ill or diseased – that appear to be supported by strong scientific research. But have we stopped to think what messages these labels are sending to the service user? Do they offer a get-out clause, or a justification for them to continue their relationship with a substance with total impunity?

As professionals we may not agree with the idea that the client is sick, or that he or she is dependent on their substance – or that they are unable to regulate their behaviour and actions because they have no control.

Services may have inherited a way of working, validated by many in the scientific community, that the substance user is in some shape or form sick. We have also created an even broader context called the bio, psycho, social model, affirmingthat the client is affected by their substance use at a biological, psychological and social level. But could we be missing out the fundamental issue of why they came to the service?

What if the service user is not sick, diseased, or addicted; could this pave the way to look at their behaviour from a different angle? An example, backed up by pharmacology, would be that drug use is very pleasurable and that is why they keep returning. While being fed messages – that they are dependent, have no control over what they do, have a sickness, and are simply a product of their addiction – the client may always be able to justify carrying on using.

The Resonance Factor, the approach used by Janus Solutions – which we will investigate further in two more articles in DDN – offers a counterpoint to the established treatment approach in that it allows the client to own their love of substance use. They explore their relationship with their substance and the behaviours that they act out to maintain this relationship.

This process is then underpinned by deconstructing justifications for continuing their use, taking them to a place of ownership and choice. Of course this is a challenging process for the service user and, as with most forms of transformation, requires the individual to go through a level of discomfort. But when our labels provide them with appropriate justifications for their past and future actions, we have to ask ourselves – is this supporting the client, or are we becoming a part of their collusion?

www.janussolutions.co.uk

Take-home naloxone in prisons

Features

DDN

February 9, 2016

Research consultant, Arun Sondhi, from the Centre for Public Innovation (CPI), talks to DDN about the findings of his latest research into take-home naloxone in prisons.

‘Through-the-Gate’forms a key part of the government’s Transforming Rehabilitation strategy aimed at supporting a prisoner’s recovery from drugs and/or alcohol once released back in the community. The provision of take-home naloxone (THN) forms a vital component for this policy with one English region acting as a pilot for the initiative. THN is an opioid antagonist to prevent an opiate-related overdose with the aim of reducing the risk of drug-related death for individuals recently released from prison.

A series of qualitative studies, including a bespoke prisoner survey, were undertaken to look at the distribution of naloxone within prisons. The findings, due to be published in two academic journals, highlight the complexities and nuances associated with the distribution of THN. Prisoners were shown to be a target group that would benefit from access to this intervention, with high levels of reported overdoses (self or witnessed). Yet for both staff and prisoners, there were varied perceptions including a number of confused perspectives and ‘urban myths’attached to naloxone and for some the harm reduction message did not exist well within an abstinence-based service framework. For prisoners, the perceptions of using (and carrying the kits on their person) were influenced by a variety of subtle factors, including the possibility of further criminal justice sanctions if THN was found on their person once released.

Process issues also affected the distribution mechanisms within prisons, including the acceptance (which has recently changed) that only clinical staff can be the vehicles for the provision of THN kits. A number of system-wide challenges were identified in the paper including the need to ensure all prison staff, from the governor onwards, were involved in the distribution of Naloxone. The difficulties of tracking and managing prisoners potentially eligible for training were also noted.

WHAT CAN BE DONE?

The papers advocate a system-wide approach to the delivery of both training and provision of THN kits at the point of release. Enhanced support could consider widening the coverage of THN training. In addition, the studies offer a range of possible next steps:

• Addressing perceptions and ‘myths’ regarding the use of naloxone among prisoners and staff

• Enhancing the identification and engagement of prisoners throughout their journey in the prison system

• Improving prison processes for the distribution of THN kits prior to release

• Ensuring the involvemt and support of all senior prison staff

• Considering linkages with community services including community rehabilitation companies to reinforce key messages.

For more information about how CPI’s expert consultants can bring their knowledge and experience in the drug sector to help your organisation tackle substance misuse issues both in the community or in prison, contact them today.

Exhibitor Info DDN Conference 2019

DDN

February 8, 2016

Dear colleague,

Thank you for supporting the DDN service user involvement conference. Please find information for your stand and the delegate bag inserts.

The DDN Conference – Keep on Moving. Thursday 21 February.

Exhibitors from 8.30am

Delegate Registration opens at 9am

Programme 10am – 4pm

Conference Closes at 4pm

More details at full programme here:

https://www.drinkanddrugsnews.com/ddn-conference-2019/

The venue is: The National Conference Centre, The National Motorcycle Museum, Coventry Road, Bickenhill, Solihull West Midlands B92 0EJ.

The venue has ample free parking and is around 10 minutes in a cab from Birmingham International Station.

If you are looking for overnight accommodation before the event, the DDN team are staying at the Hilton Garden Inn, Birmingham Airport.

Exhibition set up: Exhibitors will have access from 8.30am the morning of the event. All exhibitors will be on the ground floor main suite of the venue and you will be allocated your space on arrival. There is no access to set up the day before, but you are able to drop stands and materials off. If you are wanting to courier stands and materials to the venue, please click here for their delivery instructions.

All stands are 6×3 clothed tables and two chairs. If you have any special requirements eg power, or extra width to accommodate pop-out stands, please let me know in advance and I will make sure you are in a suitable position. The venue has free wifi and the login will be available on the day.

Delegate registration is from 9am and the event starts at 10am prompt on the conference stage. You can find more information on the programme and the day itself here: https://www.drinkanddrugsnews.com/ddn-conference-2019/

As part of your package you are welcome to place inserts in the delegate bags. If you would like to take this up please email me and let me know, and please post 500 copies to:

DDN Conference

C/o Karen Brown

Changes UK

Recovery Central

9 Allcock Street

Digbeth

B9 4DY

Please give couriers 0121 796 -1000 as a contact number.

Please be sure to mark boxes ‘DDN conference’ and the name of your organisation. Deliveries must arrive no later than 4pm Thursday 14 February. Please email me if you are sending inserts to ensure we have everything.

We are collating exhibitor name badges so please use this form to submit the names of the people attending from your organisation by Thursday 14 February. I have also copied our accounts person, if you have any query regarding invoicing. Please ignore this if you have already emailed your names.

If there is anything else you need to know, or if you would like to discuss anything regarding the conference or DDN magazine, please don’t hesitate to contact me.

We look forward very much to seeing you!

Many thanks,

Ian

—

ian@cjwellings.com

Mob: 07711 950 300

Tel: 0845 299 3429

www.cjwellings.com

Public health directors voice cuts concerns

News

DDN

February 5, 2016

More than 70 per cent of directors of public health say that drug and alcohol services in their area are likely to be reduced in 2016-17, according to a survey by their membership body, the Association of Directors of Public Health (ADPH).

ADPH members were asked about the likely impact of the government’s £200m cut in its public health grants to local authorities (DDN, September 2015, page 4). None of the respondents, however, said they expected that the cuts would mean drug or alcohol services being completely decommissioned.

Overall, 78 per cent of directors of public health said that the reduced funding would ‘have a detrimental impact on health’ in their area, with all services likely to suffer reductions next year. The cuts are a further blow in the context of ‘wider local authority cuts and NHS financial difficulties’, says ADPH, with 75 per cent of directors saying there would be an increase in health inequalities.

‘Devolving public health to local government was a positive step, and councils have embraced these new responsibilities,’ said the Local Government Association’s (LGA) community wellbeing spokesperson, Cllr Izzi Seccombe. ‘However, as ADPH’s analysis shows, the significant cuts to public health grants will have a major impact on the many prevention and early intervention services carried out by councils. These include combating the nation’s obesity problem, helping people to stop smoking and tackling alcohol and drug abuse.

CMO toughens alcohol guidelines

News

DDN

February 3, 2016

Men should drink no more than 14 units of alcohol per week, according to strict new guidelines from the chief medical officer. The previous recommendation was 14 units for women and 21 for men.

The Department of Health (DH) says the revised guidelines are based on a ‘detailed review of the scientific evidence’ and supported by a new statement from the Committee on Carcinogenity (CoC) on the links between alcohol and cancer. ‘Drinking any level of alcohol increases the risk of a range of cancers,’ states DH.

The new guidelines also recommend that people do not ‘save up’ their units for one or two heavier drinking sessions, as well as urging people to drink more slowly, alternate alcoholic drinks with water and have ‘several alcohol-free days a week’. They also revise the existing guidance for pregnant women, stating that ‘no level of alcohol’ is safe, rather than the previously recommended one to two units.

The aim is to reduce the mortality risk from cancer and other diseases, says the government, as the ‘links between alcohol and cancer were not fully understood’ when the guidelines were first published in 1995.

‘Drinking any level of alcohol regularly carries a health risk for anyone, but if men and women limit their intake to no more than 14 units a week it keeps the risk of illnesses like cancer and liver disease low,’ said chief medical officer Dame Sally Davies. ‘What we are aiming to do with these guidelines is give the public the latest and most up to date scientific information so that they can make informed decisions about their own drinking and the level of risk they are prepared to take.’

The new guidelines were welcomed by Alcohol Concern as way of raising awareness of potential health harms. ‘Beyond liver disease, the public’s understanding of the health problems associated with alcohol is low,’ said chief executive Jackie Ballard. ‘The public have a right to know what they’re consuming and these recommendations are designed to allow people to make an informed choice about how much they drink.’

Industry body the British Beer & Pub Association (BBPA), however, warned that the male recommendations now put the UK ‘well out of line’ with comparable countries such as Spain (35 units), Italy (31.5) or the US (24.5). ‘In other countries, most guidelines recognise the difference in terms of physiology and metabolism between men and women,’ said chief executive Brigid Simmonds. Cutting the limit also meant classifying ‘a whole new group of males’ as at-risk drinkers, she said, with the ‘real danger’ that people would simply ignore the advice.

A statement from the Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment (COC) at www.gov.uk

February 2016

DDN

February 2, 2016

Drink and Drugs Nws — Drink and Drugs News February 2016

In this month’s issue of DDN…

New report – new action?

Over-50s are the focus of a new report on harmful drinking, with a new report from the Drink Wise, Age Well programme (see our latest issue). One of the main issues to be identified is the widespread confusion around units and guidelines, with three quarters of the 17,000 people surveyed unable to correctly identify recommended units. So will the government’s new alcohol guidelines (our lead news story) help?

Send us your views!

PDF / Virtual Magazine

From little acorns…

Features

DDN

February 1, 2016

There’s still time to book… https://www.drinkanddrugsnews.com/conference

‘Don’t get mad, get organised’ said Si Parry from Morph at the first DDN national service user involvement conference in 2008, and it was a message that set the tone for this dynamic event, as delegates spoke out, questioned, participated – and most of all claimed it as their conference, giving it a unique life of its own.

While more than 500 people attended that first conference, most delegates were coming wearing the badge of their local drug and alcohol action team (DAAT), and while there were a few nascent service user groups attending they were clutching homemade leaflets and often completely reliant on their local service for survival.

Fast forward nine years, and how things have changed. Many of the groups that were just starting out back then – and some that weren’t even a twinkle in their founders’ eyes – have developed beyond all recognition. The 2015 conference saw a service user exhibition area filled with professional stands and high quality materials to rival the larger treatment providers.

Of course it’s not a story of untrammelled success, and sadly some groups have not survived round after round of budget cuts. It would also be naive to claim that starting and funding a group is easy, and most successful groups credit the support they received from a local commissioner or drug worker who believed in them and backed them from the early days. It’s a long hard slog making sure service users are represented meaningfully, and the purpose of the conference has never been clearer.

Many groups have managed to grow far beyond their original remit, and engage in a wide range of activities that would have been hard to imagine when they started up. Across the country we’ve been charting some highly motivated groups prepared to challenge stigma and support their members’ personal journeys. Peer-led groups now operate as equal partners supporting local treatment services, contributing widely to the community. Campaigning for national naloxone provision and other outreach initiatives has also seen groups break down the traditional barriers between harm reduction and recovery to share common ground.

Peter Yarwood from Red Rose Recovery was inspired to start a group after hearing speakers at a previous year’s DDN conference. ‘Our organisation is here for people who aren’t yet members – it’s for people that don’t know who we are yet,’ he said.

Hopefully this year’s event will once again be the empowering networking opportunity that will inspire service user groups and recovery groups to start up, grow and flourish all over the country.

See you in Birmingham!

Media savvy

Letters and Comment

DDN

February 1, 2016

The news, and the skews, in the national media…

There is no perfect template for reform. Different countries have had vastly different experiences. Culture, fashion, demographics and economics all play a part – arguably a bigger part – than state enforcement. But the international trend is moving away from the crudest form of ban-and-punish regime. Most cannabis users do little harm to themselves or others, except by funding organised crime, a function of illegality. Many who might otherwise dabble unscathed end up harmed by the consequences of prohibition: street products of unpredictable strength; career-ending convictions for minor offences; retail contact with gangsters.

Guardian editorial, 8 March

Whether you support cannabis decriminalisation or not, it’s clear that the Lib Dems have limited ability to actually influence government policy. They have eight MPs now. Eight. Less than one seventh of the number they had in 2010… The Lib Dems had a chance to stand up for young people and they blew it. It’s insulting they think this ‘cool dad’ act might be enough to turn things around.

Abi Wilkinson, Guardian, 9 March

The Big Dope lobby and its many suckers and dupes constantly attack me for pointing out the dangers of the drug they want to legalise… When will the twin lies that there is a ‘war on drugs’ and that taking cannabis is a harmless, peaceable recreation, be exposed for the dangerous falsehoods they are?

Peter Hitchens, Mail on Sunday, 27 March

The attitude towards drinking in this country is getting increasingly bizarre. On the one hand you have that laugh-a-minute health chief who says she can’t even look at a glass of wine without ruminating on the increased risk of breast cancer, on the other you have our motley crew of lads and ladettes drinking themselves into oblivion in city centres… And then there are the rest of us, the vast majority who like a glass of wine or three but tend not to run amok or pick fights on aircraft and yet are still constantly berated for a nighttime snifter.

Virginia Blackburn, Express, 10 March

Governments worldwide need to learn one crucial lesson from the emergence of NPS. Their emergence is directly related to global prohibition and the war on drugs we have been fighting for over 100 years, a war that has had few successes.

Karenza Moore, Independent, 4 March

Reach out

Uncategorized

DDN

February 1, 2016

Chris Rintoul reports positive results from a Northern Ireland naloxone programme

The Scottish Drugs Forum (SDF) watered the seeds of take-home naloxone and it allowed us to kick-start the programme in Northern Ireland. Before that we had no naloxone, and no sight of it.

People are dying – especially poor groups, people in poverty, and drug-related deaths are concentrated in these groups. People who need naloxone are likely to be people who are most disaffected. They’re not hard to reach – more easy to ignore for far too long.

Some of the action involved aggressive campaigning. I was a social worker – and that involved activism. I got active and aggressive. Service user activists and social workers pushed for us to be able to give out naloxone.

The Council for the Homeless in Northern Ireland is moving towards training for the trainers in naloxone. We developed a lot of partnerships with all stakeholders, including the Housing Executive, voluntary sector agencies, the ambulance service, and the police, and looked at the viability, efficacy, and effectiveness of naloxone. We sometimes arrive late on substitute prescribing etc – but we’ve done well on this.

People are now offered naloxone at a very early part of their treatment. We have posters and leaflets that reinforce the messages and push further for it. Take-home naloxone programmes need courageous people with credibility; people who are experts in their area.

There are opportunities now – the law change has let us expand. Outreach services and hostels can now give it out, as can pharmacies, alongside needle and syringe distribution.

Overdoses are down – we had seen them rise and rise over the decade, so to see a significant drop last year was a great thing. I can’t say that it was specifically naloxone – only time will tell. The Public Health Agency for Northern Ireland is going to devolve funding to local trusts. But because it’s in their contracts, it will be difficult for them to step away from naloxone.

Buff [Iain Cameron] and I decided we wanted to support take-home naloxone, so we developed an app and funding followed. We want to do an update, if we find the funding.

You have loads of credible and courageous people in this country – get them involved.

Chris Rintoul is lead trainer for Street Rx in Northern Ireland. He spoke at the HIT Hot Topics conference in Liverpool

Words for the wise

Features

DDN

February 1, 2016

Harry Shapiro has launched a new drug information service with his former DrugScope colleague, Jackie Buckle. He tells us more

I am very pleased to announce the launch of DrugWise, a new online drug information service carrying on the drug information tradition of DrugScope and – for those of you with long memories – its predecessor, the Institute for the Study of Drug Dependence.

As you can imagine, 2015 was a ‘bit of a year’, but with the generous assistance of the field, my colleague Jackie Buckle and I were able to continue with the seamless delivery of DS Daily directly to subscribers, five days a week. We also set up a legacy website so that people would have access to all the reports and information sources of DrugScope. But this did set me wondering.

DrugScope had two main functions; one was to be the advocacy agency for drug and alcohol treatment and focus on the attendant policy issues affecting drug users, such as welfare reform and mental health. The other half of our work focused around general drug information in all its various manifestations, for anybody who needed it – information that was up to date, evidence-based and non-judgmental.

With the demise of DrugScope, the advocacy work was taken up by Collective Voice while Making Every Adult Matter (MEAM) carried on with the related policy issues. But there remained an information vacuum and I was still being contacted by journalists for comment and background on the usual wide range of issues. And so Jackie and I came to the decision to set up DrugWise and with the very welcome assistance of the Brit Trust, the site is now up and running.

DrugWise will perform a number of functions. For a UK audience, we will update and develop drug information from DrugScope, write new thematic reports on topical issues and provide an archive not only of DrugScope reports, but hopefully in time, a complete and searchable archive of Druglink magazine articles back to 1986. The site will also be a platform for the public affairs work I am currently involved in around the issue of prescribed and over-the-counter drug dependency through the All Party Parliamentary Group on Prescribed Drug Dependence and the Opiate Painkiller Dependency Alliance. I will also be continuing the media, lecturing and public speaking work under the DrugWise umbrella.

But the ambition is for DrugWise to be more international and to broaden the focus beyond drugs to alcohol and tobacco. From a health and wellbeing perspective, it has never made much sense to separate out these substances when there are so many synergies in terms of harm reduction, treatment and recovery and education and prevention – and not least because most of those with serious drug problems are also often smoking and drinking.

Certainly across the spectrum of global drug policy, there is a growing demand that policy should be evidence rather than morally-based – and since the advent of e-cigarettes, a public health hearts and minds battle has broken out between experts with all the rancour normally associated with the drugs war. So it seems that now more than ever, it is important for policy-makers and practitioners to have access to the best evidence available across substances and interventions.

One problem though is that the material is often spread across national and international agencies and so what the DrugWise I-Know international knowledge hub aims to do is to try and bring together the most robust and reliable documentation in one place. However, every country has its own health, prevention and criminal justice systems and cultures and so there is no attempt to analyse the material – simply bring it to the attention of professionals across the disciplines.

These are the basic building blocks of DrugWise and despite the solid foundations on which it is built, it is nevertheless early days. But we are very keen to get your ideas and feedback about the service and how you think it might develop – and we will be very keen also to engage in partnerships where drug information and communications input is required.

There is every indication that the treatment sector will be coming under increasing financial pressure, so here’s hoping you all can navigate safe passage through the choppy waters of the coming months.

Contact Harry Shapiro or Jackie Buckle at www.drugwise.org.uk.

Learning for life

Features

DDN

February 1, 2016

Education and training are often discarded when substance use takes over. Richard Johnson describes how ANA’s new programme is helping clients to reconnect

ANA was founded in 1998 for people who have become reliant on drugs and/or alcohol and provides residential treatment centres in Hampshire. As part of our philosophy of abstinence, we have developed a toolkit to strengthen resilience and recovery capital among our diverse client group.

We developed an approach to education with a local further education provider, Highbury College in Portsmouth – a partnership that was recognised as good practice by the NTA in 2010 – and have been building on it since.

Over the last two years we have been working closely with the college to have our second stage treatment programme, called our Road to Recovery course (R2R), accredited as a qualification in its own right. It combines therapeutic inputs with a life skills programme, delivered through a series of seminars and workshops.

As part of the course, clients are expected to complete workbooks and, although we make provision for those who cannot or prefer not to use the written word to express themselves, most do choose to use them. We had all of our workbooks retyped and printed and our lecture notes and presentational aids revamped, including power points, lesson plans and hand-outs, and put everything in individual folders for each client to be given upon admission.

The workbooks are added to other materials to compile an individual portfolio for each client. In building these portfolios, we realised just how many educational skills our clients acquire throughout the process; it soon became clear that many of our clients had become more self-aware and had developed better interpersonal, problem solving and practical skills since going through treatment.

We tentatively showed the client portfolio to the Community Education Department at Highbury College and they enthusiastically confirmed that the portfolio had significant educational value, resulting in their accreditation. The college has been enormously supportive, visiting ANA to train the R2R staff and counsellors. Clients are also invited on a tour of the college, in preparation for further education after our second stage.

So far, 12 clients have successfully completed the R2R course and received an accreditation, through their own recovery, from the college – an enormous achievement for each of them. The course is accredited at level one, which means that many clients will not have to undertake an access course when starting college, giving them back a year of their lives in study time.

The course is helping to break down barriers to education for clients and equip them with additional skills for life. Access to education was one of the key priorities in the government’s 2010 drug strategy, and is likely to continue to be so. The qualification makes recovery tangible; it demonstrates what clients have to do, what they have achieved and what they are capable of doing in the future. It also supports the concept of ‘better than well’ and has a very great impact on client recovery capital and self-esteem.

Rosanna O’Connor, director of alcohol, drugs and tobacco at Public Health England commented: ‘There is a very significant need for better education, training and employment support for people in drug and alcohol treatment, whether in the community or in residential rehab.

‘This project, being developed by ANA, is an excellent example of how some treatment providers are taking the initiative, providing people with tailored educational support, leading to qualifications, skills and the essential confidence needed to access employment.’

The next stage is to seek national accreditation and invite other treatment providers to have their programmes accredited. We feel that the initiative facilitates very positive community reintegration through study and education, and helps people take confident strides towards the job market.

Richard Johnson is CEO of ANA Treatment Centres and ANA Works, www.anatreatmentcentres.com

Tough measures

Features

DDN

February 1, 2016

Kit Caless examines some of the issues behind the rush to outlaw new psychoactive substances (NPS)

The third reading of the Psychoactive Substances Bill took place in Parliament on 20 January, and is due to be become an act on 6 April 2016. The bill has been subject to some controversy over definitions, not least the chance that poppers (alkyl nitrites) could be outlawed – which led to MP Crispin Blunt ‘outing’ himself as a popper user during the debate in Parliament. The accuracy of reports on harm, efficacy of a blanket ban, and accusations of rushed legislation have been consistently raised. One of the major issues with NPS has been a sharp rise of misuse in UK prisons.

In December 2015 HM chief inspector of prisons, Nick Hardwick, released a hard-hitting, upfront report on the misuse of substances in prisons. In the report he stated that NPS have created ‘significant additional harm’ and ‘are now the most serious threat to the safety and security of the prison system that our inspections identify.’ At the time the report was being made, ‘there was an acceleration in the use and availability of NPS’. Synthetic cannabinoids like Spice and Black Mamba were used by 10 per cent of those surveyed. This is much higher than in the community, where only 6 per cent of those surveyed said they had used synthetic cannabinoids in the two months before going into custody.

Right now, NPS are banned in prisons, but their legal status and wide accessibility outside the prison gates makes them an attractive proposition for smuggling into prisoners. As Hardwick’s report states, ‘despite the high mark-up, they [NPS] are still relatively cheap in prisons.’ On top of this, current testing methods cannot detect synthetic cannabinoids, and new testing regimes can struggle to keep up with ever changing composition. It takes time to develop new drug tests, change legislation and develop new resources. When you’re testing for such a variety of chemical compositions, the NPS market likely always remains one step ahead.

Media reports have tended to focus on novel smuggling techniques, including drugs in tennis balls catapulted over prison walls, or even flown in using drones. Category C training prisons, which have large perimeters and relatively free prisoner movement as they go to and from work, are most susceptible to drugs coming over the wall. Of course, usual routes are also taken, through social visits and internal corruption. Hardwick controversially states that, ‘it has sometimes been difficult to make best use of the information available from individual establishments and other sources to identify changing needs and modify the strategy accordingly. In part, this reflects a too-willing acceptance in some establishments that drug misuse is an inevitable part of prison life and cannot be reduced.’

The danger of NPS use in prisons is highlighted in the report through anecdotal and quantitative evidence. Nineteen deaths in prison occurred between April 2012 and September 2014, where the prisoner ‘was known, or strongly suspected, to have been using NPS-type drugs before their deaths.’ The report surveyed more than 10,000 prisoners and found that, ‘debt associated with synthetic cannabis use sometimes leads to violence and prisoners seeking refuge in the segregation unit or refusing to leave their cells. Debts are sometimes enforced on prisoners’ friends or cell-mates in prison, or their friends and families outside.’

Not every prison has the same issues and it is not just the supply of NPS that is the problem in the UK prison network. Why have NPS become so attractive to prisoners? What can be done to tackle these problems? Should the focus, as some argue, be on the reasons why drugs are used in prison (boredom, demotivation, corruption), or on testing and punishment for usage? Hardwick says that any new strategy ‘needs to go beyond specific drug services to reducing demands for drugs by offering attractive purposeful alternatives, reducing prison violence and creating positive staff prisoner relationships.’

Kit Caless is Addaction’s communications officer for London and the south

There are no quick and easy answers to any of the questions posed by the prevalence of NPS in Britain and its prisons. But the debate is still in full swing.

You can join in by attending ‘New psychoactive substances: no longer a novelty – the expert view’,

15 March in London.

Details at http://bit.ly/1nl0Kzr

‘It’s unworkable’

The psychoactive substances bill is an unnecessary and unworkable law, Niamh Eastwood, Release’s executive director, told the HIT Hot Topics conference, as the ‘unstoppable’ bill was rushed through parliament.

‘It’s opened a Pandora’s Box,’ she said. Media reports of our streets being ‘awash with these drugs’ meant that ‘we have to respond, regardless of harm or prevalence… but it’s a tiny number compared to the treatment system not being responsive to the needs of people accessing it.’

The Centre for Social Justice had used its Broken Britain report to justify the progress of the bill through the House, said Eastwood, quoting Vice, that ‘the death stats that government’s using to ban legal highs are total bullshit’.

Last year’s Global Drug Survey (GDS) had highlighted the extent of alcohol and tobacco use. But prohibition was not about the drugs, said Eastwood, it was about ‘social control’ and ‘the othering of certain groups’, including young people in deprived areas and people in prison.

The bill had not only created ‘a number of strange possession offences’, but penalties showed ‘no proportionality’. Furthermore the ban on exportation and importation of psychoactive substances for personal use meant head shops would close and people would buy ‘dodgy stuff’ online.

Quoting ACMD advice to the Home Office that ‘the psychoactivity of a substance cannot be unequivocally proven’, Eastwood said it was an example of needing to speak out when things were wrong. Proving psychoactivity was difficult, making the legislation unenforceable.

‘Get out there and tell people that this is one of the worst pieces of legislation ever drafted,’ she said. ‘It’s an affront to our brains.’

Professor Harry Sumnall, of the Centre for Public Health at Liverpool John Moores University, said that from looking at treatment data, NPS didn’t seem to be an issue for treatment services – a long way from Neil McKeganey’s picture of ‘a scourge that could grow to eclipse heroin’, reported by the Scottish Daily Mail.

We were becoming prone to ‘risk illiteracy, where we don’t have a good handle on risk,’ he said. This could make us powerless to act or react.

The key message to emerge was, ‘don’t panic, we already know what to do’, said Sumnall. Existing approaches were ‘entirely suitable’, with classic harm reduction components ‘absolutely vital’, including messages around not sharing syringes.

‘It’s not about new drugs,’ he said. ‘We’re not seeing new and novel harms… It’s about understanding cultural practices.’

Burden of grief

Features

DDN

February 1, 2016

Helping families through the guilt and anger of losing a loved one can be gruelling for practitioners. Esther Harries looks at how to be prepared

The Bereaved Through Substance Use Guidelines were launched in June 2015 and represented the culmination of joint research between the Universities of Bath and Stirling on the experiences of families bereaved through substance use.

In the introduction, the guidelines invite practitioners to seek effective clinical supervision while working with family members following bereavement.

Although the focus is on practitioners who come into contact with substance-related deaths, the research could be equally valid for family support practitioners – particularly if they are working with the family and the client in treatment, where family meetings are integrated into the care plan.

McAuley & Forsyth (2011) conclude that ‘when someone dies of a DRD it is not only the needs of friends, family, or witnesses that need to be taken into account. The presence of grief-related reactions in almost 90 per cent of this sample suggests that staff who were involved in the care and treatment of the deceased also need to be considered when dealing in the aftermath of the event.’

Their study of the impact of a drug-related death on those who have experienced it as part of their caseload found that 65 participants were identified as having experienced at least one drug-related death on their caseload and 88 per cent identified at least one reaction: ‘The most common feelings identified were sadness (83 per cent); guilt (40 per cent) and anger (37 per cent): 26 per cent reported feeling helpless; 21.5 per cent had cried and 18.5 per cent had difficulty in concentrating.’

As a counsellor and clinical supervisor, I have witnessed the following thoughts and feelings from both family members and practitioners:

Guilt – ’I should have…’

Grief

Disbelief: ’They were doing so well…’

Anger – Perhaps directed towards the treatment system for its perceived failures.

Sad reflection: ‘What if..?’

Practitioners can also be supporting families with a loved one’s addiction as they experience a series of losses, ‘a living bereavement’, that includes the fear that their loved one may die. The intensity of this work can, without proper support, have considerable impact on the psychological well-being of the practitioner, particularly if they are involved in a serious case review and/or an appearance at the coroner’s court.

The trauma therapist Michael Gavin (www.embodiedtherapy.net) acknowledged in 2015 how challenging working with trauma can be: ‘People tell you stories of unbearable experience, and you have to listen’.

He states that the aim of supervision is to make therapy as safe and effective as it can be for both practitioner and clients or patients. For example, practitioners might be helped to improve their skills in specific ways (see box).

McAuley and Forsyth (Journal of Substance Use, February 2011) add that ‘providing a debriefing session and one-to-one support, like that proposed by Redinbaugh et al (2003), on both the events leading up to death, and staff feelings and emotions in its aftermath, should be available to those who need it and, therefore, should be considered for future policy and practice. It can also deter any notion of a ‘blame culture’ being developed and promote a working environment where each death can be used as an opportunity to reflect and learn lessons for the benefit of future practice’.

Practitioners might be helped to:

Master the skills of self-awareness, mindfulness, and of managing both their own arousal, and that of clients.

Find and cultivate their own reliable sources of safety and resilience, both internal and external.

Build a capacity for a calm yet assertive personal presence.

Foster their individual talents, style and insights as a basis for a sense of personal authority.

Find a way back to common sense (not so common!) and a sense of humour in the face of the unbearable and ‘unspeak-about-able’.

Esther Harris is an independent practitioner in counselling and clinical supervision

Hit Hot Topics

Features

DDN

February 1, 2016

Stigma, misunderstanding and a lack of communication cloud our policy and practice on drugs, said speakers at HIT Hot Topics. DDN reports on their ideas for a fresh approach. Photos by Nigel Brunsdon

‘As long as drug users are marginalised and stigmatised there are going to be harms,’ said Pat O’Hare, opening HIT’s annual Hot Topics conference. The question was, how could we tackle this against a backdrop of disinvestment, where harm reduction was being ‘dismantled bit by bit’?

Alex Stevens, professor at the University of Kent, used statistics to show how drug deaths were misused, ‘to scare and to support ineffective policies’. The attention on new psychoactive substances (NPS) had brought ‘the most radical departure in drug policy’ – but meanwhile heroin deaths had increased by 64 per cent.

‘So why aren’t we focusing on heroin? Because of who these people are,’ he said.

Death rates were particularly linked to deprived areas in the north of England, and specifically to men who had lost industrial jobs in the 1980s and ’90s and turned to heroin use as ‘it was all there was’. This group was now middle aged and becoming very vulnerable.

Looking at how deaths were reported in the national papers gave a snapshot of how different drug users were perceived. Following deaths from NPS, descriptions typically included the words ‘brilliant, student, gifted’. Heroin or methadone deaths were more likely to contain language related to ‘junkie’.

This discrimination was used to support ineffective policies, the psychoactive substances bill, prohibition in general, cuts and churn in services, and recommissioning, he said. Not only were people were being written off as ‘not useful’, but ‘the shortage of public funds is being used as an excuse for lack of action,’ he said.

So how could we try to change public perception – and therefore change policy?

US professor and research scientist, Carl Hart, threw a challenge to the audience to embrace ‘the three Cs’ – their convictions, capability and courage. Commenting that ‘you British are very controlled’, he said ‘I’m going to ask that you get a little more angry.’

‘Drugs are used as scapegoats,’ he said, quoting examples such as a newspaper headline from the 1930s: ‘Negro cocaine fiends are a new southern menace’…‘I hope this gives you conviction to change our narrative,’ he said. Using capability and courage involved critical thinking and calling on the facts to challenge exaggerated science.

‘One of the facts that people ignore is that 80-90 per cent of drug users do not have a problem,’ he said. ‘You have to have courage to tell people we have exaggerated the harmful effects of drugs. You have to have courage to challenge scientists in a public space.’

It was not a formula for popularity, he acknowledged. ‘Be prepared to lose funding, friends, professional achievements and respect… but history will judge you favourably because you are right.’

‘Hold them accountable with the facts,’ he added. ‘You have to publicly embarrass people. If you don’t, our people quietly suffer.’

Bengt Kayser, teacher and researcher at the University of Lausanne, Switzerland, explored the topic of doping to demonstrate a culture of exaggerated responses and moral panic. ‘Myths get a ring of truth because they are published in a scientific journal,’ he said. ‘Debunking this type of myth is important.’ Responses could become exaggerated and moral panic could too easily turn into a moral crusade.

‘Sebastian Coe is dangerous for harm reduction in England because he pushes zero tolerance,’ he said. There were risks, he acknowledged, but it was important to keep them in proportion, ‘or people will run away from us.’ Harm reduction was the answer, coupled with evidence-based policy-making. To have any hope of changing the narrative, we needed to spread clear and effective messages, according to Jamie Bridge and Nigel Brunsdon, who gave insight into using photo-based campaigns. ‘Back in the old days, campaigning was left to the TV,’ said Brunsdon, showing images of some of the most effective public health campaigns, such as ‘Charlie says’ (child safety), ‘Don’t die of ignorance’ (Aids) and ‘Coughs and sneezes spread diseases’. Back then there was no immediacy, with months of lead-up time for publishing in magazines. Modern devices, however, brought the opportunity of hashtags and hundreds of immediate hits.

Recalling the ‘Support. Don’t punish’ Facebook page, he said: ‘I can join in an international campaign just like that. All the barriers are taken away from me.’ The #SupportDon’tPunish campaign had borrowed from successful campaigns such as #NoH8 (against anti-gay marriage legislation), #NotinMyName (young Muslims showing solidarity against terror attacks) and the #BeTheGeneration Global Fund campaign, to create a global day of action around the world, added Bridge.

‘We constantly struggle with the stigma of our cause,’ he said. But if you had a sellable idea you could keep finding reasons to bring it back into public consciousness. ‘Keep pushing,’ he urged, ‘you need to bring it to people.’ Brunsdon gave tips and tricks to help change the narrative through viral campaigns. ‘You can’t force a campaign to go viral, but you can nudge it along,’ he said. ‘Give people the tools and tell them what you want them to write. The more barriers you remove to action, the more likely it is to happen… Have simple messages, be original, have goals and targets. Have good simple hashtags.’

Brunsdon illustrated this with a preview of his new website, harmreductionisbeautiful, due to go live in a few weeks. The site aimed to overturn the way drug use and harm reduction were perceived. ‘It’s about changing the narrative – it’s always depressing images of injecting in alleyways, and never celebratory. The idea is simple – you put up messages and have a selfie with it. Any of you can contribute to this and can download any of the images to use.’

Ethan Nadelmann of the Drug Policy Alliance brought a perspective from the US that zoomed in on Liverpool, the conference venue, as ‘the birthplace of harm reduction’.

‘Americans have no interest in what’s happening outside our country,’ he said. ‘We continue to fall tragically short in areas where you have led the way… areas like physician independence in prescribing.’ But, he continued, ‘when I hear how bad it is here right now, with the decimation of resources, the demonisation of people who use drugs, the sense of fear of people trying to do the right thing, the indifference to human life that this government is demonstrating, I know that place very well.’ We needed to keep pushing forward while playing good defence as well, he said, and this involved ‘addressing the fears of those who oppose us.’

The US was still involved in ‘the horrific drug war’ of the late 1990s, which had perpetuated incarceration. We had to think ‘how do we shift public views?,’ he explained. Nadelmann used the example of cannabis – medical marijuana – to show how the nature of debate could be shifted, and how ‘we could play ball in the big league of US politics’.

‘We changed the image of a marijuana user, from a kid to an older woman recovering from breast cancer, or someone recovering from Aids,’ he said. ‘When the pictures were shown, they touched the hearts of the hardest Republican. We focused on what we had in common.’

Equally important was finding ‘what drives our opposition’ – ‘Fear is the driving element of the war on drugs, fear of not knowing how to deal with diversity,’ he said. This involved using their language (‘pivotally important’) and exploring common ground: ‘We’re doing recovery and it works. “Grant us the serenity…” That is the prayer of the drug policy movement as well.’ It was about taking ‘unlikely voices and allies’ and embracing common values, Nadelmann told the audience.

‘Being as open and responsive as possible will lead you out of this dark period and restore you as the leader of the world in dealing with drugs.’

Concluding a thought-provoking day enhanced by plenty of audience interaction, Pat O’Hare concluded: ‘Drug policy reform is the best harm reduction. Keep the faith, keep the passion.’

News in brief

Uncategorized

DDN

February 1, 2016

Bill blasted

An early day motion on the Psychoactive Substances Bill has been tabled by Paul Flynn MP. ‘This House regrets the depth of scientific illiteracy’ in the bill, it states, adding that the document is ‘evidence-free and prejudice-rich’. A proposed amendment to exempt alkyl nitrites, or ‘poppers’, from the legislation was defeated last month, and both houses have now agreed on the text of the bill, which is waiting for the final stage of Royal Assent before becoming an Act of Parliament.

Crack on

The number of people estimated to have started using opiates and/or crack in 2013 was between 5,000 and 8,000, according to Home Office statistics. The figures represent a fall of around a fifth compared to 2005 and are down ‘hugely’ since the 1980s and ‘90s, says New opiate and crack-cocaine users: characteristics and trends. The downward trend has ‘flattened since about 2011, but available data do not suggest that this is the precursor to a new increase’, the report states. ‘If anything, the downward trend may resume in 2014, though the situation requires further monitoring.’ Report at www.gov.uk

Ketamin call

Ketamine should not be placed under international control, the World Health Organization (WHO) has ruled. The substance ‘does not pose a global public health threat’ and controlling it could limit access to anaesthesia and pain relief in many parts of the developing world, it warns. The drug’s medical benefits ‘far outweighed’ the potential harm from recreational use, said WHO’s Marie-Paule Kieny, adding that an international ban could ‘limit access to essential and emergency surgery, which would constitute a public health crisis in countries where no affordable alternatives exist.’

Synthetic threat

New psychoactive substances – particularly synthetic cannabinoids – are now the ‘most serious’ threat to safety and security in British jails, according a report from HM Inspectorate of Prisons. Changing patterns of substance misuse in adult prisons and service responses studies the evidence from more than 60 inspections and 10,000 survey responses from individual prisoners, and calls for the establishment of a national committee, chaired by the prisons minister, to bring together ‘cross-government and cross-sector expertise’.

Report at www.justiceinspectorates.gov.uk;

Emergency measures

A&E attendance rates for alcohol poisoning doubled from 72 to 148 per 100,000 population between 2008-09 and 2013-14, according to a report from the Nuffield Trust. Rates were highest among ‘older, poorer men’, says Alcohol-specific activity in hospitals in England. ‘At a time when unprecedented efficiencies need to be made by the NHS and local authorities, preventative action must be taken seriously,’ says the trust.

Document at www.nuffieldtrust.org.uk

A dog’s life

The Dogs Trust is looking at ways to help homeless hostels become dog friendly, as less than 10 per cent currently accept dogs. ‘We know from our own experience of working with dog owners that most would rather remain on the streets than be forced to give up their four-legged friend,’ says Homeless Link.

Hostel staff can fill in a survey at www.surveymonkey.co.uk/r/welcomingdogs

Priced out

The final decision on minimum unit pricing in Scotland will be taken by domestic courts, the Scottish Government has stated, following a ruling by the EU Court of Justice that the proposals could breach European law by ‘significantly’ restricting the market. ‘The Scottish Government remains certain that minimum unit pricing is the right measure for Scotland,’ said health secretary Shona Robison, despite the EU court recommending the use of tax measures – which would still allow competition between retailers – instead.

Ketamin call

Keep it breif

A review of the effectiveness of brief interventions in emergency department settings has been published by EMCDDA. These can provide a ‘unique window of opportunity’ for engaging with otherwise hard-to-access people, says Emergency department-based brief interventions for individuals with substance- related problems: a review of effectiveness. Available at www.emcdda.europa.eu

Smokeless funds

Around 40 per cent of UK local authorities are cutting their budgets for smoking cessation services, according to a report from Cancer Research UK and ASH, which also reveals high levels of recommissioning and reconfiguration. ‘Most local councils take their responsibility to reduce smoking very seriously, but they are facing enormous funding pressures,’ said ASH policy director, Hazel Cheeseman. Reading between the lines: results of a survey of tobacco control leads in local authorities in England at www.cancerresearchuk.org

Naloxone notes

A new Europe-wide review of the case for distributing naloxone has been published by EMCDDA. Preventing opioid overdose deaths with take-home naloxone includes good practice and training examples, and also looks at the legal barriers to distribution. ‘Each of the lives lost every day in Europe to opioid overdose is worth all our efforts to improve prevention and responses’, said EMCDDA director Alexis Goosdeel. Available at www.emcdda.europa.eu

Gang guidance

The government has promised more action to address the exploitation of vulnerable people in the drug trade, as part of new measures to tackle gang violence. Nine areas across the UK will receive targeted support from experts to help address local challenges, it said.

Social space

Many LGBT people begin drinking heavily when they first encounter the commercial gay scene, with an ‘expectation that they continue to do so’, according to a new report from Glasgow Caledonian University and Scottish Health Action on Alcohol Problems (SHAAP). Many also feel that alcohol services and peer support would not provide a ‘safe or welcoming space’, says The social context of LGBT people’s drinking in Scotland. Report at www.gcu.ac.uk

Peer pressure

Expanding peer support could be one way of lessening the impact of the government’s cut to the public health grant, according to a new RSA report. PHE should drive the development of a ‘creative commissioning for recovery’ approach to improve local outcomes, says Whole community recovery: the value of person, place and community. ‘Services are being asked to do more for less, so there needs to be a focus on doing things differently, harnessing the capacity within the system,’ said Susie Pascoe, the RSA’s whole person recovery programme lead. Report at www.thersa.org

Painkiller practicalities

A new web-based resource to support the ‘safe and rational’ use of opioid medicines, Opioids Aware, has been launched by the Royal College of Anaesthetists’ faculty of pain medicine and PHE, aimed at prescribers, patients and carers. Nearly 23m prescriptions for opioid painkillers were written for UK patients in 2014 alone, the resource highlights.

All change

A new project to support the families and carers of change-resistant drinkers has been launched by Adfam and Alcohol Concern as a follow-up to last year’s successful ‘Blue Light’ project. The organisations are looking to roll out the initiative as widely as possible, so any local areas interested in getting involved should contact Mward@alcoholconcern.org.uk.

Generation drink

Features

DDN

February 1, 2016

A major new report sheds light on the alcohol habits of the over-50s. Are they risking drinking themselves into an early grave?

Last month the government revised its sensible drinking guidelines for the first time in 20 years, bringing the recommended weekly levels for men down to match those for women – at 14 units (see news story, page 4). One reason for the revised limits, says the government, is that the links between alcohol and cancer were ‘not fully understood’ when they were first issued in 1995.

Now a new report from the Drink Wise, Age Well programme, whose partners include the International Longevity Centre (ILC-UK) and treatment charity Addaction, highlights the fact that it may well be the over-50s who are most risking their health through their drinking habits. Drink wise, age well: alcohol use and the over 50s in the UK is the largest ever study of its kind, surveying nearly 17,000 people from across the country. It found a population whose problem drinking may well be ‘hidden in plain sight’.

Not only were age-related issues such as bereavement, retirement, loneliness, money worries and loss of a sense of purpose leading people to drink more in many cases, those people were also far less likely to seek help. Nearly 80 per cent of those identified as higher-risk drinkers drank ‘to take their mind of their problems’, says the report, with ‘not coping with stress’ the strongest predictor for being a higher-risk drinker.

A quarter of respondents had no idea where to look for support – and said they wouldn’t ask for help even if they did know – while more than 80 per cent of those identified as being at increased risk from their drinking had never been asked about it by a professional. More than half of over-65s also thought people ‘had themselves to blame’ for any alcohol problems.

Although most survey respondents were found to be lower risk drinkers, a ‘significant minority’ were not, says the document, and it’s a problem that’s likely to get worse. More than a third of the UK population is over 50, and by 2040 nearly one in four will be 65 or above, shoring up major problems if the ‘drinking patterns of older adults do not change’. Between 1991 and 2010, alcohol-related deaths among the 55-74 age group in England increased by 87 per cent for men and 53 per cent for women, meaning there is a ‘pressing need’ for action to reduce alcohol-related harm.

As the report points out, the image that harmful alcohol use tends to conjure up is one of young people binge drinking. Is the issue of older drinkers still largely a hidden one? ‘Very much so,’ head of the Drink Wise, Age Well programme, Julie Breslin, tells DDN. ‘Quite often drinking in later life takes place behind closed doors, and therefore is not as visible as young people’s drinking in a town or city centre of a Saturday night. Also our report shows a high level of stigma for older drinkers, so it’s quite possible that if there is an issue they won’t tell anyone.’

The report highlights the lack of a coherent plan to address alcohol-related harm in older drinkers, so what could be done at government level – should there be a national strategy? ‘From a starting point we’d like to see more consistent UK-wide collection of data on alcohol use and older adults,’ she says. ‘For example, PHE have only recently started collecting alcohol statistics on adults aged 75 and over, and in order to compare and assess the scale of the problem we’d like to see some consistency in the information gathered across the four nations. Secondly, we’d like to see alcohol and ageing on the agenda across a number of cross-care areas, such as dementia, retirement, social isolation. Alcohol use doesn’t happen in a vacuum.’

The programme is also advocating for the needs of older people to be specifically highlighted in existing government strategies, in order to raise the issue in professional and commissioning circles. ‘Up until now only the Wales and Northern Ireland alcohol strategies particularly reference the needs of older adults,’ says Breslin.

One of the major issues identified by the report is a widespread confusion and lack of awareness around units and guidelines. Will the recent revisions go some way to rectifying that or is there still a lot more to be done to get a clearer message across? ‘In our report nearly three quarters of respondents were unable to correctly identify recommended units,’ she says. ‘Hopefully the new guidelines are a good starting point and easier to digest. However for many people even the concept of “units” is difficult to grasp and we may need to work together to find better ways to communicate the message. It would be helpful to provide resources that allow people to self-measure and start to understand their own consumption better.’ The drinks industry also needs to share a responsibility in getting the message across, she stresses – they may have put unit information on labels but it ‘could be a lot bigger’.

As older people have been drinking for longer, the harm becomes accumulative, she points out, although the fact that over-50s are far from a homogenous group is itself a challenge. ‘You could have an extremely fit and healthy 73-year-old, versus a 52-year-old with multiple health issues. We think more discussion and exploration is required in relation to the guidelines and how we provide nuanced age-specific advice.’

There’s always been a strong anti-‘nanny state’ feeling in the UK, however, and many are likely to say, ‘If they haven’t got much else in their lives let them enjoy a drink – why take that away?’

‘The “nanny state” backlash is certainly something we’re prepared for and we saw this very much in the recent revision of the alcohol guidelines,’ she says. ‘However we believe that older people in particular do play an active role in their own health and wellbeing, and given the right information make healthier choices. How alcohol affects us, particularly as we age, is something most people would want to know about in order to make this choice, in the same way they would take care of other health areas.’

Assuming that older people don’t want to make healthy choices or live active and healthy lives is an ageist approach, she argues, adding that when they do access alcohol treatment they tend to have better outcomes – the problem is that they’re less likely to engage with treatment in the first place. ‘Assumptions that people are too old to change are unhelpful and actually quite discriminatory,’ she states.

If the aim is to help people experience a better quality of life in their later years, a key starting point is ‘clear and credible information’, she stresses. ‘Many people identified positive reasons for alcohol use such as socialising and relaxation, and these are important factors for people as they age. We’re not telling people not to drink – we’re highlighting what the particular risks are for older people and proving advice and information.’

People have to be motivated to improve their health, however. If someone is lonely, perhaps bereaved, and feel they have little to live for they may well know they’re doing themselves harm but think, ‘So what?’ What, realistically, can be done to counter that?

‘Of course major life transitions such as bereavement and retirement can be a trigger for increased alcohol use, and people may feel that there’s little in their life to change for. In our direct engagement and support service, where we work with people over 50 who are already drinking problematically, our philosophy is that it’s our job to help people find the motivation that will help them make that change. Very often the first stage of engagement is about relationship building and dealing with practical issues.’

The problem, she points out, is that it’s resource- and time-intensive. ‘We are very lucky to be funded so we can work in this way,’ she says. ‘What can happen with busy generic addiction and social work services is resources may be stretched, and if an older person – on the face of it – is not showing motivation to change, resources may be allocated elsewhere. We know that it takes time, repeated home visits, and lots of patience for someone to start to find their own drive for making a change, and this is the model we adopt.’

Equipping people with social supports and coping strategies – ‘resilience interventions’ – is also vital, she says, so that when they do experience difficult life changes they are better able to cope without turning to alcohol.

The report says that what’s needed is an ‘age-nuanced’ approach – what would some of the elements of that look like? ‘At a wider level there needs to be a multi-agency approach to ensure older adults don’t fall through the net,’ she says. ‘Frontline staff and practitioners should receive training that specifically challenges stigma and attitudes, whilst equipping people to better recognise and respond to older people who may be drinking.’

Among the best-placed people to step in are health professionals, particularly GPs, as they’ll usually be the ones older people have the most regular dealings with. What can be done to raise awareness among them, and help them spot any warning signs? ‘Health professionals have more and more demands on their time, but better alcohol screening of patients is a good starting point and in some areas this is already offered. If older patients are re-presenting with issues such as low mood, sleep disorders, stomach problems, then alcohol use may be a contributing factor.

‘It also may be the case that whilst people are not drinking at particularly high risk levels, they are experiencing some health implications due to age-related changes,’ she continues. ‘It’s important for community agencies to work closely together so that GPs have an easy and accessible referral route when they do identify someone.’

www.drinkwiseagewell.org.uk

Ireland considers consumption rooms and decriminalisation for personal use

News

DDN

December 9, 2015

The Government of Ireland is considering the introduction of drug consumption rooms, as well as decriminalising small amounts of drugs for personal use.

The announcement was made as part of a speech by new communities, culture and equality minister Aodhán Ó Ríordáin, who has responsibility for the country’s national drugs strategy, to the London School of Economics IDEAS Forum.

Consumption rooms had proven effective in engaging hard-to-reach populations, said Ó Ríordáin, and he had asked officials to examine ‘proposals for the provision of medically supervised injection facilities’ in line with European and Australian models. This was partly to address problems with street injecting in Dublin and elsewhere, as well as a recent spike in blood-borne viruses, he said, telling the Irish Times newspaper that the facilities would ‘happen next year’. The country’s health minister Leo Varadkar, however, has stressed that while he supported the proposal it would require a change in the law and would not be ‘a simple matter’.

A drugs policy review has also been launched to consider whether a decriminalisation approach to the possession of ‘small quantities’ of drugs – such as currently operates in Portugal – should be considered in Ireland, although there was ‘certainly no desire for a permissive approach to drugs’, Ó Ríordáin emphasised.

While the country’s drug strategy was one that was ‘firmly focused on recovery’, a changing drugs landscape required renewed focus and innovation, he stated. ‘I am in favour of a decriminalisation model, but it must be one that suits the Irish context and be evidence based. I believe that this kind of approach will only work if it is accompanied by timely treatment and harm reduction services, backed up by wrap-around supports which foster recovery – such as housing, health and social care. Above all, the model must be person-centred and involve an integrated approach to treatment and rehabilitation based on a continuum of care with clearly defined referral pathways.’

Full speech at www.merrionstreet.ie

Media savvy

Letters and Comment

DDN

December 9, 2015

Drug abuse and HIV continue to present profound challenges to the health of gay people, but a climate of moral panic and blaming the gay scene is counterproductive… We need a more sophisticated analysis of the reasons driving high-risk behaviour among some gay men. Without this understanding, any future NHS responses to chemsex are destined to fail.
Marco Scalvini, Guardian, 10 November

A major reason for the media coverage of chemsex as destructive is that most of the first-hand accounts of the experience come from people who present it as a problem at sexual health clinics. The media then select the most horrifying of these…. As for the connection between chemsex and HIV transmission, there is little academic consensus on this.
Jamie Hakim, Independent, 25 November

Addressing chemsex-related morbidities should be a public health priority. However, in England funding for specialist sexual health and drugs services is waning and commissioning for these services is complex. English sexual health services tend to be open access, with costs charged back to local authorities. Drug services tend to be authority specific with users having to attend a service within their borough of residence. Despite the different funding streams, creating centres of excellence for sexual health and drug services could be a cost effective solution to diminished resources in both sectors.
BMJ editorial, 3 November

Around the world, about 25 countries including Australia, the Czech Republic, Portugal and Switzerland have initiated reform. Even Iran’s theocracy brought in progressive harm-reduction measures and has influential voices calling for cannabis and opium legalisation. Slowly but surely we are seeing the end of stupid policies to prohibit drug use that are not only stunningly illiberal but damage users, families, communities and entire countries.
Ian Birrell, Independent, 9 November

If governments really want to limit the harm from drugs – saving addicts’ lives, crushing dealers’ profits and slashing the number of people who take them in the first place – then they must seize control of the market themselves.
Economist editorial, 7 November

If people are going to use narcotics, it is best they do so safely. Relaxing the legislation on drug use, coupled with access to injection rooms, really is our only way forward.
Lorraine Courtney, Irish Independent, 6 November

What do modern terrorists have in common? Yes, they are fanatical, and usually (but not always) from ethnic minorities. But there’s something else very interesting. They are invariably on mind-altering drugs, usually cannabis.
Peter Hitchens, Mail on Sunday, 22 November

Local news from the substance misuse field

News

DDN

December 9, 2015

‘LOCK, STOCK’ STAR GIVES BOOST TO RAPT DAY PROGRAMMES

Jason Flemyng, star of Lock, Stock and Two Smoking Barrels, lent his support to Alcohol Awareness Week (16-22 November) with a visit to two of RAPt’s London community programmes – the Tower Hamlets Community Alcohol Team (THCAT) and the Island Day Programme.

He was among those at the event to speak about the effects of addiction, having seen his father struggle with alcohol.

‘I am only too aware of the stigma around it,’ he said. ‘These projects are brilliant – not only because of the incredible transformation it can help bring for those struggling with drink or drugs, but because of the support and understanding there is for families too.’

DRINKAWARE PILOT KEEPS CLUBBERS STREETWISE

Young clubbers in the south west will be targeted through the Drinkaware Club, a six-month pilot by the alcohol education charity.

Joining forces with local police, community partnerships and police and crime commissioners (PCCs), Drinkaware has trained staff in bars and clubs to increase safety by reducing drunken anti-social behaviour. Working in pairs, club hosts will begin by talking to customers as the queue is forming and ensure they leave safely as the venue closes. ‘I am delighted at the level of engagement and support we have had from local partners,’ said PCC for Devon and Cornwall, Tony Hogg. ‘We have been working closely with local authorities, street pastors and the venues to put this pilot together.’

AWARDS RECOGNISE STERLING EFFORT IN TACKLING STIGMA

The first Marsh Recovery Awards have been presented at Addaction’s recovery conference in Manchester – a result of the charity’s partnership with the Marsh Christian Trust.

Chosen for their outstanding contributions to raising awareness and reducing stigma in the field of recovery, the winners were: Kerrie Hudson for ‘exceptional individual’; Club Soda for ‘exceptional activity’; peer supporters at RISE in Devon for ‘exceptional group’; Max Daly, author of the Narcomania column in Vice and Sarah Hepola, author of Blackout: Remembering the things I drank to forget, for ‘exceptional media’.

TREAT YOURSELF AT ONLINE AUCTION

Broadway Lodge has launched an online auction to raise funds for treatment. To be in with a chance of winning two full-hospitality tickets for a day at the races, framed shirts from football stars, Sunday lunch at the Doubletree Hilton, a laptop and many more prizes, visit www.broadwaylodge.org.uk.

DYFRIG HOUSE OPENS NEW DOORS TO HELP CARDIFF’S HOMELESS

A specialist accommodation and support centre has been set up at Dyfrig House in Cardiff to help homeless people with alcohol or substance misuse problems.

The 21 self-contained bedrooms with private ensuite toilet and shower facilities, will support residents towards independent living and have been described as ‘not a hostel [but] therapy’ by one resident.

Since opening in 1967, Dyfrig House has provided one of the few ‘dry’ homeless services in the city. The completely refurbished service – result of a partnership between Solas (which provides accommodation for homeless people), Cardiff City Council and the Welsh Government – offers an individually tailored therapeutic support model.

Lee Sutcliffe, who feels he owes his life to Dyfrig House, said: ‘I was made to feel safe straightaway, which I hadn’t felt in a very long time… it’s a very, very special place indeed.’

WELCOME EVENTS PROVE POPULAR AT FORWARD LEEDS

A series of open mornings across the city have proved a successful venture for alcohol and drug charity Forward Leeds.

The Wednesday morning events have introduced service users, local residents and businesses the facilities and given them the chance to meet staff, ask questions and learn about what goes on at the charity, including the needle exchange and other harm reduction activities.

The service’s executive director, Lisa Parker, said they were extremely pleased at the turnout at the events and added, ‘The events have also been an opportunity for us to recognise the hard work our staff do… we made sure each staff member got a Forward Leeds purple and pink cupcake.’

Dark days review of the year 2015

Features

DDN

December 8, 2015

There wasn’t very much to celebrate in 2015, a year that saw both England and Scotland record their highest ever number of drug-related fatalities, while a surprise outright Conservative election win heralded yet more belt-tightening and austerity…

JANUARY

Among ever-increasing fears about the impact of new psychoactive substances, the Ministry of Justice announces a raft of punitive measures for anyone found using or supplying them in prisons. ‘If prisoners think they can get away with using these substances they need to think again,’ warns justice secretary Chris Grayling.

FEBRUARY

DDN’s eighth national service user conference, The Challenge, proves to be the liveliest yet, with a day of powerful presentations against a background of increasing anxiety in the field. DrugScope’s State of the sector report indicates that the fears may be well founded, with more than half of survey respondents reporting a reduction in frontline staff alongside widespread concerns about job insecurity and rapid commissioning cycles. The highly controversial notion of linking treatment to benefit entitlement hits the headlines again as the prime minister commissions Prof Dame Carol Black to conduct a review into sickness benefits, while Alcohol Concern chief executive Jackie Ballard backs the call for health warnings on alcohol labels. ‘Every other bottle of poison in the supermarket has a warning label on it,’ she tells DDN.

MARCH ddn march

The government announces that it is developing plans for a general ban on the supply of all emerging drugs – the first stirrings of what is to become the controversial Psychoactive Substances Bill – and DrugScope goes into liquidation, blaming its worsening financial situation. ‘It is with a heavy heart that the board has taken this extremely difficult decision’, says chair Edwin Richards.

APRIL

Five more NPS become subject to temporary banning orders, and Alcohol Concern accuses the drinks industry of using responsible drinking messages as just another way to promote its brands. Meanwhile, Dr Joss Bray writes in DDN that it’s time to put compassion back into service provision.

MAY

There’s widespread surprise – not least within the party itself – when the Conservatives win a majority in the general election. The new government loses no time in announcing its ‘landmark’ blanket ban on all NPS, described by Release as ‘full blown regression’.

JUNE

New substances are now being identified at a rate of two a week, the latest EMCDDA European drug report warns, although demand for heroin appears to be ‘stagnating’ across the continent. Delegates at the RCGP’s national drug and alcohol conference argue that GPs need to stay central to substance treatment, while the ‘Support. Don’t Punish’ campaign holds its third global day of action. Naloxone campaigner Philippe Bonnet, meanwhile, urges DDN readers to identify local champions, create networks and raise awareness of how cost-effective the intervention can be.

JULY/AUGUST

Bleak news as Scotland records its highest ever number of drug-related deaths, 16 per cent up on the previous year. The country still faces a ‘huge challenge in tackling the damaging effects of long-term drug use among an aging cohort’, says community safety minister Paul Wheelhouse. Prof Dame Carol black launches her review into ‘supporting benefit claimants with addictions and potentially treatable conditions back into work’ and ASH tells DDN that the Welsh government’s plans to ban the use of e-cigarettes in public places amounts to a misguided attack on an effective harm reduction tool, although the claim in a PHE report that the devices are 95 per cent less harmful than smoking tobacco proves divisive.

SEPTEMBER

More grim news as England follows Scotland to announce its highest drug death toll – although fatalities in Wales are down – prompting Addaction chief Simon Antrobus to call on the government to re-think proposed cuts to local authority health spending. ‘The stakes are simply too high to do otherwise’, he states. The European Court of Justice deals a blow to Scotland’s minimum pricing plans by stating that they could breach EU trade laws, while Portuguese health minister Fernando Leal Da Costa tells the pan-European Lisbon addictions conference that Portugal’s decriminalisation approach is a ‘sensible and rational’ one that other countries could follow. Recovery month sees a vibrant range of activities across the UK, and Dave Marteau’s DDN piece on the risks of diverted methadone ruffles some feathers.

O DDN october CTOBER

Another month, another stark report – this time from the ACMD, whose second publication on opioid replacement therapy for the Inter-Ministerial Group on Drugs warns that heroin treatment is being threatened by diminishing resources and constant rounds of ‘disruptive re-procurement’. Another group of MPs, the Home Affairs Committee, concludes that the government is rushing, and weakening, its psychoactive substances legislation, while Phoenix Futures cautions that people’s recovery is under threat from a ‘perfect storm’ of conditions in the UK’s over-heated rental market.

NOVEMBER

Chemsex hits the national headlines when a BMJ editorial calls it a ‘public health priority’ and a scathing report from the Institute of Alcohol Studies says the government’s ‘laughable’ public health responsibility deal for alcohol may be ‘worsening’ the health of the nation. Stirling University’s Rowdy Yates tells DDN that it’s time to get over the ‘residential bad, community good’ attitude, while Ian Sherwood writes that the sector needs to be braver in calling for drug law reform. The government’s spending review makes more cuts to cash-strapped local authorities, sending further shivers through a drug treatment sector expecting the worst and increasing demand for a meaningful drug strategy in the new year.

DECEMBER

Plans are already well under way for the ninth national service user involvement conference, Get the picture. See you there!

Festive Cheer

Features

DDN

December 7, 2015

This Christmas day will see the fifth Bubic Christmas dinner for our service users. Previous years’ events have been a huge success and provided a welcome and warm environment with a great community atmosphere.

Bubic (Bringing Unity Back Into the Community) is an award winning community-based organisation that provides support for drug users, ex-drug users, their families and friends. Our strength lies in our approach. We work in and around communities encouraging peer mentors to give those who are using drugs practical advice and emotional support to help change their lifestyle and learn life skills.

The Christmas Day event for our service users and volunteers is to help support them through an emotionally difficult time of year, with a full Christmas dinner served to 50 or more individuals. ‘It’s a worthwhile, charitable and peaceful event says Derwyn, a Bubic volunteer mentor and ex-service-user. ‘I enjoyed being a part of last year’s festivities and am eagerly anticipating this year’s event.’

In true Bubic style, the event is a community initiative and is only possible through the donation of people’s time and effort. A big thank you to organisations from within the community, including local Sainsbury’s stores in Tottenham, who support Bubic through providing donations. Haringey Mencap not only donate the use of their beautiful Grade II listed building but also assist, alongside Bubic’s staff and volunteers, in setting up for the event on Christmas Eve and provide transportation for our service users on Christmas Day.

John, a Haringey Recovery Service user, volunteered on Christmas Day last year. ‘I was struck by the diversity of the group, from single men like me to single women and couples, from the elderly to families, people with young children and babies, to people whom society has chosen to forget,’ he told The Worm magazine (featured in DDN, November, page 10).

Bubic prides itself on providing a platform from which members of our community can raise themselves up and aspire to greater things. Those who have previously encountered negative responses due to past behaviour and criminal records are given opportunity, and through proving their skills and abilities with Bubic, move onwards and upwards. Mark Nash, now a successful programme manager both in prison and the community, says, ‘Coming through Bubic gave me a platform. If there was no Bubic there would be no-one to assist those coming out of prison.’

With Bubic gaining centre recognition from Gateway Qualifications, followed by direct claims status in 2015, we are now able to further build on this platform by providing relevant, recognised, bite-size qualifications that are achievable within a matter of weeks. These qualifications centre on increasing your confidence and self-awareness, learning new skills and enhancing existing knowledge with the goal of helping others within your community. They embody what Bubic is about and provide a recognised next step in the recovery process for our service users, as well as an opportunity for others to educate themselves and give back to their community.

We’re also planning to further expand our outreach programme, which is essential to our organisation as it enables us to connect with the hard-to-reach clients; we bring the service to them. Our client Dodger recalls, ‘Bubic have engaged me in the snow, when it was cold. They’ve come into crack houses and given me food and supported me in the early hours of the morning.’

We go where others fear to tread!

Contact Bubic at www.bubic.org.uk or 020 8808 6550 for further details about services – or if you are a service user in Haringey and would like to join them for Christmas dinner