March 13, 2017

The opening session of the tenth DDN service user conference, One Life, mixed stark reflections on drug-related deaths and budget cuts with powerful exhortations to make sure the service user voice was properly heard.

Chris Robin: I don’t know what’s left to cut.

‘Looking back over the last ten years, there’s been so many cuts that I don’t know what’s left to cut,’ Chris Robin of Janus Solutions told delegates as he introduced the opening session of One Life. Service users, however, had come a long way in those ten years. ‘They know want they want, and they have a voice,’ he said.

There had been far more money in the system a decade ago, he told the conference. ‘But I’m not sure we made the most of the money we had, and maybe we’re paying the price now.’ Services had been forced into ‘unhealthy competition’ with each other, which inevitably meant that clients were losing out, while drug workers had huge caseloads and were effectively becoming mental health counsellors, housing officers and more in addition to their core work. ‘Where do they get the time to actually talk about the client’s drug use?’ What’s more, the workers themselves were also feeling extremely insecure about their future, he stressed.

‘We’re seeing so many services being re-commissioned – there’s a real need for stability,’ he stated. ‘And again, the honest question we have to ask ourselves is, “when the money was available, did we do the right thing?”’

The financial climate had forced services to be more creative and innovative, however, and to tailor their designs to the needs of their clients. ‘It’s no longer possible to get away with just offering generic services. We talk about the evidence base, but we have to open the door and create space for new kinds of evidence.

‘There’s nothing negative about service user involvement, but we can’t allow a situation where service users are running the projects while the professionals sit back and let them get on with it,’ he continued. ‘We’ve got to give workers the power to be more authentic, and to relate back to what they see.’

Annette Dale-Perera: Deaths among the over-40s are going up exponentially.

One of the most disturbing developments in the decade since the first DDN service user conference has been the increase in drug-related fatalities in the last few years, delegates heard.‘At the ACMD [Advisory Council on the Misuse of Drugs] we’re really, really worried about the trends we’re seeing in drug-related deaths,’ chair of its recovery committee, Annette Dale-Perera, told the conference. ‘We advise the government. They don’t listen to us most of the time, but we still tell them things.’

The ACMD had carried out work on opioid-related deaths because it was able to say things that Public Health England (PHE) couldn’t, she told delegates. ‘However, the data is not very good – it’s based on coroner reports and it’s not a consistent system. The data coming out of Wales is much better than what’s published in England and Scotland.’

There had been 1,842 opioid-related deaths in England alone in 2015, she told the conference. ‘That’s massive.’ Previously, the numbers had been increasing until 2001, the point at which more money started to come into the system and deaths had started to come down – ‘a direct correlation’, she said. The ‘heroin drought’ of 2009 to 2011 had also meant fewer fatalities, but the death toll had been increasing since then, she warned.

‘Deaths in the under-30s have been going down – that’s good, that’s a success story – but deaths among the over-40s have been going up exponentially. Far, far more men are dying, but the numbers are creeping up among women as well.’ The vast majority of those dying were either not in treatment at the time, or had never been in treatment, she stressed. ‘Treatment is protective.’

Some of the deaths were undoubtedly being driven by supply – ‘deaths go down when the heroin supply goes down’ – and, worryingly, Afghanistan had seen ‘bumper’ opium crops recently (DDN, November 2016, page 4). However, many of the fatalities were the result of the impact of long-term heroin use and its associations with chronic health conditions, poor diet, smoking and heavy drinking.

Someone who had been smoking for 25 to 30 years would have a substantially reduced lung capacity, she said, which inevitably meant they were more likely to stop breathing in an overdose situation. ‘Their livers are likely to be compromised as well, so it’s the combination with poor health and with mental health issues on top. Some people have got to the point where they don’t really care enough if they stay alive or not, and some deliberately overdose.’

Growing social deprivation was one of the key drivers, she warned, with deprived areas disproportionately suffering the effect of government cuts. ‘So it’s a double whammy.’

The ACMD also felt ‘quite strongly’ that another factor driving the deaths was constant re-commissioning, she said. ‘It’s creating transitions. People are being handed over from service to service, with different philosophies, different key workers, and the possibility of falling between the gaps.’ More cuts would inevitably be on the way, she stressed, with funding for treatment likely to reduce by 30 per cent by 2021. ‘We’ve lost harm reduction services. I’m very supportive of the recovery agenda, but we need harm reduction as well.’

The ACMD had told the government that it needed to do more to reduce supply, but its recommendation was also that levels of OST coverage must not be reduced. ‘We obviously need more coverage, not less,’ she said, but it was important that this went hand-in-hand with more action to prevent overdoses, such as naloxone provision and training, supervised injection facilities, and more to improve the physical and mental health of drug users.

‘You have a right to non-discriminatory treatment and healthcare,’ she told delegates. ‘Challenge these cuts, use your organisations, challenge discrimination!’

Paul Hayes: Get your voice heard, challenge discrimination.

‘Important though it is to get the messages out, it’s more important to mobilise people who can make things happen – the people in this room can do that,’ agreed head of Collective Voice, Paul Hayes. ‘You should get your voice heard, and challenge discrimination. Particularly in a local authority-led environment, if you don’t make your voice heard you won’t get the results you want.’

There was a moral obligation on everyone to concentrate on these ‘early avoidable deaths’ he said, but stressed that it was ‘not just’ about overdoses. ‘There’s a far larger number of hidden cases – people with compromised livers, lungs, hearts.’ In terms of practice, therefore, it was vital to ‘identify, integrate, intervene and engage’, he told the conference.

‘You need to identify the people most at risk. Treatment providers know where they are, and we need to spend more time and resources on them. We also need to make sure there’s much better integration between treatment services and the rest of the NHS.’ Links had become fractured through a lack of integration in commissioning, he said. ‘You can’t take the background pressure on NHS services out of the equation, but there’s no reason why we can’t engage with this and challenge those fractures.’ The fractured system between commissioning for treatment in prisons and in the community was also putting people at risk, he said.

‘The first thing that needs to happen is to engage with people outside the system,’ he said. ‘Our system has a penetration of 60 per cent – one of the highest in the world – but we need to engage with the other 40 per cent.’

In the summer, Collective Voice would be publishing a short document consistent with the clinical guidelines and evidence around best practice, he said. ‘We want to get this right. In too many places, what’s being commissioned is not consistent with the evidence, the clinical guidelines, or the 2010 drug strategy.’

Clearly, all of this was in the context of ‘very, very heavy’ cuts, which were only going to get worse, he stated. ‘The most important thing to hang on to is to protect access to evidence-based treatment. It’s interesting how the shiny new tends to drive out the boring old. The stuff that gets the headlines is consumption rooms and naloxone – they’re both important, but one of the reasons things are being cut is that drug treatment is not a natural fit with public health.’

Public health was ‘population-based’ he said, and the fact that the death tolls for tobacco and alcohol were far higher than for drugs inevitably meant they would be a higher priority. ‘But you have voices. You’re at risk. Your friends and family have died. These stories need to be heard – this has to be in the mix. I hope together we’ll be able to make some impact.’

Durham police to offer heroin-assisted treatment

News

DDN

March 7, 2017

Durham Constabulary is planning to become the first police force in England to offer heroin-assisted treatment to problem drug users.

Under the proposals, people whose drug use had led to prolific offending would be able to follow a programme designed to ‘stabilise their addiction in a controlled environment’ and reduce their dependency until they stopped taking heroin altogether, said Durham police, crime and victims’ commissioner, Ron Hogg. They would also be expected to engage with conventional treatment at the same time.

‘I have asked our local public health departments to suggest a series of options which would enable us to introduce heroin-assisted treatment in the Durham area,’ he stated, with the annual cost of heroin-assisted treatment estimated at around a third of that of keeping someone in prison. ‘The aim of the initiative is to save the lives of addicts, shut down drug dealers and reduce acquisitive crime. Instead of stealing in order to fund their habit, and money flowing the organised crime gangs, addicts will be helped to recover. The costs associated with it would be saved through reduced costs in the longer term to the courts, prisons, the police, and wider society.’

Glasgow is also planning to open a consumption room and offer heroin-assisted treatment, after city officials approved the development of a business case late last year (DDN, November 2016, page 4).

The Durham scheme is likely to prove controversial, however, with an editorial in the Mail on Sunday stating that ‘law-abiding, hard-working citizens whose taxes are used to pay for heroin may feel they have been mugged by the taxman to pay for someone else’s bad behaviour’, and adding that the ‘biggest objection’ was that the plan was sponsored by a police force. ‘Their job is to uphold the law,’ it said. ‘They cannot actively help people to do something that would be illegal in other circumstances. It is a step too far.’

Take alcohol ads off the streets, Scottish Government urged

News

DDN

March 7, 2017

Alcohol advertising should be removed from streets, parks and public transport, according to a new report from Alcohol Focus Scotland. The document also wants to see a phasing out of alcohol sponsorship in sports, music and cultural events.

Advertising restrictions also need to be introduced on social media, in print and on television, says Promoting good health from childhood: reducing the impact of alcohol marketing on children in Scotland, with advertising restricted between 6am and 11pm on TV and limited to 18-certificate films in the cinema.

The measures are necessary to reduce the ‘unacceptably high’ levels of marketing that children and young people are exposed to, it states. ‘Children are very familiar with, and influenced by, alcohol brands and advertising campaigns, despite codes of practice which are supposed to protect them,’ says the organisation.

Although the report acknowledges that drinking levels among children are falling, nearly a third of children in Scotland have drunk alcohol by the age of 13, and two-thirds by 15. Alcohol marketing is ‘extensive and persuasive’, it states, with an estimated annual UK spend of around £800m. While the industry maintains that its marketing does not target children or young people, primary school pupils were found to be ‘more familiar’ with some beer brands than with the leading brands of biscuits, crisps and ice cream, the report says (DDN, March 2015, page 4).

‘An alcohol-free childhood is the healthiest and best option, yet we allow alcohol companies to reach our children from a young age,’ said Alcohol Focus Scotland’s chief executive, Alison Douglas. ‘They are seeing and hearing positive messages about alcohol when waiting for the school bus, watching the football, at the cinema or using social media. We need to create environments that foster positive choices and support children’s healthy development. We hope ministers will respond to this report and the groundswell of support for effective alcohol marketing restrictions in Scotland.’

Report at www.alcohol-focus-scotland.org.uk

DDN welcomes your letters…

Letters and Comment

DDN

March 4, 2017

We’d love to hear your views – on topics raised in the magazine, or on any other subject related to your work in the sector or experiences related to drug or alcohol treatment or use. Please send your letters to the editor by emailing claire@cjwellings.com

Off the mark?

I am sure you know the story of The Emperor’s New Clothes. Two weavers promise him a new suit that they say is invisible to those who are unfit for their positions, stupid, or incompetent. When he parades before his subjects in his new clothes, no one dares to say that they don’t see any suit of clothes on him for fear that this is how they will be seen.

Arguably this is how the treatment field has been treating recovery. Because commissioners say they want it, guidance says we should do it and everybody else says how they great they are at it, we feel we must go along for fear of being described as ‘unfit for our positions, stupid, or incompetent’.

We can talk about recovery but we can’t hide from the facts, namely:

1. The NDTMS website shows the current recovery rate for opiate users is 6.6 per cent – a drop from 8.59 per cent in 2011/12. For all service users the rate is 38.24 per cent, a rise since 2011/12 of just 3.52 per cent.

2. Drug-related deaths have risen and continue to rise. They are at their highest point since data was first collected in 1993.

I am not suggesting that aiming for recovery is wrong. I am not trying to make an argument that harm reduction is somehow better than the focus on recovery. All I am saying is that for all the talk of recovery, the evidence suggests that we are not very good at making it happen.

This isn’t just a provider issue. Commissioners have been commissioning ‘recovery focused’ services for a number of years and yet the recovery rate has dropped. As they have pushed for more recovery, and the providers have responded with plans, initiatives and service models that don’t appear to work, drug-related deaths have risen.

If you were in central government and could see that all the investment into the field was achieving an annual recovery rate that was dropping, would you continue to invest? Perhaps it’s time we all had a realistic discussion about what can be achieved before it’s too late.

Howard King, head of Inclusion

Heavy industry

In your article ‘Industrial strength’ (DDN, November 2016, page 10), I was surprised to see so much space detailing the arguments made by mostly alcohol industry and associated bodies at the recent Westminster Social Policy Forum.

Henry Ashworth of the industry-funded Portman Group stated he was disappointed not to see more representation of public health at the event, but looking at the dominance of industry-related bodies on the agenda the reason for this seems rather self apparent. Whilst I was asked to speak at the conference and agreed, I was certainly ambivalent about doing so.

I was given five minutes to speak on a fairly narrow brief, but tried to highlight some of the limitations of a continued focus on ‘partnerships’ and ‘voluntary action’ without addressing key environmental influences such as price and availability. Whilst I do not wish to see complex policy debates over-simplified or polarised, there is a clear need for caution over how policy debates are framed and influenced by different agendas.

James Morris, Alcohol Academy

‘One Life’ – the DDN National Service User Involvement Conference

DDN Conferences

DDN

March 1, 2017

Thank you to everyone who was part of the conference!

Read the conference reports here

Or watch highlights from the day below

Thank you to all organisations who sponsored and supported this year’s conference, without them it would not be possible to hold this event.

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IMPORTANT INFORMATION!

Owing to circumstances completely beyond our control the conference venue has changed to The New Bingley Hall, 1 Hockley Circus, Birmingham, West Midlands B18 5PP. www.thenewbingleyhall.co.uk

The New Bingley Hall is a top class venue located with ample free parking and is only a ten minute cab ride from Birmingham New Street Station. The timings, and all other aspects of the conference, are unchanged.

CLICK HERE TO ADD DELEGATE NAMES FOR CONFERENCE BADGES

(This link is for delegates who have all ready booked, if you still need to book places please click here)

Please do this even if you have emailed them, told us over the phone, or think your colleague has done it. The more accurate we can make this, the more badges can be ready in advance and the quicker the registration process on the day!

At a glance…

The conference is on 23 February 2017, in The New Bingley Hall Birmingham
Registration from 9am; main programme runs from 10am-4pm. Refreshments are provided along with a full curry lunch! Click here for the conference programme

Please let us know the names of who is attending (even if you have done so already via phone or email) please click here to add delegate names.

The venue is ten minutes’ cab ride from Grand Central Station (New Street) and has ample free parking. Click here for more information

Click here for online booking. This requires a debit or credit card payment, if you need to be invoiced please email ian@cjwellings.com

You can view set up information for exhibitors here. There is still time to exhibit or include inserts in the delegate bags, contact ian@cjwellings.com to find out more.

Supported by:

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Drug-related deaths are up; targeted investment is down. There is so much that we, as a community, can do to reverse this situation.

We know what works and we have the personal stories to prove it. Let’s get the message out that service user involvement is alive and well – and makes a difference.

This year’s event is the ten-year anniversary conference and our chance to demonstrate that each and every life matters.

Our programme covers all areas – new drug treatment, alcohol, mental health, naloxone, outreach, BBVs, detox, prescribing, conquering stigma – and ways that the recovery community can engage those not in treatment.

The ‘Big Discussion’ session will tackle the crucial issues and look at what we need to do about the situation. Come with your thoughts and experiences and contribute to the conference’s message that we will not be passive to the scandal of DRDs.

Take part in a highly engaging ‘conversation café’ to learn from other groups and inspirational individuals, and share ideas and initiatives.

Be part of the vibrant exhibition, showcasing your group or organisation’s activities.

Listen, speak, participate, network, and join the call for action.

It’s the biggest and best one yet. See you in Birmingham!

See the full programme here

Click here to book and secure your place.

Thinking of exhibiting?
This established and well-regarded event brings together 500 delegates – individuals, groups and services from all over the country, including the movers and shakers who make service user involvement happen and galvanise recovery communities. Do you have a product, service, or information campaign that our service user community needs to know about? Then please get in touch – we want to help you to reach them in the best way possible. Reserve your space now!

For group bookings, service user stands, and exhibition and sponsorship opportunities contact ian@cjwellings.com

Government unveils ‘landmark’ prison and courts bill

News

DDN

March 1, 2017

The government has published its prison and courts bill, which it says will pave the way for the ‘biggest overhaul of prisons in a generation’. The bill ‘underpins’ measures in the prison reform white paper (DDN, December 2016, page 5), setting in law for the first time that ‘a key purpose’ of prisons is to reform, as well as punish, offenders.

‘I want our prisons to be places of discipline, hard work and self-improvement,’ says Elizabeth Truss.

Prison governors will ‘take control’ of budgets for health, education and employment, the government says, (DDN, June 2016, page 5), and ‘will be held to account’ for getting people off drugs and into work. League tables on key areas of performance will be published from October this year, while the powers of the prisons inspectorate has also been strengthened. New prison posts will also include specialist mental health training – recent figures showed that deaths, suicides and assaults in the prison system all reached record numbers last year (DDN, February, page 4).

‘I want our prisons to be places of discipline, hard work and self-improvement, where staff are empowered to get people off drugs, improve their English and maths and get a job on release,’ said justice secretary Elizabeth Truss.

‘Commitment to rehabilitation is great progress,’ says RAPt’s CEO Mike Trace.

The commitment to rehabilitation in the proposed legislation was ‘great progress’, according to RAPt CEO Mike Trace. ‘Our experience at the front line of drug services in prisons shows that for successful rehabilitation more provision of quality, evidence-based drug treatment programmes is essential. Without tackling the fundamental issue of drug addiction in prisons, education, training and employment can have little impact for many. We know that tackling both the drug problem and employability are crucial in reducing reoffending.’

Prison and courts bill at http://services.parliament.uk/bills/2016-17/prisonsandcourts.html

Drop ‘politically motivated’ charges against drug war critic, Duterte told

News

DDN

March 1, 2017

Human Rights Watch (HRW) is calling on authorities in the Philippines to immediately drop ‘politically motivated’ charges against senator Leila de Lima, ‘one of the few lawmakers openly critical’ of president Duterte’s violent ‘war on drugs’.

Charges have been filed against de Lima (pictured below) along with her driver and others for alleged violations of the country’s drug laws, and if convicted she faces between 12 years and life in prison. The charges claim that de Lima accepted money from ‘drug lords’ and facilitated drug dealing while serving as justice secretary under the country’s former president. However, De Lima has previously conducted investigations into Duterte’s involvement in extrajudicial killings and links to death squads, and has also chaired senate committee hearings on the methods used in his crackdown on suspected drug offenders. It has been alleged that testimonies against her have been obtained through bribery.

Although the president recently announced a temporary suspension of his ‘war on drugs’ in order to address problems of police corruption (DDN, February, page 5), more than 7,000 people are estimated to have been killed since his election last year.

‘The prosecution of senator Leila de Lima is an act of political vindictiveness that debases the rule of law in the Philippines,’ said HRW’s deputy Asia director, Phelim Kine. ‘The Duterte administration seems intent on using the courts to punish prominent critics of its murderous “war on drugs”. The politically motivated case against de Lima shows how Duterte’s “war on drugs” threatens not only the thousands of people targeted, but the criminal justice and political systems. It’s more important than ever that concerned lawmakers and foreign governments step up to denounce the Duterte administration’s disregard for basic human rights.’

Bookshelf: Sober Stick Figure

Reviews

DDN

March 1, 2017

Sober Stick Figure By Amber Tozer

Published by Blink Publishing
ISBN: 9781910536636 £9.98
Review by Mark Reid.

Amber Tozer’s stick figures brilliantly follow the recovery idea of ‘keep it simple’. In just a few strokes of her pencil, the childlike pictures are a great way to show addiction for what it is – destructive: drink too much of this and you’ll end up on the deck. It helps that Amber’s commentary alongside her storyboards is by turns hilarious and caustic.

Many drunks do ‘geographicals’, jumping from one place to another trying to find themselves or, more often, to leave themselves behind and shake off the drink. Amber’s geographical takes us on a tour of the USA. It starts in her ‘hometown of Pueblo, a midsize lower-middle-class city in the foothills of Colorado’. Her mother runs the Do Drop Inn where ‘men on stools with their elbows on the bar drink one after another’. Amber always loved the attention they gave her. She then takes her drinking to New York and Los Angeles – a coast-to-coast all-inclusive of high jinks and horror stories.

Amber is spot-on describing untreated alcoholics – low self-esteem but big ego: ‘compliments made me nervous and when I did accept a compliment, I’d let it go to my head. I’d fluctuate between feeling worthless or like I was better than anyone else – nothing in between’.

Then, getting drunk, all that mental discomfort disappears and Amber enjoyed ‘laughing at something I would normally be worried about’. Amber ‘loved the manufactured feeling alcohol gave with bad ideas that I thought were 100 per cent great’.

It is a relief when Amber finally chooses recovery. Stopping is one thing. Staying stopped another. ‘I was still stuck with the reason I drank in the first place. I drank because I had obsessive negative thinking, and without alcohol I still have negative thoughts’.

Like fearing the worst. Sober Amber was dog-sitting ‘a tiny, white, fluffy Bichon poodle named Latte’. A coyote made off with him, ‘dangling from its mouth’. In shock, Amber had two thoughts: ‘a coyote turned Latte into lunch’ and ‘I get to drink over this’. Then suddenly the poodle bounds back into the garden ‘tongue poking through his huge smile’. Amber’s ‘excuse’ to drink is gone. The stick figure drawing for this is my favourite. ‘I kicked that coyote’s ass’ says Latte. Somehow he escaped. So has Amber.

Mark Reid is peer worker at Path To Recovery (P2R), Bedfordshire

A matter of conviction

Features

DDN

February 28, 2017

Tony Margetts looks at whether prison reform is heading in the right direction.

For all the wrong reasons prisons are in the news. Hardly a week goes by without a major incident, adding further pressure on governors, staff, prisoners and the still relatively new lord chancellor and secretary of state for justice, Liz Truss. While there is a great deal of consensus about the cumulative impact that budgets and staffing cuts have had since 2010, the increased presence of novel psychoactive substances – particularly synthetic cannabinoids such as ‘spice ’ – have also undoubtedly exacerbated a difficult situation.

As part of a group set up by the Royal Society of Arts (RSA) I was involved in suggesting some key reforms. A matter of conviction set out to develop a blueprint for a future community-based rehabilitative prison (DDN, November 2016, page 4). It argued that the potential impact that prisons could have on reducing reoffending and community safety has been undermined by a lack of consistent political leadership and clear purpose and that this has led to reactive policy, which has disempowered the workforce and undermined public confidence. We argued for a national rehabilitation strategy with health and wellbeing as a key component.

So what lessons can recent history on drug policy and practice have to offer in rising to this challenge and how does the Prison safety and reform white paper, published in November, seek to learn from these?

Some of our ideas have found their way into the white paper, including introducing a new duty on the secretary of state to ‘reform’, along with additional freedoms for governors and an enhanced inspection regime. But it fails to address wider links to the community or aftercare in detail and has not embraced our proposals for a phased process of devolution and the introduction of local prison boards. This approach leaves the central grip – of the National Offender Management Service – intact, while introducing greater accountability on governors, risking, we believe, a mismatch between local decision-making and central directives.

The additional investment in prison officers and some focus on workforce development is welcome and, alongside a greater emphasis on education and employment, should help to reduce demand; if people are bored, miserable and locked up for most of the time, drugs have a greater pull. Also welcome were some of the longer-term proposals including attempts to control the supply side of drug taking in prisons. The increased emphasis on local commissioning and decision-making will be accompanied by a target to reduce reoffending, and more governor involvement in health services in custody.

Prisons are not healthy places and have always had a high proportion of drug and alcohol users among their population. The provision of treatment has had to balance three considerations – the health of prisoners, reducing reoffending and the good order and running of prisons – which can create conflicts in management.

Back in the real dark past, prisons had the Prison Health Service. This responsibility was then moved to the NHS, and health services were effectively commissioned between Primary Care Trusts with the prison service acting as co-commissioners, often through local partnership boards. The prison service also directly commissioned a drug service in prisons, known as Counselling, Assessment, Referral, Advice and Throughcare, or CARATs, from the turn of this century, provided by trained prison officers in some prisons and by voluntary organisations in others. From around 2006 additional funding was provided via the NHS to commission drug treatment in prison.

In 2013 drug and alcohol treatment became part of prison healthcare and was commissioned through NHS England, reducing the role both of local drug and alcohol commissioners and prison management. Since this happened, I have been concerned that the focus on the treatment of illicit opiates, particularly heroin, in healthcare contracts left prison drug treatment services slow to respond to new patterns of drug use in prisons and did not recognise the significance of alcohol use and dependency. Prison drug treatment has been slower in adapting to changes in drug use than community services, in particular the emergence of novel psychoactive substances in prisons since 2009, the use of image and performance enhancing drugs (IPEDs), particularly anabolic steroids – whose prevalence has greatly increased in both prisons and the community – and the misuse of prescription medicines.

So what can be done? The RSA report proposed prison and community boards as a way of breaking down barriers between prisons and communities, driving longer-term strategy and enabling a locally accountable approach. It argued for an increased role for local and regional government including city mayors and police and crime commissioners (PCCs), in commissioning probation and prison services. This approach would bring services closer to communities, encourage co-commissioning and the pooling of resources and address some of the concerns regarding disinvestment.

Despite Theresa May being a champion of PCCs while at the Home Office, the white paper does not go this far and it remains to be seen what the Ministry of Justice review of probation will suggest. The focus on rehabilitation by prisons, and by implication the rest of the criminal justice system, is very welcome. It is to be hoped that we can edge towards good quality, evidence-based drug and alcohol services in prisons, which are linked to the community and are part of a wider package of measures designed to reduce further reoffending.

Tony Margetts is the substance misuse manager responsible for commissioning drug and alcohol treatment for the East Riding of Yorkshire

Resources Corner: Focus on family

Columnists

DDN

February 28, 2017

The 5-Step Method offers services a valuable tool for working with relatives, says George Allan.

Few would disagree that adult family members of people with substance problems rarely receive consistent responses across frontline agencies. Dealing with substance users leaves little space for working with ‘others’ who continue to be viewed, primarily, as providing potential support systems for recovery or as allies in dealing with childcare concerns. Lacking training, practitioners may be wary of engaging more fully with relatives. It is easier to signpost them to self-help groups; these will not suit everyone or may not provide a forum for addressing all their difficulties. However, a model has been developed which concentrates entirely on helping relatives to cope.

The 5-Step Method is present-focused. It discards the notion that the causes of substance problems inevitably lie in past family problems and views relatives as ‘ordinary people facing highly stressful circumstances’. As such, family members tend to adopt one of three coping styles – ‘standing up to it’; ‘putting up with it’; ‘becoming independent’. Each of these has advantages and disadvantages and the practitioner’s task is to help the person explore what is best for him/herself and then adopt effective coping strategies and build supportive networks. The practitioner style mirrors that used in motivational interviewing: non-judgemental; use of open questions; reflective listening etc.

The ‘steps’ are themes to be worked through with the family member:
Step 1 – listening; exploring stresses
Step 2 – providing targeted information
Step 3 – discussing coping responses
Step 4 – enhancing social supports
Step 5 – exploring what else might be needed.

The method is readily learned, and can be adapted to various settings and delivered flexibly over a shorter or longer number of sessions. It is important, however, that sufficient time is given to step 1 and that step 3 is not addressed too early.

The 5-Step Method chimes with guidance given by NICE. As the gold standard for working with relatives, commissioners should build it into every contract for services for substance users so that their family members receive due attention.

The application of the model is fully described in The 5-Step Method: Principles and practice. Coppello, A., Templeton, L., Orford, J. and Velleman, R. 2010. Drugs: Education, Prevention and Policy, 17 (s1). This supplement to the journal also contains papers exploring the development of the model and is well worth accessing in full.

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

A moment to reflect

DDN

February 28, 2017

Addaction started 50 years ago with a desperate mother writing to the paper about her son’s addiction. Much has changed but the charity’s purpose grows ever stronger, says Alistair Bohm.

Fifty years ago, the Guardian newspaper published a letter from Mollie Craven (above). Mollie’s son had been a registered heroin addict since the age of 18 and, feeling powerless to help, she wrote: ‘we parents of addicts are a neglected and ignored group.’ Her vision was for a parental support group that could research the little understood issue and support each other to find effective ways of helping children with drug problems.

That organisation was founded in 1967 as APA, standing both for the Association of Parents of Addicts, and the Association for Prevention of Addiction. Sadly, Mollie’s son died at the age of 21, but she continued her pioneering work into the 1990s, helping to influence policy in the UK. APA also continued, moving increasingly into harm reduction and treatment services throughout the heroin epidemics of the 1980s and 90s, and rebranding as Addaction in 1998.

Addaction has grown significantly since then, from 19 services in 1998 to 120 today. Staff numbers have increased ten-fold in that time, taking in nurses, doctors and pharmacists as the charity expanded its remit into more clinical work. The staff profile has also changed. The number of former service users volunteering as recovery champions has grown and the people who use Addaction services now have influence across the entire organisation, including in senior leadership settings.

Mollie Craven wrote to the newspaper about her son’s addiction. Her vision for a support group planted the roots for Addaction.

In recent years, there’s been an increasing appreciation of complex needs, expressed through mental health issues, wider physical health concerns, and higher levels of medication. We’ve also seen the emergence of new psychoactive substances, an explosion in alcohol problems, and rising mortality associated with an ageing heroin-using population. Throughout, Addaction has adapted to the environment while lobbying for a system that works more effectively, and for more people.

‘Our work is sadly more necessary than ever’: The charity’s chair, Lord Alex Carlile, looks to the challenges ahead

Addaction’s 50th anniversary is both a cause for celebration and an opportunity for reflection. Every charity should aspire to build a world in which it is no longer needed, but for Addaction that remains a distant ambition. Much has changed in 50 years, but our work is sadly more necessary than ever.

Lord Alex Carlile: Addaction’s challenges are greater than ever.

We can be proud of our successes in the UK treatment system, boasting comprehensive coverage, adherence to the evidence base, basic humanity and pragmatism. We can also take heart from the ever lower rates of heroin use over the past decade. However, in the record numbers of drug-related deaths, the estimated 1.6 million dependent drinkers and the emerging issues in young people’s mental health needs there lies a warning: the system doesn’t work for everyone, and our most vulnerable citizens deserve better.

In that sense, it was heartening to hear the prime minister’s plans to transform mental health support at the annual Charity Commission lecture. This is an issue that unites us across the political spectrum, indicating the widespread recognition that the status quo is no longer acceptable. However, rhetoric is one thing and resources quite another. Following years of underfunding and neglect, it’s essential that any plans to transform mental health provision are backed up by concrete commitment of resources. Without that, comprehensive change will be a very tall order indeed.

For Addaction’s part, we’re looking to the future with a broader offer, supporting people in all of their complexity, and taking action early to tackle harmful behaviours. We believe that our role as a charity can’t be limited to service delivery but requires us to influence policy to provide easier and more equitable access for all. Were Mollie Craven still with us today, I believe she would be immensely proud of where her letter has taken us. I believe too that she would recognise how much remains to be done.

Doe’s story

Doe’s life changed at 15 years old when she discovered her dad wasn’t her real father. ‘My mum told me I was actually the product of a rape. I’d never felt so alone and I started hating myself. If I’d had someone to talk to back then, I don’t think my life would have spiralled quite so far out of my control.’

Leaving school with few qualifications, Doe met her partner through drug taking and they got married. ‘We thought babies might make everything better. I did stop using when I was pregnant, but as soon as breastfeeding ended, it all began again. My kids didn’t have a good start. The house was disgusting, with no lightbulbs and no carpets. We would inject in front of them.’

Doe’s husband died suddenly at the age of 37. ‘I hated him for dying. I wanted that to happen to me. I was aware how awful life was, but didn’t know what to do about it.’

One morning, Doe woke at 4am with the shakes. ‘Every little bit of alcohol came back up. My body was rejecting it. I crawled downstairs to get help. I’ll never forget the look on my daughter’s face as she watched me being taken to hospital.’

Doe spent six months in rehab before attending Addaction. ‘I was terrified of the world outside. I ran the whole way from the front door of the rehab to the reception at Addaction. I’m now volunteering five days a week. Just being here for people to talk to, and inspiring them with how things can change. It’s like I’ve found my life again.

‘I’m so grateful to everyone who has supported me. I didn’t have the strength to do it for myself, because I didn’t think I was worth doing it for. I now know I am.’

Clare’s story*

‘Before it all happened I was a very independent person. I relied on nobody at all to help me through situations in life.’

Clare, 50, came to Thinkaction Merton after finding out about the service from a local group.

‘I know now I was having a breakdown. I had lost my job, and the job centre was making me even more anxious and stressed. Then I lost my home, which pushed me into a depression.’

Clare self-referred to Thinkaction. ‘I had had depression before, when my daughter left home. And I went through a nightmare with that – we were close and it really hurt. When you’re in that state, nothing really makes sense.’

Clare spoke to Hannah at Thinkaction for a number of therapy sessions on the phone and found common ground talking about photography – something she had wanted to do, but had never had the opportunity to pursue. After the third or fourth session, Clare realised that she wanted to take it up again and joined a photography club.

‘We talked about techniques to manage my thoughts. The five minute rule became very handy with getting things done, because I had also developed anxiety as well as depression. By starting tasks in small time chunks it really helped me to be calm and productive. I still use it today.

‘I’m one of those people who, before this happened to me, wouldn’t even ask my friends for help. Now I’m doing okay. I’m pushing ahead with the photography. Without Hannah digging in and finding out what I wanted to do, which I couldn’t see myself, I don’t know where I would be.’
*Clare’s name has been changed

Children’s t-shirt design competition 1993

Legal eye: ‘How can we show CQC that we provide exit pathways?’

DDN

February 28, 2017

Nicole Ridgwell of Ridouts answers your legal questions.

‘We have received criticism for not providing clear patient pathways on exit from our residential treatment service. We are very focused on aftercare and have strong relationships with fellowships and community groups – however these are informal. How should we present our evidence to demonstrate that we provide this?’

Nicole answers: While the question does not confirm whether the criticism originates from CQC, the local authority or a third party commissioner, the answer remains broadly the same: to refer to the standards against which you are being measured and ensure that you produce the evidence in the recommended format. The easiest way to demonstrate compliance is to use the language of the body assessing you.

For example, within their specialist substance misuse services provider handbook, July 2015, CQC set out their commitment to focusing on ‘transitions between services, care pathways and joint working as part of our inspections of specialist substance misuse services’. It highlights the importance of addressing both physical and mental health needs and enabling service users to achieve a good quality of life by assisting with aspects of wellbeing such as housing, employment and social participation. CQC always focuses upon the ability of services to provide a holistic person-centred approach, with integration of healthcare professionals, to meet individuals’ needs and expected outcomes.

A service looking to demonstrate compliance, therefore, would ensure their policies identify stages during treatment when post-rehab support is discussed and advice given. Care plans and patient notes should record these conversations, include evidence of when and to where individuals were signposted, and aftercare organisations should be required to provide confirmation of arrangements made with individuals prior to discharge from the service.

However, that is easier said than done if relationships are informal, and you should begin to formalise those relationships so that you do not encounter the same criticisms again. Services are expected to provide documented proof of an integrated care pathway, from initial assessment through to post-treatment referrals and aftercare plans. Your protocols should list the organisations and groups with which you have relationships and on whom you rely for aftercare, and should identify which types of service users are suitable for referral to which group. Finally, your files should demonstrate that you put those policies, procedures and protocols into practice.

In circumstances where you have yet to draft formalised policies, I would suggest obtaining as much evidence of your actual practices as possible – such as statements from the groups themselves, questionnaires completed by service users and excerpts from care notes.

The question of what appropriate aftercare looks like is a timely one. The inspection system for substance misuse services is currently being re-evaluated by CQC, with the expectation that more services will become subject to regulation than ever before; among those will be certain categories of aftercare. This may assist services by structuring expectations and reducing the chance that services are caught out by not appreciating the need for formalised policies.

Nicole Ridgwell is a solicitor at Ridouts LLP. Visit www.ridout-law.com

Send your legal queries to legal@drinkanddrugsnews.com

Government must ‘create a national strategy’ for children of alcoholics

News

DDN

February 18, 2017

The government needs to develop a national strategy for the children of alcoholics alongside properly funded local support, says the first ever manifesto for the group.

Launched at the House of Commons by the All Party Parliamentary Group (APPG) on Children of Alcoholics, A manifesto for change sets out a ten point plan to help the estimated 2.5m children affected. The document calls for improved education and training for professionals along with better awareness raising for children themselves, and more support for families with alcohol issues. It also wants to see national alcohol policy revised to focus on price and availability, as well as curbs on promotion, particularly to children.

Children living with heavy-drinking parents are Britain’s ‘innocent victims of drink’, says the document, which was written by those with first-hand experience of the issues along with policymakers and representatives of charities and health organisations.

We need to stop the cycle of alcoholism repeating through the generations, says the document.

Children of alcoholics are twice as likely as other children to have problems at school, five times more likely to develop eating disorders and three times more likely to consider suicide. ‘Worst of all, children of alcoholics are also four times more likely to become alcoholics themselves – there is a cycle of alcoholism cascading down the generations,’ it says. ‘We have to break the cycle of this terrible disease – and that starts by breaking the silence around Britain’s biggest secret scandal.’

Chaired by Liam Byrne MP, the APPG was launched last year to ‘make a difference’ (DDN, April 2016, page 7). Its research has found a ‘patchwork of poorly funded and disjointed support services at the local level’ and no local authority with a specific strategy to support children of alcoholics.

Those children affected ‘fall through the gaps’ between the adult and children’s social care systems and the public health system, says the document.

‘Children of alcoholics are currently a forgotten part of the government’s stance on alcohol,’ it states. ‘A lead from central government is essential if alcohol harm in the country is to be tackled effectively. This is essential since local government – the level at which almost all treatment and support services for alcohol harm are provided – is at the whim of central government when it comes to funding these services.’

Meanwhile, PHE has published its latest Local Alcohol Profiles for England (LAPE). Among the findings are a 2 per cent increase in mortality from chronic liver disease – 1.5 per cent among men and 2.8 per cent among women. Overall, however, gender and inequality gaps ‘persist across the updated measures showing that disproportionate levels of harm are impacting on men and the most deprived’.

APPG on children of alcoholics: a manifesto for change at liambyrne.co.uk

Local alcohol profiles for England: Feb 2017 at www.gov.uk

Winning attitude

Features

DDN

February 18, 2017

Being recognised through a national award made Catherine Larkin and Danny Hames realise the value of Inclusion’s eager adoption of a naloxone strategy.

Last November Inclusion, which is part of South Staffordshire and Shropshire NHS Foundation Trust, won the Health Service Journal award for patient safety. This was for our project titled Naloxone – Increasing Awareness, Saving Lives. As much as this award was well received – and for the team involved, a chance to stop and take pride in what had been achieved – it was also a moment to reflect on what had started back in 2009 in Birmingham.

Catherine Larkin, clinical director at Inclusion.

This was when Inclusion began issuing naloxone in its services. We were able to do this because of the expertise and knowledge our colleagues in medicines management were able to provide, a benefit from being part of an NHS organisation. It wasn’t commissioned or paid for, it started because it was clearly the right thing to do. We could do it because of the infrastructure we had alongside us, and Inclusion were willing to fund it.

Danny Hames is head of development for Inclusion.

The change in legislation that occurred in 2015 provided the catalyst for the development of a national protocol, enabling us to increase the reach of the naloxone through training frontline staff, service users and family members across all our services. We were able to take advantage of the change in legislation straight away because of the knowledge and expertise we had in our trust, and as such were the first organisation in the sector to introduce a protocol of this kind.

The benefit of all this has been that since July 2015, nearly 2,500 people have been trained to administer the kits and, so far, at least 130 lives have been saved and at least £408,000 saved to the local health economy. This has been achieved through the hard work of those involved in the project – service users, managers and staff but also through the bold actions of those who led the organisation and had the foresight and courage to enable the provision of naloxone and then be ready for the change in legislation.

The benefit of making naloxone available is clear for all to see in terms
of saving lives, and we know that for every £1 spent on naloxone it saves the health economy £14.30. However, we have also found that there are further benefits to service users’ health and wellbeing through providing an effective naloxone distribution programme. One example of this has been that we have increased and strengthened our relationships in settings where the most vulnerable service users can be reached. Hostels are a great example of this; working closely with the hostel staff, training them and the service users has meant that stronger relationships have been formed.

By providing naloxone you have a tangible and powerful intervention available to people, and the benefits are obvious. Through forming these relationships, we have then been able to offer health and wellbeing clinics in these settings and provide some of the most vulnerable with flu vaccinations. Before the naloxone programme this wouldn’t have happened, but it is just another of its benefits, raising awareness and improving a service’s ability to engage.

So the reflections from that awards night are that there is still more to do, and that an effective naloxone programme creates new opportunities to reach the most vulnerable members of our communities. It is heartening to see that the provision of naloxone in all community services is increasingly becoming an expectation and reality; however, as we enter into 2017 there are no excuses that this shouldn’t be the case across the whole UK.

There is a responsibility for commissioners, but also providers, to make sure this happens. Who pays for it and how this is achieved are problems to be solved. But there is a moral imperative it should happen, because if it isn’t solved quickly more people who use and don’t use our services will die, with all of the impact on th ose who are close to them. Surely for all of us, whether we work in the NHS, local authorities, charities or are independent providers, this cannot be tolerated.

Inclusion is committed to this and will continue to champion the use of naloxone in our services and to offer any help we can to those who want to learn from our experience.

Trauma of war

Columnists

DDN

February 18, 2017

In Germany, refugees from Syria, Iraq, Iran and Afghanistan already traumatised by war and upheaval are seeking treatment for substance dependence. What are the lessons for the UK, asks Dr Chris Ford.

Chris Ford is clinical director at International Doctors for Healthier Drug Policies (IDHDP)

I was looking forward to hearing my friend and colleague, Hans-Guenter, talking about the issues of caring for refugees who have already been traumatised by war, violence and upheaval when they presented seeking help with their substance dependence.

When Hans had told Mr A’s story there was complete silence in the room. ‘Mr A was in his mid-20s and was born and raised in Iran. His family was originally from Afghanistan, from where they had fled to the neighbouring country. When Mr A was 17, the family was expelled by the Iranian authorities and returned to Afghanistan.

There the father was killed and the mother once more battled her way with the children to Tehran. At this time Mr A began to consume theriac, as opium is called in this part of the world, and then after a while to smoke heroin. In his early twenties he was arrested and faced the choice of avoiding the expulsion of his family by registering as a “volunteer” for deployment in Syria. There he fought in the Iranian military units on the side of the Assad government.

When the heroin supply he brought along was getting low, his commander supplied him with morphine. After a shrapnel injury he returned to Iran, continued taking heroin and, for the first time, methadone. He took some methadone with him when he fled to Europe, where some months after arriving in Hamburg he relapsed and came to our clinic and asked for treatment.’

Hans-Guenter explained that over the past 25 years the clinic in Germany had seen people from at least 50 countries, including migrants and asylum seekers from Afghanistan, Iran and Turkey, partisans from the mountains of Kurdistan, refugees from the Balkan wars and from the conflicts in the former republics of the USSR.

He explained that many were treated, and had been able to establish new roots and become members of the community in Hamburg. From January 2015 to August 2016, however, one million people applied for asylum in Germany – two out of three were from Syria, Iraq, Iran and Afghanistan, and many of the men had grown up in an opium/theriac/heroin culture.

How did Hamburg cope with this large influx of refugees? It responded quickly, setting up a model system, which included consultation hours in the refugee reception centres, uniform screening for all and special places reserved for children and women.

All departments are working together, with prevention available in key languages and the police supportive. Sadly the situation isn’t like this in other areas of Germany.

Dr Hans-Guenter Meyer Thompson is a physician based in Hamburg.

Hans-Guenter then posed a number of questions, which I now pose to you:

Can we manage to gain transcultural competence in treating refugees?

Do we need special teams?

When is it the right time to take a detailed medical history of traumatic experiences?

How can we bring trauma therapy and addiction medicine together?

How can we reach the female refugees with a substance problem from these countries?

In the context of migration, should integration be defined as the fifth pillar of drug policy?

Should we develop recommendations, guidelines and best practice models for treating refugees with substance use disorders?

And in the UK: what do you provide in your area for refugees?

Which are the main groups you are seeing? How do you manage with translation?

What additional skills would you like?

Dr Chris Ford, IDHDP with Dr Hans-Guenter Meyer Thompson, Hamburg

A third of relationships affected by substance use ‘break down’

News

DDN

February 12, 2017

Thirty three per cent of relationships affected by drug or alcohol problems will eventually break down, according to research by the charity OnePlusOne in partnership with Adfam.

Of the survey sample of 100 people with substance issues, nearly 80 per cent reported arguing with their partner and more than 70 per cent said their relationship had been affected ‘to a large extent’.

More than half reported intimacy problems with their partner, while a quarter had even stopped talking to each other. However, more than 27 per cent said their relationship had become ‘stronger’ after seeking professional support.

The research forms part of the wider DWP-funded Relationship Realities project, an audio collection of stories and practical advice from people in families affected by substance use.

‘The couple relationship can be a major source of both support and worry for the many people around the country negatively affected by someone else’s drug or alcohol use,’ said Adfam chief executive Vivienne Evans. ‘Relationship Realities shines the light of real life experience on this issue to reveal the many challenges but, crucially, the amazing resilience and support the relationships can provide – especially with a little bit of help. If they resonate with you then please do reach out for support.’

Relationship Realities project at www.adfam.org.uk/couple_relationships

‘Unprecedented’ purity levels for heroin, cocaine and ecstasy

News

DDN

February 12, 2017

Heroin, cocaine, crack cocaine and MDMA are now being sold at ‘unprecedented’ levels of purity, according to the latest DrugWise survey of the UK’s street drugs market. This confirms a trend of rising purity levels detected since 2014, says Highways and buyways: a snapshot of UK drug scenes 2016, which is based on interviews with police officers, treatment staff and researchers from more than 30 organisations across the country.

While heroin purity had reached 40 per cent three years ago, following the ‘drought’ of 2010, purity levels of up to 60 per cent are now being quoted, the document states, with drug tests also ‘regularly’ reporting ecstasy pills containing MDMA doses of 150mg and above.

The document adds that while the ‘primary aims’ of last year’s controversial Psychoactive Substances Act (DDN, June 2016, page 4) had been achieved – closing ‘head shops’ and putting an end to the ‘legal cat and mouse game’ whereby chemists would simply tweak the formula each time a drug was banned – synthetic cannabinoids have now become firmly established as street drugs in some areas, causing ‘continuing problems for vulnerable groups’ like rough sleepers and prisoners. ‘‘Spice’’ is being added to the menu of multi-commodity dealers who trade in heroin and crack,’ says the document, which also found reports of people ‘self-medicating’ with heroin to counter the effects of the synthetic cannabinoids.

The report also finds further evidence of the shifting nature of drug distribution – with inner city dealers taking over dealing networks in new areas – and continuing ‘significant’ non-medical use of prescription and over-the-counter drugs. Treatment staff also reported increasing numbers of people presenting with cannabis as their primary drug problem, it says.

‘The title of the report reflects the very diverse nature of non-medical and recreational drug use in the UK,’ said DrugWise director Harry Shapiro. ‘Spice as a street drug adds another layer of complexity and is a concern, especially as the numbers of those rough sleeping continue to rise. But some of those interviewed thought that once former stocks of head shop spice sold onto the streets were exhausted, the bad reputation earned by spice might see use diminish.

‘Other concerns are the strength of some street drugs which interviewees ascribed mainly to drug gangs competing for customers while fuelling the recent rise in drug-related deaths and also the huge amount of opiate painkillers and tranquillisers in circulation both from legitimate medical and illicit sources,’ he continued. ‘All of which underlines the need to retain investment in drug treatment and mental health capacity, allowing the creation of new services to meet the challenges of an ever-changing drug market.’

Report at www.drugwise.org.uk

Adjusting the focus

DDN

February 12, 2017

Change, grow, live’s executive director of health and social care, Mark Moody, tells DDN about the organisation’s change of name and what it signifies.

‘I think it’s much more representative of who we are,’ says Mark Moody of the name ‘change, grow, live’ (CGL).

CGL’s change of identity is pragmatic and positive, says Mark Moody.

It’s coming up to a year since the organisation, which had developed through working with people who accessed it via offender housing or arrest referral schemes, decided to stop calling itself Crime Reduction Initiatives (CRI). ‘The scope of what we do had grown massively beyond that and the old name wasn’t representative,’ he says. ‘With alcohol services and young people’s services particularly, it’s quite a low number of people who come to us via a criminal justice route.’

Perhaps surprisingly, the people who most felt a name change was in order were the staff. ‘Service users would sometimes say they didn’t much like it, but if their experience was good they got over it quickly. But we did identify that for some it was a barrier – just one more thing to make them wonder “do I really want to go to this place?”’ Everyone refers to it as a rebranding, but for me the name should be what you do. It’s just calling it something that makes it more attractive to people who might need us.’

As well as moving away from the original criminal justice focus, ‘change, grow, live’ reflects a belief that change is something anyone is capable of. Was this more positive slant in any way a response to the ongoing challenges facing the sector? ‘It’s more about the way we choose to deliver the services,’ he says. ‘All providers have gone through the journey of much more recovery-focused services, with an emphasis on doing things with people rather than to them. I strongly believe that the way we deliver services now is just better than it was ten years ago, even if there was more money in the system then. I think we would be doing things this way regardless of the challenges, financial or otherwise. So it’s more about the opportunities.’

The new identity could be defined as a ‘pragmatic and realistic positivity’ for both service users and staff, he says, and it’s been well received. ‘There’s been a bit of joshing on social media – I’ve heard us called ‘Eat Pray Love’ and someone told me we sounded like a charity for disenfranchised horticulturists, but I haven’t spoken to anyone who thinks we should have hung on to the old name. We consulted staff, service users, external commissioners, and people really do think it articulates what we do and how we do it.’

So has it led to a renewed sense of focus or energy? ‘It’s already a very focused and energetic organisation, but I think there was a relief to get past something that had become an unwanted distraction – occasionally we’d find ourselves having the whole “this is why we’re called that” conversation – and it does provide an opportunity to get the message out there to the people who need us. When you do something like this you’re kind of forced to put your head over the parapet a bit, so it’s probably encouraged us to be more outward looking. Despite the size of the organisation, historically we’ve probably been less visible on a national scale than some other organisations. All the emphasis has been on local services, and even now a lot of people accessing our local services won’t have a clue who’s running them, because they have branding that’s relevant to their community.’

So how would he define the organisation’s vision and strategy for the coming years? ‘I think the most important thing is that we continue to focus on delivering services of the quality that people really require. It’s no secret to anyone that there are cuts to funding, but I think if you continue to do things the way you always have, but with less funding, then simple arithmetic tells you that you’re going to have a worse service. So it’s the importance of really looking at what works and at innovation – investment in technology to allow us to work more out in communities and so on. Just getting a lot smarter about the way we use resources and stealing some business practices from the private sector but retaining the charitable ethos. It’s about being prudent, innovative, looking at different ways to do things.’

Part of this comes from ‘truly embracing the recovery ethos’, he states. ‘For me, running a recovery-oriented organisation is not about being an organisation that just deals with a narrow set of problems, but one that exists to help people get past their immediate challenges and move on to have the kind of life they wanted. We’ve never been solely a substance misuse organisation – we’ve always done other things, like domestic violence, family services, homelessness. Even if someone’s presenting problem is substance misuse, living the life they want is about a whole lot of things beyond that – housing, social connections, jobs, the stuff that makes it possible to be a happy person. Mostly the substance misuse part is a symptom.

‘So the way we do things would have changed whether there was a change in the funding scenario or not. You learn as you do this work that the way you’ve always done it might be OK, but there’s always a way to be better.’

Safe Corner

Features

DDN

February 12, 2017

What would persuade a city to accept a drug consumption room? Natalie Davies examines the argument.

Glasgow could become the site of the UK’s first drug consumption room (DDN, November 2016, page 4) in response to visible public injecting and a spike in HIV infections in the city. Brighton floated the idea in 2014, but despite 50 cities in mainland Europe having opened rooms, concluded that the time was not right. So what lay behind their decision, and how could the story end differently in Glasgow?

The decision on whether drug consumption rooms are introduced will come down to how the debate is framed, says Natalie Davies.

Brighton was known for having one of the UK’s highest rates of drug-related deaths, prompting its Independent Drugs Commission to recommend in April 2013 that ‘where it is not possible to stop users from taking risks, it is better that they have access to safe, clean premises, rather than administer drugs on the streets or in residential settings’. A working group was set up to investigate the feasibility, but a year later delivered their verdict that it was not a priority.

As well as other options to meet the needs of drug users and the wider community, there were, they felt, inconsistencies between drug consumption rooms and the prevailing policies of enforcement and abstinence-based recovery.

One critical issue for the group was whether a drug consumption room could operate legally in the UK, and if so, what would be required. The UK Misuse of Drugs Act makes it illegal to allow drug dealing or production on your premises, but when it comes to using drugs, only the smoking of cannabis or opium must be prevented – premises owners do not contravene the act by allowing the possession or injecting of controlled drugs like heroin or cocaine.

Yet, based on statements from Sussex Police (a key stakeholder), the Home Office, and the Association of Chief Police Officers (ACPO), the working group determined that drug consumption rooms were ‘unlawful’. The fact that the room’s potential users would be breaking the law by possessing controlled drugs was somehow conflated with the legality of the rooms themselves.

Sussex Police said officers could use their discretion, but had ‘fundamental concerns’. Deploying the pejorative term ‘shooting galleries’, ACPO feared such facilities could ‘impact on local communities as a whole, attracting drug users to one area and also create a hotspot for associated criminality and anti-social behaviour’. Though understandable, ‘hotspot’ fears have invariably been contradicted by the evidence; most consumption-room users live locally.

Without a ‘local accord’ between police and other stakeholders, the proposal failed the test of feasibility. Resistance was attributed partly to a ‘shift in focus for substance misuse services from harm reduction to recovery [which placed…] a greater emphasis on abstinence’. It was unclear whether stakeholders were themselves aligned with the values of abstinence-based recovery, or whether the policy and funding climate was forcing their hand. Brighton’s local paper The Argus reported that weeks after the feasibility study was launched, several stakeholders spoke out against drug consumption rooms, including Andy Winter, chief executive of Brighton Housing Trust, who wanted to see ‘something far more positive [done] with addiction and recovery’. Frustrated at what he considered a ‘distraction’ from ‘recovery, treatment and abstinence’, he resolved to ‘oppose any further waste of public funds, time and effort on exploring [their] feasibility’.

According to the final report of the Independent Drugs Commission in May 2014, the working group concluded that drug consumption rooms would have ‘little impact on the types of factors contributing to deaths in the city’. While some injectors could benefit, ‘the overall need for the local community’ did not warrant this new type of service – particularly as ‘the improvement in the number of drug related deaths [in Brighton] since 2009 suggested that the current strategies [were] having an impact’. Yet there was little appreciation that effective mainstream strategies may be inaccessible to people who would use drug consumption rooms, leaving a vulnerable cohort.

Drug consumption rooms are typically aimed at socially excluded drug users who would otherwise be injecting in public places or unsafe domestic settings. This includes sex workers, homeless people, and those who have never been in treatment. The bubble of acceptance within the four walls of a drug consumption room not only supports users to inject safely, but provides a link to vital health and social care services, including addiction treatment. Admittedly, this acceptance of drug-taking is not an easy message to sell, and even areas with flourishing needle exchange and naloxone programmes would probably consider drug consumption rooms a ‘big leap’. But what many struggle to understand is how consumption rooms can provoke more controversy than people dying from preventable fatal overdoses.

Drug consumption rooms may not be the answer to addiction, but they are a humane solution to public injecting. In the end, the decision about whether to introduce drug consumption rooms in Glasgow may come down to how the debate is framed – the extent to which local stakeholders are looking at the opportunities of extending harm reduction among vulnerable, marginalised, and socially excluded injectors. If, as in Brighton, they view them through the lenses of enforcement and recovery, the project could stop before it has started, and the human cost of public injecting will continue to stack up.

Full story and citations at: http://findings.org.uk/PHP/dl.php?file=hot_rooms.hot&s=dd

Natalie Davies is assistant editor at Drug and Alcohol Findings, http://findings.org.uk

Making choice real

DDN

February 8, 2017

How can we improve the range of options available to bring more people into services, asks DDN.

The options that exist for drug treatment surely influence a person’s choice on whether to enter treatment at all. Broadly speaking there’s the pharmacotherapy option, using one of two main drugs as opioid substitution therapy (OST) – methadone or buprenorphine or both at different times – and there’s psychosocial support. Both are vital components in the package of support that people may need at different times in their lives to help reduce or end illicit ‘problem’ drug use. But there’s an unhelpful polarity that exists between interventions targeting immediate abstinence, and substitution treatments promoting stabilisation and harm reduction.

The use of OST has for a long time been challenged politically and through mainstream media. This cultural opposition, despite a strong evidence base for harm reduction, suggests that politicians and the public are still not fully aware of the benefits of this treatment approach.

In 2010 the (UK) drug strategy made clear the government’s concern that ‘for too many people currently on a substitute prescription, what should be the first step on the journey to recovery risks ending there’ and that it wanted to ‘ensure that all those on a substitute prescription engage in recovery activities’. Two years earlier in 2008, the Scottish Government published The Road to Recovery, stating ‘Recovery is a process through which an individual is enabled to move on from their problem drug use towards a drug-free life and become an active and contributing member of society’. Both strategies were essentially saying the same thing; drug treatment MUST be about becoming illicit or problem drug free, with the ideal being abstinent from drugs/alcohol.

The UK drug treatment sector refocus was sharp, and the proactive involvement of abstinence-based fellowships, groups and programmes proliferated. The sector was rebranded to reflect this aspiration and the lexicon was changed. ‘Recovery outcomes’ replaced treatment retention goals, and recovery coaches and mentors were set to support the change. It brought about the showcasing of visible abstinence-based recovery in the community and let communities see that ‘people can and do recover’. Services became places for working towards ending illicit drug use and OST prescriptions, and exiting drug free in a timely fashion.

The government’s drug strategies would also influence clinical management and pharmacotherapy protocols, as noted in Medications in Recovery: re-orientating drug dependence treatment: ‘The task was to provide guidance to clinicians and agencies so they can help individuals on opioid substitution treatment (OST) achieve their fullest personal recovery, improve support for long-term recovery, and avoid unplanned drift into open-ended maintenance prescribing’.

But there’s a significant problem with this, believes Stephen Malloy, who as a trainer, consultant and volunteer board member of the International Network of People who use Drugs (INPUD), has an insight into the disparate interests of stakeholders.

‘The current paradigm dictates that the individual’s choice is simple – to engage with treatment and progress towards becoming a drug-free and active member of society, or not to engage. There’s no “half way” option… if you’re not compliant then it’s quite likely you’ll be exited from the service.’

Considering that the person making the decision to enter treatment could be motivated by an acute crisis in their lives, it’s a tough commitment to make.

‘Charities and commissioned services must have on their governing board representatives from the population they’re seeking to treat and support.’ Stephen Malloy

‘Suppose you’re a 40-something heroin user and you’ve been in and out of treatment several times over the last 20 years,’ he says, by way of example. ‘Your health is failing and you’re experiencing withdrawals from a break in supply of heroin on the street and there’s lots of other difficult stuff going on in your life, so you present at a drug service looking for a script. Imagine saying, “well I’m only looking for a script to keep things stable. I might continue to smoke cannabis, I might still have a drink now and again, and I want a bit of flexibility in my prescribing, because I might use illicit heroin again”.

‘I’m quite sure that the prescriber would explain that this would be impossible because of the risks attached to using on top of a prescription, in addition to prescribing being tied to compliance with a recovery programme and drug testing. So instead of saying this – which may be a fairer representation of where you are at – you agree to engage with a programme that you may not be “ready” for.’

Malloy meets ‘lots of people in this situation’, who appear to engage effectively with treatment until the crisis has passed. ‘Then it’s a question of what happens next. Signs of returning to illicit drug use, or noncompliance with any recovery programme activity will likely bring about challenge by the service. Continued noncompliance will see you detoxed and exited from the services.’

Saying whatever needs to be said to get treatment can completely undermine ‘one of the key factors that is pivotal to progress’ – the relationship with workers or care providers, he says. ‘That relationship has to begin with honesty.’ And for it to be honest, the person must have choices that are viable.

Fundamentally, we still don’t know enough about what motivates an individual to access treatment, he says, and so drug-related deaths (DRDs) continue to rise, with many of these people not in touch with treatment services.

Scotland’s system of having a drugs death database offers insight through ‘a kind of social autopsy’, he explains. This shows whether the person was working, their economic circumstances and whether they had been in treatment and on OST. It also looks at whether they had been in hospital recently or in touch with a GP, ‘and what you routinely see is that 70 per cent of the people who die were in touch with some form of service in the six months before their death’ – maybe a GP, hospital, community psychiatric nurse, or mental health care worker. Figures from 2014 show that only around a third of people were prescribed ORT (predominantly methadone) at the time of death.

With more than 100,000 people accessing OST on a daily basis, this still represents ‘a very significant community’ who are working to ‘stay compliant’ (or not get caught if they’re not) within prescribing and dispensing regimes. Concern about misuse has seen the pharmaceutical industry introduce medicines with ‘abuse deterrents’ added (naloxone’s addition to buprenorphine, for example) ostensibly to prevent their injection or reduce the chances of diversion. Urine screening takes place routinely to corroborate what the client is saying. Malloy is disturbed that ‘recovery workers who’ve been through treatment programmes themselves are now being coached to catch someone else’.

Even The language around OST is negative, he points out – ‘nobody likes you going to the chemist for that’, or ‘you’re not in recovery’. This, coupled with the broader stigma attached to OST, ‘doesn’t frame drug treatment as a particularly attractive prospect, when everything around it is about squeezing you out of it.’

With the pharmaceutical industry racing to develop forms of OST – such as fast-dissolving buprenorphine products, which offer additional benefits to clients and healthcare professionals, and which are easier to dispense, supervise and consume – he believes it’s never been more important to understand what’s driving each new development: ‘Is it about patient acceptability, clinical effectiveness, cost effectiveness, or systems compliance?’ Alongside current and new forms of oral (sublingual or on the tongue) buprenorphine we are familiar with, we may see longer acting formulations – implanted pellet-type formulations and depot injections.

‘For the person whose life depends on it, the situation could not be more crucial and requires a fundamental shake-up in the way we view and engage people who use drugs, those receiving OST medicines, service users and patients,’ says Malloy.

He throws a challenge to the treatment sector: ‘charities and commissioned services must have on their governing board representatives from the population they’re seeking to treat and support. At the moment we might hear, “we consulted with service users” – but they don’t actually empower them to be involved in the decision-making. You’re back to a rather paternalistic approach of “here’s what we’ll do for you”.’

Further to this, ‘the pharma and regulatory industry has to make greater efforts to engage the patient population,’ he says. A way forward could be through community advisory boards for OST patients and drug users to learn about the regulatory machinery for newly developed drugs.

‘We have to start having this conversation,’ says Malloy. ‘Because the market is changing – and if we don’t respond to some of these changes, they will be imposed on us. We’ll find ourselves with options that very few people will properly understand or have been consulted on.’

This article has been produced with support from Martindale Pharma, which has not influenced the content in any way.

Alcohol deaths up again

News

DDN

February 8, 2017

There were 8,758 alcohol-related deaths in the UK in 2015, according the latest ONS figures, a slight increase from 8,697 the preceding year. The figures are nearly double the 4,929 deaths recorded 20 years previously, however.

Nearly two thirds of the deaths were among men, and both male and female death rates were highest in the 55-64 age range. Scotland remains the UK country with the highest death rates, although these have been falling since their peak in the early 2000s.

‘We need measures which address the pocket money prices alcohol is being sold,’ says Professor Sir Ian Gilmore.

‘Despite recent falls in overall alcohol consumption, the upward trend of alcohol-related deaths persists,’ said chair of the Alcohol Health Alliance, Professor Sir Ian Gilmore. ‘We know that alcohol is the third largest risk factor for disability and disease, and the biggest risk factor for death, ill-health and disability for people aged 15-49. Yet the UK government has yet to implement the measures needed to lower this burden of alcohol-related mortality. We need measures which address the pocket money prices alcohol is being sold at, the 24 hour availability of alcohol, and its heavy marketing.’

The alliance is calling on the chancellor to use next month’s spring budget to increase the duty on ‘cheap, high-strength cider’ and introduce a minimum unit price, ‘which we know would reduce consumption and in doing so, the attendant harm’, said Gilmore.

Meanwhile, the latest Department for Transport figures show an increase in drink-driving casualties and no improvement in drink driving-related deaths since the beginning of the decade. There were 8,480 drink-drive casualties in 2015 – 3 per cent up on the previous year – along with around 220 deaths.

Campaigners have long been calling for the government to lower the drink-drive limit in England and Wales in line with other European countries. ‘The government have taken their eye off the ball, and need to listen to the overwhelming evidence that a lower drink driving limit would save lives and improve road safety,’ said senior research and policy officer at the Institute of Alcohol Studies, Jon Foster. ‘There is huge professional and public support for this.’

Alcohol-related deaths in the UK registered in 2015 at www.ons.gov.uk

Reported road casualties in Great Britain: estimates for accidents involving illegal alcohol levels 2015 at www.gov.uk

By hook or by crook

DDN

February 7, 2017

We’re not reaching people with problematic cannabis use says Lizzie McCulloch, whose report Black sheep offers a new approach to policy and treatment.

Cannabis is now being cited as a problematic substance by 21 per cent of clients going through treatment and figures from Public Health England (PHE) show that new presentations for cannabis treatment increased by 55 per cent between 2005 and 2014. These figures do not paint the whole picture though, as there are also thousands of people outside of treatment who require support.

In response to indicators showing there is an increasing need for support and guidance, Volteface, a drug policy think tank, wanted to find out how effectively existing interventions were supporting people experiencing problematic cannabis use. Drawing on contributions from leading experts and practitioners, and people with lived experience of problematic cannabis use, our newly released report, Black sheep, shines a spotlight on the harms of heavy and sustained cannabis use.

Put bluntly, we found that cannabis has been neglected in public health discourses, which is at odds with the growing number of people in England who are seeking support for problematic cannabis use. It was apparent that there has been increasing attention given to problematic cannabis use, mostly at an operational level, but overall, cannabis has not been appropriately prioritised. What is concerning is that out of non-opiate clients accessing treatment, cannabis users were the most likely to have unchanged use at the six-month review, which equated to 42 per cent of those who entered treatment.

For people who do not enter treatment, it was revealed that the ‘image’ of treatment was off-putting, whether due to social stigma surrounding treatment or the perception that treatment was only for ‘extreme’ cases. However, alternative options were limited as one-to-one interventions were mostly confined to dedicated drug treatment services, with wider community services severely limited in what they could offer. For people who are seeking to manage their cannabis use relatively independently, there are limited public resources available, with added concerns over quality and accessibility.

A unified and multifaceted approach is needed to respond to the cannabis cohort. A wider structural barrier that stakeholders identified, however, was that practitioners do not have a clear strategy for linking people experiencing problematic cannabis use into services. With the current illegal and unregulated market reducing the visibility of cannabis users, one practitioner commented that ‘we’re just fumbling around in the dark trying to find them’. Among people showing signs of cannabis dependence, only ‘14.6 per cent had ever received treatment, help or support specifically because of their drug use, and 5.5 per cent had received this in the past six months’.

To respond to these challenges, Volteface have drawn up sensible, innovative policy options, which are grounded in contributions from stakeholders and experts. We identified that a two-stage approach is needed: reforming existing public health measures to tailor support to the needs of problematic cannabis users and the introduction of a regulatory framework that links these public health measures with their intended audience.

Research into the social costs of problematic cannabis use by PHE would provide justification for commissioners, and therefore providers, to appropriately prioritise cannabis within treatment. Moreover, a shift towards holistic service provision and promotion by drug and alcohol service providers and wider community services would aim to increase interaction and engagement with support, while reducing stigma attached to drug treatment.

A move towards a regulated market would offer a targeted dialogue with people experiencing problematic cannabis use, offering opportunities for harm reduction advice to be delivered at point of purchase, and any person in need of support to be linked into reformed public health measures. There would also be the emergence of wider opportunities for more public guidance, packaging controls, products that vary in potency, and research into cannabis culture and consumption. During Volteface’s consultation with people experiencing problematic cannabis use, it became apparent that respondents felt ‘advice from a professional is far better than advice from a dealer’.

Despite numerous examples of good practice taking place across the sector, the collective effort is currently not meeting the needs of people experiencing problematic cannabis use. Change is within our grasp, but we need to be ambitious and innovative when it comes to reaching a growing and diverse group of people.

Lizzie McCulloch is policy advisor at Volteface

Across the great divide

DDN

February 6, 2017

Contemplating a landscape of change and fear, HIT Hot Topics speakers called for solidarity. DDN reports.

‘When we meet someone, we ask what music they listen to – it gives us a mirror we can understand. We start to apply labels “us and them” as soon as we start to talk that language.’ Talking at the recent Hit Hot Topics conference, epidemiologist Keith Sabin suggested that we being to categorise and stigmatise without even realising it.

Even the researchers were part of the problem. ‘We put people in a box and say “these people are higher risk”. It’s a dichotomy that doesn’t need to exist. We have to overcome this language, because language becomes a perception.’

With Donald Trump’s election victory newly sinking in, the threat of division and alienation felt raw to many of the speakers and delegates.

‘The war on drugs is an efficient and effective umbrella for genocide,’ said US activist Deborah Peterson Small. ‘The goal is to eliminate people, and what’s happening in the Philippines is the logical extension. It’s not just the actions of a mad man – it’s happening all over the world… if you think Duterte is an aberration, think again. Read your history – all the conditions before World War Two are in place now.’

Furthermore, she said, the media talked about ‘this stuff’ as if it was normal. ‘But Trump and his hostility to drugs and drug policy is no joke.’

So what do we do to stop this slide into the abyss? Neuroscientist Dr Carl Hart drew a positive from the shock election result.

‘The progressives fell asleep under the Obama administration… maybe now they’ll wake up!’ he said. ‘We claimed victories for things that weren’t victories. You know the score with Trump. It’s best to know the score than to hear pretty lies. Go to work!’

For many of the speakers, the challenges were very clear. Magdalena Harris, qualitative sociologist at the London School of Hygiene and Tropical Medicine, brought scrutiny to the complicated scenario of hepatitis C treatment.

For the 216,000 people living with chronic hepatitis C in the UK, the revolutionary new treatment was giving them the opportunity of a 90 to 100 per cent cure rate, without the former gruelling side effects. Being able to dispense the treatment in community drug treatment settings conjured up the vision of eliminating hepatitis C in a generation.

But restricted budgets, and a list price of around £35,000 per person per course (although the price to the NHS was confidential), meant that NHS England had limited treatment slots to 10,000 a year. The 22 local area networks had just 50 slots each a month, so were having to prioritise patients with the greatest clinical need, such as those with cirrhosis.

People who inject drugs came high up on the priority list – but only because they were seen as at risk of transmitting the virus, Harris explained. ‘They are being called transmitters and tracked like salmon. This language can be very alienating.’

While reducing mortality and onward transmission were clear criteria, Harris was also concerned that other life transforming benefits of treatment were not being acknowledged, such as the change to identity and the social benefits. It was easy to lose the full picture when looking at statistics and ranking greatest clinical need.

Faye McCrory, a recently retired consultant midwife, said we should cast the net wide for the full picture.

‘What has a midwife to do with drug services?’ she said, before answering ‘Drug misuse does not sit in isolation.’ Her challenge while working at a specialist midwifery service was to get staff to treat patients ‘as women, not as drug users and prostitutes’.

Many taboos had had an impact on these women – sexual abuse, child sexual exploitation, human trafficking, sharing information, safeguarding and child protection – and there were many ethical and moral dilemmas that meant health professionals should listen without prejudice.

Researcher Aaron Goodman also had an interesting view on challenging stereotypes, presenting his digital storytelling initiative, Story Turns (www.storyturns.org). Working with people who used heroin, he involved them in workshops to make a short video telling their personal story. Instead of the ‘dark, seedy, anonymous’ portrayal of drug users, the project resulted in ‘humanising’ stories and images – the message that (in the words of one participant) ‘there’s more to me than addiction’.

Psychologist Dr Suzi Gage shared another imaginative initiative, the ‘Say why to drugs?’ project, which uses podcasts to look at the harms and the potential benefits of drugs, with ‘no judgement, no spin and no hyperbole’. Her first series, in conversation with rapper Scroobius Pip, took the conversation to young people and aimed to take them into territory where they could ask questions and build up a full and fair picture of drugs and people who use them.

The theme of changing the narrative continued, from both a UK and international perspective. Michael Shiner from the London School of Economics focused on disproportionate policing, particularly stop and search, which had ‘engulfed policing since 1980’ and intensified since the Stephen Lawrence inquiry gave police ‘more power with less accountability’.

He explained that he was part of an organisation called Stop Watch, which was trying to change the narrative around stop and search, including tackling the ‘massive disproportionality in relation to drugs’.

Maria Phelan of Harm Reduction International (HRI) widened the view to the global state of harm reduction. While there had been progress on opioid substitution therapy (OST) in Monaco, Senegal and Kenya, funding cuts – and in some cases the lack of momentum to prioritise harm reduction – had scaled down progress in many countries.

Referring to HRI’s latest biennial report, she highlighted that harm reduction in prisons ‘lies far behind what’s available in the community’, with several programmes closing since the last report and Spain being ‘the only country that has anything up to scale’.

While Europe was seen as the ‘leader of a harm reduction approach’, there had been a decrease in needle and syringe programmes in the last two years, including in Portugal – the result of its financial crisis. Hepatitis C among injecting drug users remained a serious concern.

‘There has been growth, but not fast enough,’ she said. ‘The biggest question is how do we get countries to invest and sustain funding? It’s about protecting the gains we’ve made.’

In a talk about supervised injecting facilities, the Scottish Drugs Forum’s Kirsten Horsburgh suggested that doubts about their advantages tended to relate to lack of knowledge. When presented with clear benefits (from the results of 135 research projects) and ‘myth busting’ facts, most people were persuaded that providing a sterile environment was beneficial all round and did not perpetuate drug use.

Sharing this kind of research and information was of great benefit to drug users – the ‘popular scapegoats’, according to Mat Southwell of the European Network of People who use Drugs (EuroNPUD).

‘Drug user organising is no longer seen as separate, marginalised work,’ he said. ‘Europe has a strong network of drug user activists and we realised there was a need to get our act together and mobilise… We need to seize the opportunity to be active partners – we are high level advocates and technical providers.’

Looking at developing joint advocacy plans with other networks and running simultaneous campaigns would ‘help to create more noise’ and move towards meaningful representation with government and the EU.

But above all, the close working and information-sharing had the potential of much greater results – a key message from this year’s Hot Topics.‘We are committed to solidarity,’ he said. ‘Changes can’t happen in isolation.’

Picture credit: Nigel Brunsdon.
Pics in DDN magazine by Nigel Brunsdon and Craig Hardy.

See all the new DDN features at www.drinkanddrugsnews.com

DDN February 2017

DDN

February 5, 2017

Welcome to our latest issue!

‘The situation requires a real shake-up in the way we engage’

‘We begin to categorise and stigmatise without even realising it,’ said a speaker at the recent ‘Hit Hot Topics’. Throughout the event we heard how ‘language can become perception’ and be very alienating. We also heard about people who inject drugs ‘being called transmitters and tracked like salmon’ and feeling ‘dehumanised’.

But we were also reminded of our responsibilities in actively challenging stigma and overturning myth. Public perception – relating to supervised injection facilities for instance – was found to be based on a lack of knowledge. Within the sector we have a wealth of expertise to address this.

In this issue, Natalie Davies examines the argument for consumption rooms in detail; Catherine Larkin and Danny Hames take stock of the value of a naloxone strategy; Tony Margetts evaluates the progress of prison reform; Lizzie McCulloch looks at a new approach to cannabis policy and treatment; and two of the major treatment charities explain how they are tuned to the challenges ahead.

In a climate of fear, information-sharing is our weapon to keep options open and steer policy towards life-saving gains. As Stephen Malloy says, ‘For the person whose life depends on it, the situation could not be more crucial and requires a fundamental shake-up in the way we view and engage people who use drugs, those receiving OST medicines, service users and patients.’

We’ll be challenging stigma and indifference at our tenth anniversary service user involvement conference, ‘One Life’ – hope to see you in Birmingham on 23 February!

Claire Brown, editor

Read the latest issue as PDF version or a virtual magazine

Keep in touch at @DDNmagazine

Let’s talk about sex work

News

DDN

February 4, 2017

A new guide to the legal framework around sex work has been published by Release. As well as setting out the criminal offences related to sex working,

Sex workers and the law includes advice on issues such as criminal records, welfare benefits, anti social behaviour orders, dealing the police and going to court.

The guide is aimed at people engaged in sex work as well as statutory and voluntary agencies and professionals who come into contact with those in the sex industry. There are also detailed sections on safety, sex work and drugs, sex working parents and a list of useful contacts. The booklet is written by Release’s head of legal services, and DDN contributor, Kirstie Douse, with additional input from executive director Niamh Eastwood, legal researcher Jodie Cudworth and others.

Alcohol and drugs can affect people’s awareness and ability to act on their instincts, it warns, and advises sex workers that they are at much greater risk when using either. ‘If you do use when you are working, try to use an amount that keeps you stable,’ it states. ‘Use just enough so you are not withdrawing but not so much that you are “drunk”, “gouching” or “off your head”. If you are in any of these states, you may be less likely to use your safety strategies effectively, and might be targeted by some people.’

Alongside the main booklet the charity has also produced sets of ‘rights cards’ on both indoor and outdoor sex work, summarising the main offences and people’s rights when dealing with the police.

Release’s new guide aims to keep sex workers safe and informed.

Documents at www.release.org.uk

FDAP members offered support and development by SMMGP

News

DDN

February 1, 2017

SMMGP has reassured members of the Federation of Drug and Alcohol Professionals (FDAP) that they will be fully supported throughout their takeover of the sector’s professional body, which came into effect on 1 February.

In a statement, Dr Steve Brinksman said there would be ‘as little disruption as possible during this period of transition’.

Dr Brinksman, who makes up the SMMGP management team alongside Kate Halliday and Elsa Browne (and is also DDN’s Post-its from Practice columnist) added: ‘We look forward to including FDAP members in our exciting plans this year to provide online continuing professional development (CPD).’

Plans include regular webinars and podcasts, alongside the full membership and accreditation services previously enjoyed by members.

Dr Steve Brinksman’s letter to FDAP members is in full below.

Dear FDAP member,

Welcome to FDAP members

SMMGP is a long-standing training, education and support network in the drugs and alcohol field. We work to encourage and maintain the highest standards of practice in drug and alcohol treatment and act as the voice of our membership on education, training, research and clinical standards.

SMMGP started out over 20 years ago when general practice became more involved in drug treatment. Over time, with changes in the drug and alcohol treatment field, the people in our 6000-strong network now include GPs, counsellors, psychologists, psychiatrists, drug and alcohol workers, nurses, pharmacists and people who are in treatment.

SMMGP will take over the membership and accreditation function of FDAP from the 1st February. Our aim is for there to be as little disruption as possible for FDAP members during this period of transition. This means:

The FDAP membership scheme is under new management with SMMGP, trading as Federation of Drug and Alcohol Practitioners. (The familiar FDAP logo will remain, and the website will not change significantly).
Existing FDAP membership will be transferred to SMMGP with members being invoiced on the date that their membership is due for renewal, as before. There is no need to reapply. SMMGP will adopt and uphold the FDAP Code of Conduct.
The new FDAP will adopt the accreditation process and provide the full accreditation service previously offered to members of the Federation of Drug and Alcohol Professionals, including NCAC accreditation.

Please note that SMMGP (trading as Federation of Drug and Alcohol Practitioners) will not be responsible for issues, or complaints against a Federation of Drug and Alcohol Professionals member or Affiliate Member, or any FDAP business prior to the 1^st February 2017.

We look forward to including FDAP members in our exciting plans this year to provide online continuing professional development (CPD). We will support continuing professional development by providing regular web-based learning including webinars and podcasts covering up-to-date psychosocial, clinical and policy issues.

All that remains now is to introduce you to the SMMGP management team:

Dr Steve Brinksman, our Clinical Lead, is a GP in Birmingham, Kate Halliday, Programme Lead, PGCE (FEHE) DipSW Social Work, Masters in Social Work. Elsa Browne has provided Operational Support since 2009.

SMMGP Board Trustees include Andre Geel, Consultant Clinical Psychologist (C.Psychol, CSci, AFBPsS); April Wareham, Independent Consultant/Trainer and Expert by Experience; Jim Barnard, Regional Drug Service Manager, Dip SW. We will be appointing new members to the SMMGP Board with experience to support the FDAP work.

Please ask if you have any questions, please write to us on: fdap@smmgp.org.uk

Dr Steve Brinksman, GP and Clinical Lead

Duterte temporarily suspends his ‘war on drugs’

News

DDN

January 31, 2017

Philippines president Rodrigo Duterte has announced a temporary suspension of his violent ‘war on drugs’ while he addresses the problem of police corruption.

He told a press conference that he intends to abolish the Philippine National Police’s (PNP) anti-drugs units and replace them with ‘an anti-narcotics body that will work hand in hand with the Philippine Drug Enforcement Agency (PDEA)’. The announcement follows the alleged murder of a Korean businessman on police headquarters.

Duterte came to power last May after campaign-trail promises to ‘fatten the fishes’ in Manila Bay on the bodies of dead criminals. Within a few months 3,000 people –predominantly drug dealers and drug users – were estimated to have become victims of the president’s ‘war on drugs’ (DDN, October 2016, page 8), allegedly killed either by police or state-sanctioned vigilante action. Despite widespread international condemnation, the death toll is now more than double that and Duterte has vowed to continue the policy until the end of his presidency in 2022.

Duterte has suspended his ‘war on drugs’ policy, thought to be responsible for the deaths of around 3,000 people.

Human Rights Watch has called for a UN-led independent international investigation into alleged unlawful killings by the Philippines police. ‘Suspending police anti-drug operations could reduce the killings, but they won’t stop without a meaningful investigation into the 7,000 deaths already reported,’ said the organisation’s deputy Asia director, Phelim Kine. ‘The Philippine police won’t seriously investigate themselves, so the UN should take the lead in conducting an investigation. Unless there is an independent international investigation into these killings, and soon, the already long list of grave rights violations linked to the “drug war” will only continue to grow.’

Deaths in prison hit record levels

News

DDN

January 31, 2017

Last year saw a record 354 deaths in prison custody, according to figures from the Ministry of Justice – an increase of nearly 100 from the previous year. Almost 120 were self-inflicted deaths, including 12 women, while three were homicides.

The rate of prison suicides has now doubled since 2012, says the document, while self-harm incidents also increased by nearly 7,000 to a record high of 37,784. Assault incidents were also up by more than 30 per cent, to another record high of 25,049 – almost 3,400 of which were classed as serious. Assaults on staff increased by 40 per cent, to almost 6,500, while prisoner-on-prisoner violence was up by 28 per cent to more than 18,500 incidents. Serious assaults on staff have trebled since 2012.

Responding to the statistics, justice secretary Liz Truss said that the government had taken action to ‘stabilise the estate by tackling the drugs, drones and phones that undermine security. These are long-standing issues that will not be resolved in weeks or months but our wholescale reforms will lay the groundwork to transform our prisons, reduce reoffending and make our communities safer.’

‘It is official – more people died in prisons in 2016 than in any other year on record, and more prisoners died by suicide than ever before,’ said chief executive of the Howard League for Penal Reform, Frances Crook. ‘No one should be so desperate while in the care of the state that they take their own life, and yet every three days a family is told that a loved one has died behind bars. Cutting staff and prison budgets while allowing the number of people behind bars to grow unchecked has created a toxic mix of violence, death and human misery.’

Safety in custody statistics bulletin, England and Wales, deaths in prison custody to December 2016, assaults and self-harm to September 2016 at www.gov.uk

Last year saw a record number of deaths in custody, many of them self-inflicted.

See feature in February’s DDN

Nearly two thirds of opioid users in treatment, says PHE

News

DDN

January 27, 2017

Sixty per cent of England’s opioid users are now in treatment – one of the highest reported international rates – according to an evidence review by Public Health England (PHE) which compares international research literature on treatment effectiveness to the English system. Rates of HIV infection among injecting drug users remain at just 1 per cent, it says, while 97 per cent of drug users are able to start their treatment within three weeks.

The areas where the English system were ‘not doing so well’, however, were the record rates of drug-related deaths (DDN, October, page 4) and the number of people who continue to use opiates after beginning treatment. Rates of abstinence from illicit opiates after three and six months of treatment in England stood at 46 and 48 per cent respectively, a ‘relatively poorer performance’ internationally, while the drug-related death rate was ‘substantially lower than in the USA but considerably higher than elsewhere in Europe’.

Nearly two thirds of opiate users are in treatment – but many wellbeing factors need to be addressed, says PHE

The report reiterates the importance of factors such as housing, employment and good social networks in remaining drug-free, along with properly integrated services, and states that increases in drug-related harms are largely among a ‘small but growing number of vulnerable, older entrenched heroin users’ who experience poor physical and mental health. ‘The number of drug misuse deaths has increased over the past 20 years, with a significant rise in the last three years, to the highest number on record,’ it says. ‘In the next four years, PHE estimates that there will be an increase in the proportion of people in treatment for opiate dependence who die from long-term health conditions and overdose.’

‘Local areas increasingly have to meet the complex needs of older long-term heroin users, often in poor health, with other problems – particularly housing, poor social networks and unemployment, which are vital to successful recovery,’ said PHE’s national director of health and wellbeing, Professor Kevin Fenton. ‘Services will also need to be flexible, ensuring appropriate treatment to those seeking help for the first time, particularly with emerging issues such as new psychoactive substances or the problematic use of medication.’

An evidence review of the outcomes that can be expected of drug misuse treatment in England at www.gov.uk

Figures reveal worrying increase in number of rough sleepers

News

DDN

January 27, 2017

The number of people sleeping rough in England has increased by 16 per cent in a year, according to government figures. The autumn 2016 figure was 4,134 rough sleepers, says the Department for Communities and Local Government (DCLG), compared to 3,569 in autumn 2015. The numbers are based on a ‘single night snapshot’ of street counts and ‘intelligence-driven estimates’ from local agencies such as the police, outreach workers, the voluntary sector and others.

The figures have now increased for six years in a row, and of the 4,134 rough sleepers in 2016, 17 per cent were EU nationals from outside the UK, 12 per cent were women, 7 per cent were under 25, and 3 per cent were from outside the EU.

London saw a 3 per cent increase on the previous year – to just under 1,000 people – compared to a 21 per cent increase in the rest of England, with London’s percentage of the total number of rough sleepers falling from 26 per cent to 23 cent. The local authority area with the highest number of people sleeping rough was the London borough of Westminster, at 260, followed by Brighton and Hove, at 144.

The official statistics are seen by many as an underestimate, however. According to the most recent figures from the Combined Homelessness and Information Network (CHAIN), which is managed by homelessness charity St Mungo’s, the total number of people seen sleeping rough in London by outreach workers during 2015-16 was more than 8,000 – an increase of 7 per cent on the previous year. Of those who had undergone a support needs assessment, 43 per cent had alcohol support needs, 31 per cent drug support needs and 46 per cent mental health support needs, while 13 per cent had all three.

St Mungo’s chief executive Howard Sinclair said the figures were ‘nothing short of a scandal’, while Crisis chief executive Jon Sparkes said numbers were rising at an ‘appalling’ rate. ‘Rough sleeping ruins lives, leaving people vulnerable

The number of rough sleepers in England has increased for the sixth year in a row.

to violence and abuse, and taking a dreadful toll on their mental and physical health,’ he said. ‘Our recent research has shown how rough sleepers are 17 times more likely to be victims of violence. This is no way for anyone to live. There is no time to waste. We need the government to take action on this issue, and we stand ready to work with officials to plan and deliver an ambitious new approach. It’s time we came together to put an end to this scandal – government, local authorities and charities.’

Statistics at www.gov.uk

New chief appointed for Addaction

News

DDN

January 27, 2017

Mike Dixon will take over the role of Addaction chief executive from 1 May, the organisation has announced, replacing interim chief executive Guy Pink.

Dixon is currently assistant chief executive of Citizens Advice, before which he worked as a director at Victim Support and as an advisor in a number of government departments. Addaction’s previous chief executive, Simon Antrobus, left to become head of Children in Need last year.

‘Mike has an excellent track record of working at the highest levels of government and the voluntary sector in a wide range of political, strategic and service delivery roles,’ said Addaction’s chair, Lord Alex Carlile. ‘We are confident he will bring formidable strategic vision and operational energy to Addaction. We hope that he will take us from strength to strength and greatly help in delivering our ambitious five-year strategy. On behalf of the entire board, I would like to congratulate him on his appointment. We look forward to welcoming him as leader of the team.’

Dixon said that he was ‘delighted’ to be joining Addaction. ‘For the past 50 years, its staff and volunteers have helped people take control of their lives, and pioneered new ways of solving complex problems,’ he said. ‘Under Simon Antrobus’ leadership, and during Guy Pink’s recent tenure, Addaction has grown into a broad-based, public health charity that provides drug, alcohol, mental health, young people and family services to more than 75,000 people a year. Our challenge at Addaction now is to deepen the impact of our work, use our delivery experience to help improve government policy and services, and support as many people as we can.’

FDAP members’ interests and accreditation safe with SMMGP

News

DDN

January 26, 2017

It’s business as usual for FDAP members, the organisation’s outgoing chief executive has confirmed. In a statement on 19 January that the professional body for substance misuse workers would close at the end of the month (drinkanddrugsnews.com/fdap-closes-and-transfers-functions-to-smmgp), FDAP’s board transferred all member services to SMMGP.

Carole Sharma: Member interests are fully protected

In the days following the announcement, Carole Sharma has been reiterating this position and today issued the following statement to reassure members:

‘To ensure there is no confusion about the closure of FDAP I wish to state clearly that all membership services are being transferred to SMMGP. This includes all types of accreditation and re-accreditation for individuals, service providers and educational institutions.

‘SMMGP will be writing to members soon and we are all working hard to ensure the handover is as smooth as possible.’

Better joined up working needed between treatment and child sexual abuse services

News

DDN

January 25, 2017

Around six per cent of young people seeking alcohol or drug treatment report having been the victims of sexual exploitation, according to a PHE-commissioned review of young people’s treatment services by the Children’s Society. The figure is far higher among girls, at 14 per cent, than boys, at 1 per cent.

A quarter of females starting treatment in 2015-16 reported having mental health problems, along with 15 per cent of males, while 33 per cent of females and 9 per cent of males reported having self-harmed. The review stresses that these ‘multiple vulnerabilities and complex needs’ need to be properly addressed, while ‘young people becoming young adults need to be supported as they move into adult services through appropriate transitional arrangements’.

Meanwhile, annual figures from the National Drug Treatment Monitoring System (NDTMS) show that the number of young people seeking help for substance issues has fallen to 17,000 since its peak of 24,000 just under a decade ago, with cannabis and alcohol remaining the main reasons young people needed support. While the drop in numbers was encouraging, it was important to ‘look behind the headline’ and remember that young people did not develop substance problems in isolation, said PHE’s director of alcohol, drugs and tobacco, Rosanna O’Connor.

‘For some young people these wider issues may be the cause of their substance misuse problems, and for others, a consequence,’ she said. ‘So it is vitally important that young people’s treatment services are working closely with a wide range of other children and young people’s health and social care services, to ensure that vulnerable young people have all their needs supported.’

The Children’s Society review is based partly on interviews with commissioners, service managers, alcohol and drug leads and young people in treatment, but is not ‘exhaustive’, the document acknowledges. However, the majority of professionals consulted reported that they ‘are seeing more young people with multiple vulnerabilities and complex needs in specialist substance misuse services, including mental health, child sexual exploitation and abuse, domestic abuse, and poor sexual health’.

Partnerships with child sexual exploitation and abuse support services, youth offending teams and sexual health services need to be established and developed, the document stresses, while commissioners also need to recognise that young people’s changing needs require a multi-agency approach with clear roles, accountability and lines of communication. Young people’s treatment services also need to be able to respond appropriately to child sexual exploitation and ‘offer structured identification and assessment of risk’, it says.

The picture revealed by the service review was ‘one of a mixed landscape of provision across England’, both in terms of service delivery and commissioning approaches, with increased local autonomy leading to ‘significant differences’ in provision – fully integrated with other young people’s services in some places, but evolving in a more ‘piecemeal’ fashion in others. There was also evidence of funding reductions, it states.

Specialist substance misuse services for young people: a rapid mixed methods evidence review of current provision and main principles for commissioning, and Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS): financial year ending March 2016 at www.gov.uk

Improve cooperation to tackle criminal justice system’s health inequalities

News

DDN

January 23, 2017

The mortality rate for prisoners is 50 per cent higher than for the general population, according to a new report from the Revolving Doors charity in partnership with Public Health England, NHS England and the Home Office.

Around 15 per cent of prisoners had been homeless immediately before custody and more than 40 per cent suffered from depression, says Rebalancing act, compared to a 3.5 per cent lifetime experience of homelessness and 10 per cent rates of depression among the wider population.

People in frequent contact with the criminal justice system are also four times more likely to smoke and often have ‘the biological characteristics’ of those ten years older, the document says. Aimed at local decision makers such as directors of public health and police and crime commissioners, it urges better use of existing resources such as joint commissioning or pooled budgets.

Mortality rates are much higher for prisoners than for the general population, says the new report.

The criminal justice system is ‘uniquely placed’ to tackle substance misuse and break the cycle of reoffending, it stresses, but adds that those in contact with the system ‘may be the bearers of multiple labels which carry or are perceived to carry stigma: “offender”, “mentally ill”, “homeless”, “substance abuser”, “personality disordered”. Such labels can lead to negative attitudes from professionals and act as a barrier to access or engagement with healthcare.’

PHE will be publishing revised guidance on coexisting substance misuse and mental ill health this year, the report adds, while restating the need for assessment and intervention pathways to be as integrated and streamlined as possible and, ‘where practicable, based on the principle of “no wrong door”’– that someone presenting with a mental health or substance misuse need, or combination, should be able to ‘receive a service or to be seamlessly referred no matter which service’ they access first.

‘People in touch with the criminal justice system are more likely to smoke, experience depression and have overall poorer health than the general population,’ said PHE chief executive Duncan Selbie. ‘This is not right and it doesn’t have to be this way. Crime prevention and the prevention of ill health go hand in hand. This resource will help local health and crime prevention experts end this travesty, improve health across local populations and reduce re-offending rates.’

PHE has also published guidance on designing and delivering programmes to reduce TB in ‘under-served populations’ such as people with substance misuse problems or those in contact with the criminal justice system, including examples of good practice from across the country.

Rebalancing act at www.revolving-doors.org.uk

Tackling tuberculosis in under-served populations at www.gov.uk

Obama commutes drug sentences before leaving office

News

DDN

January 20, 2017

Barack Obama marked the end of his presidency by commuting the sentences of 330 prisoners, bringing the total number of commutations granted to more
than 1,700. ‘The vast majority of these men and women are serving unduly long sentences for drug crimes,’ said a White House statement. ‘With today’s action, the president has granted more commutations than any president in this nation’s history and has surpassed the number of commutations granted by the past 13 presidents combined.’

In 2014, Obama directed officials at the US Department of Justice to encourage federal prison inmates serving sentences imposed under ‘outdated’ laws and ‘overly harsh drug sentencing’ to apply for clemency. More than 500 of the 1,715 inmates to have their sentences commuted had been sentenced to life in prison. Those granted commutations were ‘stories of rehabilitation and growth, of families reunited and lives turned around,’ said the White House.

FDAP closes and transfers functions to SMMGP

News

DDN

January 20, 2017

Carole Sharma, a chief executive with years of experience in the health and substance misuse fields

The Federation of Drug and Alcohol Professionals (FDAP) is to close at the end of this month, it has been announced. In a statement released on 19 January, its board said that the ‘difficult decision’ had been made that it was ‘impossible to continue’. However from 1 February, member interests would be looked after by Substance Misuse Management in General Practice (SMMGP), who would continue the function of providing accreditation and CPD support.

‘We are confident that the future of our members is in good hands with SMMGP who have a long standing history of supporting good practice in drug and alcohol treatment, as well as the experience and reputation to provide accreditation for people working in the field,’ said FDAP board’s co-chairs Debbie Lindsey and Vic Hogg.

Chief executive Carole Sharma, who has worked in close partnership with many organisations in the field, including DDN, will leave her post on 31 January. DDN extended gratitude to her for her support, including expertly chairing sessions at the National Service User Involvement Conference, and wished her well for the future.

FDAP board’s statement is in full below:

FEDERATION OF DRUG AND ALCOHOL PROFESSIONALS: IMPORTANT NOTICE
This notice comes to you on behalf of the Board of the Federation of Drug and Alcohol Professionals (FDAP), to advise you of important changes that are taking place, namely that the company is to close with effect from 31 January 2017.

As from 1 February 2017 the function of providing accreditation and CPD support for FDAP members will be moving to SMMGP (Substance Misuse Management in General Practice) who will continue this work.

The decision to close FDAP has not been an easy one and we feel sure you will understand that the Board would not have come to the difficult decision to close the company were it not for the fact that it is impossible to continue.

In conveying this news, FDAP’s Board and Chief Executive would like to extend their warm and very sincere thanks to you, and all other partners and stakeholders, for your tremendous support over many years in working with FDAP to achieve our principal objective of helping to improve standards of practice across the substance use sector.

We are confident that the future of our members is in good hands with SMMGP who have a long standing history of supporting good practice in drug and alcohol treatment, as well as the experience and reputation to provide accreditation for people working in the field. SMMGP will be contacting you in the near future.

If there is anything contained in this message which you would like to discuss, please contact the Chief Executive, Carole Sharma [carole@fdap.org.uk] who will be continuing in that role on a part time basis until 31 January 2017.

Debbie Lindsey, Vic Hogg, Co-Chairs, FDAP Board

Campaigners call for total alcohol advertising ban

DDN

January 19, 2017

The content of adverts should be limited to factual information, says the Alcohol Health Alliance

Existing regulations are failing to protect young people from exposure to alcohol advertising and the ‘subsequent drinking’ it leads to, according to a collection of worldwide research published in the academic journal Addiction. The documents have led to renewed calls from public health bodies to ban alcohol advertising outright.

The research concludes that exposure to alcohol marketing ‘is associated’ with youth alcohol consumption and that self-regulation by the drinks industry does not sufficiently ‘protect children and adolescents from exposure to alcohol promotions, especially through social media’ – where lines between marketing and user-generated consent can blur. Alcohol marketing during the 2014 FIFA World Cup frequently ‘appeared to breach industry voluntary codes of practice’, it states.

The ‘most effective’ response would be a comprehensive ban on alcohol advertising, promotion and sponsorship in accordance with ‘each country’s constitution or constitutional principles’, say the researchers. Statutory regulations should be in place, enforced by local or national public health agencies rather than the industry itself, as the latter’s primary aims are ‘growing its markets and maximising profits’. A global agreement on alcohol marketing could also support individual countries to move towards a comprehensive ban, it says.

‘It is clear that self-regulation is not working and we welcome calls for greater action from governments to protect children from exposure to alcohol marketing,’ said chair of the Alcohol Health Alliance (AHA), Professor Sir Ian Gilmore. ‘We know that alcohol marketing contains content and messages that appeal to children, and that due to exposure to this advertising, children drink more, and start drinking at an earlier age. In the long run, all advertising and sponsorship should be prohibited. In the short term, alcohol advertising should only be permitted in newspapers and other adult press, and the content of these adverts should be limited to factual information about brand, provenance and product strength.’

‘Governments have previously approved self-regulatory measures on alcohol advertising; however, we can no longer say that they might work to protect our young people – they don’t,’ said director of Global Business Development at the UK Health Forum, Chris Brookes. ‘In a literature review of more than 100 studies, none was identified that supported the effectiveness of industry self-regulation programmes.’

Research documents at www.addictionjournal.org

Doctors call for urgent tobacco control plan

DDN

January 16, 2017

More than 1,000 doctors and other healthcare professionals have written an open letter to prime minister Theresa May and health secretary Jeremy Hunt calling for a new tobacco control plan to be published ‘without further delay’.

The signatories, which include five former royal college presidents, say the move is essential to tackle health inequalities. Despite the previous Tobacco control plan for England expiring in 2015, no publication date has been given for a new document. ‘If the prime minister is really committed to social justice she needs to put her weight behind publication of a new tobacco control plan without further delay,’ the letter states.

Although smoking prevalence in England has halved in the last 35 years – with less than a fifth of adults now smokers – the highest rates of smoking are found in disadvantaged communities. The letter praises previous efforts to address smoking, such as standardised packaging, advertising curbs and taxation measures, but says more funding is needed for smoking cessation services and awareness campaigns.

The open letter is published in the BMJ, where an editorial also stresses that a future tobacco plan would need to include support for young people to make ‘sound decisions’ regarding health issues. ‘National surveys into smoking, drinking and drug use in schools have shown that smoking amongst young people has fallen consistently over the years and that lessons on smoking have had some impact,’ it says. ‘However, such lessons do need to be contextualised by inclusion in a mandatory, properly planned PSHE programme for all pupils taught by well trained, confident and competent teachers and one that avoids “shock horror” approaches.’

Smoking rates have fallen steadily since the introduction of the first tobacco plan for England, 1998’s Smoking kills, demonstrating ‘the importance of having a clear strategy in place’, according to ASH chief executive Deborah Arnott. ‘We have made great progress in reducing smoking, the leading cause of premature death and disability in this country,’ she said. ‘But we can’t rest on our laurels if we are to continue to drive down smoking rates. We need the government to implement the promised new tobacco control strategy without further delay.’

Open letter at www.bmj.com

Irish liver cancer rates up 300 per cent in two decades

News

DDN

January 10, 2017

High cancer rates ‘simply a result of drinking too much’.

The number of primary liver cancers in Ireland increased by more than 300 per cent between 1994 and 2014, according to figures from the country’s National Cancer Registry.

More than 270 patients were diagnosed in both 2013 and 2014, compared to an average of around 60 in the mid-1990s, says Cancer trends: primary liver cancer, with rates three times higher in men than in women. ‘The increase in alcohol consumption observed in Ireland in recent decades is likely to have had a strong influence on the increase observed in HCC [hepatocellular carcinoma] incidence, particularly in men,’ it states. Men in urban areas were also 64 per cent more likely to develop liver cancer than those in rural districts, with male incidence in Dublin ‘statistically significantly higher than the national average’.

Although liver cancer rates in Ireland are higher than in the UK, they are still below those in many European countries, with Italy, France, Spain and Romania at the top of the list. Survival rates in Ireland are poor, however, with the latest estimate of five-year survival standing at less than 20 per cent.

The figures were ‘startling’, said the Irish Cancer Society, with the high incidence rates ‘a result of decades of people in Ireland simply drinking too much,’ according to its head of research, Dr Robert O’Connor. ‘One in five of all alcohol-related deaths are due to cancer. But our consumption of alcohol is increasing – in 2010 it was 145 per cent higher than the average amount drank in 1960,’ he said.

Document at www.ncri.ie

Government promises to ‘transform’ mental health support

News

DDN

January 9, 2017

Prime minister Theresa May has announced a range of measures to ‘transform’ mental health support across the country. Tackling the ‘burning injustice’ of mental ill health would be part of the government’s wider commitment to ‘wholesale social reform’, she told the Charity Commission’s annual lecture.

Theresa May: Government is committed to tackling ‘burning injustice’ of mental ill health.

Mental ill health commonly affects younger people and those on lower incomes, with some estimates putting the annual economic and social cost at more than £100bn, close to the equivalent of the entire annual NHS budget.

Among the plans announced are a ‘rapid expansion’ of digital and online mental health services, more alternatives to hospital care such as community clinics, a ‘major thematic review’ of young people’s mental health services led by the Care Quality Commission (CQC), and action to improve mental health support in the workplace. There will also be a review of the controversial ‘health debt form’, which can see people charged up to £300 for documentation from their GP to prove they have mental health issues.

Not only was mental health ‘dangerously disregarded as a secondary issue,’ she said, it was also ‘shrouded in a completely unacceptable stigma’. The plans would start with ‘ensuring that young people get the help and support they need and deserve’ before issues became entrenched and risked blighting lives, she stated. ‘This is a historic opportunity to right a wrong and give people deserving of compassion and support the attention and treatment they deserve’.

Chief executive of mental health charity Mind, Paul Farmer, said that although his organisation welcomed the announcement, the proof would be in the ‘difference it makes to the day-to-day experience of the one in four who will experience a mental health problem this year’, while Rethink Mental Illness said it was ‘cautiously optimistic’.

One Life Programme

DDN

January 9, 2017

Supported by:

[slideshow_deploy id=’17698′]

Conference programme

Thursday 23 February, Birmingham, The New Bingley Hall

9.00am – 10.00am – Registration

Come early and join us for tea, coffee and refreshments before the start of the sessions.

Here are details of the sessions, and the running times. Please click on a speaker’s name to read a short biography.

10.00am – 11.15am – Opening Session, Setting the scene.

Welcome to ‘One Life’ – the ten-year anniversary conference.

The statistics, the situation

Chris Robin from Janus Solutions gives his personal impressions of the current state of treatment. Chris will also chair the session.

Annette Dale Perera brings the latest messages from the ACMD on what we must do to reduce opioid-related deaths.

Paul Hayes from Collective Voice gives the treatment agencies’ response.

Voices from the frontline

Joining up services for people with multiple needs. Sinead McKeown and Paul Brown share their experience of the Every Step of the Way user involvement and engagement programme to show how effective partnerships can make a real difference.

Why treatment needs to be available to all

Let’s make sure that getting treatment is not a lottery. Dee Cunniffe, of the London Joint Working Group on Substance Use and Hepatitis C, calls for improved services to prevent thousands of unnecessary deaths.

11.15am – 11.45am – Tea and coffee break.

11.45am – 1.00pm – Session Two, the big debate.

Chaired by Tim Sampey and Alex Boyt.

What contributes to drug-related deaths and what can we do? A provocative, wide-ranging and inclusive discussion, looking at what every one of us can do about the situation. Join the debate and contribute to the action points.

1.00pm – 2.30pm – Lunch and networking.

Fill up on an authentic Birmingham balti, and network with organisations from around the country. Enjoy lunch, music, entertainment, mingling, massages, meetings and exhibition.

2.30pm – 4.00pm – The round table knowledge exchange.

This session provides the opportunity to attend short interactive sessions to discuss topics including recovery in the community, overdose prevention, building and social enterprise and more. Click here for full details of the session.

4.00pm Conference close

Speaker Biographies

As author of Crack Cocaine, The Open Door and co-founder of Janus Solutions where he has developed The Resonance Factor Chris Robin has never been afraid to ask difficult questions about the traditional role of the drug and alcohol worker as well as role and function of services. Chris also spoke at the first DDN conference in 2007.

Paul hayes collective voice — Paul Hayes

Paul Hayes was chief executive of the National Treatment Agency from its creation in 2001, until it transferred to Public Health England in 2013. Before joining the NTA Paul worked for the Probation Service for more than 20 years. He now leads Collective Voice, an organisation representing the views of some of the UK’s largest treatment providers. Paul also spoke at the first DDN conference in 2007.

Annette Dale Perrera — Annette Dale-Perera

Annette Dale-Perera has worked in substance misuse in a variety of roles from frontline practitioner to Director of Policy for Drugscope, Director of Quality at the NTA and Strategic Director of Addiction and Offender Care for CNWL NHS Foundation Trust. Annette has been a member of the Advisory Council on the Misuse of Drugs since 2010 and co-chair of the Recovery Committee. Since launching ADPConsultancyUK she has worked with UNODC and EMCDDA, among many others.

Tim Sampey helped to create the innovative user led organisation Build on Belief (BoB). BoB does not offer therapeutic services, but instead provides a range of socially based services intended to support people through their treatment journey while they work to move forward with their lives.

Alex Boyt has been a long time advocate of service user rights, working for organisations in London and Bristol. Until recently he delivered service user involvement and peer support initiatives at Voiceability in Camden. Alex regularly contributes to policy debates, and is a regular contributor to DDN Magazine.

Round Table Discussions

Alcohol-Related Brain Damage (ARBD)
Notaro Homes
Alcohol-Related Brain Damage (ARBD) is a term for the damage that can happen to the brain as a result of long-term heavy drinking. Among many symptoms this can result in people experiencing memory loss and difficulty with routine tasks, as well as having severely impaired judgement and decision-making skills. This session will help you to spot these symptoms, and find out how early diagnosis and referral to treatment can increase the chances of a positive recovery.
http://www.notarohomes.co.uk/services-overview/alcohol-related-brain-damage/

Solvent and aerosol misuse
Nicola Jones, Re-Solv
Solvent abuse continues to be a ‘hidden’ problem today, stigmatised and with relatively few adult users finding their way into support and recovery services. Come and share your thoughts and experiences, and discuss ways that local groups can use lived experience to connect with current users.
http://www.re-solv.org

Naloxone: Lobbying for local distribution
Lee Collingham, Naloxone Action Group (NAG)
Naloxone is the drug that can temporarily reverse the effect of an opioid overdose, and is proven to save lives. Since October 2015 any worker in a commissioned drug service can distribute naloxone without prescription, and while this has led to an increased availability of the drug, universal access has not been achieved. Current distribution varies dramatically area by area, and sometimes written commitments do not equate to the number of kits provided on the frontline. How many naloxone kits were distributed in your area, who should you ask to find out, and how do you lobby for increased provision? This session will provide practical advice and easy to follow guidance to help you campaign for adequate provision of take-home naloxone in your local area.
https://nagengland.wordpress.com/

Effective service user involvement within an organisation
Sue Edwards, CGL Service User Council
Real service user involvement allows an organisation to create a better fairer treatment system for their clients. However, providing genuine independent and effective service user involvement within an organisation is not always easy, and can sometimes create tensions. Sue Edwards will explain the challenges faced and lay bare the process that has led to a genuine independent service user council that provides valued input into one of the UK’s largest treatment providers.
https://www.changegrowlive.org/service-user-involvement

Sustaining a social enterprise
Changes UK
Self-funding a group through a social enterprise is a desirable path to follow. Freeing the group from the ongoing pressure to find funding in the current tough economic climate provides an opportunity to be truly independent, while also providing valuable experience and potential transferable skills and training for members of the group returning to the workplace. But sustaining and growing the business to be profitable can prove to be a challenge. Learn from a successful social enterprise in Birmingham that provides gardening services, and take the opportunity to speak with a dedicated social enterprise manager who can provide advice for your enterprise.
http://changesuk.org/

Working with hard to reach groups
The Shanti Project (Aquarius)
Hard-to-reach groups may sometimes ‘slip through the net’ of traditional drug and alcohol services. Shanti works to tackle the taboo issue of alcohol misuse in the Punjabi Sikh community, working with individuals and affected others to promote recovery and engagement, delivering brief interventions in Gurdwaras (Sikh places of worship), hospitals and community venues, and creating links with GP surgeries, schools and colleges.
Find out more about how Shanti is working to break down the barriers of denial and shame surrounding alcohol misuse within Punjabi Sikh culture, and discuss ways to work with other culturally sensitive minorities.
http://aquarius.org.uk/contact/shanti/

Reaching out from recovery
B3
Recovery communities provide a fantastic, safe, supportive environment to help members build personal recovery capital, while often providing benefit to the wider community. But it’s of equal importance that groups continue to engage with people still misusing drugs and alcohol, in an inclusive, non-judgemental way. B3 is an innovative, growing organisation providing peer support and advocacy in the London borough of Brent, including an open access weekend drop-in service. Join this session to share ideas on how groups can support their members, while engaging with those yet to find recovery.
https://www.b-3.org.uk/bsafe

From residential to community
Choices UK
Good rehabs ensure that aftercare is in place for clients leaving treatment and returning to the community. While this is often done through a service’s own network and the fellowships, there is always scope to grow stronger links with local organisations. The Choices group of rehabs would love to meet and network with local recovery groups to form alliances, and look at ways to help clients transition back to the community and help them build a strong sustainable recovery.

A place for fellowships
Cocaine Anonymous
Since the 1980s, Cocaine Anonymous (CA) has used the 12-step process to help people addicted to cocaine or other mind altering substances. While this process does not work for everyone, millions of people attribute their ongoing recovery to the support provided by CA or similar fellowships. Despite more than 80 years of global success since the first fellowship meeting, there are still several misconceptions around the 12 step fellowships that can prevent some individuals or organisations engaging with them. Come along to find out more, hear some myth busting, and ask questions. All you need is an open mind!
http://www.cauk.org.uk/

Patient choice and the right to OST
Stephen Malloy, independent trainer and director of INPUD
Methadone maintenance and buprenorphine prescribing are evidence based interventions that are proven routes to stabilising drug use, and can be the first step on the road to recovery. Even with more than 40 years of evidence to support it, there have been recent high profile criticisms levelled at maintenance treatment. This session will provide the opportunity for a frank, open discussion on the individual nature of recovery, and the right of the individual to follow the path best suited to them.

Naloxone Training
Philippe Bonnet, CGL
Since October 2015 any worker in a commissioned drug service can distribute naloxone without prescription. This, coupled with the simplicity of administering the drug, provides the opportunity to provide simple practical training, and distribute prenoxad injection kits at the event. If you have not been trained in this life saving intervention already, do not miss out today!

Hep C – get tested, get treated
Dee Cunniffe, The London Joint Working Group on Substance Use and Hepatitis C
New treatment options should ensure that no one should have to live with this potentially life-threatening disease, but how do we make sure that treatment is accessible to those who most need it? Dee opens out the discussion she began in her morning presentation, about making sure hep C treatment is not a lottery.

Going for growth
Red Rose Recovery
Setting up and running a local recovery group is challenging, but as an organisation because successful and attracts more members a different set of challenges can be faced. How do you support these new members and cater for increased activities and services –and importantly, how do you fund this? Red Rose Recovery have grown from a small local group with a few members to a organisation in the north west that works with some of the UK’s largest treatment providers, employs more than 20 full and part-time staff and turns over nearly £1m. Find out how they achieved this without compromising their independence, and look at strategies for growing your recovery community.

Everything’s possible – with the right support
Members of the Every Step of the Way programme (Birmingham Changing Futures Together Project)
Paul Brown and Sinead McKeown, who introduced the Every Step of the Way flagship user involvement and engagement programme in the morning session, bring in colleagues Mark Fitzgerald and Andrew Shelton to show how they support and training can open a world of opportunity to people with multiple needs.

Let’s talk about sex
Nic and Christine, Paula Hall Associates
Like all other addictions, sex addiction has a negative impact on both the individual and their family and loved ones. Whether it’s compulsive use of pornography, visiting sex workers, multiple affairs or any other kind of sexual behaviour, it is not always recognised by mainstream services. Paula Hall and her team have more than 40 years’ clinical experience in sex and porn addiction recovery; come along and find out more about identifying harmful behaviours and offering specialist treatment models and interventions for this often overlooked problem.

Nearly 2m drinkers should be sent for liver scans, says NICE

News

DDN

January 4, 2017

People drinking at potentially harmful levels should be sent for scans to detect early liver disease, according to new draft guidance from the National Institute for Health and Care Excellence (NICE). The proposed quality standard, which is out for consultation until early February, recommends that men drinking more than 50 units per week and women drinking more than 35 units – adding up to around 1.9m people in England – should be sent for cirrhosis scans by their GPs.

The document recommends two non-invasive tests – transient elastography and acoustic radiation force impulse imaging – to detect early signs of liver problems. While the first test is available in around 120 hospitals, the second is more recent technology and so far not as widespread. Ten years ago clinicians would usually have had to perform a liver biopsy to make a diagnosis.

More than 4,000 people a year die from liver disease in England and Wales, making it the fifth largest cause of death, while 700 more patients need transplants. NICE would welcome comments from ‘anyone who has been affected by liver disease’ for the consultation.

at-the-bar — Draft guidance proposes that people drinking more than recommended limits should be sent for liver scans.

‘Many people with liver disease do not show symptoms until it is too late,’ said deputy chief executive of NICE, Professor Gillian Leng. ‘If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover. Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do. This draft quality standard makes a number of important suggestions to improve care for those with liver disease, from offering advice to less invasive testing.’

While the draft guidance has been welcomed by alcohol health organisations, free-market think tank the Institute of Economic Affairs (IEA) stated that the ‘average liver cirrhosis patient drinks vastly more than 35 units a week’ and that resources should be targeted on ‘chronic’ drinkers. ‘Unnecessarily testing millions of people on the basis of an arbitrary target would be a colossal waste of NHS resources,’ said its head of lifestyle economics, Christopher Snowdon.

Liver disease NICE quality standard: draft for consultation available at www.nice.org.uk until 2 February 2017

‘Don’t go cold turkey this January – get long-term help’

News

DDN

January 4, 2017

People with addiction issues should avoid going ‘cold turkey’ in January, according to national charity Change, Grow, Live (CGL).

‘New Year’s resolutions are great, but stopping alcohol or sedative drugs (like Valium or sleeping tablets) suddenly, if you use them most days, could land you in A&E or worse,’ said Ken Checinski, CGL’s lead consultant in the South East. ‘It’s better to seek advice for your addiction issues to understand the mental and general health risks of going “cold turkey”, and to get the right support to stop using drugs and alcohol, safely.’

The charity’s advice focuses on health checks, offering prescribing services rooted in harm reduction to help individuals recover at their own pace, and one-to-one support with a recovery professional.

Their ‘top tips for recovery in 2017’ include ‘Look after your mental health and wellbeing’, ‘Be inspired by connecting with peer mentors’ and ‘Know that there is light at the end of the tunnel – never give up.’

Tailored treatment needed for prescription drug misuse, says ACMD

News

DDN

December 23, 2016

Prescription-only drugs are being widely diverted to supplement the use of illegal substances, according to a new report from the Advisory Council on the Misuse of Drugs (ACMD). However, diversion and illicit supply remains a ‘much smaller problem’ than in the US, it states.

Diverted prescription drugs are supplementing, rather than replacing, the use of street drugs like heroin, it says – either as a way of complementing their effects or to ‘tide over’ users until they can access illicit drugs.

More people are now seeking treatment for addiction to prescription drugs, it states, and there is growing anecdotal evidence from treatment services of clients whose opioid-dependency developed through use of over-the-counter codeine products. Use of diverted medicines can also increase the risk of overdose, it adds, while ‘unethical’ online sales of prescription drugs via unregistered pharmacies are also increasing, with some people using prescription drugs to manage the comedown from stimulants like cocaine. Alongside prescription opioids, the most commonly diverted drug types are benzodiazepines and ‘Z drugs’, as well as pregabalin, gabapentin and anti-psychotics.

The report wants to see the development of tailored treatment for people who are dependent on prescription or over-the-counter drugs, as well a ‘watch list’ of medicines that could potentially be misused. It also calls on prison healthcare commissioners to ‘embed responsibility’ for the issue into healthcare provider specifications.

‘The diversion of prescription-only medicine damages patient-doctor relationships and can create an atmosphere of distrust,’ said ACMD chair Professor Les Iversen. ‘The use of medicines supplied illicitly is dangerous – it is essential that tailored treatment is developed for users who have become dependent on prescription or over-the-counter medicines.’

The government has also announced that Owen Bowden-Jones, consultant in addiction psychiatry at Imperial College and clinical adviser to PHE, will take over the role of ACMD chair from January. ‘The ACMD plays a hugely important role in ensuring the government has the evidence it needs to tackle the misuse of drugs, and I am confident Dr Bowden-Jones will continue to drive this work forward as we strive to prevent the harms caused by drug misuse,’ said minister for vulnerability, safeguarding and countering extremism, Sarah Newton.

Diversion and illicit supply of medicines at www.gov.uk

Address ‘blind spot’ around older drinkers, charity urges

News

DDN

December 22, 2016

More needs to be done to help older adults avoid alcohol-related harm, says a new report from the International Longevity Centre (ILC-UK). Retirement is a ‘danger point’ for problem drinking, states the document, with recent retirees more likely to drink every day.

Nearly a third of over-50s in the ‘professional occupational classes’ drink between five and seven days a week, with stress, boredom and ‘lack of control over work and retirement worries’ contributing to the higher consumption levels of those still in work, it says.

older-drinkers — Recent retirees are more likely to drink every day, says the new report from ILC-UK.

The report, which was commissioned by Drink Wise, Age Well, wants to see both the government and employers do more to help the over 50s ‘avoid serious alcohol problems in later life’. This could include counselling and workplace policies that treat alcohol like ‘any other health issue’, as well as making it easier for older people who’ve had an alcohol problem to return to the workforce. Just 16 per cent of employers said they would consider employing someone with a previous alcohol problem, the document points out. GPs should also consider the effects of retirement when giving alcohol health advice, it says.

‘Retirement is like a cliff edge and often older people go from having a busy schedule and colleagues to interact with, to days where they might not see anyone or even have a conversation on the phone,’ said chief executive of older people’s charity the Royal Voluntary Service, David McCullough. ‘It doesn’t take long for loneliness to set in and drinking a little more than they should each day can quickly become the norm. It’s vital that people facing retirement or those recently retired remain mentally and physically active and engaged in their community, and we would urge employers to ensure they have the necessary support and guidance in place to help employees with what can be a very steep transition.’

Easing the transition – older adults and the labour market at drinkwiseagewell.org.uk

Leeds volunteers thanked for their vital role

DDN

December 22, 2016

The vital role of volunteers was recognised by Forward Leeds, at a celebratory meal to thank them for their ‘fantastic commitment’ throughout the year.

The charity’s volunteers put in a total of 905 hours of work between them in November alone – almost a working week per month for each volunteer. The volunteer programme attracts around ten applications a month to support adults and young people to make healthy choices about alcohol and drugs and reduce risk-taking behaviour.

Work takes place at three centres across Leeds, plus a young persons’ hub and a recovery academy. The academy provides education, training and employment support, as well as activities including a gardening group, yoga sessions and music production workshops.

The get-together was ‘a great opportunity for volunteers to meet each other as they are usually all busy, coming in at different days and times,’ said Ann Hall, volunteer development manager, adding ‘We are always keen to support volunteers in achieving their end goal, whether that is to gain skills and experience or to be ready for paid employment.’

If you are interested in volunteering for Forward Leeds you can fill in a form on their website, www.forwardleeds.co.uk, give them a call on 0113 887 2477 or email volunteering@disc-vol.org.uk

Poor commissioning practices hitting smaller charities

News

DDN

December 20, 2016

The survival of smaller charities is being threatened by ‘shockingly complicated and inappropriate’ commissioning and contracting processes on the part of central and local government, according to a report from the Lloyds Bank Foundation.

Examples of poor commissioning practice include forced mergers in order to be able to bid for work, as well as ‘irrelevant requirements’ and poor scrutiny, says Commissioning in crisis. The report is based on the experiences of organisations taking part in 120 tenders and ‘shines a spotlight on a catalogue of errors and unacceptable hoops small charities are forced to jump through to be able to continue supporting local people in need’, says the foundation.

Although acknowledging that commissioners themselves face pressure from smaller budgets and cuts in staff, poor commissioning practices are widespread and are themselves ‘adding cost, inefficiency and complexity’, it claims. The report wants to see urgent reform to make sure small organisations can compete for contracts ‘on a level playing field’. This should include simplifying processes, improving collaboration and an increased focus on ‘the long-term value of effective service delivery’ rather than on short-term cost savings, it says. Central government should also be improving transparency, challenging poor practice and holding commissioners to account.

‘We are alarmed at the scale of the commissioning crisis which is engulfing small charities and threatening their very survival,’ said Lloyds Bank Foundation chief executive Paul Streets. ‘Small charities are struggling to respond to bureaucratic, complex and inappropriate requests by commissioners. When it comes to commissioning services, it seems common sense has failed. It’s not just charities that stand to lose, but communities and individuals in need.’

Report at www.lloydsbankfoundation.org.uk

ACMD: safeguarding treatment vital to avoid more deaths

News

DDN

December 19, 2016

Maintaining the ‘capacity and quality’ of treatment is essential to prevent more increases in opioid-related deaths, says a new report from the ACMD. The large cohort of people who have been using heroin since the 1980s and ‘90s are ‘increasingly vulnerable’ as they age, stresses Reducing opioid-related deaths in the UK,with fatalities increasing by almost 60 per cent in England and over 20 per cent in Scotland and Wales in the last four years.

Alongside the ‘increasingly complex’ health and social care needs of ageing users, other factors in the recent increases in death rates are likely to include commissioning changes and cuts to benefits and local services, the report states.

The document calls on central and local government to protect current levels of funding for evidence-based treatment as well as investment in ‘high quality, tailored opioid substitute therapy of optimal dosage and duration’. Data standards and research also need be improved, it says, while naloxone should be made routinely available. The government should also look at the potential to reduce deaths through ‘the provision of medically supervised drug consumption clinics in localities with a high concentration of injecting drug use’, as is currently being considered in Glasgow (DDN, November, page 4).

It is unlikely that allowing a regulated market for heroin – ‘outside the confines of medical prescription for a tightly defined group of patients’ – would reduce deaths, the report concludes, but it does recommend that government funding should be provided to ‘support heroin-assisted treatment for patients for whom other forms of OST have not been effective’.

‘We can assert with a good degree of confidence that the ageing profile of heroin users with increasingly complex health needs, social care needs and continuing multiple risk behaviours has contributed to recent increases in drug-related deaths,’ said co-chair of the ACMD’s drug-related deaths working group, Annette Dale-Perera (pictured). ‘The greater availability of heroin at street level, the deepening of socio-economic deprivation since the financial crisis of 2008, changes to drug treatment and commissioning practices, and the lack of access to mainstream mental and physical health services for this ageing cohort have also potentially had an impact.’

Report at www.gov.uk

One Life Exhibitor Information

DDN

December 14, 2016

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

The venue is the The New Bingley Hall, 1 Hockley Circus, Birmingham, West Midlands B18 5pp. Details on how to get there and parking information can be found here. The venue has ample free parking at the rear and is less than 10 minutes walk from Birmingham New Street Station.

If you are looking for overnight accommodation before the event, the DDN team are staying at the Bullring Travel Lodge. But closer hotels can be found via late rooms and similar sites.

Exhibition Set Up. I can confirm that exhibitors will have access between 4-7pm the day before and from 8am the morning of the event. Stand numbers will be given out on arrival, when you will be welcomed by one of the team and shown to your stand. 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.

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:

C/o Chantell Marler, Changes UK, Recovery Central, 9 Allcock Street, Digbeth, B9 4DY

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

We will need 500 if you wish to go in every bag, and please mark boxes DDN conference. Deliveries must arrive no later than Friday 17 February.

We are collating name badges so please click here to submit names of the people attending from your organisation by 5pm Wednesday 15 February.

On the day of the conference you can contact the team on 07936127237. In the meantime if you have any further questions or need more information please email ian@cjwellings.com

Around 9,000 children are ‘problem gamblers’

News

DDN

December 9, 2016

Approximately 450,000 children in England and Wales are now gambling every week, according to a report from the Gambling Commission, with around 9,000 of them likely to be problem gamblers.

Problem gambling — Scratch cards are one of the most popular forms of gambling for under sixteens

The overall rate of gambling among 11 to 15-year-olds is around 16 per cent, compared to 8 per cent who had drunk alcohol in the last week and 6 per cent who had taken drugs in the last month. Three quarters of this age group reported seeing gambling adverts on TV, while more than 60 per cent had seen them on social media. Gambling in the past week was twice as prevalent among boys (21 per cent) as among girls (11 per cent).

Among the most popular forms of gambling were fruit machines or scratch cards, although 8 per cent had gambled in a commercial premises in the last week, including betting shops and arcades.

It was important that parents speak to their children about the risks associated with gambling, said Gambling Commission executive director Tim Miller.

‘We’re often reminded to discuss the risks of drinking, drugs and smoking with our children. However our research shows that children are twice as likely to gamble than do any of those things. We want to reassure parents that our rules require gambling businesses to prevent and tackle underage gambling, and we take firm action where young people are not properly protected.’

Young people and gambling 2016: a research study among 11 to 15-year-olds in England and Wales at www.gamblingcommission.gov.uk

Government rules out benefit sanctions for refusing treatment

News

DDN

December 9, 2016

People with drug and alcohol problems should not be made to undergo treatment in order to claim benefits, according to a long-awaited review by Dame Carol Black.

The review, which was originally announced last year, was tasked with exploring the best ways to ‘support benefit claimants with addictions and potentially treatable conditions’ – including obesity – back into work, and re-ignited the controversial debate over whether benefit entitlement should be linked to agreeing to enter treatment (DDN, September 2105, page 4).

‘We are clear that benefit claimants with addictions should, like all other claimants, do all they can to re-enter work,’ the document states. ‘Mandation’ of treatment, however, is likely to lead to more people ‘hiding their addiction’, says An independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity. The review also heard ‘serious concerns’ from health professionals about the ‘legal and ethical implications of mandating treatment, and whether this would be a cost effective approach’. The government has confirmed that the proposals are ‘not under consideration’.

Among the document’s many recommendations are that the government should agree an ‘expanded recovery measure’ that includes work and ‘meaningful activity outcomes’ such as volunteering, and support joined up working between job centres and treatment services. Jobcentre Plus should also work with treatment providers to trial a network of peer mentors ‘to act as advocates and visible symbols of recovery’, it adds, while the government should work with employers to develop guidance on best practice in recruiting people with drug and alcohol issues.

‘Fractured commissioning responsibilities and lines of accountability’ can make coordinated action across the treatment system challenging, however, says the report. ‘Addiction treatment does not, in itself, ensure employment, though it brings other social gains’, it adds, stating that work ‘has not hitherto been an integral part of treatment’, but needs to be if progress is to be made. The benefits system also requires ‘significant change’, it stresses, as it is characterised by ‘severe’ lack of information on health conditions, poor incentives for staff to tackle difficult or long-term cases, and ‘patchy offers of support’. Providing treatment alone, without skills or housing support, is likely to have little impact on improving employment prospects, it stresses.

Collective Voice said it welcomed the report as ‘an ideal opportunity to remedy this long standing problem which, as the review points out, treatment providers cannot address in isolation. Dame Carol has provided a roadmap identifying realistic practical steps to give as many service users as possible a real prospect to earn their own livings and provide for their families.’

Report at www.gov.uk

Frontline staff worn down by alcohol-fuelled behaviour

News

DDN

December 8, 2016

Ambulance staff face daily risk of assault and abuse

Alcohol-related behaviour is having a severe impact on the ability of emergency services staff to do their jobs, according to a report from the All-Party Parliamentary Group (APPG) on Alcohol Harm. The government needs to urgently develop a ‘coordinated national strategy’ to tackle the country’s excessive alcohol intake, says The frontline battle: an inquiry into the impact of alcohol on emergency services.

Police, fire, ambulance and A&E staff face the daily risk – and ‘frequently daily reality’ – of assault and abuse, including sexual abuse, in the course of carrying out their professional duties, the document states, with one police force reporting that 90 per cent of its officers ‘expected’ to be assaulted on Friday and Saturday nights.

Alcohol-fuelled behaviour is placing intolerable pressure on services, and affecting the health, wellbeing and morale of staff, the report stresses, with services experiencing recruitment and retention problems as a result. In the North East, 86 per cent of police officers surveyed had been assaulted by people under the influence of alcohol, and more than 20 per cent had been assaulted six or more times.

The document is calling for alcohol awareness training and support to be delivered to emergency service personnel, as well as a lowering of the drink drive limit, more investment in alcohol liaison teams and more training in the use of Identification and Brief Advice (IBA) programmes. The report comes less than a week after a Public Health England (PHE) review estimated the economic burden of alcohol at up to 3 per cent of the country’s GDP.

‘It should be wholly unacceptable to hear of an A&E consultant being kicked in the face, medical staff having TVs thrown at them, or female police officers being sexually assaulted,’ said APPG chair Fiona Bruce MP. ‘And it’s not just emergency staff who suffer – as this report describes, many other people are impacted too, from taxpayers who foot the bill to patients who can’t be seen promptly, or worse, those innocent people killed in avoidable drunk driving accidents.’

‘We need the UK government to act and take steps to implement the report’s recommendations, including lowering the drink drive limit and tackling cheap and high-strength alcohol, which we know will work in reducing alcohol-related harms and ease the strain on frontline staff,’ said Alcohol Concern chief executive Joanna Simons.

Meanwhile a merger has been announced between Alcohol Concern and Alcohol Research UK, to be completed by April 2017. The chief executive of the merged charities will be Alcohol Research UK CEO Dave Roberts. ‘Alcohol Concern is well recognised for its high-profile advocacy work to help reduce the many harms from alcohol misuse, and in particular for its excellent Dry January initiative,’ said Alcohol Research UK chair Professor Alan Maryon Davis. ‘We see the marrying of evidence-based advocacy with our primary function of fostering research into reducing alcohol harm as a powerful strategic fit.’

Report at www.alcoholconcern.org.uk

Economic burden of alcohol could be almost 3 per cent of GDP, says PHE

News

DDN

December 8, 2016

Combining minimum unit pricing (MUP) with increased alcohol taxation would lead to both ‘substantial’ reductions in alcohol-related harm and increases in government revenue, according to a wide-ranging review by Public Health England (PHE). Plans to introduce MUP were shelved by the coalition government on the grounds that there was not enough ‘concrete evidence’ to justify their implementation (DDN, August 2013, page 4) and are subject to an ongoing legal challenge in Scotland (DDN, December, page 4).

The economic burden of ‘health, social and economic alcohol-related harm’ has been underestimated and is now thought to be between 1.3 and 2.7 per cent of annual GDP, states The public health burden of alcohol and the effectiveness and cost-effectiveness of alcohol control policies. Although it acknowledges recent declines in both alcohol sales and drinking levels, as a nation ‘we are still drinking too much’, it says, with more than 1m alcohol-related hospital admissions per year and a 42 per cent increase in alcohol sales between 1980 and 2008.

More than 10m people in England are drinking at a level that increases the risk of health harms, it continues, with 5 per cent of the heaviest drinkers accounting for a third of all alcohol consumed. Alcohol now causes more years of life lost to the workforce than the ten most common cancers combined, and is the leading cause of death among 15 to 49-year-olds. Deaths from liver disease have seen a 400 per cent increase since 1970, ‘in stark contrast to much of Western Europe’, while in England the average age at death of those dying from an alcohol-specific cause is 54.3 years, compared to the average age of death from all causes at 77.6 years.

‘The harm alcohol causes is much wider than just on the individual drinker,’ said PHE’s national director of health and wellbeing, Professor Kevin Fenton (pictured).

‘Excessive alcohol consumption can harm children, wreck families, impact on workplace colleagues and can be a burden and drain on the NHS and economy. It hits poor communities the hardest. As a nation we are drinking more alcohol than we did in the past and there are more than one million alcohol-related hospital admissions a year, half of which occur among the most deprived groups.’

Industry body the Portman Group, however, said that the report did not ‘contain any new policy ideas, nor does it fully reflect the significant declines in harmful drinking in the last decade’.

Report at www.gov.uk

First national guidance on tackling street drinking issued

News

DDN

December 7, 2016

The first national guidance on tackling street drinking has been launched by the Association of Police and Crime Commissioners (PCCs). Written by Alcohol Concern with input from national bodies, the guidance suggests effective strategies for working with street drinkers, particularly those most resistant to help.

The project to support the development and implementation of the guidance is being led by Nottinghamshire PCC Paddy Tipping, with the active involvement of other PCCs from across the country. The goal is to reach those people who have ‘continually fallen out of the grip of help’, he said, as well as ‘open the gateway’ to tackling serious associated issues such as exploitation, domestic violence and mental health problems.

The response to street drinking begins at the ‘strategic level’, says the document, stressing that ‘evidence suggests that no single approach works on its own’. Among the key recommendations are establishing a multi-agency operational group, encouraging the commissioning of alcohol services that focus on change-resistant drinkers, and working in partnership with the retail trade. It also includes examples of good practice from across the country.

‘This work highlights the serious drain on resources that just a small number of street drinkers can have on public services,’ said Paddy Tipping. ‘It offers PCCs and other agencies positive strategies for reducing this burden. These strategies rely heavily on effective partnership working and show that the management of this problem can be achieved with the right framework.’

Tackling street drinking: police and crime commissioner guidance on best practice available at www.apccs.police.uk

BAC O’connor applications

DDN

December 7, 2016

Please find full job descriptions and application forms for BAC O’Connor and O’Connor Gateway vacancies. If you have any queries please contact Louise.Watts@bacandoconnor.co.uk

Job descriptions

Service Manager Job Description

RIOT Coordinator Job description

Senior Resettlement Worker Job description

Application forms:

Please download the relevant application form, email all completed forms to:

Louise.Watts@bacandoconnor.co.uk

BAC Application Form (Use for Senior Resettlement worker and service manager)

OConnor Gateway Application Form (Use for RIOT Coordinator)

A round-up of national news: December 2016

News

DDN

December 5, 2016

WORRYING PREDICTIONS
Alcohol is expected to cause around 135,000 cancer deaths over the next 20 years, costing the NHS an estimated £2bn, according to a new Sheffield University report. Oesophageal cancer is expected to see the largest increase, followed by bowel cancer, mouth and throat cancer and liver cancer. ‘These new figures reveal the devastating impact alcohol will have over the coming years,’ said Cancer Research UK’s director of prevention, Alison Cox. ‘That’s why it’s hugely important the public are aware of the link between alcohol and cancer.’
Alcohol and cancer trends: intervention scenarios at www.cancerresearchuk.org

RISK MANAGEMENT
HIV levels in the UK remain low but there are continuing risks among people who inject drugs and ‘outbreaks still occur’, according to PHE’s updated Shooting up: infections among people who injected drugs in the UK report. Diagnostic testing for HIV should be offered to all those at risk, it says, while ‘new patterns of injecting drug use among some groups of MSM’ is also a concern. Only 1 per cent of people who inject drugs in the UK are infected, although 17 per cent reported sharing injecting equipment and around half have been infected with hepatitis C, often without being aware. Bacterial infections also remain common, it states, some of which can lead to severe illnesses.
Report at www.gov.uk

UNAPPEALING DEVELOPMENTS
The Scotch Whisky Association (SWA) has said it intends to appeal the Scottish Court of Session’s ruling on minimum unit pricing (MUP) (DDN, November, page 5). The decision to appeal to the UK Supreme Court – and so extend the seemingly endless MUP saga – is not one the organisation has ‘taken lightly’, said its acting chief executive, Julie Hesketh-Laird. ‘It comes after wide consultation with our member companies and other parties to the case to see whether there is an alternative way forward. However, given our strong view that minimum pricing is incompatible with EU law and likely to be ineffective, we now hope that our appeal can be heard quickly in the UK Supreme Court.’ SHAAP director Eric Carlin said the decision ‘beggared belief’, while Alcohol Focus Scotland chief executive Alison Douglas called it ‘truly shocking and saddening news’ and accused SWA members of putting shareholder profits ‘above the public interest’.

HIGH VOTER TURNOUT
Last month’s US presidential elections also saw citizens vote on commercial models of recreational cannabis supply in five more states. Maine, Massachusetts, Nevada and, significantly, California – which has a population of nearly 40m – all voted in favour of legalising the sale and consumption of recreational cannabis, while Arizona voted against. Meanwhile, a new report from the Global Commission on Drug Policy calls for UN member states to explore regulatory models for illicit drugs and end all penalties for possession for personal use. ‘It is time to highlight the benefits of well-designed and well-implemented people-centred drug policies,’ said commission chair Ruth Dreifuss.
Advancing drug policy reform available at www.globalcommissionondrugs.org

SKEWED SYSTEM
Black and Asian men are about 1.4 times more likely to receive a custodial sentence for drugs offences than white men, according to the interim report from David Lammy MP’s review of race and the criminal justice system. For every 100 white women handed custodial sentences at crown courts for drugs offences, meanwhile, 227 black women are sentenced to custody. The review, which was commissioned by David Cameron, is due to publish its full report next year. ‘These emerging findings raise difficult questions about whether ethnic minority communities are getting a fair deal in our justice system,’ said Lammy.
Black, Asian and minority ethnic disproportionality in the criminal justice system in England and Wales at www.gov.uk

EASY DECISION
France has opened its second consumption room, less than a month after the country piloted its first project in Paris (DDN, November, page 4). Councillors in the city of Strasbourg voted 90 per cent in favour of the facility, which has a capacity for up to 150 visits a day. A third facility, in Bordeaux, is set to open soon.

URGENT UPSCALE
There is an urgent need to scale up needle and syringe programmes (NSP) and opioid substitution therapy (OST) to keep pace with growing need, according to HRI’s latest Global state of harm reduction report. Out of more than 150 countries where injecting drug use is reported, nearly 70 still do not provide NSP – with no new countries establishing it since 2014 – while just 80 implement OST. ‘The 2011 UN target to halve HIV among people who inject drugs by 2015 was missed by 80 per cent,’ said report author Katie Stone. ‘Now people who inject drugs are being left ever further behind.’
Report at idpc.net

DESPERATE MEASURES
New guidelines for the management of coexisting severe mental illness and substance use – ‘dual diagnosis’ – have been published by NICE. Aimed at commissioners, providers, frontline staff, families, carers and others, they cover issues like referral, care plans and improving service delivery. The guidelines were ‘desperately needed’ said chair of the guideline committee, Professor Alan Maryon Davis. There needs to be ‘much wider recognition that this group of people, despite their complexities, have as much right to dedicated care and support as anyone else,’ he stated. ‘They should not be turned away or left to flounder. Every effort should be made to help them benefit from the services they so badly need. Crucial to this is a non-judgmental, empathetic approach and the building up of mutual respect and trust.’
Available at www.nice.org.uk

Review of the year

Features

DDN

December 5, 2016

As the old Chinese curse has it, ‘may you live in interesting times’…

A truly seismic year for world events saw the triumph of populist policies, and politicians, across the globe – including one head of state elected after a campaign promise to eradicate drug users.

JANUARY

As people are getting over their festive hangovers, the chief medical officer starts 2016 by revising the UK’s alcohol guidelines. The official recommendation is now that men should drink no more than 14 units per week, bringing the level in line with that for women and making the UK’s recommended consumption levels among the lowest in the world. An early day motion on the government’s Psychoactive Substances Bill, meanwhile, brands the document ‘evidence-free and prejudice-rich’.

FEBRUARY

The ninth annual service user conference in Birmingham sees powerful presentations, heated debate and a rousing closing speech from Big Issue founder John Bird. ‘The skills you used to score and beg – use them.’ he told delegates. ‘Don’t let anyone tell you that you don’t have valuable skills!’ As austerity policies continue to bite, a survey of directors of public health finds that 70 per cent of them expect drug and alcohol services in their area to face cuts.

MARCH

The bleak news continues as a report by the Recovery Partnership finds that nearly 60 per cent of residential services have reported a decrease in funding, along with almost 40 per cent of community services. The government, meanwhile, delays its beleaguered Psychoactive Substances Act.

APRIL

The UN convenes its first special session of the General Assembly (UNGASS) on drugs since 1998, with UNODC executive director Yury Fedotov telling the session that the world needs drug policies that ‘put people first’. The event’s outcome document, however, receives a decidedly lukewarm response – despite some welcome language on human rights and harm reduction, the need for consensus renders it ‘watered down’ and ‘generally a huge disappointment’, Transform’s Steve Rolles tells DDN. The seemingly unstoppable flow of new psychoactive substances continues in Europe, with EMCDDA now monitoring almost 600 of them – a sixth of which were reported for the first time in 2015.

MAY

In one of the grimmest developments yet in the ‘war on drugs’, Rodrigo Duterte is elected president of the Philippines, vowing to eradicate crime in the country in six months – a plan, he says, that would see him ‘fatten the fishes’ in Manila bay on the bodies of dead criminals, drug dealers and drug users. Closer to home, the Queen’s Speech contains major reforms to the UK’s struggling prison system – ‘the biggest shake-up’ since the Victorian era, says the government – although the Prison Bill’s chief architect, justice secretary Michael Gove, will be sacked the following month. MDMA, meanwhile, is once again European young people’s ‘stimulant drug of choice’, according to EMCDDA, with figures showing increased levels of use in nine out of 12 countries, along with stronger pills. The Psychoactive Substances Act, meanwhile, finally limps into UK law.

JUNE

As the UK’s Brexit vote sends shockwaves through the world, consensus on the country’s drug legislation continues to shift as a report by the two major public health bodies calls for personal possession of all illegal substances to be decriminalised. A Times editorial on the document goes further, stating that full legalisation should ‘still be the ultimate goal’. Alcohol-related hospital admissions continue their upward curve, and the idea that problems in the prison service are ‘all down to NPS and overcrowding’ is naïve, former governor of Brixton and Belmarsh, John Podmore, tells DDN. ‘It’s looking for a quick fix, and there is no quick fix in this.’

JULY

‘The chances of political time and energy being focused on addressing alcohol and drug treatment are negligible,’ Collective Voice head Paul Hayes writes in DDN as he considers Brexit’s implications for the sector. While this may be useful in preventing ‘renewed ideological attacks’ in the short term, he says, the sector needs to come together to ‘find anew narrative, as persuasive to local authorities as previous harm reduction and crime-led narratives have been to central government’.

AUGUST

Another bleak milestone for Scotland as the country records its highest ever level of drug-related deaths for the third year in a row. With over 700 fatalities in 2015 – nearly two per day, and more than double the figure from a decade ago – the statistics are ‘a national tragedy’ and ‘the ultimate indicators’ of the country’s entrenched health inequalities, says Scottish Drugs Forum chief David Liddell. More than 300 NGOs sign an open letter to the UN’s drug control bodies urging them to call for an immediate stop to the extrajudicial killings of suspected drug offenders in the Philippines by president Duterte.

SEPTEMBER

Hot on the heels of last month’s grim figures from Scotland, the ONS reveals that the number of heroin-related deaths in England and Wales has doubled in the space of four years, to more than 1,200. The highest number of deaths, for the third year running, are in the North East, while in the Philippines more than 3,000 people are now thought to have fallen victim to Duterte’s ‘war on drugs’.

OCTOBER

The Glasgow City Joint Integration Board approves the development of a business case for the UK’s first consumption room, along with provision of heroin-assisted treatment, generating predictably outraged headlines in some newspapers. Meanwhile, France opens its first consumption room in Paris, with another to follow in Strasbourg.

NOVEMBER

As the world digests the news that Donald Trump is to become the 45th US president, another set of American voting results see recreational cannabis legalised in four more states, including California.

DECEMBER

A year that many people will be keen to see the back of draws to a close, and still no sign of the 2016 Drug Strategy. However, preparations are well under way for DDN’s milestone tenth annual service user conference. With drug-related deaths continuing to rise and resources diminishing, the need for strong, targeted, effective service user involvement has never been stronger. Join us in Birmingham and let’s make a difference!

Government seeks to address prisons crisis with extra staff

News

DDN

December 5, 2016

Justice secretary Elizabeth Truss has announced funding to recruit 2,500 more prison officers as part of the government’s new prison safety and reform white paper. There will also be new measures to test offenders on entry and exit from prison ‘to show how well jails are performing’ in getting them off drugs and giving them basic education and employment skills.

The white paper also includes measures to introduce no-fly zones over prisons to stop drones being used to drop drugs inside the prison walls, as well as extra sniffer dogs. Prisons should be ‘places where offenders get off drugs and get the education and skills they need to find work and turn their back on crime for good’, said Truss.

Deaths in custody rose by 30 per cent in the year to June 2016, while suicides and assaults on staff rose by 28 per cent and 40 cent respectively (DDN, September, page 4). A recent report by the Prison and Probation Ombudsman said that prison authorities must to do more to tackle the role of NPS and associated debts in the rising and ‘unacceptable’ levels of violence in the prison estate (DDN, October, page 4).

RAPt CEO Mike Trace – whose organisation recorded a seven-fold increase in reports of NPS use in prisons last year – said that while it was vital to undermine the prison drug market, more also needed to be done to reduce demand. ‘More than half of new arrivals in prison are daily users of drugs, or dependent on alcohol,’ he said. ‘Most seek to continue using inside and, if a way isn’t found to turn them away from the dealer and towards treatment and recovery, their demand fuels the profits of the gangs, which itself is behind most of the violence, disorder, and health emergencies in prison today. We call on the new secretary of state for justice to tackle the issue by prioritising effective drug treatment in the criminal justice system.’

The call for more investment in treatment was echoed by CGL executive director Mike Pattinson, who also stressed the need for better education, training and employment support, as well as provision of safe accommodation on release. ‘Disappointingly there remains a complete absence in thinking and action about some of the other fundamental concerns that impact upon the prison population and therefore the safety of those being detained, namely sentencing reform and a sensible debate about the role of prisons in a modern society and who should be incarcerated,’ he added.

White paper at www.gov.uk

A name not a number: ‘Behind every drug-related death statistic is a life that could have been saved’.

Features

DDN

December 5, 2016

Behind every drug-related death statistic is a life that could have been saved. It’s our duty to do more, says Dr Judith Yates.

I first met David in the 1980s when, as a small child, his mother kept him away from school all too often. She struggled to cope with life. By the end of the 1990s, in his early twenties, David was a regular attendee at my surgery, prescribed methadone and supported by my drug worker.

One night he banged on the back door of the surgery after 7pm when we were supposed to be closed and trying to pack up and go home. Our gentle-hearted nurse Angela opened the door to ask what he needed and stepped back as he staggered in, fell to the floor, stopped breathing and turned rapidly blue. My quick-witted partner ran to the emergency cupboard and dug out our newly acquired naloxone kit. Naloxone is the antidote to opiate overdose and David was breathing again, although still groggy when the ambulance arrived.

When he returned to my surgery for his routine appointment the following Tuesday he was surprised to be met joyfully by the reception staff who had thought he might have died. On waking in the hospital he had no idea how he got there, how close he had been to death, nor the role played by the surgery team. His was the first life I had known to be saved by naloxone.

It was therefore a shock two weeks ago to see David’s name in the stark ‘drug-related death’ summary I was reading on a clear sunny day in Birmingham. I had trodden a familiar path to our local coroner’s office to review the thick ring-bind folder containing reports of all inquests held in the city during 2016, as part of the preparation for our newly re-formed drug-related death (DRD) local inquiry group.

It seems that David had no longer been in treatment at the time of his death, as only heroin had been found on toxicology. I suppose there was nobody around to administer naloxone on this occasion.

This reviewing of the inquest reports is a miserable job, not only because beneath the terse language of the certificates lie the shocking stories leading to these sudden and unexpected deaths, but also because having been a GP in the area for over 30 years, I have known many of the people who have now come to the end of their lives in ways which might have been avoidable. It is always especially upsetting to find that one of my old patients has died in this way.

Last week, standing at the podium to address the audience at the 21st RCGP/SMMGP Managing drug and alcohol problems in primary care conference, I felt the warm glow of a room full of people who have been working together for all of the 21 years and more, but my subject matter – a review of drug-related deaths in Birmingham – replaced this with an icy chill and a feeling that we must be missing something. I thought of David and the other people I have known who have died suddenly and unexpectedly in this way.

We have all read the headlines telling us that heroin-related deaths have more than doubled in England and Wales between 2012 and 2015 (DDN, October, page 4). Prof David Nutt, speaking at the same conference, asked the question ‘Why are we collecting all these statistics if we aren’t doing anything about them?’ It is only by looking behind the statistics that we can have a chance of understanding what may be the causes and, more importantly, what solutions can be found.

It is shocking that in many parts of the country, as in my city, drug-related death inquiry groups fell victim to the financial cuts in services, and often no longer meet at all. As a result, nobody has been investigating the deaths of people not actually engaged with treatment services at the time of their death. The latest analysis by PHE shows that more than half of people who die in this way have never been involved with drug treatment services, at least since NDTMS records began seven years ago, and more than 70 per cent were not engaged with treatment services at the time when they died (http://bit.ly/2c3k2H6).

We need to learn from each of these tragedies and add to the frequently simple and usually not even expensive actions, which we already know from international evidence contribute to reducing future deaths. These include: low-threshold prescribing (and welcoming rapid re-engagement for those who drop out), supervised consumption facilities offering cups of tea, conversation and a safe hygienic place to inject for the most vulnerable who are not ready or able to come into treatment, and wide access to take-home naloxone wherever it might be used to save a life.

David was only in his late thirties when he died, an increasingly common age for people to suffer accidental overdose. He was of course more at risk because of his age and history, because he had fallen out of treatment, and because he had a history of non-lethal overdose in the past. His death almost certainly could have been avoided.

We have powerful examples of effective analysis and action, for example from the airline industry, the maternal deaths confidential inquiry groups, and the investigations into every road traffic accident death, all of which have found ways to prevent avoidable deaths.

In 2009 airline pilot Captain Sullenberger astonished the world when he made an emergency landing of his plane on the Hudson River, saving every life on board. When asked how he knew what to do, he said, ‘Everything we know in aviation, every rule in the rulebook, every procedure we have, we know because someone somewhere died. We cannot have the moral failure of forgetting these lessons and have to relearn them.’ (Quoted in Black Box Thinking by Matthew Syed, 2015.)

Local inquiry groups are needed now more than ever to look at every fatality and ideally at the near misses as well, to inform our treatment efforts and perhaps even more powerfully to inform people who use drugs how to keep themselves alive and safe into the future.

Dr Judith Yates is writing a guest ‘Post-it’ on behalf of SMMGP, www.smmgp.org.uk

Media Savvy: the news, and the skews, in the national media

News

DDN

December 5, 2016

On drugs, like so many people on drugs, Britain is predictable, embarrassing and stuck in the past. Occasionally some bold public figure will admit to once smoking a joint whereupon tradition now dictates that a phalanx of columnists will descend, either to brag about their own boring acid trip in 1982, or to offer terrifying anecdotes about godsons who got hooked on skunk and now aren’t getting into Oxbridge. For the most part, senior politicians simply leave the subject well alone. Two months ago, the all-party parliamentary group on drug reform declared that current policy on medical marijuana was ‘irrational’. The Home Office just shrugged. In the absence of direction, or even debate, British drugs policy drifts, shaped by the whims of police forces. Nobody seems in charge of anything.

Hugo Rifkind, Times, 8 November

The confirmation that a full business case for [a consumption room] is being prepared following a meeting of the Glasgow City Integration Joint Board has generated a predictable gnashing of teeth from those who regard addicts as a criminal underclass undeserving of basic human compassion, let alone state-funded treatment. The critics are only getting warmed up, tossing out phrases such as ‘shooting galleries’ or ‘heroin hotels’, aghast at the prospect of medical-grade opiates being provided under supervision. A few have even offered a taste of the vitriol to come as the plans begin navigate uncertain legislative waters. One right-leaning newspaper warned of a doomsday scenario where ‘pampered users of all ages pump themselves full of freebie drugs’. It is hard to know which addiction is more ruinous: heroin, or this kind of diet of fear, anger and misinformation.

Martyn McLaughlin, Scotsman, 2 November

The long-term aim of drug policy has always been, and should remain, to help addicts recover. But for a small number of vulnerable addicts, safe heroin and a safe place to consume it may be the only answer.

Herald editorial, 1 November

One of the hopes of devolving power to governments in Scotland and Wales was that they would experiment with policies that could spread to the rest of Britain. Glasgow’s promising trial should be watched closely by other cities.

Economist editorial, 5 November

Canada and the US are waking up to the realisation that decades of cannabis prohibition have caused far more problems than they have solved, and it is only a matter of time until such enlightened thinking washes up on shore here.

Henry Fisher, Independent, 21 November