European Network of People who Use Drugs

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September 7, 2015

Hands across Europe

It’s an exciting time for activism and advocacy among people who use drugs, says Mags Maher

For the first time in years, Europe has been able to gather together an experienced group of advocates to form a motivated, innovative and forward thinking activist group interested in implementing harm reduction policy and practice across the EU. The group is called The European Network of People who Use Drugs (EuroNPUD).

We began in 2010/11 when EuroNPUD received €20,000 for a network mapping and case study project from the EU. After a planning meeting at the International Harm Reduction Conference in Liverpool in 2010, we began the project, with a consultant mapping out the range of drug user groups in Europe. Information from this was presented to the European Harm Reduction Conference, held in Marseille in 2011.

EuroNPUD reflects input from 14 countries from across the EU, whose advocates and networks bring a range of different experience and expertise. Many of our leading activists and members are well-established players in the world of drug policy, harm reduction and community mobilisation among people who use drugs (PWUD).

Drug-related activities are the core focus of our organisation and include drug-demand reduction, supply reduction, international cooperation, information, research and evaluation. We have also established communication systems among drug user groups and activists in the EU, as this is key to our intelligence gathering and consultation at grass roots level.

EuroNPUD is already engaged in domestic advocacy and we have members with experience of representation at both EU and UN meetings. One of our key targets will be the development of an EU advocacy strategy, and our members are involved in many best practice projects looking at responses to overdose, HIV and viral hepatitis. We have a clear mandate around drug law reform.

Western Europe has a tradition of drug user activism dating back to the 1970s that reflects the diversity of drug taking and drug-related cultures. The European HIV epidemic in the 1980s and 1990s saw people who inject drugs organising together, while the development of opioid substitution therapy (OST) services also led to a consumer rights movement. As networks have matured there has been strong collaboration between different types of drug users, leading to national policy-making, advocacy and lobbying for drug law reform.

EuroNPUD will be actively engaged in the planning and preparations for the UN General Assembly Special Session on Drugs (UNGASS) 2016, where the global community will have the opportunity to consider decriminalising people who use drugs. Whether this goal is achieved or not, this drug policy summit meeting will provide a key milestone in the global dialogue about drug control regulations.

We will also support the UNAIDS and co-sponsors push to end the HIV epidemic by 2030, actively promoting the nine core harm reduction interventions recommended by WHO, UNAIDS and UNODC in the technical guide on HIV and injecting drug use across EU countries.

EuroNPUD is mindful of new drug trends, such as novel psychoactive substances, and will be supporting the development and dissemination of learning and best practice in these areas. We will also promote the meaningful participation of PWUD in drug policy discussions, the review and development of drug treatment systems, and the continuing public health agendas around HIV, TB, and viral hepatitis. We are aiming to hold an international campaign over the Christmas period promoting access to naloxone, and are hoping to engage the UK’s dedicated drug user activists in this.

In short, we hope that EuroNPUD provides a pathway to draw on national experiences and expertise among drug user groups, in terms of both identifying best practice and highlighting current gaps in service. Through a steering group representing members from 14 countries, we now have a mechanism to consult and gather intelligence and testimony from those directly affected by drugs policy and practice.

Mags Maher is coordinator of EuroNPUD

Legislation to allow naloxone to be more widely available

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DDN

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September 7, 2015

Ready for action

Naloxone is to be made more readily available next month. Public Health England’s Steve Taylor looks at how local services and commissioners can respond to this change in the law

Legislation to allow naloxone to be more widely available for those who need it is on track to be enacted next month. This follows the Advisory Council on the Misuse of Drugs (ACMD)’s recommendation in 2013 and a public consultation by the Medicines and Healthcare products Regulatory Agency in 2014 that saw wide support for the proposals.

The evidence shows that take-home naloxone given to service users, and training family members or peers in how to administer naloxone, can be effective in reversing heroin overdoses. Because it is only available as an injectable product, naloxone will remain a prescription-only medicine but the legislation will permit people working in commissioned, lawful drug treatment services to supply naloxone without a prescription to anyone needing it to prevent a heroin overdose.

Drug treatment services are generally seen to be those providing specialist services, primary care drug treatment, and needle and syringe programmes (including pharmacy-based programmes).

These services will legally be able to order naloxone and their staff will be able to supply it to individuals without needing a prescription or any other written instruction from a health professional. These individuals could be drug users themselves, or it could be family members, friends, carers or hostel managers who may need easy access to the medication.

Services that work with drug users but do not provide drug treatment would be unlikely to count as lawful drug treatment services, so would not be able to supply naloxone according to the new proposals. However, these services could arrange for people to visit another service that does supply naloxone or, using existing mechanisms, could ask a doctor to prescribe naloxone if the individual has been identified as at risk of overdose.

The legislation is about supply to individuals, so a drug treatment service will not be able to supply stocks of naloxone to another service.

Preliminary advice from the working group updating the 2007 clinical guidelines on drug misuse and dependence clarifies appropriate naloxone dosing in the case of an overdose, naloxone products that can be supplied, and training that should be provided.

Once legislated, commissioners will need to agree how any new naloxone supply works locally, including:

What naloxone product should be supplied and how it should be packaged, if needed, to include one or more needles and a sharps box.
Which services will be funded to supply naloxone.
Which groups of people should be able to receive naloxone.
How these groups might be prioritised and whether there is any limit on how much naloxone can be supplied.
What record keeping is required to track supplies and arrange for re-supply.
What training should be provided alongside naloxone.

PHE’s advice earlier this year – http://bit.ly/1G37cz9 – covers many of these points and PHE is now considering what further resources would be helpful to commissioners before October’s legislative change.

Steve Taylor is programme manager, alcohol, drugs and tobacco division, health and wellbeing, Public Health England

Scottish drug deaths

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September 7, 2015

Stark statistics

Scotland has recorded its highest ever number of drug-related deaths. DDN looks at what’s behind this bleak trend, and what could be done to reverse it

Last year there was cautious optimism when figures showed that the number of drug-related deaths in Scotland fell by just under 10 per cent in 2013. Admittedly, this followed 2011’s record high of 584, a figure almost unchanged in 2012, but many still hoped that the tide had finally turned.

Those hopes were dashed last month when the 2014 statistics from National Records of Scotland were released, recording the highest death toll ever, at 613. Once again, the vast majority were older drug users, with 67 per cent of deaths in the over-35s. ‘I think within the whole sector there was a feeling of depression that the figures were going up again, and a realisation that it’s likely the trend is still upwards,’ Scottish Drugs Forum director David Liddell tells DDN.

As well as being older, the majority of those dying appear not to have been engaged with services at the time, raising questions not only around access, but also about what should be done ‘for those falling out’, he says. ‘Should we be doing more in terms of assertive outreach and looking at other models to chase people up?’

With services already under intense pressure, changing approach to become even more proactive is going to be a challenge, he acknowledges. ‘But I think it’s definitely something we need to do. The other thing that links into that, knowing what we know about the protective factors of treatment, is that in Scotland we’ve probably got half the population of 60,000 [problem drug users] in treatment. In countries like Switzerland and Holland it’s much higher, and that’s what we should be aiming at.’

On the subject of pressures, some have commented that government cuts and austerity measures will have played a role in the increased number of deaths. Is that something he’d go along with?

‘I’m only cautious in the sense that it’s very difficult to prove that,’ he says. ‘But certainly what we have with the older group is a group that came out of the 1980s and mass unemployment and austerity, so what we’re seeing is that same group being hit by a second wave of austerity now. Clearly that’s having an impact. Whether it’s adding to people’s ambivalence as to whether they live or die, and those whole feelings of despair – I’m sure that’s the case, but it’s very hard to quantify.

‘More generally, in terms of service cuts, we’ve been very fortunate in Scotland in that core funding for specialist health services has been ring-fenced for many years,’ he continues. ‘It hasn’t kept pace with inflation, but it’s largely been untouched. But some of the wider services, particularly within local authorities, have obviously been hit. I’m sure it’s had some impact.’

It’s been pointed out that older drug users perhaps haven’t been as much of a priority, because they don’t tend to be as involved in acquisitive crime. Is that focus starting to change? ‘It has to, just because of the profile of the population in services,’ he states. ‘There has been that sense that you’ve had a group who maybe weren’t creating significant demands, but I think services do need to pay more attention.’

However, it’s important not to lose sight of the fact that deaths in under-35s have actually remained fairly constant over the last couple of decades. ‘It was interesting in that the narrative was that the deaths had continued to fall in the younger age group as a percentage, but certainly when we looked at the actual figures they were up,’ he says. ‘In the 15-24 group they were up by 14 on the previous year, and for 25-34 they were up by 19.’

Here lies the challenge around the aging cohort narrative, he stresses. ‘It’s true in overall terms, but there are still younger people developing drug problems and of course you still have a large group of vulnerable young people. So sadly it shouldn’t really come as any surprise.’

It also highlights the importance of continuing to pay attention to the emerging population, he says. ‘It’s not an easy balance, but certainly it’s a wake-up call. We can’t just adapt our services to an aging cohort then realise that there’s a younger group that have opted out of services because we’re not meeting their needs.’

As he’s pointed out, little has changed for that older cohort over the last three decades. Is it becoming more accepted that problem drug use is largely the result of poverty, or is the dominant message still the opposite?

‘I don’t think it’s largely recognised, beyond people who work in the area or are more widely involved in health policy,’ he says. ‘I just did an article in the Edinburgh Evening News and got a particularly vicious email response, basically saying these people should be left to die. I was talking about underlying problems such as trauma, on the basis that a lot of the public narrative is around lifestyle choices and so on. It’s about trying to get people to understand that the folk who are dying are actually victims of society, by and large – they’ve had a raw deal, their drug use is largely a way of coping with the hand they’ve been dealt, and they deserve a bit more public sympathy. But clearly that’s an uphill struggle.

‘Our government has been hugely supportive in trying to reduce drug-related deaths, but you do have to think that if there were 600 deaths in any other area, there’d be a public outcry. It’s a sad state of affairs, but it’s the reality.’

Diverted methadone

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September 7, 2015

Kill or cure?

Is it time for us to reappraise our relationship with the ‘life-saving’ drug methadone? Dave Marteau discusses the evidence

Since the early 1970s, methadone has been the predominant opioid prescribed in the UK for the ongoing treatment of heroin addiction. It has proved extremely useful in the fight to contain HIV among injecting heroin users, and there is strong evidence that longer-term methadone treatment of heroin addiction reduces death rates by as much as 50 per cent. Moral objections have been voiced by many about a treatment that swaps addiction to one drug (heroin) for dependence on another (methadone), but perhaps we can all agree on the primacy of life itself: it trumps any argument.

In 2007 the National Institute for health & Clinical Excellence (NICE) positively evaluated methadone and buprenorphine. In circumstances where assessments had suggested that both drugs were equally suitable, NICE recommended that ‘methadone should be prescribed as the first choice’.

However, in a review of drug-related deaths in France between 1994 and 1998, Marc Auriacombe found that, set within the context of numbers of prescriptions issued, methadone was at least three times more lethal than buprenorphine in respect of overdose deaths within the French population as a whole (ie, among patients and the wider public).

On the subject of the relative toxicity of methadone and buprenorphine, NICE had this to say:

‘Comparison of data from population cross-sectional studies suggests that the level of mortality with BMT [buprenorphine maintenance] may be lower than that with MMT [methadone maintenance], although other authors have commented that these data were unlikely to capture all related deaths.’

This was a cursory summary of an important matter in 2007; it would be insufficient to the point of negligence now. In 2009 James Bell and colleagues in New South Wales found that, per prescription, methadone was 4.25 times more lethal than buprenorphine. This year Rebecca McDonald, Kamlesh Patel and I carried out a similar but larger study in England and Wales. We found that between 2007 and 2012, 57 death certificates mentioned buprenorphine, and 2,366 death certificates mentioned methadone.

Allowing for a calculation that seven methadone prescriptions were issued for every buprenorphine prescription, methadone emerged as six times more dangerous across the population as a whole. The picture in Scotland appears no prettier. Between 2011 and 2013, heroin and its metabolite morphine were implicated in 538 drug poisoning deaths; methadone was found to be implicated in 663 deaths.

So how is it that a drug with the potential to halve a patient’s risk of dying ends up killing so many people? The answer is horribly simple: while most patients are safer on methadone, the wider population are at continued risk from diverted supplies of the drug. The National Programme on Substance Abuse Deaths found that of 1,117 UK deaths that involved methadone alone or in combination with other drugs, only 36 per cent occurred among individuals who were known to be receiving methadone treatment.

To be fair to NICE, their methodology was designed to determine the cost-effectiveness of a drug, not its safety. That same methodology, based solidly on randomised controlled trials, compares the outcomes for a patient group on drug A with those for members of a patient group on drug B. No persons outside of these two groups are considered. This is a very good means to evaluate antibiotics or chemotherapy, but altogether less suitable for drugs intended to treat people with a drug-taking problem. No one on antibiotic ‘A’ would be likely, for instance, to consider trading their medication with a non-patient, or to be put under duress to hand over their medication outside the pharmacy.

There is another stark statistic: of all drugs detected at post-mortem over the past three years in Scotland, methadone has, at 93 per cent, the highest degree of implication in the unfortunate person’s death. So, if you were to die from a drugs overdose, and methadone was among the substances found in your body, there is a 93 per cent chance that it had been wholly or partly responsible for your death. This makes methadone significantly more toxic than heroin, (which had an implication rate of 83 per cent), buprenorphine (65 per cent) and cocaine (63 per cent). Put simply, methadone is the most dangerous drug out there.

Methadone has the capacity to retain more people in treatment than buprenorphine, but the evidence is now overwhelming that it is significantly more lethal. Hundreds of our fellow UK citizens are dying every year from methadone poisoning. If we agree with the premise at the start of this article that the value of life prevails over any other argument, then we have now to relegate methadone to a secondary option for the substitute treatment of opioid dependence, behind buprenorphine and buprenorphine-naloxone. Failure to change would indicate that we are less courageous than our clients in confronting a dangerous pattern of our own behaviour.

For the record, I have never taken nor will ever take a penny from a drug company.

Dave Marteau is research fellow at the University of London

References

Auriacombe M, Franques P, Tignol J. Deaths attributable to methadone vs buprenorphine in France. JAMA. 2001 Jan 3;285(1):45. PubMed PMID: 11150107.

Bell JR, Butler B, Lawrance A, Batey R, Salmelainen P. Comparing overdose mortality associated with methadone and buprenorphine treatment. Drug Alcohol Depend. 2009 Sep 1;104(1-2):73-7. PubMed PMID: 19443138.

Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010; 341.

Corkery J, Claridge H, Loi B, Goodair C, Schifano F. Drug-related Deaths in the UK, National Programme on Substance Abuse Deaths (np-SAD), UK Annual Report 2012. London: St George’s University; 2013.

Heinemann A, Iwersen-Bergmann S, Stein S, Schmoldt A, Puschel K. Methadone-related fatalities in Hamburg 1990-1999: implications for quality standards in maintenance treatment? Forensic science international. 2000 Sep 11;113(1-3):449-55. PubMed PMID: 10978661.

Kimber J, Copeland L, Hickman M, Macleod J, McKenzie J, De Angelis D, et al. Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ. 2010;341:c3172. PubMed PMID: 20595255. Pubmed Central PMCID: 2895695.

Marteau D, McDonald R, Patel K. The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales. BMJ Open 2015; 5: e007629

National Institute for health & Clinical Excellence (NICE), Technology appraisal guidance 114, Methadone and buprenorphine for the management of opioid dependence 2007 [April 25 2014]. Available from: www.nice.org.uk/TA114

ONS. Statistical bulletin: Deaths related to drug poisoning in England and Wales, 2012 2013 [May 30, 2014]. Available from: http://www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/2012/stb—deaths-related-to-drug-poisoning-2012.html

NHS Scotland Information Services Division. The National Drug Related Deaths Database (Scotland) Report 2013. Available from: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/data-tables.asp?id=1386#1386

E-cigarettes ‘safer than smoking’

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August 19, 2015

E-cigarettes are around 95 per cent less harmful than tobacco and have the ‘potential to help smokers’ quit, according to a new expert independent evidence review published by Public Health England (PHE).

The subject of e-cigarettes has been extremely controversial, with the Welsh Government announcing plans to ban their use in public places earlier this year (DDN, July/August, page 8). However the new report, which PHE is calling ‘a landmark review’, concludes that there is no evidence ‘so far’ that e-cigarettes act as a gateway into smoking for children or other non-smokers.

The review’s authors found that almost all of the UK’s 2.6m e-cigarette users were current or ex-smokers, with most using the devices as an aid to quit smoking. Their use may be helping to contribute to falling smoking rates, it says, with some of the highest successful quit rates found among those who combined e-cigarettes with support from local smoking cessation services. Less than 1 per cent of adults and young people who had never smoked had gone on to become regular e-cigarette users, it states.

While e-cigarettes carry a ‘fraction of the risk’ of smoking cigarettes, they are not ‘risk-free’, says the document. It calls on health and social care professionals to provide accurate advice on the relevant risks, as around half the population are unaware that e-cigarettes are significantly less harmful. The devices could also be a ‘game changer’ in reducing health inequalities, it adds, in that they potentially offer a ‘wide reach, low-cost intervention’ to cut smoking rates in deprived communities, as well as among people with mental health problems.

‘E-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm,’ said PHE’s director of health and wellbeing, Professor Kevin Fenton. ‘The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting. Local stop smoking services should look to support e-cigarette users in their journey to quitting completely.’

‘This timely statement from Public Health England should reassure health professionals, the media, and the public – particularly smokers – that the evidence is clear: electronic cigarettes are very much less harmful than smoking,’ added ASH chief executive Deborah Arnott.

Government to consider benefit sanctions for refusing treatment

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July 29, 2015

The government has re-ignited the debate over whether benefit entitlement should be linked to accepting treatment, with the publication of a new review by Professor Dame Carol Black. Couched in terms of exploring the best ways to ‘support benefit claimants with addictions and potentially treatable conditions’ – such as obesity – back into work, the review will consider ‘the case for linking benefit entitlements to accepting appropriate treatment or support’.

A consultation has been launched to consider the evidence, the results of which will form part of a final report to be published later in the year. Similar plans considered by the last Labour government proved controversial and did not become law.

The independent review will ‘explore the support provided by the existing benefit system and the incentives/barriers created’, says the Department of Work and Pensions (DWP), as well as assess the ‘cost to taxpayers and the economy of worklessness resulting from obesity and addictions’. It will also look at the availability of treatment and study international practice to provide ‘fully costed, robust and deliverable recommendations’ and analysis of the available options.

The review will fully consider the ‘legal, ethical and other implications’ of linking benefit entitlements to the take up of treatment, the government states, and will consult ‘a wide range’ of health and addiction professionals. A steering group will also be established with representatives from DWP, Home Office, Ministry of Justice, Department of Health and others, and the government has said it wants to hear from ‘individuals who have experienced these conditions or any relevant aspects of the health and benefits systems’.

Harmful drinking is estimated to cost around £3.5bn a year to the NHS and £11bn to the criminal justice system, while the review puts the ‘societal costs’ of drug addiction at more than £15bn. Previous research had found one in 15 working-age benefit claimants to be dependent on heroin or crack, says the document, and one in 25 to be suffering from alcohol dependency.

‘Our one nation approach is about giving everyone the opportunity to improve their lives, and for some that means dealing with those underlying health issues first and foremost,’ said David Cameron. ‘Whether it is drug or alcohol problems, or preventable conditions in terms of obesity, support and treatment will be there for you. And we must look at what we do when people simply say no thanks and refuse that help but expect taxpayers to carry on funding their benefits. Over the next five years I want to see many more people coming off of sickness benefit and into work, and Carol Black will report back to me on how best to achieve that.’

An independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity: call for evidence at www.gov.uk. Consultation closes on 11 September.

DDN July/August 2015

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DDN

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July 6, 2015

In this month’s issue of DDN…

In this month’s DDN, nutritionist Helen Sandwell looks at the risk of ‘pure, white and deadly’ sugar to people in recovery. Also this issue – GPs fight to preserve access to shared care at this year’s RCGP conference, and how to improve support for those bereaved through drugs or alcohol.

Click on the links below to read more, and don’t forget to join the discussion by commenting, tweeting and liking our Facebook page.

PDF Version/ Mobile Version

New psychoactive substances in Europe

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July 6, 2015

Two new substances a week identified in Europe

New psychoactive substances (NPS) are now being detected in Europe at a rate of two per week, according to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). More than 100 NPS were reported last year, says the European drug report 2015, with the total number of substances being monitored by the agency now standing at more than 450.

As in previous years the majority of substances reported were either synthetic cannabinoids or cathinones, with the internet now playing a ‘growing role’ in supplying both NPS and more established drugs and posing a ‘major challenge to law enforcement and drug control policies’. The British government recently moved to introduce a blanket ban on all NPS (DDN, June, page 4).

Meanwhile, although problems relating to heroin continue to ‘account for a large share of drug-related health and social costs’ across the continent, demand for the drug appears to be stagnating, says the document. More than half of Europe’s 1.3m long-term opioid users are now estimated to be in treatment, while the number of people entering heroin treatment for the first time stood at 23,000 in 2013, down from 2007’s figure of almost 60,000. The median age of opioid users rose by five years between 2006 and 2013, with a ‘significant number’ now in their 40s or 50s. However the report warns of potential future problems as a result of increased opium production in Afghanistan and alternative smuggling routes into Europe.

Unsurprisingly, cannabis remains the continent’s most widely consumed drug, with almost 20m people reporting use within the last year and more than 60,000 people entering first-time treatment for cannabis problems in 2013, while cocaine is still Europe’s most commonly used illicit stimulant. The document also reports increasing potency levels for cannabis, MDMA and other drugs.

‘The report shows that we are confronted with a rapidly changing, globalised drug market,’ said European commissioner for migration, home affairs and citizenship, Dimitris Avramopoulos. ‘I am particularly concerned that the internet is increasingly becoming a new source of supply, for both controlled and uncontrolled psychoactive substances.’

The latest United Nations Office on Drugs and Crime’s (UNODC) World drug report, meanwhile, finds worldwide drug use rates to be ‘stable’, with just over 5 per cent of 15 to 64-year-olds using an illicit substance in 2013 and the total number of problem drug users standing at 27m.

Around 1.65m people who inject drugs are living with HIV, while 2013 saw just under 190,000 drug-related deaths. Just one in six problem drug users has access to treatment, the document adds. ‘Women in particular appear to face barriers to treatment,’ said UNODC executive director Yury Fedotov. ‘While one out of three drug users globally is a woman, only one out of five drug users in treatment is a woman.’

European drug report 2015 at www.emcdda.europa.eu

World drug report 2015 at www.unodc.or

Drug-driving arrests

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July 6, 2015

Monthly drug-driving arrests top 400

More than 400 people a month are being arrested for drug driving in England and Wales, according to the Institute of Advanced Motorists (IAM). The figure is based on statistics obtained from every police force area by IAM under a Freedom of Information request.

More than 900 arrests were made by forces between March – when a new offence of driving with more than the specified limit of a control drug in the body was introduced (DDN, March, page 4) – and May. The figures reveal that there is ‘little consistency in testing and arrests’, however, with London’s Metropolitan Police making 214 arrests – around three per day – while other forces, including Warwickshire, Leicestershire and Gwent, made none.

Since the law was passed, police have the power to stop motorists and conduct a ‘field impairment assessment’ if they suspect them of driving under the influence of drugs. This could then lead to arrest and a blood or urine test at a police station, with penalties including a £5,000 fine or up to six months in prison for those convicted. A 2010 government-commissioned report by Sir Peter North concluded that drug driving could be responsible for up to 200 deaths a year, and that six per cent of drivers aged between 17 and 39 had driven under the influence of drugs.

‘We have reached a point where drink-driving has become socially unacceptable, particularly amongst younger people,’ said IAM chief executive Sarah Sillars. ‘We now need a sustained campaign to back up the police enforcement effort and ensure drug-driving is seen in exactly the same way. The effects of driving under the influence of drugs can be devastating.’

Psychoactive Substances Bill

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July 6, 2015

Psychoactive Substances Bill must be re-worded, warns ACMD

The Psychoactive Substances Bill should be re-worded to ensure the legislation is effective, enforceable and does not result in ‘serious unintended consequences’, the Advisory Council on the Misuse of Drugs (ACMD) has said. The controversial bill (DDN, June, page 4) is currently making its way through Parliament.

The council has written to home secretary Theresa May to say that while it is ‘supportive’ of moves to prevent harm from new psychoactive substances (NPS) the bill should be re-worded to include the word ‘novel’, which should be tightly defined. The ACMD states that it would support a blanket ban on NPS but cautions against a similar ban ‘on all psychoactive substances’, writes chair Professor Les Iversen, adding that it would be ‘almost impossible’ to list all the desirable exemptions under the bill as it stands. ‘As drafted, the bill may now include substances that are benign or even helpful to people,’ he says, stressing that the ‘psychoactivity’ of a substance cannot be unequivocally proven.

The current bill also ‘uncouples the concept of harm’ from the control of supply, importation and production, despite the expert panel that carried out the original new psychoactive substances review (DDN, December 2014, page 5) recommending a ‘safety clause’ to exclude substances of little or no harm. The bill could ‘seriously inhibit’ medical and scientific research, warns Iversen, and has the potential to ‘both criminalise and apply disproportionate penalties to many otherwise law abiding’ people. Closing ‘headshops’ could also simply displace the market, he says, while those in charge of clubs, festivals, pubs or even prisons could be liable to prosecution.

The ACMD says it is willing to work with the government to draw up lists of substances to be included and excluded and make the sure the bill is enforceable, proportionate and ‘framed using evidence’, but wants to see ‘sufficient resources’ allocated for a ‘thorough, independent’ evaluation of its impacts. It also wants to see ‘social supply’ excluded from the document to make sure that the legislation targets commercial suppliers rather than users. The Home Office has said it will respond to the letter before the bill is next debated in the House of Lords later this month.

Letter at www.gov.uk

Substance-related bereavement

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July 6, 2015

Don’t worsen substance-related bereavement, professionals urged

A new set of good practice guidelines to support people who have lost a family member or friend through drugs or alcohol has been launched by the University of Bath, in partnership with the University of Stirling. Both the death itself and the previous substance use ‘may be considered taboo’, says Bereaved by substance abuse, with people often encountering ‘poor, unkind or stigmatising responses’ that can exacerbate their grief and increase alienation.

The guidelines are designed for use by any professionals whose work brings them into contact with people bereaved through substance use, and are based on interviews with more than 100 bereaved adults – the largest known qualitative research sample – as well as practitioners. Although some bereaved people did report positive experiences, the report identifies ‘much poor practice’ through practitioners not fully understanding the issues involved.

The document sets out a number of key messages alongside extensive good practice recommendations, developed by a working group that included treatment professionals and police along with a paramedic, GP, funeral director and others.

Interviewees reported issues such as guilt at not having been able to help, the stress of living with the substance use prior to the death, and even the attitude of the press. People also reported being daunted and bewildered by the ‘myriad’ different individuals and organisations they encountered after the death.

Establishing a single point of support is a key recommendation, along with treating every bereaved person as an individual and always showing kindness and compassion. This, however, should be genuine, the document stresses, and cautions against ‘trying to too hard’ and appearing fake. It also encourages joint working and stresses that, ‘Whatever your role, do what you can to protect the bereaved person’s wellbeing in a difficult and stressful situation.’

‘The unique combination of circumstances surrounding the death of somebody from alcohol or drug use can produce particularly severe bereavements,’ said lead researcher Dr Christine Valentine. ‘A kinder and more compassionate approach can make a real difference. Our hope is that these guidelines – developed for practitioners by practitioners – will provide a much needed blueprint for how services can respond to these bereaved people.’

Bereaved through substance use: guidelines for those whose work brings them into contact with adults bereaved after a drug or alcohol-related death at www.bath.ac.uk

Local news from the substance misuse field

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July 6, 2015

Festival-goers offered harm reduction advice

Swanswell team members were on hand to provide drug and alcohol advice at the Download Festival in Leicestershire last month.

Working with North West Leicestershire District Council’s community safety team, the Swanswell staff offered harm reduction information and were available to answer questions about drug and alcohol use to anyone who dropped in.

This was the fourth year that the recovery charity had attended the festival to provide advice and support.

Recovery Games scheduled for August

The 2015 Recovery Games will be taking place on 21 August at Hatfield Activity Centre.

Backed by Doncaster Drug and Alcohol Services and Rotherham Doncaster and South Humber NHS Foundation Trust, the games will build on the success of the 2013 competition with events and team building activities. Health professionals providing advice, presentations from motivational speakers and fun activities will also be on offer.

Email neil.firbank@rdash.nhs.uk to register your interest

South Wales students learn about substance misuse

Cardiff-based Ashcroft House has been supporting local South Wales schools with free educational workshops about substance misuse.

Counsellors from the centre gave students information and advice during the workshops, which were followed by music therapy in the form of drumming sessions.

Ashcroft House hopes to continue the programme throughout 2015 and 2016, and to develop additional educational and learning sessions for teachers.

Art exhibit explores addiction

Twelve, a new video installation, looks at the personal stories of people affected by addiction and recovery.

Visual artist Melanie Manchot worked with 12 people in recovery in Liverpool, Oxford and London, and created the installation based on their written and oral testimonies.

Twelve was commissioned by Mark Prest of Portraits of Recovery, and supported by Action on Addiction, the Ley Community and the psychosocial research unit at the University of Central Lancashire.

For more information and exhibition dates, visit www.twelve.org.uk

New young person’s outreach service launched

An ‘outreach bus’ is offering young people in west Wales a new way to learn about substance misuse and harm reduction.

Drugaid’s harm reduction project for young people, Choices West, launched the bus at the Haverfordwest Skate Park event in June. The bus provides video games, three large flat screens, a workshop room and chill-out space to help the project engage with young people.

Choices West will use the bus to target secondary schools, young people’s projects, colleges and community events across Carmarthenshire, Ceredigion and Pembrokeshire. The bus will also be used to link the project to other support services in the area.

Event celebrates hard work of service users

The hard work of students from the Spitalfields Crypt Trust was recognised this month with the unveiling of the ‘Bard’s Yard’.

The garden was transformed over the past year from a former concrete space in Shoreditch by gardening students at the New Hanbury Project.

Actor Timothy West cut the ribbon to open the celebrations, followed by a garden party attended by current and former staff, volunteers, residents and trainees – as well as special guests including Prunella Scales and Molly Meacher, Baroness of Spitalfields.

National news from the substance misuse field

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DDN

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July 6, 2015

News in brief

A round-up of national news – July 2015

Report it

A new campaign to raise awareness of LGBT hate crime, and urge people to report it, has been launched by a coalition of more than 30 organisations. While the Home Office recorded 100 such crimes a week in England and Wales in 2013, it’s estimated that only around 6 per cent of incidences are actually reported. ‘We know that people can turn to using drugs or alcohol as a means of coping with the stress of being targeted in a hate crime attack,’ said London Friend chief executive Monty Moncrieff (DDN, April, page 12). ‘We want to help people recognise incidents of hate crime, and provide support for them to both report it and deal with the emotional issues this might bring.’ www.lgbthatecrime.org.uk

Diabetes danger

Consuming 26 units of alcohol over a three-day period can increase the risk of developing type 2 diabetes by up to five times, according to a new fact sheet from Alcohol Concern, with the risk ‘particularly acute’ in women. Just two drinks a day, meanwhile, can increase the risk of breast cancer by 18 per cent. ‘Alcohol is no ordinary item for consumption and people need to be more aware of the risks associated with its use,’ said chief executive Jackie Ballard. ‘Alcohol is linked to over 60 medical conditions including diabetes, cancer and high blood pressure. We need evidence-based health warnings and nutritional information to be made available on alcohol labels to allow people to make an informed choice.’ The charity is also calling for an increase in spirit duty of 4 per cent above inflation in this month’s budget. Fact sheets at www.alcoholconcern.org.uk

Scots’ strategy

A new strategy to address youth offending has been launched by the Scottish Government. Preventing offending: getting it right for children and young people focuses on a ‘whole-system approach’ based around early intervention. ‘If we are to stop young people going down the wrong path in life and into a life of crime we need to be smart in our response – ensuring timely, appropriate and effective interventions so that we can address offending behaviour at the outset and keep our communities and children safe from crime,’ said justice secretary Michael Matheson.

Admissions up

Hospital admissions in England for an alcohol-related disease, condition or injury rose by 5 per cent in the year to 2013-14, to 1,059,210, according to the latest set of alcohol statistics from ONS. Alcohol-related deaths were also up, by 1 per cent. The proportion of 16 to 24-year-olds who report ‘binge drinking’, however, has fallen by more than a third – from 29 per cent to 18 per cent – over the last decade. Statistics on alcohol, England, 2015 at www.ons.gov.uk

Cost concerns

Charities and liver specialists have written to health secretary Jeremy Hunt urging him to overturn attempts to limit the number of hepatitis C patients able to access new treatments. Organised by the Hepatitis C Trust, the letter expresses concern about NHS England’s ‘seemingly unprecedented requests’ for NICE to delay access to a new generation of drugs on affordability grounds. NICE has already ruled favourably on the cost-effectiveness of one drug, sofosbuvir, and is currently appraising others. ‘Patients have been waiting years for these new highly tolerable drugs that can cure almost everyone, all but eliminate hepatitis C in England and address a major health inequality,’ it states. NHS England’s arguments for delaying access were ‘absolutely ridiculous’, said Hepatitis C chief executive Charles Gore. Letter at www.hepctrust.org.uk

Temporary tactics

Two more ‘legal highs’ have been banned under a Temporary Class Drug Order (TCDO) while the government’s Psychoactive Substances Bill makes its way through Parliament (DDN, June, page 4). The compounds 4-Methylmethylphenidate and Ethylnaphthidate have been added to five already controlled in April (DDN, May, page 4) after having been found on sale as replacements for the banned drugs. ‘We are determined to protect young people from the dangers of so-called “legal highs” and target those who profit from their trade,’ said crime minister Mike Penning.

Crucial comparisons

A new study comparing urban drug policies across ten European capitals has been published by EMCDDA. Among the topics covered by Drugs policy and the city in Europe are the best ways to coordinate and fund city-level strategies. ‘It is within cities that new problems first become visible and we increasingly see innovative policies and measures developing,’ said EMCDDA director Wolfgang Götz. ‘I believe there is considerable scope for European cities to share their experiences and to learn from each other in this challenging policy area.’ Report at www.emcdda.europa.eu

PbR problems

Payment by results schemes are risky, hard to get right and costly for commissioners, according to a report from the National Audit Office. Credible evidence for their effectiveness is ‘now needed’, says Outcome-based payment schemes: government’s use of payment by results, adding that when poorly designed, PbR models – which account for around £15bn of public spending – can create ‘perverse incentives’ that prioritise people who are easier to help and neglect others. Document at www.nao.org.uk

Comment from the substance misuse sector

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DDN

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July 6, 2015

Letters and comment

DDN welcomes your Letters Please email the editor, claire@cjwellings.com, or post them to DDN, CJ Wellings Ltd, 57 High Street, Ashford, Kent TN24 8SG. Letters may be edited for space or clarity.

Naloxone no-brainer

I’ve just been reading the article talking with Philippe Bonnet about naloxone (DDN, June, page 6) and agree with what he says. Naloxone is relatively easy to deploy – the key issue in most places is the political will to do so. The administration of it is simple, the economics are a ‘no-brainer’ and the paperwork/training is so simple to implement, given that there is so much already been done in other areas around providing naloxone.

I recently worked as commissioner in Barnsley and left the area last December, where they were committed to providing every client with two kits, one for home and one to carry with them – the economics are that good. I convinced the DPH and DAAT board that this was a necessary piece of work to undertake.

Currently I’m working in Herefordshire, retendering the substance misuse services for the county. In that there is a clear expectation that the new provider will offer naloxone across the service to those who might need/would benefit from the provision of kits. Again I would be advocating a double kit allocation per person. At the moment people are provided naloxone on script but I’ve sanctioned training for staff around this. As Philippe mentions, the cost of a lost life outweighs any cost for naloxone and associated expense. I know that Herefordshire will take this forward to reduce the risk of overdose and death.

Clive Hallam, public health commissioning manager (interim), Hereford

Prison testing

The article in your April edition (page 14) on drugs in prison was excellent. Nothing could be more logical and effective than Neil McKeganey’s proposals for mounting a massive programme of regular and exhaustive drug testing of all prisoners – providing the usage to which that valuable test data is put is also itself sane and effective.

Failure to stop drug smuggling and lack of encouragement for widespread testing may well be the prison system’s natural compensation for the failure of prison psychiatrists and pharmaceutical advisors to cure addiction.

It therefore follows that an identified drug user should immediately be transferred to a ‘withdrawal wing’ where they can be handled with a 49-year established and proven ‘drug-free’ withdrawal procedure, as a precursor to a fuller sauna and vitamin detoxification course leading to stable recovery.

These procedures have been followed in prisons around the world since 1966, some of which today have their own addiction recovery training courses – run by the prisoners themselves. Readers wanting proof of the above should phone (0044) or (0) 1342 810151 to request a free copy of a DVD shot inside prisons as far apart as the USA and China.

Ken Eckersley, CEO Addiction Recovery Training Services (ART)

James Dickinson holds a framed picture of A dog’s life (DDN, June, p18), the story of Bert – the unofficial head of treatment at Chandos House. It now has pride of place in their entrance hall.

Views from the substance misuse sector

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DDN

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July 6, 2015

Media savvy

The news and views from the national media

Yes, politicians who abandon the failed mantra of the drug war risk the incandescent rage of the Daily Mail. But how many lives have to be lost – or simply ruined – before reality and common sense finally prevail? Rather than expanding the efforts of a disastrous policy, the old failed approach must finally be abandoned. An earlier David Cameron would have agreed. It is a tragedy the current incarnation does not.

Owen Jones, Guardian, 3 June

The government seems to have decided that banning 500 substances is not enough. It must ban almost everything that gives pleasure. And what a ban. Of all the many idiotic, ill thought out and pointless laws ever passed, this would be the one of the silliest… The [Psychoactive Substances] Bill is a textbook example of bad legislation. It is unnecessary, incomprehensible, largely unenforceable, and, by encouraging professional criminals into a new area of business, it is likely to prove entirely counterproductive.

Matthew Scott, Telegraph, 2 June

I am too old now for anyone, least of all the government, to tell me what I may or may not ingest. What is this nannying? Where are the conservative concerns about liberty? What is this coalition of puritans? None of this is actually about helping addicts or saving lives.

Suzanne Moore, Guardian, 4 June

The prohibition of certain psychoactive substances is an affront to the basic right of bodily autonomy: the right to do whatever we want with our own bodies.

Stephen Reid, Independent, 11 June

Another mass killing is followed by the usual thoughtless political and media responses… If all these events were properly investigated (and few are, because conventional wisdom closes the minds of investigators), my guess is that almost all of the killers would be found to have been taking legal or illegal mind-altering drugs.

Peter Hitchens, Mail on Sunday, 21 June

Alcoholism, like all addictions, is a mental illness. It’s also the only mental illness that is treated with a strange sort of jocularity by too many people in this country. And that’s not surprising, considering the attitude towards alcohol in Britain. We all know that Britain has a problem: the binge drinking, the brawling, the town centres filled with vomit on Saturday nights, the courtrooms packed with alcohol-related crimes. These are the extreme – but by no means rare – examples… Less comfortable to acknowledge is the national attitude that alcohol is an essential social lubricant.

Hadley Freeman, Guardian, 3 June

The Naloxone Action Group

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DDN

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July 6, 2015

Keep nagging on naloxone, says the naloxone action Group

DDN listened to a lively lunchtime meeting of The Naloxone Action Group (NAG) at the RCGP conference, looking at barriers to naloxone distribution

A show of hands revealed that about half of the audience – many of whom were GPs – believed their area had naloxone, but as Chris Ford pointed out, ‘There are many areas of good practice but many areas where nothing is happening at all.’

Subscribe to email updates for more on naloxone.

‘What’s really making an impact is some brilliant grassroots action by people on the ground,’ said Blenheim chief executive, John Jolly. But Dr Judith Yates told the audience: ‘It’s shocking if people are prescribing methadone and buprenorphine and not naloxone.’ Naloxone distribution was ‘just so easy and we should all be doing it,’ she said.

Release lawyer Kirstie Douse shared the results of Release’s freedom of information requests to all Public Health England directors on whether take-home naloxone was provided in their areas. The findings produced 47 ‘yes’ answers, 80 ‘no’ answers (with ten of these due to be rolled out), with no response from 25 areas. (Some areas had made progress since the survey.)

Release’s website (www.release.org.uk) offered advice to overcoming barriers, ‘but we need to take it forward at a local level’, said Douse. ‘We’re happy to help with letters and guiding you through it.’

The session also identified a discrepancy between areas that said they had naloxone but were not actually distributing it. This situation could be improved by identifying local champions, said Ford – ‘so if you haven’t found one, get one!’

Kevin Ratcliffe, a consultant pharmacist in Birmingham, said his team knew of at least 40 people who wouldn’t still be walking round the city without naloxone. Alongside improving awareness among prescribers and commissioners, he advised creating simple supply routes with fewer opportunities for patients to drop out – ‘it’s hard for patients to get to different appointments to get it’.

Training should be given to ‘absolutely everybody’ he said, and there were plenty of training packages that were free to download, including the e-learning module at www.smmgp.org.uk.

A targeted approach to distribution could start with prisons and hostels, he said, but should be inclusive, and ‘service-driven at each hub by a naloxone champion’.

See the naloxone action group on FaceBook and read more on naloxone in DDN magazine

Substance-related bereavement

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DDN

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July 6, 2015

A right to grieve

How can support be improved for those bereaved through drug or alcohol-related deaths? A new set of guidelines offers advice for professionals who come into contact with substance-related bereavement, as Kayleigh Hutchins reports

‘There is a vast difference between listening and hearing,’ said DrugFAM’s Gill Owen Conway at an event to launch the Bereaved through substance use guidelines last month. Developed after three years of research by the universities of Bath and Stirling, the guidelines were presented to an audience made up of researchers, family members and care professionals for feedback, and to provoke a much-needed discussion.

The research was prompted by the gap in knowledge in how to respond to this isolated, poorly understood group, whose needs were often overlooked. The project conducted in-depth interviews with bereaved family members, detailing their experiences and the type of care they had received – which was often ‘found wanting’. The guidelines were developed by a working group based on this, and highlighted five key messages that were aimed at improving support, as well as providing examples of good practice.

Interviewees were drawn from Scotland and the South West of England, and were mostly female, according to researcher Jennifer McKell, as women were found to be much more likely to open up about their emotions than men. More than half were parents, and included family members of people who had died after a long history of drug or alcohol use, as well as from sudden overdoses.

In such cases, many interviewees had found out about the death from the police, and found the proceedings ‘complicated, confusing and lacking in consideration of their needs,’ said McKell. The first key message, therefore, was to show kindness and compassion to family members, who said they were often poorly informed about the processes that would take place after such a death, causing them more distress.

The bereaved often felt a lack of empathy from the professionals they came into contact with. There was a lack of humanisation of the deceased, with family members feeling as though their loved one – and they themselves – were being stigmatised.

This was closely tied to another key point – the importance of language. Many family members often felt as though they had to hide the real cause of death, said McKell, fearing the stigma associated with drug use and the idea that the death was somehow ‘self-inflicted’ and not the same as other kinds of bereavement. ‘You get a label on you, you are labelled… it’s as if, when she died, “Oh another one bites the dust”,’ said one interviewee of her experience.

Using language like ‘junkie’ or ‘drunk’ made the bereaved feel as though they were the subject of judgement from others, causing them to isolate themselves from possible sources of support.

These people were dealing with ‘complex emotional reactions’, said researcher Lorna Templeton, which made it crucial to treat every bereaved person as an individual – a third key message. Emotions could be a diverse mix of relief, guilt and grief, and so support needs would vary from person to person.

Professor Richard Velleman, another member of the research group, discussed how the number of professionals that family members came into contact with could be vast – from police to lawyers and funeral directors, many of whom didn’t understand the issues surrounding drug and alcohol addiction.

This meant many of these professionals felt they were not equipped to offer support, so it was crucial to empower them with the right kind of knowledge to make a contribution to the care of bereaved families – another key point of the findings.

With the guidelines now ready to be distributed, the event gave stakeholders the opportunity to discuss what could be improved, and how the information could be disseminated effectively. The final message of the research was that professionals needed to work together to share knowledge and good practice with those who needed it, to ensure that the needs of bereaved families were being met and that they would no longer have to suffer ‘disenfranchised grief’.

For more information, and for copies of the guidelines, visit www.bath.ac.uk/cdas

2015 RCGP national conference

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DDN

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July 6, 2015

Better together

With primary care facing its severest set of challenges, delegates at the 2015 RCGP national conference argued vociferously for GPs to remain at the centre of substance misuse treatment.

The theme of this year’s RCGP conference on drugs and alcohol – now in its 20th year – was ‘the integrated future of primary care’. But what does this mean against a backdrop of widespread cuts and recommissioning, that in some areas means a reduction in shared care?

Dr Stephen Willott chaired a panel that aimed to bring different perspectives and open a debate with the audience, many of whom were GPs with a special interest in drugs and alcohol.

Opening discussion, Willott set the scene, describing a political situation where ‘tackling things for people who use drugs seems even less important.’ Welfare reforms were ‘one of the most worrying negatives’, he said, adding ‘A number of my patients are on sanctions, their benefits on ice.’

Jim Barnard of Inclusion Drug and Alcohol Services had worked for many years in shared care. He worried that the focus on completions threatened the capacity for building recovery capital, and lost perspective of the family.

‘Primary care has such involvement with families and service users – there are so many opportunities to get better outcomes,’ he said. ‘We’re facing a non-unified and disjointed system.’

Professor Oscar D’Agnone, medical director of CRI, said that in every country he had worked, drug treatment was political, but emphasised that ‘the focus should be the individual person’. This was a challenge, with shared care models differing according to local areas and commissioners’ views, but he said that most patients should be treated in general practice with services supporting GPs in dealing with the many complex issues around alcohol and drug use and mental health.

Nuzhat Anjum, head of strategic commissioning at Waltham Forest Clinical Commissioning Group (CCG) also acknowledged that these were difficult times, ‘and going to become harder’. But she brought a strong message on the need to work together to break barriers.

‘The worst thing a commissioner can do is ignore primary care,’ she said, while urging clinical colleagues to use their voice as ‘part of decision-making’. CCGs had a £63.4bn budget, she pointed out, with wellbeing boards having a senior position for a GP. ‘How do we use that?’ she asked the audience, adding ‘It is our responsibility to support each other, bringing together GPs, practice managers, helping each other. It’s not just about targets being met but about service users being happy. It’s an opportunity.’

Pharmacy services were another ‘really positive story’, giving scope for much wider services.

Acknowledging that money was tight, she highlighted a ‘real opportunity’ for joint bids with the third sector, and asked ‘are we exploring those areas?’

‘My suggestion is that primary care, GPs, commissioners and public health need to work much more closely together, minimising exclusions,’ she said. ‘If we do it together we can break it together.’

Sunny Dhadley brought a perspective from Wolverhampton Service User Involvement Team (SUIT), saying ‘It is our responsibility to help those that are vulnerable in our midst… there’s a lot more that can be done in terms of a joint approach.’

Targets didn’t necessarily make sense for every individual, with a holistic approach needed. But each service user had the capacity to unlock potential that could be ‘really cost effective’.

Dhadley reminded the audience that individuals had many complex needs – ‘we can’t expect people to be job-ready if there are other areas of their lives they need to address’ and asked, ‘are we providing things that’ll help people to be fulfilled?’

‘We hear the word holistic all the time,’ he added. ‘But if there are GPs who find this area of work challenging they shouldn’t be working with drug and alcohol users at all.’

After taking comments from the floor (one of which was a suggestion to produce a conference ‘mission statement’) Willott summed up the key themes, acknowledging the many concerns around erosion of shared care in many areas of the country and emphasising the need to reintegrate care properly.

‘We all have a responsibility to attack commissioning that’s going on and make sure it represents the most vulnerable,’ he said. ‘The message from this conference is that we can’t do it alone, but we can achieve it together.’

From the floor…

‘We’ve lost a really good shared care service – it’s been taken away from us. We’ve lost everything we’ve worked so bloody hard for…. Panel, you need to listen to what we have to say as we’re pissed off.’

GP, Sheffield

‘The commissioning process puts GPs at a disadvantage. There are professional people doing bids. GPs need to put together a spec that covers all the points, including recovery.’

GP, Derbyshire

‘All this talk about an integrated future… GPs don’t have a voice – how can they influence decisions?’

GP, Hackney

‘Use your CCGs to raise these points. They have to be raised at the top.’

Nuzhat Anjum

‘I wonder when people are going to stand up and say the focus on completions is totally unacceptable. It’s about time we stood up together and said there are a lot better things to concentrate on.’

Joss Bray, ‘ex-GP and troublemaker’

‘I’m a service user, I don’t give a shit who pays your wages. I’ve been in shared care for ten years – I wouldn’t be here if it wasn’t for shared care.’

Lee Collingham, Nottingham

‘The quality of commissioning is really patchy. Responsibility is being devolved locally.’

GP, Suffolk

‘In the last five years things have gone into reverse; 100 per cent of people with drug and alcohol problems should be treated in primary care with the right support… management of drug users in primary care is rotting away.’

Dr Chris Ford, IDHDP

‘SMMGP is looking more at integration. We need closer integration with addiction psychiatry and are looking at building links with third sector organisations. We’ve not integrated as well as we could have done.’

Kate Halliday, SMMGP

Recovery in the North West

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DDN

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July 6, 2015

Recovery rising

Ray Jenkins and Mark Gilman talk about the North West’s contributions to the UK recovery movement

The North West of England has a reputation for leadership and innovation in responding to the challenges of addiction. The Merseyside harm reduction response to heroin in the 1980s has taken on legendary status, while the comic capers of Manchester’s Grandpa Smackhead Jones and Peanut Pete were eagerly followed in the late 1980s and 1990s.

The North West is now the epicentre of the UK ‘recovery movement’. The common denominator in 30 years of North West developments is ethnographic authenticity – the people on the receiving end of research, policy and practice would never allow someone else to speak for them. The origin of the contemporary North West recovery movement began when a small group of people came together to ask each other if there could be more to treatment than staying alive, keeping out of jail and being HIV-free.

The North West legacy has three key messages: that modernised treatment services can initiate recovery; that recovery is a community thing based on jobs, homes and friends; and that the future of sustainable health and social care systems lies in asset-based community development.

In April 2014, the National Offender Management Service (NOMS) and Public Health England (PHE) launched a scheme to work with prisoners who signed up to abstinence-based recovery support during their journey through the penal system – Through The Gate, later renamed by service users as Gateways.

Prisoners are engaged with coaches recruited from local recovery communities prior to and upon release. Coaches are selected as experts by experience and trained to engage people by sharing their story, while facilitating access to community support, including mutual aid meetings, family support and recovery housing.

The other defining feature of the North West is pragmatism. We want recovery and you want to save money. So, why don’t we come together and design systems of treatment and recovery that will keep the harm reduction gains while promoting recovery at the same time?

Ray Jenkins is director at Emerging Horizons and Emerging Futures CIC, www.emergingfutures.org.uk.

Mark Gilman is managing director at Discovering Health, www.discoveringhealth.co.uk

Sheffield Addiction Recovery Research Group

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DDN

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July 6, 2015

Sharing knowledge

Andy Irving discusses a new project in Sheffield aimed at promoting research, good practice and joined-up working

A group of researchers from Sheffield Hallam University and the University of Sheffield, alongside representatives from the main treatment providers in the city, formed the Sheffield Addiction Recovery Research Group (SARRG) in September 2014. Professor of criminology and well known addiction recovery researcher David Best wanted to create a group to support an existing vibrant recovery community in Sheffield. SARRG builds on two existing strands of research expertise within Sheffield Hallam University: pathways to addiction recovery and desistance from offending. The two themes combine innovative work around routes taken towards desistance and recovery, and the differing modalities that support these endeavours.

The group met for the first time in after a Sheffield City Council’s drug and alcohol coordination team (DACT) recovery month event. Representatives from both universities were met by staff from Sheffield Alcohol Support Service (SASS) and the DACT and from the outset it was clear the groups’ aims aligned with those of SURRG, (service user recovery reference group). Chaired by the DACT, this group is the primary communication forum between service providers (commissioned and non-commissioned) and Sheffield DACT in the implementation of the Sheffield service user involvement strategy.

SARRG is ideally placed to help bridge the gap between treatment providers and the research community interested in evidencing and enhancing treatment/recovery efficacy and effectiveness. Drawing on the academic strengths of SARRG members we can capitalise on the rich repository of skills and experience creating research grounded in peoples’ real ‘lived experience’ of addiction and recovery. The group has formed a coalition of people in recovery, services, commissioners, academics and the wider community, representing differing pathways to recovery, actively supporting the recovery community, promoting events and providing help and expert advice to groups asking for support. SARRG’s vision is make Sheffield the UK’s foremost recovery city, providing a model of advanced recovery research and action for others to follow.

The group was officially launched on 26 March as part of Social Justice Week, at an event organised by Hallam University’s Helena Kennedy Centre for International Justice. The event included the official launch of the veteran-tailored programme, Right Turn, which is run by Addaction and works with veterans who need drugs and/or alcohol treatment in the north of England and Scotland. Professor David Best will lead an independent evaluation, aiming to capture the scope and scale of the problem and to providing the evidence base needed to further support service and ex-service personnel to lead fulfilling civilian lives, in recovery. The project aims to influence policy makers and improve the way services are delivered to veterans right across the country.

Professor Best continued with a presentation of the findings from the US and Australian Life in Recovery Surveys, as well as the launch of the first nationwide survey designed to document the lives of people in recovery from addiction in the UK. It is hoped the information gathered will inform the public, policymakers, service planners and providers and the recovery community about the milestones that people achieve in recovery. The information will contribute to educating the public about recovery and addressing discriminatory barriers facing people in, or seeking, recovery. At present the survey has had over 670, responses and counting.

There was also the launch of the Sheffield Addiction Recovery Research Panel (ShARRP), the region’s first addiction patient and public involvement (PPI) group. With the assistance of Sheffield Teaching Hospitals Clinical Research Office, Andy Irving, a researcher from the University of Sheffield’s school of health and related research (ScHARR) has formed a group of people in recovery and those directly affected. The group’s remit is to provide much-needed patient and public input into the various stages of research initiation, design, methodologies and dissemination. The group meets quarterly and undertakes various tasks including considering whether a research idea is worthwhile, reviewing funding and ethics applications and advising on how best to recruit participants and share research results with a lay audience.

The launch event culminated in lively debate about what recovery means to people. Clearly recovery is a private personal journey, yet there was a sense that recovery is also, by necessity, a social phenomenon. At the heart of the debate people appeared to agree that, as a recovery movement, SARRG and all services, groups and networks associated with Sheffield can create the conditions that allow those with addiction problems to overcome the barriers of stigma and marginalisation to achieve a sense of connection in the community. There was a real buzz created on the day and a genuine push to get involved in research and action to help build recovery capitol in the new recovery capital!

SARRG is now working on several research initiatives including the evaluation of the Right Turn project, the UK Life in Recovery Survey, a city-wide recovery asset mapping exercise and another social justice conference for 2016, as well as planning and promoting lively and inspiring events as part of this September’s recovery month.

We would like to thank all our contributors within Sheffield Hallam University, University of Sheffield – School of Health and Related Research, Sheffield City Council – DACT, Sheffield Alcohol Support Service as well as: Addaction, Crime Reductions Initiatives (CRI), Phoenix Futures, Primary Care Addiction Service Sheffield (Guernsey House), representatives from Alcoholics and Narcotics Annonymous, Sheffield Health and Social Care Trust (Fitzwilliam Centre), Turning Point Adult Treatment Services, The Amy Winehouse Foundation, Derbyshire Healthcare foundation trust and Dry-Road – Sheffield, as well as the Sheffield Addiction Recovery Research Panel (ShARRP)

It’s still early days for the SARRG, but we believe we can mobilise people and resources in the city to drive research for an enhanced understanding of addiction and recovery, and ultimately improve the lives of all those affected.

For more information about the SARRG please visit http://www.shu.ac.uk/faculties/ds/dlc/sarrg.html

To access the UK Life In Recovery Survey please go to https://www.surveymonkey.com/s/LifeinRecoverySurvey2015QHDDHVV

For more information about the Sheffield Addiction Recovery Research Panel (ShARRP please visit http://www.sheffield.ac.uk/scharr/ppi/sharrp

Ban on electronic cigarette use

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DDN

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July 6, 2015

Electrical Storm

With a controversial ban on electronic cigarette use in public places in Wales now looking likely, DDN hears from anti-smoking charity ASH on why, perhaps surprisingly, it thinks the plan is misguided

Although the treatment sector is slightly less polarised than it was, the harm reduction/abstinence argument has raged for so long that’s it’s become the field’s background music. So it’s interesting to see similar debates played out – sometimes bitterly – around electronic cigarettes, with some seeing them as a powerful harm reduction tool and others as a cynical attempt by the tobacco industry to recruit more consumers while also winning over the health lobby.

As DDN went to press, Oil and Gas UK became the latest organisation to enter the fray, advising its companies to ban the use of e-cigarettes on offshore installations. But the most high-profile intervention is last month’s Public Health (Wales) Bill, which includes plans for a country-wide ban on their use in enclosed public spaces. The legislation is scheduled to come into force in 2017 and has divided the health sector, with organisations including the BMA and Public Health Wales in favour, while ASH and Cancer Research UK – neither friends of the tobacco industry, to put it mildly – are among those lining up against.

The Welsh Government’s stance is that the law would help to stop smoking becoming ‘re-normalised’ after the positive impact of the 2007 ban, and also prevent e-cigarettes acting as a ‘gateway product’ to tobacco. Both Cancer Research UK and ASH refute the ‘gateway’ argument, however. ‘We can’t see any evidence that electronic cigarettes are re-normalising smoking, certainly in the UK,’ ASH’s director of policy, Hazel Cheeseman, tells DDN. ‘We’ve seen this steady drop in the number of young people smoking, which is great, and those who are using electronic cigarettes are largely young people who are already smoking. Our own research found that – as did large school-based surveys in Scotland and Wales.’

Among those young people who’ve never smoked but have tried e-cigarettes, most of the use seems to be short-lived experimentation, she says. ‘They’ll say they tried electronic cigarettes once or twice, but we aren’t at the moment seeing that translate into regular use of electronic cigarettes, let alone regular smoking.’

There’s no guarantee that experimentation won’t translate into regular e-cigarette use, she concedes, but questions whether that would necessarily be an entirely bad thing. ‘If electronic cigarettes turn out to be a replacement for smoking, then over the longer term what you would expect to see be would be young people who might otherwise have smoked taking up electronic cigarettes instead.’

Does this mean that they really are effective harm reduction tools? ‘They certainly would appear to be at the moment. In the adult population you’ve got 2.6m regular users of electronic cigarettes, according to our research, and about two out of five of those have quit smoking altogether, while pretty much all the rest tell us they’re either actively trying to quit or cutting down on the amount they smoke and using electronic cigarettes instead.’

There’s also little evidence that vapour from e-cigarettes is harmful to bystanders, says ASH, and they have mass appeal in a way that nicotine-replacement never did. The risk then, presumably, is that the Welsh ban could discourage smokers from switching? ‘That’s one of the reasons why we wouldn’t support the decision – it gives a false perception,’ she states. ‘People aren’t always out there looking at all the evidence – it’s not their job to do that – so they use shortcuts to understand how harmful something is. If you say something’s banned people will automatically assume that’s because it’s bad for you.’ What about the argument that widespread use of e-cigarettes undermines the positive impact of the smoking ban? ‘If they’re concerned that kids and adults are going to see people using these products and think it’s OK to smoke, I guess that’s a hypothesis, but I don’t know of any evidence that supports it.’

The treatment sector is used to its harm reduction versus abstinence debate being bitter and divisive – is this debate heading in the same direction? ‘It’s obviously been a difficult one, and people have disagreed, but in the UK we’ve actually had much more of a rounded debate than other countries, because we’ve had this tradition of harm reduction and we tend to be more pragmatic.’

So what about the claim that the tobacco industry’s involvement is little more than a cynical ploy to get the health lobby onside – a Trojan Horse? ‘Tobacco companies have actually been quite late to the party in terms of electronic cigarettes,’ she states. ‘They certainly weren’t the people that invented them, and it’s only in the last couple of years that they’ve started investing in them. We should definitely be suspicious of their motives, as – obviously – they’ve never previously demonstrated that they’re interested in public health. But the products on the market that seem to be most effective at helping people quit and have growing appeal – the ones that you refill yourself – aren’t really owned by the tobacco industry yet, though that might change.

‘However, one thing is clear. While tobacco companies continue to make billions from selling a lethal product, there’s no room round the table for them, whatever else they’re selling.’

Bill at gov.wales

Health risks of sugar

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DDN

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July 6, 2015

Hidden menace

For those with a history of addiction the well-publicised health risks of sugar could pose serious dangers. Nutritionist Helen Sandwell looks at the evidence

Pure, White and Deadly refers to a white crystalline killer, but not one that will appear on any drug classification list. The book of this title was written more than 30 years ago by a British physiologist Dr John Yudkin, who warned about the many serious health risks associated with sugar consumption.

For many years it was saturated fats that were largely seen as the culprit in the major non-communicable diseases, particularly heart disease. Only in the last decade have Yudkin’s stark sugar predictions been taken more seriously by the scientific community.

A diet high in sugar is now thought to be the leading factor in the development of obesity and can play a significant role in type 2 diabetes, heart disease, stroke, fatty liver disease and some cancers. Research is showing that even Alzheimer’s (also now referred to as type 3 diabetes) could be associated with a high sugar diet.

Earlier this year, the World Health Organization (WHO) produced guidelines for the maximum intake of free sugars – that’s all sugar added to food, as well as honey, syrup and the sugar present in fruit juice. They recommend that adults reduce their free sugar intake to 5 per cent of their total calories – just six teaspoons. A 500ml bottle of coke contains almost double this amount of sugar.

The intake of many people in the general population is likely to be way above this, but individuals in recovery can have notoriously high intakes of free sugar, anecdotally spooning several teaspoons into countless cups of tea or coffee.

However, it’s not only the sugar knowingly added, but the hidden sugars added by food manufacturers that are contributing to the rise in obesity and associated illnesses.

Katharine Jenner, campaign director of Action on Sugar comments: ‘Sugars are hidden in so many of our everyday foods. We eat and drink more than our maximum recommendation without even realising it.’

When individuals reach the point of recovery, long-term physical health becomes more of a priority. In considering long-term health, should we now be encouraging those with history of substance misuse to cut down drastically on sugar, which has previously been perceived as a relatively harmless vice?

A person who has experienced liver damage from alcohol or hepatitis C may be unaware that high levels of sugar can also contribute to damage. Although such individuals haven’t been specifically studied, cardiologist and science director at Action on Sugar, Aseem Malhotra says that, ‘The same rules apply to fatty liver disease from excess sugar consumption as they do from alcohol.’

But for those with a history of addiction, kicking the sugar habit may be particularly difficult. A hypothesis that is gaining ground suggests that sugar is an addictive substance. Researchers have described it as acting in the body in a similar way to psychoactive substances. Like addictive substances, it releases both opioids and dopamine – chemicals that are involved the brain’s reward pathways. Self-identified ‘food addicts’ describe using food to self-medicate, by eating in order to try to change a negative mood state.

What’s more, sugar consumption can share features typical of an addiction pathway, namely bingeing, withdrawal, craving and cross-sensitisation. Reward deficiency syndrome (RDS) is a gene-related condition where brain impairment results in abnormal craving behaviour, with an individual craving and seeking substances known to cause dopamine release. RDS demonstrates that a genetic commonality exists between a number of dopamine-activating substances, including alcohol, opiates and sugar.

The similarity in pathways has further been demonstrated in studies in animals with food bingeing behaviour, where pharmaceutical treatments for drug addiction – baclofen and naltrexone – have been shown to be effective in treating overeating. Since caffeine also affects dopamine levels, it’s no wonder that highly sugared coffees and energy drinks are favourites among those abstaining from other substances.

While sugar may well be considered as the lesser of many evils as far as addictive substances go, some residential treatment centres are already aware of the difficulties sugar can present and this is influencing the catering they provide.

‘We are increasingly paying attention to the effect sugar has on mood and the links between sugar and addiction,’ says Sarah Small, head of service at Clouds House. ‘Our kitchen team are progressively looking towards lower GI foods.’

At Hope House, similar measures have been introduced as head of service, Susanne Hakimi, explains: ‘Three years ago we implemented a low GI diet. Essentially what that means here is that bread, rice, and pasta, for example, are wholemeal. Chocolate, fizzy drinks and cakes are not allowed in the project.’

Hope House treats women with substance dependency as well as other compulsive disorders, including eating disorders. It’s not only food provision, but also education that’s important, as Susanne goes on to say: ‘Our chef also runs a workshop on nutrition, and the dangers of high sugar consumption.

‘We run an intense food group that educates the women and also allows them a space to discuss their issues with food. This has to be an ongoing development, as the women can eat out, and not necessarily healthily. We can only but educate and provide what we understand is healthy food.’

Aseem Malhotra, would certainly see these measures as heading in the right direction. As for recommendations for treatment providers in their catering provision, Aseem advises, ‘In terms of a healthy diet, it shouldn’t really have any added sugar at all.’

He thinks that ideally fruit juice and white bread should also be out: ‘The body doesn’t know the difference between sugar in fruit juice and sugar in coke. The impact of refined starches is similar to sugar.’

It’s all very well health professionals and scientists proclaiming we should cut out sugar but how easy is it, especially for those who experience cravings?

John Yudkin describes himself as a sugar ‘addict’ in Pure, White and Deadly, previously consuming close to 400g a day. His advice, based on personal experience, is to cut down gradually, the result being an increased appreciation of food.

‘Swamping everything with sugar tends to hide flavours,’ he adds. ‘When you really have got used to taking a very little sugar in your food and drinks, you will notice that your all foods have a wide range of interesting flavours that you had forgotten.’

Helen Sandwell is an independent registered nutritionist, www.goodfoodandhealth.co.uk

Monthly drug-driving arrests top 400

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DDN

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June 15, 2015

More than 400 people a month are being arrested for drug driving in England and Wales, according to the Institute of Advanced Motorists (IAM). The figure is based on statistics obtained from every police force area by IAM under a Freedom of Information request.

More than 900 arrests were made by forces between March – when a new offence of driving with more than the specified limit of a control drug in the body was introduced (DDN, March, page 4) – and May. The figures reveal that there is ‘little consistency in testing and arrests’, however, with London’s Metropolitan Police making 214 arrests – around three per day – while other forces, including Warwickshire, Leicestershire and Gwent, made none.

Since the law was passed, police have the power to stop motorists and conduct a ‘field impairment assessment’ if they suspect them of driving under the influence of drugs. This could then lead to arrest and a blood or urine test at a police station, with penalties including a £5,000 fine or up to six months in prison for those convicted. A 2010 government-commissioned report by Sir Peter North concluded that drug driving could be responsible for up to 200 deaths a year, and that six per cent of drivers aged between 17 and 39 had driven under the influence of drugs.

‘We have reached a point where drink-driving has become socially unacceptable, particularly amongst younger people,’ said IAM chief executive Sarah Sillars. ‘We now need a sustained campaign to back up the police enforcement effort and ensure drug-driving is seen in exactly the same way. The effects of driving under the influence of drugs can be devastating.’

New psychoactive substances detected

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DDN

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June 10, 2015

Two new substances a week identified in Europe

New psychoactive substances (NPS) are now being detected in Europe at a rate of two per week, according to the European Monitoring Centre for Drugs and Drug Addiction. More than 100 NPS were reported last year, says the European drug report 2015, with the total number of substances being monitored by the agency now standing at more than 450.

As in previous years the majority of substances reported were either synthetic cannabinoids or cathinones, with the internet now playing a ‘growing role’ in supplying both NPS and more established drugs, and posing a ‘major challenge to law enforcement and drug control policies’. The British government has recently moved to introduce a blanket ban on all NPS (DDN, June, page 4).

Meanwhile, although problems relating to heroin continue to ‘account for a large share of drug-related health and social costs’ across the continent, demand for the drug appears to be stagnating, says the document.

More than half of Europe’s 1.3m long-term opioid users are now estimated to be in treatment, while the number of people entering heroin treatment for the first time stood at 23,000 in 2013, down from 2007’s figure of almost 60,000. The median age of opioid users rose by five years between 2006 and 2013, with a ‘significant number’ now in their 40s or 50s. However the report warns of potential future problems as a result of increased opium production in Afghanistan, as well as alternative smuggling routes into Europe.

Unsurprisingly, cannabis remains the continent’s most widely consumed drug, with almost 20m people reporting use within the last year and more than 60,000 people entering first-time treatment for cannabis problems in 2013, while cocaine is still Europe’s most commonly used illicit stimulant. The document also reports increasing potency levels for cannabis, MDMA and other drugs.

‘The report shows that we are confronted with a rapidly changing, globalised drug market and, therefore, we need to be united, swift and determined in our response to the drugs threat,’ said European commissioner for migration, home affairs and citizenship, Dimitris Avramopoulos. ‘I am particularly concerned that the internet is increasingly becoming a new source of supply, for both controlled and uncontrolled psychoactive substances. Europe plays a leading role in tackling the “new drugs” phenomenon and we will continue to do so for the wellbeing and safety of our citizens.’

European drug report 2015 at www.emcdda.europa.eu

NPS to be subject to ‘landmark’ blanket ban

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DDN

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June 8, 2015

The government is to introduce a blanket ban on ‘legal highs’, as announced in last month’s Queen’s Speech. The Psychoactive Substances Bill will ‘prohibit and disrupt’ the production, distribution and supply of all new psychoactive substances (NPS).

The legislation will be UK-wide, and will include powers to both seize and destroy NPS as well as to ‘search persons, premises and vehicles’. The blanket ban means that the authorities will no longer need to take a substance-by-substance approach to NPS, more than 500 of which have been banned already.

The new laws, which will also extend to nitrous oxide, are likely to effectively spell the end of the high street ‘head shop’, and offences detailed in the bill will carry a maximum sentence of seven years. Once the legislation is passed, it will be an offence to produce, import, supply or possess with intent to supply ‘any substance intended for human consumption that is capable of producing a psychoactive effect’, although substances such as caffeine, alcohol and tobacco will be exempt.

‘The landmark bill will fundamentally change the way we tackle new psychoactive substances – and put an end to the game of cat and mouse in which new drugs appear on the market more quickly than government can identify and ban them,’ said crime minister Mike Penning. ‘The blanket ban will give police and other law enforcement agencies greater powers to tackle the reckless trade in psychoactive substances, instead of having to take a substance-by-substance approach.’

The announcement has met with a mixed response, with Transform accusing the government of ceding control to ‘those on the wrong side of the law’ and Release executive director Niamh Eastwood describing the bill as ‘full blown regression’.

The Local Government Association (LGA), however, said that an outright ban would enable trading standards officers to protect the public from ‘devastating consequences’ by closing down head shops, while Addaction chief executive Simon Antrobus said that, although the government was right to clarify the ‘legal grey area’ around the sale of NPS, ‘we mustn’t kid ourselves that this legislation is enough to address the harm caused by these substances’. Any regulatory measures would need to be backed up by a ‘renewed focus on education, support, advice and specialist treatment’, he stated.

Harmful youth drinking falls, but inequalities persist

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DDN

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June 8, 2015

The rate of alcohol-related hospital admissions among the under-18s has fallen by more than 40 per cent over the last decade, according to new figures from Public Health England (PHE).

The latest statistics from the local alcohol profiles for England (LAPE) show that alcohol-specific admissions for this group fell to 13,725 nationally over the last three years, compared nearly 23,000 in 2006-07. The numbers provide more evidence of ‘a continuing decline in young people’s harmful drinking’, says PHE.

However, almost 60 per cent of English local authorities saw small increases in adult admissions, up by 1.3 per cent overall to 326,000. The increase was larger among women, at more than 2 per cent, than men (less than 1 per cent). Inequalities in alcohol-related deaths also remain ‘particularly stark’ in relation to chronic liver disease, says the agency, with the most deprived areas experiencing double the death rate, while general alcohol-related hospital admissions were 55 per cent higher in the same areas.

An average of one year of life is lost due to alcohol-related conditions among English males, according to the data. In the most deprived communities, this rises to 15 months – almost double the eight months lost in the least deprived. For women, an average of just under six months of life is lost due to premature alcohol-related deaths.

‘The decline in hospital admissions from alcohol for under-18s is promising, but current levels of harm caused by alcohol remain unacceptably high, especially within the most deprived communities, who suffer the most from poor health in general,’ said PHE’s director of health and wellbeing, Professor Kevin Fenton. ‘Much of this harm is preventable and we need further action at a national and local level to implement the most effective evidence-based policies. Public Health England will continue to provide leadership and support to local areas to reduce the devastating harm that alcohol can cause to individuals, families and communities.’

Local alcohol profiles for England at http://fingertips.phe.org.uk

OECD urges governments to get tough on alcohol

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DDN

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June 8, 2015

Governments need to introduce more effective policies to tackle harmful drinking, according to a new report from the Organisation for Economic Co-operation and Development (OECD).

Levels of ‘hazardous and heavy episodic drinking’ are on the rise among young people and women across many OECD nations, states Tackling harmful alcohol use: economics and public health policy, and while overall consumption has fallen slightly over the last 20 years, drinking levels have risen ‘particularly’ in Finland, Iceland, Israel, Norway, Poland and Sweden. There have also beensubstantial increases in the Russian Federation, Brazil, India and China – albeit from low levels in the last two – with average annual alcohol consumption by adults in OECD countries now estimated at around 10 litres of pure alcohol per capita, the equivalent of more than 100 bottles of wine.

The report puts the blame on alcohol becoming ‘more available, more affordable and more effectively advertised’. Levels of alcohol consumption in the UK stand above the OECD average – at around 10.6 litres of pure alcohol per capita – and have increased over the last three decades, with almost 63 per cent of all alcohol drunk in England consumed by the heaviest-drinking 20 per cent of the population.

The report urges governments to introduce policies that target the heaviest drinkers first – such as using primary care staff to identify and encourage them to seek help – alongside financial measures such as minimum pricing and increased taxes. It also wants to see tougher advertising rules and better education.

Worldwide, alcohol misuse rose from the eighth to the fifth leading cause of death and disability in the 20 years to 2010, the document states, and now kills more people than HIV/Aids, tuberculosis and violence combined. ‘The cost to society and the economy of excessive alcohol consumption around the world is massive, especially in OECD countries,’ said OECD secretary general Angel Gurría. ‘This report provides clear evidence that even expensive alcohol abuse prevention policies are cost-effective in the long run, and underlines the need for urgent action by governments.’

Meanwhile, researchers at Liverpool John Moores University have identified that most alcohol consumption surveys dramatically under-estimate people’s drinking as they fail to account for ‘atypical’ occasions such as weddings and holidays. Including these would add more than 120m units per week, says the report, whereas the results of most surveys only account for around 60 per cent of the alcohol actually sold.

Tackling harmful alcohol use: economics and public health policy at www.oecd.org

Holidays, celebrations and commiserations: measuring drinking during feasting and fasting to improve national and individual estimates of alcohol consumption at www.biomedcentral.com

DDN June 2015

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DDN

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June 8, 2015

In this month’s issue of DDN…

‘It is worth spelling out that harm reduction reduces harm.’

In this month’s issue: Tracy Walker talks about reducing drug-related damage at music festivals, Philippe Bonnet discusses moving forward with naloxone distribution – and James Dickinson tells the story of Chandos House’s unofficial head of treatment.

Click on the links below to read more, and don’t forget to join the discussion by commenting, tweeting and liking our Facebook page.

PDF Version / Mobile Version

National news from the substance misuse field

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DDN

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June 8, 2015

News in brief – June 2015

Support. Don’t Punish

The Support. Don’t Punish campaign will be holding its third global day of action on 26 June, to coincide with the UN’s international day against drug abuse and illicit trafficking. The campaign aims to stage ‘high profile and visually symbolic local actions’ following similar events in 100 cities worldwide last year (DDN, July 2014, page 4). The day will be an ‘excellent opportunity to raise awareness’ before next year’s UN General Assembly Special Session (UNGASS) on drugs, says the campaign. More information at supportdontpunish.org

Hyper links

More than three drinks a day can increase the risk of developing hypertension by up to 75 per cent, according to a new document from Alcohol Concern. ‘Having just one drink a day can increase the risk, and the overall risk climbs higher for every drink after that,’ said chief executive Jackie Ballard. The relationship between alcohol and hypertension ‘stays significant’ even when issues like age, weight, gender, ethnicity, diet, exercise and smoking are taken into account, she added, making alcohol ‘one of the most controllable and preventable risk factors’ for the condition. Alcohol and hypertension at www.alcoholconcern.org.uk

Barton bows out

Action on Addiction chief executive Nick Barton is to step down in September after seven years in the post. He’ll be replaced by acting chief executive of Nacro, Graham Beech, but will continue to work with the organisation until the end of the year. ‘It has been an immense privilege and personally very rewarding to have been able to serve as chief executive of Action on Addiction, and I am delighted to be handing over to someone like Graham who brings such a range and depth of experience as well a personal and professional commitment to the charity’s ethos and purpose,’ he said.

DISC man

Chief executive of DISC (Developing Initiatives Supporting Communities), Mark Weeding, is to retire after 25 years with the organisation. His replacement will be northern director of the Lifeline Project, Paul Townsley. ‘Working in the sector I have always admired DISC and the chief executive role is a fantastic opportunity coming at an exciting time for DISC and myself,’ said Townsley. ‘Mark and his team have brought DISC to a great place.’

Favoured faces

The UK Recovery Walk charity has changed its name to FAVOR UK, which stands for Faces and Voices of Recovery. ‘We have grown in a way we could never have anticipated or imagined, and now have over 1,100 members made up of individuals in recovery, their friends and families, and community recovery organisations,’ said the charity, which was originally inspired by the work of FAVOR in the US.

Parental pints

More than 30 per cent of drinkers in the 45 to 64 age bracket drink to higher-risk or increasing-risk levels, according to research by Drinkaware, compared to less than 20 per cent of those aged 18 to 24. More than half of the older age group also said they didn’t want guidance on moderating their drinking, compared with just over a third of 18 to 24-year-olds. ‘In contrast to public perceptions that young adults are the more risky drinkers in the UK, in fact over the course of the week, their parents’ generation are drinking more,’ said chief executive Elaine Hindal. ‘Our research shows that 45 to 64-year-olds could potentially be sleepwalking into long-term health problems as a result of their drinking patterns.’

Prison practice

A new set of research and policy briefings on best practice in reducing drug and alcohol-related crime has been launched by RAPt. The papers include priorities for government action, as well as a focus on mental health and substance use in prison. Documents available at www.rapt.org.uk

Cutting costs

Offenders enrolled in alcohol treatment as part of their sentencing are less than half as likely to be reconvicted, according to a study by Plymouth University. The cost of community-based alcohol treatment is also nearly 40 times lower than sending someone to jail, it adds. ‘Given the hundreds if not thousands of offenders who might be eligible to attend an alcohol treatment programme each year, this could amount to substantial public savings,’ says the study. www.plymouth.ac.uk

Local news from the substance misuse field

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DDN

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June 8, 2015

Live LSD drug trials take place

Research has taken place that saw the world’s first live brain scans of individuals taking LSD.

A group of scientists, including Dr Ben Sessa, consultant psychiatrist at Addaction, took LSD while their colleagues scanned their brains in an effort to learn more about how consciousness works on the brain.

Dr Sessa will be doing similar trials with MDMA next year, to see how the drug affects individuals with post-traumatic stress disorder.

‘This work is not about encouraging the recreational use of the drugs, but how they can be developed as tools and treatments for medicine. Every drug has side effects, including painkillers, which is why they should only be taken with guidance and support from a doctor,’ said Dr Sessa.

‘The results from the experiments are showing that if you carry out psychotherapy under the influence of psychedelic drugs, it can boost the power of the therapy. Abstinence rates for alcohol and opiates are significantly higher from this kind of therapy, so I believe it is vitally important to keep progressing this research.’

A video of the trial can be found at http://walacea.com/campaigns/lsd/

Photographer documents homeless

A local photographer has published a book that documents the lives of homeless individuals in Cardiff.

Andrew McNeill spent a year engaging with people on the streets in his hometown, many of whom struggled with mental health and substance misuse problems (DDN, May 2014, p8).

‘I think there are several messages in these pictures. I think there’s a message of hope. I think there are cries for help, and despair. And there is a message that they don’t want to be ignored – that they’re real people, they’re real human beings,’ says McNeill.

Under The Bridge: Being Homeless in Cardiff is McNeill’s second photography book, and is published by Butetown History and Arts Centre.

Film raises awareness of psychosis

A new film that aims to raise awareness of psychosis in young people has had its premier at an educational event in Manchester.

Greater Manchester West Mental Health NHS Foundation Trust collaborated with a local filmmaker to create a film that gave service users from their early intervention service the opportunity to share their experiences. It will be shown at local schools and colleges to demonstrate the importance of early intervention, and aims to reduce the stigma surrounding psychosis.

The film will also be used as part of psychological therapy sessions and family interventions to help individuals and their families understand psychosis.

Available on the GMW YouTube channel, http://bit.ly/1EY8V5V

Bike ride to raise funds for recovery

A fund raising bike ride, Le Tour De Recovery, will be setting off from The Recovery Partnership in Leamington Spa on 7 September, and aiming to arrive in Durham on 12 September, the day of the seventh annual Recovery Walk.

The team from Coventry Recovery Community also hope to stage Dear Albert screenings at every overnight stop.

They are currently seeking sponsors, and are inviting riders from services and communities along their route to join them.

www.coventryrecoverycommunity.org.uk

Project promotes ‘natural highs’

Young people in Weston have had the opportunity to try power kiting as part of Addaction’s 18225 project.

One of the project’s aims is to show young people ways to engage in ‘natural highs’, without the need to use drugs or alcohol.

Project leaders have been working with Weston Foyer, which provides accommodation and support for young homeless or vulnerable young people, to engage with individuals aged between 18 and 25 and offer them more information about drugs and alcohol, in particular legal highs.

Service users help build exhibit

Service users from Bristol Drugs Project’s (BDP) training, education, volunteering and employment service have helped create a new Bristol art installation aimed at raising awareness of energy issues.

The Energy Tree was designed and built by artist John Packer, and workshops on building solar panels for BDP volunteers were led by Demand Energy Equality.

‘The opportunity for people in Bristol with a history of problematic drug or alcohol use – one of the city’s most marginalised and stigmatised populations – to build the Energy Tree in the city’s green capital year helps to support their recovery,’ said Maggie Telfer, CEO of BDP.

The installation is a renewable power source that will offer a number of interactive functions to the public, such as WiFi and phone charging.

UK drug policy

Features

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DDN

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June 8, 2015

Get real

The government’s drug policies are not grounded in reality, says law student Alice Gambell

Reading the government’s annual review of its 2010 drugs strategy, it would seem that, despite the wealth of evidence that suggests its policies are counter-productive, the Home Office doesn’t want to listen to anyone’s advice.

The government says that drug use and mandatory drug testing in prisons are down – but is any of this really true?

The figures that the government uses are from the Crime Survey of England and Wales (CSEW). Those who conduct the survey admit these figures are not necessarily reliable – an unknown proportion of respondents may not report their behaviour honestly, and the estimates of prevalence in the findings may be considered lower than the true level of illicit drug use within the general population because of the nature of the survey’s questions.

With regard to mandatory testing (MDT) in prisons, the report claims that positive drug tests are down, as if this is an indication that drug use in prisons is decreasing. HM Inspectorate of Prisons (HMIP) has said that MDT figures are not an accurate reflection of drug use in the prison estate, and that the decline in positive tests does not mean a decline in drug use.

One thing that is true, and that the government fails to even mention in its report, is that drug-related deaths are increasing, as are post-release drug-related deaths. This is a direct result of the government’s drug policy, yet they are failing to do anything about it.

Basing policies on skewed statistics will never result in anything other than further harm. Criminalising drugs and sticking to a purely abstinence-based approach will not make drug use disappear. It only puts people in danger, increases stigmatisation, and places unrealistic conditions on those would benefit from harm reduction practices.

Cycling for recovery

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DDN

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June 8, 2015

The ultimate challenge

John Lowes takes us with him on a very personal journey

Today I walked two miles, swam one mile, cycled 20 miles and ran two miles. I’m doing the same again tomorrow, then the next day and the next. One hundred miles in four days – more than I’ve ever done before and far more than I ever thought possible of myself.

There were no crowds, no one to cheer me on, no prize, no round of applause at the end. Today was quiet, lonely, and uneventful, my only company being the faces in the shared swimming lanes that regarded me with indifference as they didn’t know what I was doing or why.

About 20 years ago I was a drug user. Not the weekend, smiley, go back to work on a Monday kind, but the kind that the newspapers warn you to stay away from. The kind that you don’t want living at the end of your street. The kind you hope beyond all hopes your sons, daughters, sisters, brothers, mothers and fathers never turn out to be. But some of us do turn out to be just that, not out of active choice, but rather a succession of bad choices that get us relentlessly to that bitter end.

We don’t like it there, but for a time we push everything away, even help, until our only friend is the drug or the drink that takes us into its daily world of oblivion and lets us forget; forget who we are, forget who we could be, forget what we’ve lost, forget what we’ve chased away and run away from, just to be alone.

Today wasn’t about recognition. It was about change, it was about second chances… third, fourth, fifth, six chances. Today was about the people who, given the right opportunities at the right time, can make a real difference to their lives and to the lives of those who love them.

Today and the next three days I run, cycle, swim and walk in support of NewLink Wales’ MILE project, which helps people move away from the misery of problematic drug and alcohol use and gives them the skills, tools, and more importantly the self-belief to make the changes necessary to start living a positive and meaningful life.

I hope my four days of doing this will highlight the positive side of substance misuse services and promote an understanding among the wider public that people can, and do, change.

I was given my chances, I was given my opportunities, and eventually I was able to make them work for me. If I was written off I know I would have been dead years ago, but instead I’m now doing my bit to help support others, to create chances like they were once created for me.

John Lowes, NewLink Wales business development officer

If you would like to do a mile for MILE (not 100 – one will do nicely!) and help raise some much-needed funds for the project, please get in touch: fundraising@newlinkwales.org.uk

News from the substance misuse sector

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DDN

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June 8, 2015

Media savvy

The news and views from the national media

The alleged purpose of the [Psychoactive Substances] Bill is to ‘protect hard-working citizens from the risks posed by untested, unknown and potentially harmful drugs’. How noble of the government. Does this mean, therefore, that there is an exemption in the legislation so that those who aren’t in work, or those who aren’t that ‘hard-working’, will be able to be involved in the trade without fear of prosecution?

Niamh Eastwood, Huffington Post, 28 May

The counter-narcotics sideshow in Afghanistan was a desperate and patronising attempt to tart up an ugly and unpopular war, but it serves as a depressingly accurate microcosm for our current, almost wilfully irrational policy on recreational drugs: the underlying reasoning is incoherent; methods of enforcement are questionable; the unintended consequences are malign and disproportionate; and, the whole thing costs an absolute fortune.

Patrick Hennessy, Independent, 6 May

Each prisoner costs the state about £45,000 a year – yet almost two-thirds of those sentenced to less than 12 months reoffend again, most within a year of release since their social issues are often left unaddressed. Core problems such as substance abuse, family breakdown and unemployment can often worsen in jail. [New justice secretary Michael] Gove should be as angered by this failing prison system as he was by failing schools; even his new department knows non-custodial sentences are more effective than a short spell inside from its own studies… is it possible Gove, a restless reformer unjustly loathed on the left, might become an unlikely liberal hero by pointing out the glaring contradictions for conservatives to be supporting perhaps the most grotesque state failure of them all?

Ian Birrell, Guardian, 20 May

No one wants to ask if the mass incarceration policy of the last 20 years really works and why it is so costly. No one is willing to make money available to help educate or rehabilitate prisoners, to stop so many being sent in or to help those released recover work and dignity.

Denis MacShane, Guardian, 21 May

How interesting that the new head of the Downing Street Policy Unit, Camilla Cavendish, is an openly declared supporter of the legalisation of drugs. Such a view, publicly expressed on the record, would once have disqualified anyone from this job. Ms Cavendish was an Oxford contemporary of David Cameron, and even went to the same college. He once signed a Commons report calling for weaker drug policies. Does she say openly what he thinks privately?

Peter Hitchens, Mail on Sunday, 31 May

Smoking cessation

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DDN

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June 8, 2015

Why don’t we take smoking cessation seriously, asks Dr Steve Brinksman

Sajid looked quite bemused when I started talking to him about smoking cessation. ‘I had been using five bags of heroin a day, doc, so I think that’s the least of my worries,’ he said.

I think it is fair to say that over the years that has been the fairly typical response to my questions on smoking, and that probably includes the attitude of many a key worker as well. I’ve said many times that GPs do not ask patients about alcohol often enough, as for some it reflects on their own behaviour. The same, it could be said, applies to keyworkers and smoking questions.

As well as improving physical health, there is evidence that those who do also stop smoking are moreover less likely to relapse to illicit drug use. It is also one of the most effective interventions we have when working with cannabis users.

So, I persisted with Sajid: he was 38, had smoked cigarettes since the age of 13 and heroin since he was 25 – with a fair bit of crack along the way as well. We have recently invested in mini spirometers at our practice and using one of these I was able to show him that he had a lung age of 60, meaning his lung function was equivalent to that of a 60-year-old man.

It was suggestive of chronic obstructive pulmonary disease (COPD). I was able to explain that COPD is increasingly the cause of death for those who use illicit drugs as they get into middle age, and that cigarette smoking was a key component of this.

I have come across people who have been through drug treatment and have been discharged, but who haven’t had their smoking addressed and therefore sadly remain at risk of significant respiratory disease.

In working with clients or patients we cannot downplay the significance of the impact of smoking on health, wellbeing and recovery, and we must encourage them to stop even if we are smokers ourselves.

In the next edition of our popular Network newsletter (look out for it this month) we are pleased to include an article on current pilots to address smoking in people who use drugs and alcohol, as well as an article on brief interventions for problematic cannabis use.

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

Using life skills to aid recovery

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DDN

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June 8, 2015

Natural remedy

Kate Furey talks about how she used long-forgotten skills to get her life back on track

My life started to spiral out of control when I lost my job as a fundraiser. I was struggling to bring up my little girl, who has Asperger’s syndrome, as a single mum and things seemed pretty bleak. While it was clear to everyone around me that my drinking had become a problem, it wasn’t until my daughter was taken away that I realised how my actions were affecting others.

Having a dependency robs you of your self-worth and confidence. CRI provided the support I needed to make it through my recovery. While it felt like an emotional boot camp at times, my key recovery worker helped me to realise how many useful skills I have – for example, I have successfully run three businesses and I’m a qualified aromatherapist. I came out determined to make the most of my talents and to take positive steps in my life.

I opened up Clean and Green Recovery on my first ‘sober’ anniversary two years ago. I began selling my own hand-made, natural cleaning products on a market stall, and two years on I’m running my very own shop! I sell cards and jewellery by others in recovery, as well as my own cleaning and beauty products. I’ve also just received funding to turn one of the rooms in the shop into a holistic salon to provide aromatherapy and reflexology treatments to people in recovery.

I also volunteer with CRI because it’s wonderful to support the recovery of others. It’s amazing to help them rebuild their confidence. Because I have shared many of the same experiences, I’m able to relate to their situation and can prove to them that, even at their lowest points there is always hope.

Kate Furey is the founder of Clean and Green Recovery

www.cleanandgreenrecovery.com

Online support for women in recovery

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DDN

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June 8, 2015

Women first

Annalice Sibley talks about how she set up an online support group to help women in recovery

After working with women in substance misuse services and being a woman in recovery myself, I noticed that many women-only face-to-face groups had been set up and closed due to low levels of continuous attendance. One of the reasons I found for this was fear of being ‘known’, as many members had children and were concerned about issues such as childcare and domestic violence.

I decided to set up a Facebook group, dedicated to my friend Michelle Duell who died as a result of addiction early last year. I believe the group helps with coping strategies, helps women feel more empowered and gives them a sense of community – a place to relate their personal experiences and one that provides understanding.

Women open up on issues that would otherwise be taboo in mixed meetings. The ‘closed’ group means only members can see posts, and it is open to women already in recovery looking for continued support, as well as those looking for a way out. The group is also open to female family members seeking understanding as well as professional females, such as counsellors and drug workers.

‘Women have very different issues to men regarding addiction,’ said one anonymous member of the group. ‘Many are afraid to admit they have a problem due to the fear of losing their children. If we can help and support just one such mother with our own experiences, then it’s a worthwhile group.’

The group, which can be found through Facebook’s searchbar, has more than 1,000 members – the majority from the UK – and is growing every day. I believe we need other women in our lives to heal and stay sober – we pray for the right women to join so we can experience the ‘spirit of sisterhood’.

Annalice Sibley is a counsellor/12-step therapist and founder of Women Only

www.facebook.com/groups/womansrecovery/

Treatment at Chandos House

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DDN

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June 8, 2015

A dog’s life

James Dickinson shares the story of Bert, the unofficial head of treatment at Chandos House

Born to two workaholic and exercise-addicted parents, Bert was abandoned before birth by his father, with a mother chronically co-dependent and preoccupied with dad. After his birth, mum immediately returned to work.

Bert, one of eight siblings, was left to fend for himself in a boundary-less and lawless stable in Shepton Mallet. Mum only returned to the stable once a day for an hour to feed.

When he was about eight weeks old, all his brothers and sisters were adopted, due to their perfectly formed four white socks and white tipped tails.

Bert, having only three and a half white socks and half a dozen white hairs at the tip of his tail, was left alone in the stable for a further three weeks, until I visited the farm.

He was so desperate for attention he would have gone home with me even if I was a three-headed monster – so many children in similar circumstances have felt utterly unlovable and that everything is their fault. Any attention was better than none.

Bert inherited the job of deputy manager at Chandos House, where he was asked to do something other than what he truly was – a sheepdog.

In day one of his new role, at the tender age of 14 weeks, in the middle of a family tree ‘constellation sculpt’, a young man fell to his knees sobbing about his deceased parents. Bert leapt from the sofa whimpering and snuggled up to the young man lying on the floor, licking the tears from his face.

From that day onwards, Bert’s continuing professional development was born out of the perfect life experience – abandonment, rejection and betrayal, and an advanced sense of empathy to do the job.

Ten years old this August, he now commands respect as ‘leader of the pack’. He gives the men we treat here at Chandos an opportunity to take risks and practice both giving and receiving unconditional love, respect and safety. On many occasions, it has been reported and witnessed that this has acted as a positive template of a relationship that can be applied to other relationships and to life outside Chandos.

James Dickinson is head of treatment at Chandos House, www.chandoshouse.org

Prepare for your CQC Inspection

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DDN

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June 8, 2015

Definitely, maybe…

David Finney tells you how to prepare for your CQC Inspection, ahead of the latest changes

I wonder if, every time the doorbell rings, you imagine that it might be the CQC inspector making their unannounced visit to inspect your service and, potentially, decide your future.

The latest news from CQC is that they have told all substance misuse treatment providers that the start of the inspections of all ‘independent standalone’ services will begin in July 2015. This basically refers to residential rehabilitation services.

Until then, CQC have said that they will be conducting a ‘survey of the provider landscape’. This means that you will probably receive a form in which you will be asked to give a range of factual information, such as how many beds you have, staffing numbers, and registration details. This does not mean that you will be inspected soon; it is merely an information-gathering exercise.

Meanwhile, there are two important changes to bear in mind when preparing for inspection:

You are no longer considered to be care homes. I think this should be a relief, as for years you have been trying to convince CQC that you are specialist treatment services first and foremost. CQC now take this view as well.
You are now within the specialist mental health section of the Hospitals Directorate at CQC. This will mean that inspections will look very different. The questions you will be asked will come from a treatment perspective, and the inspectors will probably have a mental health background. CQC say they are going to provide specific training for inspectors in substance misuse, although I am not sure that this has started yet.

So what will inspections look like; and how can you best prepare yourself for them?

There are two distinct stages outlined by CQC:

Intelligent Monitoring: CQC will aim to gather information from a range of sources about the operation of your service.
They will scan information provided by organisations such as Safeguarding Boards, Public Health England, Healthwatch, and Clinical Commissioning Groups.
They will rely on you to supply information about your stakeholders – such as people who commission your services, local authorities, mental health teams, and any other professionals with whom you do business. You will be asked for this information in a ‘Provider Information Return’ (PIR). Normally you will only have a few days to supply this information.

Tip: Make a list of all your stakeholders so that you can supply this information quickly.

In your PIR, you will be asked to answer the five questions: how is your service safe, effective, caring, responsive, and well-led? You will also be asked what improvements you are intending to make to your service.

Tip: Match your answers to the characteristics for ‘good’ services, published by CQC.

Site visit: You will probably be visited by an inspection team, which will include an ‘expert by experience’ (ie a person who has used services), and possibly a specialist professional advisor.
The team will use the new methodology, which is yet to be published in its final form, but will follow the ‘Key Lines of Enquiry’. This will include new questions about treatment effectiveness, use of evidence-based outcomes, systems for keeping people safe, implementation of the Mental Capacity Act and governance structures, as well as all the standard issues such as premises, staffing, and safeguarding.

Tip: Look at the new Key Lines of Enquiry when they are published and ensure that you have covered every angle.

Finally, look out for any training that is specific to the substance misuse sector so that you have the right focus to your preparation.

David Finney is an independent social care consultant with a specialist interest in the regulation of substance misuse services.

A DDN/FDAP CQC compliance workshop will be taking place 7 July 2015. For more information and to book, visit www.drinkanddrugsnews.com/cqc-training

Meeting the needs of anabolic steroid users

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DDN

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June 8, 2015

A growing problem

Users of anabolic steroids are now the biggest client group in many needle and syringe programmes. David Gilliver talks to Jim McVeigh of Liverpool John Moores University’s Centre for Public Health about how services can meet their needs

If you’re in any way connected to the substance sector then chances are you’ll be familiar with the wide-ranging research of Liverpool John Moores University’s Centre for Public Health. And if that research is about image and performance-enhancing drugs, it’s likely to have had the input of the centre’s acting director, Jim McVeigh, one of the foremost authorities on the subject.

While the centre’s remit is far broader than just substance use, its work is united by themes of vulnerable populations and behaviour change. ‘Obviously substance use, sexual health and violence prevention are key areas, and we often find that many of those issues affect the same populations – families with multiple needs,’ says McVeigh.

He’s been at John Moores since 1998, but had ‘always had an interest in the drugs side of things’, he says. ‘My original background is in general nursing in Liverpool, when we had increasing numbers of people coming in who’d been injecting temazepam, and they had horrendous injuries from poor injecting techniques. That’s how I got into working in drug services, through that desire to get involved in harm reduction.’

There’s a great deal of harm to be prevented when it comes to users of anabolic steroids and associated drugs. As well as putting themselves at risk of a lengthy list of possible physical side effects including liver, heart and blood pressure problems, there are potential mental health issues such as depression or even psychosis. The number of users, however, continues to grow – why aren’t they being put off using these substances?

‘Well, one of the key reasons is that they work,’ he says. ‘People taking large dosages of anabolic steroids and a range of other enhancement drugs – when combined with appropriate exercise and nutrition – will get substantial gains. That’s the first thing to bear in mind. Young men, in particular, will want what they want and not necessarily look beyond that at some of the potential implications.’

While most steroid users will experience some adverse effects, they tend to be things seen as ‘coming with the territory’, he points out, particularly cosmetic side effects such as acne, premature balding or even gynaecomastia – the growth of breast tissue. ‘People will either accept it or they’ll take other drugs to try and counter it. It’s a belief that none of the very serious short-term things will happen. And while there are many different adverse effects, in terms of things like psychosis they’re very, very rare. I could introduce you to hundreds, if not thousands, of steroid users who will never have come across anyone who’s had a life-threatening condition that they’re aware of, or a life-changing set of psychological adverse effects.’

Although users may feel reasonably confident about the lack of immediate risk, what’s still relatively unknown is what could happen in the longer term. But if use starts at a young age, then, as with most things, users will tend to assume they’re basically immortal and that none of these things will ever be an issue. ‘Absolutely,’ he says. ‘But there’s evidence coming out from the states that large dosages for prolonged periods do have detrimental effects on your cardiovascular system. That sounds like an absolute no-brainer, but we’ve actually got that hard and fast evidence now.’

And it does seem to be the case that the steroid-using population is getting younger, with around a quarter of first-time users now in their teens. ‘We have been seeing an increasing number of young people – either in their late teens or early 20s – over the last few years,’ he says. ‘In the early ‘90s the vast majority of steroid users were in their 30s and either body builders or aspiring body builders or doormen. Now the vast majority of steroid users presenting to needle and syringe programmes will just be looking to make some quick gains – put on a bid of muscle mass or improve their definition – so it’s not a “career choice” of people looking at longer-term or occupational use so much. It’s almost a whim.’

The current problem is also on a far bigger scale than it was then, he stresses. ‘I knew a small number of people who were using anabolic steroids in the 1980s, but it was only really when I was working in the needle and syringe programmes in the early ‘90s that we saw that explosion of use, going from literally half a dozen people to what we thought were massive numbers, but which pale into insignificance compared to the numbers we’re seeing now across the country. All of a sudden you had this different group of people presenting with different attitudes, different needs, but the staff there – who were very, very experienced – weren’t experienced in this particular area.’

In some needle and syringe programmes, particularly in the north of England, steroid users represent the biggest client group. So are workers up to speed in terms of meeting their needs now? ‘I think so, particularly in the last few years, where there’s been a groundswell of people working within those environments joining up, contacting each other, exchanging experience,’ he says. ‘It’s been driven from the ground up in relation to the practitioners and also users, much more so in many cases than from, say, commissioners, managers or those tasked with developing strategy.’

Recent years have seen the treatment sector having to adapt to new patterns of drug use – the dramatic rise of new psychoactive substances, as well growing problems with people injecting drugs such as mephedrone and crystal meth. Is there any sense that the focus on these new issues has meant services taking their eye off the ball when it comes to steroids?

‘I don’t think so,’ he states. ‘I think the movement away from just opiates and crack cocaine to this much wider area encompassing both enhancement drugs and the novel psychoactives isn’t to the detriment of either. It’s important that we don’t take our eye off the ball in terms of the complex needs of heroin injectors, but we’ve got to accept the fact that we’ve got a much more varied population of injectors now, and they can move between those groups quite easily. It’s not one clear-cut population. Injectors are injectors, and HIV doesn’t really care what drug you’re using.’

Indeed, a 2013 study by John Moores and Public Health England (PHE) found that one in ten steroid drugs had been exposed to one or more of hepatitis C, B or HIV. Is there enough awareness of those risks? ‘Well, what we’ve found repeatedly has been a comparable level of HIV in anabolic steroid injectors to heroin injectors, and I don’t think that population of steroid users are aware of that,’ he states. ‘What we don’t know is exactly how those steroid users contracted HIV – it could be from previous injecting behaviours or it could be sexual contact – but in some ways that’s very much secondary to the fact that HIV is within that population. Unsafe injecting practices will put you at the same kind of risk.’

Despite the sizeable crossover between people injecting steroids and those injecting other drugs, one issue that services need to address is that many steroid users see themselves as completely distinct from the traditional view of a ‘drug user’. ‘It’s quite ironic really when you consider the substances they’re using and the fact that the vast majority of them are injecting,’ he says. ‘But it is a barrier. A lot of them don’t feel they fit into the stereotypical view of what they consider a drug user to be – they feel their attitudes or their whole outlook on life are different. But we know that up to half of anabolic steroid users presenting to needle and syringe programmes have used cocaine in the last year, for example – there really is a massive crossover.’

As well as the potential side effects and the very real risk of blood-borne viruses, another issue is that most users of performance-enhancing drugs have very little idea what they’re actually taking. ‘There’s very few examples of people being able to obtain legitimately produced pharmaceutical grade anabolic steroids, or any of the enhancement drugs. The vast majority of them are illicitly manufactured. That doesn’t mean that they don’t have active ingredients in them, but you don’t know the strength of that particular active ingredient or what contamination may be in there.’

While people now buy from a mixture of local black markets and the internet, the latter has completely revolutionised the steroid scene, he stresses. ‘It’s always somewhere there in the background, whether at the commercial level of links between importers here and manufacturers in the Far East or whether it’s people just buying them from a website. The internet has made a massive difference.’

There are also reports of a growing market in the prison estate, which ‘isn’t really surprising’, he points out. ‘You’ve got the gym culture there – relatively long periods of boredom where the gym is perhaps the main escape – and people often feel that they want to make a new start when they’re in prison. They’ll start exercising and it can get to a point where people want to get those gains quickly.’

So is there anything that commissioners or services can be doing to better tackle the problem? ‘There’s a couple of important things. One is ensuring that services really do engage with this population of injectors. It’s not sufficient just to have clean injecting equipment for people to pick up – you have to engage with them and see exactly what they want. It’s important that we translate the lessons we’ve learned from injecting heroin users to this group. We found very quickly that it was important for services to be designed around needs, with non-judgemental attitudes, and having services where people wanted to use them and at the times they wanted to use them.

‘Those users were the best source of intelligence and information about the public health issues. It really is important that it’s not seen just as “we’re also letting steroid users come to the service”. You really do need engagement.’

Liverpool John Moores has a range of educational programmes, including an MSc in addictions. For more information visit www.cph.org.uk

Recovery Street Film Festival 2015

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DDN

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June 8, 2015

Share your story

Storytelling through film can play an important role in recovery, says Lou Boyd

The Recovery Street Film Festival was founded as a way of helping the general public understand more about recovery from substance misuse, by giving those who have lived through it a platform to tell their story. In 2014 it reached people in London, Liverpool, Glasgow, Cardiff and Birmingham, and it was clear from speaking to those who took part that telling their story had helped their recovery.

Research illustrates the benefits of giving those in recovery a platform to tell others about their experiences – after all, creating a narrative is the foundation of many types of group work and key working – and it can be a very positive step to formalise this process.

Creative writing, visual arts and music are all options, but smartphones now mean that film is very accessible – the tips at the end of this article give an idea of how easy this can be. We have increasingly seen film and other media used effectively to support those who may consider themselves marginalised or misrepresented, such as members of BME and LGBT communities, and those with mental health needs or criminal justice issues.
Paul from London, who took part in the Recovery Street Film Festival last year, was clear on what the benefits were for him:

‘Making a film was definitely helpful to me in my recovery. Being a bit shy in nature and not a very talkative person, this was a great way in which I could share some of my experiences, and I would certainly recommend it to others.’

Last year the film festival received more than 70 entries. We hope that more people get involved this year and would encourage anyone working with people who have, or are affected by, substance misuse issues to enter the competition.

Lou Boyd is operations manager for Turning Point in south Westminster

Entry details at www.recoverystreetfilmfestival.co.uk

Naloxone distribution

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DDN

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June 8, 2015

Naloxone distribution campaigner Philippe Bonnet

Fast forward on naloxone distribution

Progress on naloxone distribution is still slow and inconsistent throughout the UK. DDN asked naloxone champion Philippe Bonnet for some tips on moving forward

As part of a team committed to distributing naloxone, Philippe Bonnet hears of an overdose being reversed every week in Birmingham. While he credits a very active commissioner and a proactive treatment provider for their role in making naloxone a central part of the area’s drug strategy, he has learned some useful lessons over the past three years. As chair of Birmingham’s naloxone steering group and Reach Out Recovery worker at the sharp end of client care, he has experience worth sharing.

Make naloxone champions

‘What is key is to have real champions, who are going to be proactive,’ he says. ‘We identified champions from each service and told them their role was to get to colleagues as well as clients – to get those kits out into the clients’ hands. It’s no good just talking about it.

‘The staff can be trained in two hours, which covers who’s most at risk, myth busting, overdose awareness and how to use the kit,’ he says. ‘They can then train a client in five minutes. It’s so straightforward.’

Create a naloxone distribution network

The support of local doctors makes life easier, says Bonnet. ‘We have a number of doctors who are so pragmatic, very switched on. Dr Judith Yates was instrumental from the beginning, not to mention many wonderful prescribing nurses.’

Another important partner is the local ambulance service – and there were some barriers to tackle, he admits. Following an incident where paramedics told a client off for using naloxone, Bonnet contacted the lead of the ambulance service.

‘I couldn’t believe how pragmatic that guy was,’ he says. ‘The next day I had an email saying a memo would be sent out to all the crews, telling them that in Birmingham all drug users were being equipped with naloxone.’

The process had to be repeated with the 999 telephone operators, after one of them told a caller from a hostel not to give naloxone to an overdose victim. Bonnet drew a comparison with anaphylaxis – ‘would you tell them not to use adrenaline?’ – and protocol for telephone operators is changing.

Discussions are still underway with the police to work out how initiatives can be incorporated into protocol, but there has been progress with other local partners, he says. Just weeks ago, HMP Birmingham gave the go-ahead for kits on release.

Making sure hostel owners ‘understand the rationale and legislation around naloxone’ has given many more confidence, knowing that ‘absolutely, categorically, anyone can not only carry, but use, naloxone to save a life.’

Likewise, working with central Birmingham hostels that dealt with countless overdoses led to training for the homeless treatment team of Dr Andrew Thompson at a major hospital. ‘This is a major initiative and it’s early days,’ says Bonnet. ‘The idea would be to give a naloxone kit following discharge from an overdose or other drug-related admission – ideally this would be rolled out for all hospitals in England.

‘What doesn’t work is giving them an appointment and telling them to come back,’ he adds. ‘With some of our clients, you really need to do everything you can with them while you’ve got them.’

Get paperwork in place

The first stage is to increasing naloxone distribution in your area is to get together a prescribing protocol, like PGD or PSD, says Bonnet. ‘That’s easy, just a couple of signatures on a document, really.’

Get kits in place

Then you need to buy naloxone kits and distribute them – ‘all you need is money to buy the kits, so you need to get the commissioner on your side,’ says Bonnet.

‘I remember our previous commissioner, around three years ago, saying he had bought 250 kits to start with. He just told us to get on with it, to go and save lives. The funding keeps coming through to this day. As a result, Birmingham is the leader for naloxone distribution in England. Around 2,500 kits have now gone out. We are now in a position whereby there is real consensus amongst expert organisations, including the Advisory Council on the Misuse of Drugs and the World Health Organization, that this is a medication that should be made more widely available. I hope we see that come to fruition over the coming year.’

CRI, the charity behind the delivery of Reach Out Recovery, actively supported the Naloxone Action Group’s campaign to widen provision of naloxone in England by asking services and stakeholders to write to their MPs to sign a motion which would prioritise its roll-out across the whole of the UK.

Show the economics

‘Our top priority is to save lives, in any way we can,’ says Bonnet. ‘However, it’s important to note that an overdose death costs thousands. Therefore, spending £18 on a kit which has the capability to save a life, as well as precious NHS resources – not to mention the trauma caused to the victim’s loved ones – seems to me like the obvious choice. It’s not rocket science.’

Do you have a naloxone strategy in your area? Let us know your experiences – good or bad – by emailing claire@cjwellings.com

Back to life

John’s experience is typical of the naloxone reversals each week in Birmingham. Philippe Bonnet shares his story.

‘John had scored two £10 bags, one for him, one for his girlfriend. He was aware that his girlfriend had diazepam and pregabalin in her system.

They cooked up the gear and within minutes of withdrawing the needle she collapsed in her chair and her head went back. John got up and shouted “babe are you ok,” shaking her shoulders. Her lips went blue straight away.

He panicked, grabbed her, and put her on the floor. He grabbed the phone and called the ambulance, shouting ‘hurry up, hurry up’. He got his naloxone and gave her a dose. Nothing happened.

He gave her a second dose; nothing happened. He gave her a third dose; nothing happened. At this stage I asked him how long he had waited between doses. He said “I don’t remember. She was dying in front of me.”

Then he gave her the last two doses in one, emptying the plunger. The ambulance arrived as she was coming round. He told the ambulance that he had had to give her five doses. As they took her into the ambulance, a member of the crew said, “If it wasn’t for your actions she’d be dead now.”

That happened at about 9am. At 3pm John came back to our service to get another kit. He was shaking, saying “Oh my God, I nearly lost my girl.’ She had been discharged from hospital. She was OK.”’

See the naloxone action group on FaceBook and read more on naloxone in DDN magazine

Harm reduction at music festivals

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DDN

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June 8, 2015

The song remains the same

Music festivals may go hand in hand with drug culture, but we can be loud and clear on harm reduction, says Tracy Walker

In a muddy field, the distant thud of bass and excitement in the air, a small band of drug workers flies the flag for harm reduction (HR) on behalf of one of the largest festivals in England. Today’s festivals attract a much wider range of attendees than the subculture gatherings of yesteryear. Families are often well catered for along with a wide variety of music genres, with some attracting tens of thousands of people daily.

The synergy between music and drug culture is well documented and while the music and drugs may change and evolve, their intertwined legacy remains the same. Some campaign for drug-free festivals, which both the current law and policing are aiming to achieve. But with little to no clear resolution in sight, and drug-related deaths or serious drug-related harm still all too common, a different approach is needed. Some festivals are now leading a change of direction by pioneering a more proactive strategy to address preventable risks.

One of these festivals is BoomTown Fair, which last year commissioned Bristol Drugs Project (BDP) to provide HR advice and information, along with a safe space for attendees who need it. In the run-up to the event, they enlisted the advice and support of BDP in creating their drug awareness campaign, while onsite they promoted the BDP tent as a safe non-judgemental place for attendees to visit, relax in, and get advice or open up about drug-related concerns. The festival also provided volunteers to disperse HR information and direct people to the tent to further engage with the service.

BoomTown Fair provided amnesty boxes and HR information at the festival entrances. However, acknowledging that not all attendees onsite would follow the abstinence route of drug harm prevention, BDP festival HR workers Jim Bartlett, Ian Borland, Jacob Crook, Jasmine Lawrie, and Jane Neale issued free condoms, water and sniffing tubes to those who needed them, along with HR advice to support people in staying safe. The BDP team, with an interest in new patterns of drug use, engaged large numbers of festival-goers in more complex interventions around individual concerns or wider issues. Jasmine said that The Drugs Wheel: a new model for substance awareness (designed by Mark Adley/DrugWatch) proved a good aid for useful discussions about new psychoactive substances (NPS) and drug interactions.

The BDP tent contained a ‘chill-out’ space with beanbags, where those experiencing problems could recuperate. Workers facilitated this in a pragmatic and non-judgemental way, often preventing an escalation towards the need for other welfare or medical interventions.

With a banner announcing ‘free drugs’, qualified by the less eye-catching ‘advice and information’, acting as a magnet for interested passers-by, BDP took the opportunity to learn about their drug use and where they’d seek help if they needed it. Despite the many attractions at BoomTown, 420 people completed BDP’s short questionnaire about their drug use during the previous 12 months and where they sought information and support, as well as general demographic data.

This opportunistic sampling may not be representative of the festival population, but may be a useful indicator of the target, potentially at-risk, population for whom HR services may be relevant.

The sample was young adults, 72 per cent being under 25 and only 7 per cent over 30. Women were marginally under-represented at 47 per cent. The majority were in full-time work (60 per cent) or education (27 per cent).

The biggest surprise was the number of different drugs used in the previous 12 months, totalling 93 named substances. Respondents cited alcohol and polydrug use as common, with 83 per cent reporting alcohol use alongside other drugs. Many psychoactive substances were listed, including 2Cb, 2Ci, LSD, DMT, and AMT. Empathogens included MDMA powder and pills, while cocaine, amphetamine and skunk featured strongly. Men were significantly more likely to take psychedelics like DMT, LSD and mushrooms, as well as depressants, particularly diazepam.

Of the festival sample, 80 per cent might be broadly categorised as casual, infrequent or weekend drug users, showing the potential for risks of harm. The importance of this area of work is illustrated by Ian’s interaction with a young couple. They had only one previous experience of illicit drugs and the woman in particular experienced a bad reaction. Ian helped them explore whether they wanted to take the substance again, discuss testing strategies and dose, drug and alcohol interactions and other contributing factors like environment. Before this intervention they had intended taking a half-gram single dose each, putting themselves at considerable risk. We don’t know what their decision was, but we do know it was a more informed one. There were dozens of similar HR interventions.

The majority of respondents sourced drugs from friends, while a quarter bought from street dealers, with only 9 per cent purchasing via the internet.

Friends and the internet were equally popular sources of drug information, and friends were the major reported source of support. More respondents would consult drugs agencies for support than for information, but 70 per cent did not use agencies at all. A majority (56 per cent) said they had taken a substance without knowing what it was, with 11 per cent reporting doing this often. There was a significant gender bias of this risk towards men, which fits with more general trends in health-related research on gender and risk-taking behaviours. A significantly greater figure of 53 per cent of women never took unknown substances, compared to 37 per cent of men.

Although the majority said they had not deliberately taken an unknown substance, many expressed concern that they could do so unwittingly. This substantial risk could be addressed with drug checking, which happens already in some contexts in the UK and elsewhere. It may be that festivals would embrace drug-checking onsite, if legislation allowed.

The success of BDP’s HR presence at the festival in 2014 is demonstrated particularly well by workers being sought out by those concerned for friends who had used and become unwell – the result of positive earlier engagement with the service. Workers were able to assess and liaise with medical and welfare services using radios provided by the festival.

BoomTown Fair has re-commissioned BDP this year to build on the good work achieved at the 2014 event, with additional BDP volunteers to provide a greater capacity for HR and outreach. There will also be a structured programme of interactive HR workshops, information films and live speakers to engage with a wider audience at the festival and to inspire people to feel confident about talking openly about drug use and HR. BDP will also run the research questionnaire again, providing the opportunity to see any changes from 2014 and to demonstrate tangible results in engagement and the effectiveness of the service.

Tautology it may be, but it is worth spelling out that harm reduction reduces harm. We have the will, knowledge and ability to do more. A pragmatic governmental policy shift to enable delivery of more effective HR at festivals would mean a reduction in drug-related damage – so the song need not remain the same.

Tracy Walker is assessment engagement worker at BDP. Tom Martin can be found at www.tmoose.co.uk

Photography by Tom Martin

CQC Training Booking Form

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June 5, 2015

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NPS to be subject to ‘landmark’ blanket ban

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June 1, 2015

The government is to introduce a blanket ban on ‘legal highs’, as announced in last month’s Queen’s Speech. The Psychoactive Substances Bill will ‘prohibit and disrupt’ the production, distribution and supply of all new psychoactive substances (NPS).

The legislation will be UK-wide, and will include powers to both seize and destroy NPS as well as to ‘search persons, premises and vehicles’. The blanket ban means that the authorities will no longer need to take a substance-by-substance approach to NPS, more than 500 of which have been banned already.

The new legislation, which will also extend to nitrous oxide, is likely to effectively spell the end of the high street ‘head shop’, and offences detailed in the bill will carry a maximum sentence of seven years. Once the legislation is passed, it will be an offence to produce, import, supply or possess with intent to supply ‘any substance intended for human consumption that is capable of producing a psychoactive effect’, although substances such as caffeine, alcohol and tobacco will be exempt.

‘The landmark bill will fundamentally change the way we tackle new psychoactive substances – and put an end to the game of cat and mouse in which new drugs appear on the market more quickly than government can identify and ban them,’ said crime minister Mike Penning. ‘The blanket ban will give police and other law enforcement agencies greater powers to tackle the reckless trade in psychoactive substances, instead of having to take a substance-by-substance approach.’

The announcement has met with a mixed response, with Transform accusing the government of ceding control to ‘those on the wrong side of the law’ and Release executive director Niamh Eastwood describing the bill as ‘full blown regression’.

The Local Government Association (LGA), however, said that an outright ban would enable trading standards officers to protect the public from ‘devastating consequences’ by closing down head shops, while Addaction chief executive Simon Antrobus said that, while the government was right to clarify the ‘legal grey area’ around the sale of NPS, ‘we mustn’t kid ourselves that this legislation is enough to address the harm caused by these substances’. Any regulatory measures would need to be backed up by a ‘renewed focus on education, support, advice and specialist treatment’, he stated.

New policies needed to tackle harmful drinking

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May 14, 2015

Get tough on alcohol, OECD urges governments

Governments need to introduce more effective policies to tackle harmful drinking, according to a new report from the Organisation for Economic Co-operation and Development (OECD).

Levels of ‘hazardous and heavy episodic drinking’ are on the rise among young people and women across many OECD nations, states Tackling harmful alcohol use: economics and public health policy, and while overall consumption has fallen slightly over the last 20 years, drinking levels have risen ‘particularly’ in Finland, Iceland, Israel, Norway, Poland and Sweden. There have also been substantial increases in the Russian Federation, Brazil, India and China – albeit from low levels in the last two – with average annual alcohol consumption by adults in OECD countries now estimated at around 10 litres of pure alcohol per capita, the equivalent of more than 100 bottles of wine.

The report puts the blame on alcohol becoming ‘more available, more affordable and more effectively advertised’. Levels of alcohol consumption in the UK stand above the OECD average – at around 10.6 litres of pure alcohol per capita – and have increased over the last three decades, with almost 63 per cent of all alcohol drunk in England consumed by the heaviest-drinking 20 per cent of the population.

The report urges governments to introduce policies that target the heaviest drinkers first – such as using primary care staff to identify and encourage them to seek help – alongside financial measures such as minimum pricing and increased taxes. It also wants to see tougher advertising rules and better education.

Worldwide, alcohol misuse rose from the eighth to the fifth leading cause of death and disability in the 20 years to 2010, the document states, and now kills more people than HIV/Aids, tuberculosis and violence combined. ‘The cost to society and the economy of excessive alcohol consumption around the world is massive, especially in OECD countries,’ said OECD secretary general Angel Gurría. ‘This report provides clear evidence that even expensive alcohol abuse prevention policies are cost-effective in the long run, and underlines the need for urgent action by governments.’

Report at www.oecd.org

From our foreign correspondent

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DDN

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May 6, 2015

In her first international column Chris Ford looks at Ireland’s lack of naloxone provision

Noticing a number from abroad, I answered my phone. Before I could even say hello, a woman who I now know as Siobhan was telling me a story about her son Gary. Just 31 years old, he had died in the family home from a heroin overdose about three months previously.

On returning from work one evening, Siobhan had called up to Gary and getting no response she went upstairs to investigate. He appeared to be asleep and was snoring. She felt so angry as they had agreed to talk that evening about possible next steps, and instead she saw that he had injected. Seeing him lying on his side she decided to leave him to ‘sleep it off’. She returned to his room in the morning to find him cold and dead. With a mixture of sadness and anger, she told me how she’d screamed uncontrollably for what had seemed like hours. She described how she’d hugged and kissed him, willing him to come around, but knowing in her heart he was long dead.

Without pausing for breath, Siobhan said that she was to blame for his death: ‘If only I’d known that he was overdosing when I found him, I could have called for help and given him naloxone.’ But could she?

Gary’s history was sadly like too many other people’s. He’d had a problem with heroin for 12 years and had been in and out of treatment in Dublin for many of those years. After a short prison sentence, which he never wanted to repeat, he had decided to leave Dublin and return home to a small community close to Galway just over a year ago. He had relapsed about ten months previously and decided he couldn’t face drug treatment again. He also knew from friends that the Galway drug treatment clinic was over-subscribed and had a long waiting list, and that even if a place became available it would be almost impossible for him to get there on the compulsory daily basis.

This is not an unusual situation in rural parts of Ireland. With limited options, Gary had decided to try on his own, but this was not working; so what next steps could be possible was going to be the subject of the talk with his mum on that fateful evening.

Siobhan stopped talking for a second and realised I was listening intently to her tragic story. I was welling up myself imagining her pain of losing a son and from such a preventable condition. We talked, cried and hugged down the phone. Siobhan has learned a lot since Gary’s death and one day soon will join the campaign to stop these preventable deaths. Although not quite ready yet, she did want Gary’s story told to try and inform the debate and help other mothers to not have this happen to them.

So what is the situation in Ireland with naloxone at the moment? It is only available in hospitals and healthcare facilities under licence, for someone who has already overdosed. That is, it is not available to patients or carers.
There are moves towards changing this with training to staff, people who inject drugs and carers and a national roll-out programme, but this is not going to happen in Galway for sometime to come. As a friend who works in Ireland said, ‘Unfortunately, like most things in Ireland, strategies tend to remain in the planning phase and as we all know too well, “planning” has never reversed the effects of a single opioid overdose.’

One of the problems seems to be that no one is taking clinical responsibility for prescribing naloxone, to be given to a person injecting drugs or a family member. Patient group directives don’t exist in Ireland. Even in big centres like Dublin, naloxone isn’t on the formulary – so individual doctors working there can’t prescribe it.

Irish drug-related deaths (DRDs) are among the highest in Europe. Lack of effective, timely treatment including naloxone is undoubtedly a factor. The drug-induced mortality rate from overdose among adults (aged 15–64) was 70.5 deaths per million in 2011, more than four times the 2012 European average of 17.1 deaths per million. (http://www.emcdda.europa.eu/publications/country-overviews/ie#drd)

Increasing the availability and accessibility of naloxone would reduce these deaths overnight. We do know that the availability of naloxone is growing in several countries. Scotland implemented a national programme in 2010, and outcomes there have demonstrated its effectiveness in reducing drug overdose deaths. Canada and Estonia have pioneered programmes on take-home naloxone. In the United States, policymakers called for greater availability and accessibility of naloxone after opioid overdose deaths more than tripled between 2000 and 2010. In some states distribution has expanded, leading to a 70 per cent decrease in overdose deaths in some areas.

Last November, guidelines from the World Health Organization (WHO) recommended increased access to naloxone for people who use opioids themselves, as well as for their families and friends. Naloxone is also included on the WHO Essential Medicines List.

The role of naloxone in addressing opioid overdose was recognised for the first time in a high-level international resolution in March 2012. Members at the UN’s 55th CND unanimously endorsed a resolution promoting evidence-based strategies to address opioid overdose. Recently, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a very useful literature review of the effectiveness of take-home naloxone.

I finish this piece with deep sadness at the unnecessary loss of so many lives, all of whom are someone’s brother, friend, mother, daughter or as Gary, son. I also feel angry that there is an easy cost-effective, evidence-based medication that could be used to immediately cut these deaths and it is only bad policy and bureaucracy that is preventing it being available to all in Ireland and many other countries.

From the early results of the IDHDP survey it appears that naloxone is available in just over half the places that have completed it, but its accessibility is limited and often only available on prescription and/or to health workers. If you haven’t already, please complete our short
Global Naloxone Survey.

Let’s change this situation now! If you don’t have naloxone available in your area, ask commissioners why they are contravening WHO’s recommendations.

Dr Chris Ford is clinical director at International doctors for healthier drug policies (IDHDP), www.idhdp.com

Media savvy

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May 5, 2015

The news and views from the national media

Substance misuse policy is, of course, a subject of passionate debate at all points on the political spectrum. While policy will always remain a highly charged issue, it is facts that should guide the commissioning of substance misuse, not politicised opinion or ill-informed conjecture.

Victor Adebowale, Guardian, 2 April

If being evidence based is not your thing and the use of medically prescribed heroin is still too radical for you, it is incumbent on you to provide an alternative. Is it another attempt at methadone or an abstinence programme based on a fervent hope and prayer that this time it will work? Given their histories of unsuccessful treatment, the evidence is overwhelming that many people will relapse quickly to using illicit heroin.

Martin T Schechter, BMJ, 14 April

I see addiction as driven by supply. Almost half the US soldiers serving in the later stages of the Vietnam war tried heroin or opium; about 20 per cent became addicted. Back home in America, most of those addicts kicked the habit because they couldn’t buy grade-A heroin from their housemaids, as they could as GIs. As a young man I was an alcoholic and the only way I could stop drinking was three years’ total immersion in Alcoholics Anonymous, to whom I owe a huge debt even though I don’t buy their disease model of addiction. Later I got into cocaine but didn’t become addicted to it – because the supply dried up. If it were legal I’d probably be a cokehead or dead by now.

Damian Thompson, Spectator, 9 April

If you are a man, it has virtually become gospel that drinking more than 21 units of alcohol a week is damaging to your health. But where did the evidence to support this well-known ‘fact’ come from?… According to Richard Smith, a former editor of the British Medical Journal, the level for safe drinking was ‘plucked out of the air’. He was on a Royal College of Physicians team that helped produce the guidelines in 1987. He told the Times newspaper that the committee’s epidemiologist had conceded that there was no data about safe limits available and that ‘it’s impossible to say what’s safe and what isn’t’. Smith said the drinking limits were ‘not based on any firm evidence at all’, but were an ‘intelligent guess’. In time, the intelligent guess becomes an undisputed fact.

Malcolm Kendrick, Independent, 6 April

Joan Hollywood – obituary

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May 5, 2015

Joan Hollywood

1941 – 2015

Joan Hollywood was a mother whose adult son died in 2008 after many years of drug and alcohol use. Unable to find support for grieving a substance-related death, Joan, with her husband Paul, founded the support organisation, Bereavement Through Addiction (BTA), in Bristol.

BTA provides a helpline, support groups and an annual memorial service for people bereaved in this way, as well as training for organisations in the field.

Already an accomplished artist and crafts person, with a long-standing concern for social justice, Joan became a tireless campaigner for people bereaved by substance use. Through BTA she developed an extensive network of bereaved people and practitioners involved with substance use deaths, drug and alcohol treatment and bereavement support. She was also The Compassionate Friends’ national contact for parents bereaved in this way.

Joan was the inspiration behind a major research project to better understand and improve support for this kind of bereavement. Based at the University of Bath, in collaboration with the University of Stirling, the project is funded by the Economic and Social Research Council from September 2012 to September 2015. Joan’s passionate commitment to the research has been crucial to the project’s design; her networks were instrumental in helping us to interview 106 bereaved people and undertake focus groups with 40 practitioners (some also bereaved).

Joan also participated in a working group of 12 practitioners tasked with developing guidelines for improving how services respond to those bereaved through substance use.

Unexpectedly, Joan suffered two strokes and died a few weeks later on 10 March. The guidelines, to be launched at the project’s final event on 23 June, will be dedicated to Joan and her passionate commitment to improve support for people who have lost a loved one to drugs and alcohol.

Christine Valentine, Lorna Templeton, Tony Walter, Richard Velleman, Linda Bauld, Jennifer McKell, Allison Ford, Gordon Hay, Bereavement Through Substance Use Project.

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Joan was graced with the rare gift of being able to transform personal pain into a flame of inspiration, which she used to bring solace to those bereaved by addiction. Equally important was the power of her conviction that this issue must be taken seriously, and she worked tirelessly with the Universities of Bath and Stirling, making a most valuable, and much-needed, contribution to the research on this, hitherto, marginalised topic. Joan has left a landmark legacy, and the inspiration ignited by her dedication is certain to carry on into the future.

Esther E Harris, independent practitioner

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Joan was part of the advisory group for the Adfam and Cruse project, supporting those bereaved through drug or alcohol use to develop and deliver peer support to others bereaved in this way. Joan was one of a small number of people who had focused on this most pressing issue and laid the groundwork for national projects such as ours. In the time she was involved in the project, her passion and dedication were highly evident – she was always willing to contribute her time to providing the vital voice of families in our work. Her contribution to the family support sector will be sadly missed, and we will do anything we can to support the work of Bereaved Through Addiction over the coming years.

Oliver Standing, on behalf of Adfam, and Fiona Turnball, on behalf of Cruse Bereavement Care

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Joan Hollywood: the world has lost one of its most gentle yet influential ambassadors for the deprived and unfortunate. Joan had a huge tenacity and resilience for pioneering and driving new areas of work that can make a difference to the lives of so many. She leaves behind the legacy of her charity BTA, and the near completion of the Bath and Stirling University Research Project for those bereaved through substance use. In death, Joan continues to inspire us all to continue to develop her work and remain connected to her memory.

Darren McEvoy, senior family practitioner DHI Bristol and committee member BTA

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As mothers, Joan and I had an immediate bond because we shared a common sorrow and heartache – the loss of our sons to addiction. Since 2009, she and her husband Paul loyally attended DrugFAM’s annual Bereaved by Addiction conference to remember their son Paul. Despite her own loss, she was a kind, supportive, understanding and sympathetic lady who always had time to listen and care for others who were experiencing that devastating loss.

We spoke many times on the phone about her desire to set up Bereavement Through Addiction, which I am proud to say she and Paul achieved. Since then she has worked tirelessly in offering support and in raising awareness of the problems faced by those dealing with the death of a loved one through addiction.

I was so pleased that I attended the Bereavement Through Addiction memorial event, which took place at St. James Priory in Bristol in November last year. As always, thanks to Joan it was a welcoming and well-supported event offering all those who have lost a loved one through addiction the opportunity to come together for a wonderful, uplifting and powerful ceremony of remembrance. Her thank you email to me read, ‘Dear Elizabeth, thank you for your contribution to the BTA memorial event on Saturday – to have Simon speak as well made it extra special. I think you are right, we should team up to hold a joint memorial in 2016/17. I will have this on the agenda for our next BTA management meeting in January. We should check out Westminster Abbey and St Pauls Cathedral and have a day out together. Thank you again. Best wishes, Joan’.

It was a privilege to sit with her on the Adfam/Cruse advisory panel. She would often ring or email me with constant positive encouraging words of support for the work DrugFAM does to support the bereaved.

I have lost a soul mate who has left a dignified and long lasting legacy through the passion for her work for the bereaved in Bristol and the South West.

Elizabeth Burton-Phillips, chief executive DrugFAM

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I remember meeting Joan for the first time over six years ago, following the death of her son Paul in 2008. What has always stayed with me was hearing her relate someone’s response to her son’s death as, ‘It must be such a relief for you’. It was this comment that brought the stigma attached to the death of a child to drugs or alcohol into such sharp relief.

The death of a child is the death of a child and the grief remains the same – regardless of the cause. Her experience with the police and coroner added to the trauma of losing her son. Joan’s need to address the stigma attached to bereavement through drug or alcohol use burned bright and led to improvements by both police and coroner’s office in how they respond to bereaved family members.

Joan and her husband Paul went on to set up a support group for others who’d also lost loved ones to drugs and alcohol, and this met regularly at Bristol Drugs Project’s (BDP) premises.

Joan’s final blow against stigma was establishing a memorial event to remember lives lost to drugs and alcohol. The first event took place in December 2010, and was both heart-breaking and uplifting in equal parts.

The names of lost loved ones were read out and then recorded permanently in a book designed by people in recovery at BDP.

Poems were shared, songs sung and a wonderful choir created space for people to remember and celebrate the lives of loved ones lost to drugs and alcohol.

In the sixth memorial event in this year we will also be able to remember and celebrate Joan’s life who, with her partner Paul, turned an experience most of us can only imagine the horror of into Bereavement Through Addiction, which supported those who were bereaved and challenged the attitude of ‘others’ to their loved ones . This is Joan’s very fine legacy.

Maggie Telfer, CEO Bristol Drugs Project

European Alcohol Conference

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May 5, 2015

Shake it up

Speakers called for a fresh look at policy and new ways to engage drinkers at the European Alcohol Conference, held at the Guildhall last month.

‘In policy terms, it’s a relatively new drug on the block,’ began Colin Drummond, consultant psychiatrist at the National Addiction Centre. He emphasised that there was a ‘policy vacuum’ where alcohol was concerned, comparing it to tobacco, which had been tackled much more successfully.

In 2012, the EU alcohol strategy had expired, and the European Commission had neither reinstated the old strategy nor brought out a new one. The House of Lords had published an EU alcohol strategy report, laying out the need for policy to be entirely independent, free from ‘vested interests’, and without influence from the industry – which ‘had no place at the table when designing policies,’ he said.

Statistics provided by the AMPHORA research project identified a huge variation of access to treatment throughout Europe, said Drummond – for instance, 23.3 per cent of problem drinkers had access in Italy, compared to 6.4 per cent in the UK – with similar variances across local authorities within the UK.

In London, for example, things were ‘beginning to get better,’ said Dr Helen Walters, head of health at the Greater London Authority (GLA). London alcohol death rates weren’t as bad as other places in the country – but alcohol-related crimes had a much higher rate.

She said that the GLA had focused on keeping alcohol on the public and government agenda. We could change how people were drinking, she said, ‘partly by changing politics, partly by changing public outlook.’

Putting alcohol policy within a cultural context, James Nicholls from Alcohol Research said that ‘there are lessons to be learned from the history of alcohol policy.’

Consumption levels had gone up and down throughout history, with the most significant recent reduction in consumption among young people – not just in the UK, but right across the board. ‘Something is happening here’ said Nicholls, ‘but we don’t know what it is.’

‘Drinking cultures aren’t static,’ he said – they have changed and changed quite quickly. Policy impacts were unpredictable, and changes occurred differently in different populations and generations.

There was a need to develop more advanced theories – policy worked within a cultural environment, and would have different effects depending on the culture around it, he said.

When thinking of new ways to engage drinkers, ‘being honest about the pleasure of drugs and alcohol is important,’ said Dr Adam Winstock, director of the Global Drugs Survey.

There were a wide variety of different relationships to alcohol across Europe, he said. The UK, for example, had the highest rate of turning up to work hungover, but also had one of the highest rates of awareness of drinking guidelines.

The countries that tended to drink more were the ones that wanted help to drink less – but were also reluctant to change their behaviour.

‘We underestimate our personal vulnerability to harm,’ said Winstock – pointing out that individuals not only enjoyed drinking, but rationalised and normalised their behaviour when it suited them, so they were more likely to accept the harms of drinking and drug taking.

The UK had the highest rate of ‘normative misconception’ in the world, with most people with alcohol dependence going undiagnosed – people didn’t know they were alcoholics.

We needed a different way to engage people, he said. The idea of stopping completely was difficult to understand, whereas simply reducing the amount consumed was more palatable. ‘We need to start a dialogue with people who drink so they just drink a little bit less,’ he said.

Treatment challenges of novel psychoactive substances

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May 5, 2015

Novel ideas

Dima Abdulrahim talks about meeting the treatment challenges of novel psychoactive substances

When it comes to managing substance misuse, there is an existing – and substantial – body of research evidence, as well as a number of clinical guidelines. Can we apply this guidance to club drugs and novel psychoactive substances (NPS)? To a large extent, we can, and should. The principles underpinning treatment are the same. Good practice is transferable.

However, it would also be wrong to ignore the particular challenges posed by club drugs and NPS, and the need to address them specifically. It is also widely acknowledged that professionals require support to improve their knowledge and confidence in the assessment and management of the acute and chronic harms resulting from the use of these substances.

With generous support from the Health Foundation, project NEPTUNE has responded to the gap in knowledge and addressed the challenges of club drugs and NPS by developing guidance based on the best available evidence and clinical consensus.

The challenges include those resulting from the drugs themselves: what are they and how do they work? There is a rapidly changing profile and ever increasing numbers of substances available for recreational use. More than 450 NPS are currently monitored in Europe, with more than half reported in the last three years alone and 101 reported for the first time in 2014. The potential harms of the NPS are still poorly understood, particularly their long-term impact. The evidence base for treatment remains limited.

NPS appear to be attracting a new group of younger users. Engaging them is a particular challenge for drug services, which are historically orientated towards opiate and/or crack users. Clinicians require improved knowledge of who is using club drugs, and how. Services generally have limited understanding of the diverse ‘cultural’ contexts of club drug use (clubbing, festivals, LGBT venues, sexual context, psychonautic use), or context of use, risk and harm. One particular challenge to drug services is the link between drug use and high-risk sexual behaviours and the use of drugs in a sexual context, particularly by gay men.

There are new challenges associated with the clinical management of club drugs and a need to improve ‘clinical’ knowledge of how to manage acute/chronic presentations. For example, the management of GBL can be complex in emergency departments, as well as in drug recovery services, as acute intoxication and withdrawal syndrome can be severe and potentially fatal. The overlap of substance misuse harms with other harms has also compelled drug treatment professionals to develop knowledge and clinical pathways in uncharted territories. For example, ketamine is associated with severe urinary system damage and management may therefore require collaboration with urology and competencies in pain management in the context of ulcerative cystitis.

NEPTUNE has responded to the fact that the management of the harms of club drugs and NPS is not only about drugs services. Guidance is therefore also aimed at emergency departments, primary care and sexual health clinics. Not only do these services manage the harmful effects of club drugs, but they also provide a good access to populations with high levels of club drug use. This makes for a strong opportunistic approach to access people who may be in need of drug treatment, but reluctant or unwilling to contact services.

Although the number of people currently in drug services for club drugs is still small, there is a growing demand for treatment. The NEPTUNE guidance and forthcoming clinical tools have been developed to support clinicians to provide effective and safe treatment and care.

Dima Abdulrahim is NEPTUNE programme manager and lead researcher

www.neptune-clinical-guidance.co.uk

Engaging dependent drinkers

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DDN

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May 5, 2015

Pathway to change

Mike Ward talks about a new project that is aiming to engage dependent drinkers with treatment services

Often those of us working in the alcohol field have heard families and non-specialist workers express the heartfelt view that, ‘There was nothing we could do because they didn’t want to change their drinking.’

People believe that if a problem drinker does not want to change, nothing can be done. This is not true, but this negative attitude has hampered the response to many of the riskiest and most vulnerable drinkers.

According to Public Health England, 94 per cent of dependent drinkers are not engaged with treatment at any one time. A small group of these, so called ‘blue light’ clients, are both treatment resistant and placing a huge burden on public services.

Since 2014, we have been working on the Blue Light Project – our national initiative to develop alternative approaches and care pathways for this group. It has challenged the traditional approach by showing that there are positive strategies.

The project has developed the Blue light project manual, which contains tools for understanding why clients may not engage, risk assessment tools that are appropriate for drinkers and harm reduction techniques that workers can use.

The manual also offers advice on crucial nutritional approaches, which can reduce alcohol-related harm, questions to help non-clinicians identify potential serious health problems and deliver enhanced personalised education, and guidance on legal frameworks.

‘The response to the project has been fantastic,’ said Mark Holmes, team leader of the Nottinghamshire alcohol related long term condition team, who worked with me on the project. ‘It is filling a real gap in the health, social care and criminal justice system. For too long we have done nothing about this challenging issue.’

Mike Ward is senior consultant at Alcohol Concern

A free PDF version of the manual is available at www.alcoholconcern.org.uk

Occupational support during recovery

Features

By

DDN

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May 5, 2015

All in a day’s work

Sue Bright describes how offering occupational support can bolster an individual’s recovery journey

How many activities have you already carried out today?

If you take a moment and think of perhaps some of the activities you were involved in during the first couple of hours of your morning, it gives a sense of how occupation is essential in our lives and how we are programmed to ‘do’.

Occupations are all of the things we do day-to-day, which can include domestic and personal care, socialising, hobbies, work or voluntary activities. They can include things we are expected to do, need to do and want to do.

Occupation is a natural means of restoring function and is particularly important in recovery. The World Health Organization ‘no longer looks at health in terms of impairment, disability and handicap but a person’s ability to engage in activities and thereby participate in daily life’.

As an occupational therapist (OT), my aim is to help individuals develop or maintain a satisfying routine of meaningful everyday activities that can give a sense of direction and purpose.

In my role within Unity as a recovery occupational therapist specialising in education, training and employment (ETE), I work with individuals who are ready to address their occupational functioning; in short, ready to do things – the ultimate goal being to move towards education, training and employment.

Research shows that being unemployed or not meaningfully engaged in occupation can have an impact on health. This includes reduced life satisfaction and wellbeing, increased risk of mental illness and suicide, decreased self-esteem and feelings of guilt, diminished social status, disturbed roles and routines as well as the more obvious financial impact.

Spending most of the time engaged in passive, home-based activities such as watching television, ‘doing nothing’ or sleeping is often simply a means of filling the perceived ‘endless free time’ resulting from unemployment. These activities are not often actively chosen, nor may they hold any particular significance for the individual or thought of as purposeful by them.

As Aristotle says, the quality of life is determined by its activities.

One of my daily activities is to facilitate employability clinics in our local Unity bases. Initially I will ask someone to chat about what a typical day looks like for them, from getting up in the morning to going to bed at night, as this creates a picture of their occupations, roles and routines.

For example, Robin told me he didn’t get out of bed until lunchtime unless he had appointments – ‘what’s the point? There’s only mind-numbing telly. I’ve no money to do things and need to keep away from other users. I go to bed at two in the morning as I’m not tired; I’ve not done anything in the day!’

I focus on the will, drill and skill of the individual – motivation, routines and assets.

For instance, when I met Malcolm, I discovered he was motivated to go out on a daily basis to buy his newspaper, but was not interested in cooking – living on snacks. He would regularly go out walking but always the same route. He would get frustrated and bored with the sameness of his days, acknowledging that it would often be a trigger for him to return to drinking. He lacked confidence being with people but was accomplished on the computer, having done book keeping.

Using the Model of Human Occupation to underpin my work provides a basis to then look at occupational goal-setting. Activity grading is important – breaking down an activity into stages that become increasingly more difficult. This enables an individual to become more confident with an activity before they progress to the next stage. This is also true of an occupational journey – breaking it into manageable chunks.

Phil embarked on such a journey. He’d been abstinent from alcohol and had stopped smoking, making many positive changes to his life – such as regular contact with his family, decorating his flat, cycling, engaging in peer support, resolving his debts and managing his mental health. He began volunteering for several organisations, with varied occupations from re-building bicycles to answering telephones.

He had not been in employment for three years, having worked in IT, but was unsure if this was a career he wanted to re-pursue. Phil became a volunteer for us, facilitating our cyber café. As his confidence grew, he felt ready to move towards employment.

He completed a four-week employability course and attended a job club. This helped prepare him to get back into the jobs market. Phil remained unsure if he wanted to go back into an office environment, so I arranged an eight-week office work placement at a large company that maintains social housing throughout Cumbria. This allowed him to re-experience office life, regain skills and gain new ones, as well as establishing a regular work routine. Phil is now searching for IT jobs, having the belief that this is what he wants to do and is able to do.

Support is an integral part of the process. Conversations around occupation in early recovery are valuable in instilling a sense of hope and belief of a positive future as there are many fears that individuals raise – lack of confidence and self-belief, fear of relapse if they take on new occupations, concern about criminal records and not knowing what direction to take.

Jonny had mentioned several of these issues in our discussions but gradually changed his outlook.

‘Life wasn’t going anywhere anytime soon for me and I thought that I had nothing to offer or anything of value to others.

‘All that changed for me in February 2014.

‘I hesitantly started an NVQ level 2 course in adult social care – slightly overwhelming at first. All the staff and service users made me feel welcome and smoothed the transition into Heathlands Project (Learn to Care project, Carlisle).

‘The NVQ is catered for the pace of the individual and run at a relaxed pace, mixed with practical work supporting adults with learning disabilities on two days of the week.

‘I quickly realised that even a small gesture of goodwill, or an ear to offer to listen and a bit of advice, can make someone’s day better. This made me realise I had so much to offer.

‘The six-month course flew by so quickly for me and I was amazed to be offered a relief contract of two days a week working with and supporting the service users. I had a job and soon after it went to three, then four and now five days a week at Heathlands.

‘I feel a sense of worth now I’m doing a job I really enjoy. I have a different circle of friends and colleagues, and have been told I’m a trusted valued member of staff. My social life is good; I have taken up old interests and started some new.

‘I still learn everyday. I enjoy the challenges. I now intend to work my way up and become a group leader and beyond. Who knows?’

In working with individuals, I try to encourage a ‘give it a go’ attitude, focusing on positive coping strategies including a plan b. Linda had always wanted to go on a barbering course at college but was scared she would not cope with it and return to drinking. She had previously started hairdressing, but dropped out due to her addiction. We worked on activities to build her confidence and Linda was encouraged to give her dream a go, with some safety plans in place just in case. She has now almost completed her first year at college.

I work with everyone as an individual, making use of each person’s unique qualities and not taking a one size fits all approach. Occupation for those not work ready may perhaps be volunteering or structured activity as meaningful productivity.

Malcolm, whom I mentioned earlier, was dissatisfied with his routine but very gradually by using goal-setting, started to change his productivity using small steps over a period of time. He started to attend a peer support group, began walking slightly different routes and had an occasional game of golf or coffee with someone he became friends with at the group.

I encouraged him to think about volunteering, but at that time he felt this was ‘trivial’ and ‘not utilising his potential’. We discussed occupation not just as a means to succeeding but all the other positives it could bring to his life. He gradually started to warm to the idea, initially thinking about helping with dogs at an animal refuge to accompany his interest in walking.

I suggested we explored volunteering opportunities to make use of his computing and book-keeping skills. He now regularly updates a website and carries out book-keeping for a mindfulness project. He has meetings with the co-ordinators on a regular basis. Malcolm readily says, ‘It’s given me something to do which also carries quite a lot of responsibility which I needed. It also got me out of a rut.’

Little would be achievable without the Unity staff, who help stabilise and lay the foundation for ETE with individuals or the partnership agencies I work with. The Unity Asset Building Fund has helped support placements around the county as part of the wider Cumbrian commitment to recovery (Jonny has seen the real benefits of this). The Lawrie Brewis Trust in Carlisle (part of Heathlands) creates opportunities for those who may wish to find work in the care sector, to gain experience and qualifications working alongside staff and volunteers in their Learn to Care programme. Participants spend one day a week studying for an NVQ in health and social care and two days working with people with physical and learning disabilities.

Growing Well is a farm-based mental health social enterprise near Kendal. Volunteer placements there enable the recovery of people whose lives have been disrupted by mental distress. Participants spend one day a week involved in organic growing. There is an opportunity to gain a level 1 award in horticulture. Learning Fields is a community interest company near Appleby, offering educational and environmental opportunities for people of all ages and abilities. It provides a range of countryside activities in grass and woodland settings. Participants develop practical work skills to help them reconnect to their community. Connection with projects like these and others is fundamental to providing opportunities for people to develop work-based skills.

My regular attendance at an education, training and employment (ETE) North West Regional Forum, organised by Public Health England, provides information on current practice and enables networking opportunities which I find invaluable – we are able to both give and receive practical and up to the minute ideas.

I consider myself incredibly fortunate within my role as it encompasses two of my passions – people and productivity. My own meaningful occupation is the privilege of accompanying an individual on their journey of occupation.

I would be really interested in hearing from other occupational therapists working within the field of recovery from addiction, and can be contacted at sue.bright@gmw.nhs.uk

Sue Bright is a recovery occupational therapist working for Unity alcohol and drug recovery service

Make or break time?

Features

By

DDN

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May 5, 2015

In a couple of days the country goes to the polls for one of the most unpredictable – and significant – elections in decades. As the outcome is likely to have a decisive impact on what the treatment sector, and wider society, might look like in a few years’ time, DDN decided to canvass opinion on what the new government’s priorities should be.

Mike Trace, chief executive, RAPt

The first thing an incoming government should do is take drug and alcohol treatment seriously. While the period of top-level political attention and increased investment is over, it is still the case that effective drug and alcohol treatment makes a significant contribution to crime reduction, public health and social inclusion of the most marginalised groups. Treatment policy has been drifting – with no clear direction, and the beginnings of disinvestment – and needs to have a renewed focus.

This does not mean going back to ring-fenced budgets, or central control, but there has to be some more strategic planning to ensure that the reduced funds available are directed towards the most effective interventions. Any treatment strategy has to maintain the ‘menu of services’ approach that was established in the 1990s, but needs to give more support to services and mutual aid groups that help people move towards recovery. This is achievable within restricted budgets – many of these activities are relatively cheap, and there is still a lot of potential in the system to reduce spending on bureaucracy and ineffective interventions.

The best lever the government possesses to ensure its treatment policy is pursued around the country is to set strong indicators of successful outcomes – the opportunity to do this through the payment by results pilots was squandered by overcomplicating the metrics. In my view, any treatment pathway or system that can demonstrate that a fair proportion of its service users are not committing crimes, not receiving benefits, and are reducing their reliance on health and social services can claim it is worthy of investment of taxpayers’ money. The next government should set these clear expectations, and ensure commissioners and providers are judged by them.

Alex Boyt, service user involvement coordinator, VoiceAbility, Camden

I sit on the drugs, alcohol and justice parliamentary group who invited all the parties to come and tell us about their stance on drugs. Pretty much nobody turned up. Politicians see drug policy as a lose/lose debate – if they have a chance of winning a seat, they go quiet.

Theresa May in her introduction to the 2010 drug strategy said, ‘people should not use drugs, and if they do, they should stop.’ The approach is infantile, pandering to Daily Mail readers who might clamour for the disembowelling of anyone who cares for a stigmatised community. What I’d like to see from a new government is a grown-up conversation about evidence-based treatment and a new legal framework.

The current fiscal approach has absolutely no sophistication or insight. It is well known that for every pound spent on treatment, around five pounds is saved on healthcare, crime and harms to the wider community. I’d like to see an incoming government join the dots and deliver care; the kind that looks after people and saves money, not the kind that squeezes the vulnerable out of the system and spends infinitely more mopping up the damage.

I’d like to see services shaped by people whose needs are not being met, as well as those who have benefitted. The recovery agenda is pulling some people forward but it is leaving too many behind. I would like to see the next government return to holding people who need it, not pushing everyone forward whether they are ready or not.

Last year drug-related deaths went up by 32 per cent, but the treatment system is more interested in tweaking successful completion rates. I would like a new government to look at drug-related deaths as if they were the deaths of people who mattered.

David Biddle, chief executive, CRI

Put simply, I want to see the progress that has been made in improving services over the past few years maintained and built upon. Time frames for working with addictions can be lengthy, therefore a reiteration of the principles of the drug strategy and a commitment to ensuring stability of funding – possibly at a lower level – is critically important.

I would also like to see public recognition of the value that third sector-organisations bring to fostering quality and innovation in the provision of services. The NHS public/private debate has the potential to damage the sector, and yet to date we have been virtually invisible in the dialogue. There needs to be a recognition that ‘not for profits’ operate from a different value base to their private counterparts, and that this ability to offer highly effective interventions that do not ‘drain’ money away from service provision can be advantageous at a time of enhanced budgetary pressures. Policymakers need to stay focused, maintain funding and keep pushing for innovation and outcomes that justify the investment.

The government’s move towards integrating health and social care is the right move on so many levels. There will inevitably be difficulties because it’s a long-term project that requires upfront investment, but nevertheless it has to be a key priority over the coming five years because of the potential it has to drive improvements in care for service users and patients. The challenge for us is to ensure our services are integrated into that system and not subsumed within it.

If I were to focus on one campaigning issue for the field, it would be tackling the stigma that has a devastating impact upon the lives of service users and long-lasting implications for their wellbeing and ability to recover. We need to be doing everything we can to tackle that by using our clout to influence key opinion makers who can help change enduing perceptions. The more people who understand recovery and what our service users can, and have, achieved, the more opportunities they will have to work and thrive. I never cease to be humbled by the commitment and resilience of people in recovery – stigma and ignorance is such an unnecessary barrier standing in the way of recovery, and it diminishes us as a society.

Graham Miller, CEO, Double Impact

From a perspective of being a relatively small, but well-established, voluntary sector provider of recovery-oriented services, we feel that a new government should consider whether the relentless cycle of re-commissioning services every three or so years really benefits the end user.

This process can place a significant strain on the resources of smaller organisations such as ours without a full-time, dedicated bid-writing team. Short contracts do not always provide partnerships with the time required to really embed a new recovery culture or delivery model to best effect for service users. If services are to make a lasting influence and contribute to the origination and growth of recovery communities, then the impact on providers of this rapid cycle of change needs to be reconsidered.

At the very least, the new government could ensure that EU procurement laws designed to make opportunities more accessible for smaller organisations – by dividing large contracts into discrete lots – are adhered to by commissioners.

It feels like a tall order for providers to fulfill PHE’s logical ambition to bring alcohol treatment alongside drug treatment, after a long history of under-investment in the alcohol sector, and at a time when the ring-fenced budget for drug treatment has been removed. We have benefited from a good relationship with commissioners throughout the transition to PHE, based on a mutual understanding and shared goals. However, there is a real risk that local authorities across the country will direct their budgets into other more ‘deserving’ areas of need.

We fully support the current government’s emphasis on being ambitious for service users to achieve a full recovery – but too many providers appear to have jumped on the bandwagon, claiming to deliver this. Double Impact has always had a clear focus on being a specialist provider of recovery interventions and not a provider of clinical interventions. Through this experience, the organisation feels well placed to understand how to deliver a genuine recovery model and would ask the new government to commit to a more defined understanding of ‘recovery’ and measure performance against this.

Viv Evans, chief executive, Adfam

Fundamentally, I would like to see the routine consideration of the needs of families affected by drugs and alcohol built into any drugs/alcohol policy adopted by the incoming government. The purpose of supporting families is twofold – firstly, they need and deserve support in their own right, and secondly, well-supported families are in a much better position to aid their loved ones through their own journeys of recovery.

So I’d like to see family support right up there, both as part of an ambitious treatment system and a vibrant and innovative community sector. And to back up this I’d also like to see, of course, some spending commitment that is much broader than ‘troubled families’ – effective and sensitive support for any family member in the country, no matter where they live. We are currently quite a way from this.

Drug and alcohol use has of course a strong correlation with the wider picture of social inequality, so I’d like to see a more just society. I think the wider policy area for us is really around the carers’ agenda – we’ve witnessed some good progress with the Care Act last year – so we’d like to see more recognition of those caring for people with drug or alcohol problems within the wider pool of carers. We are also concerned that a new government addresses the needs of the children of drug/alcohol users. Treatment for parents can improve outcomes for children, and parents who are able to care effectively for their children save government money by keeping them out of the care system.

The field needs to stop obsessing over the minutiae of recovery. Let’s all come together to try and promote a coherent voice to the ‘outside’. Sometimes convincing people of the need for support, investment and compassion towards anyone affected by drugs and alcohol can be difficult on account of the ‘well it’s their own fault, isn’t it?’ argument. We need to keep making the case for support for drug users and their families, both in terms of economics – it makes sense if you do the sums – and compassion.

Niamh Eastwood, executive director, Release

With a growing number of jurisdictions implementing drug policy reform, including the ending of criminal sanctions for possession offences and regulated markets for cannabis, it will be hard for the next government to ignore the issue. The recent Home Office report that concluded that there was no obvious relationship between the toughness of a country’s enforcement against drug possession and levels of drug use clearly demonstrates that any government pursuing the current criminal justice approach is needlessly criminalising tens of thousands of people every year.

In terms of the treatment sector, Release would like to see the next government promote interventions based on the evidence rather than ideology, recognising the importance of harm reduction. That’s not to say that the availability of abstinence-based options is not important, but rather that we need a treatment system that responds to the needs and wishes of the individual, instead of one based on a political doctrine.

Something we talk about a lot at Release is how in many ways the problems our clients face are not strictly about drugs. As such we would like to see the next government revoke some of the worst aspects of welfare reform, including the bedroom tax, the restriction on social fund payments and the housing allowance cap, all of which have significantly and negatively impacted on many of those we represent. We would also challenge any government that brings in treatment conditionality for benefit claimants.

On the issue of policing, we would like to see the next government tackle the issue of our drugs stop and search laws and explore ways in which these could be reformed. These laws are having a detrimental impact on community-police relations and criminalising vast numbers of youth.

With the UK government spending £1.5bn on law enforcement but only £600m on drug treatment, we would like to see the field unite around the need to shift our drug policy from one based on a criminal justice response to one based on health, human rights and harm reduction. At the end of the day we should be advocating for the rights of those we represent, which should include that they are no longer treated as criminals.

Victor Adebowale, chief executive, Turning Point

Whoever forms the next government, and however it is formed, they will need to recognise that drug and alcohol treatment is changing. Services today must innovate in order to get better results from lesser resources and to cope with emerging challenges, such as legal highs and restrictions on other social care provision. This makes it imperative that services are able to cater for other health needs that are often co-morbidities with substance misuse issues, such as sexual health and smoking cessation. We must also reach groups such as the over-55s and those who misuse prescription medications. Policymakers must not fall into the trap of considering substance misuse services as somehow separate from the wider public health agenda.

With nearly three-quarters of substance misuse service users also experiencing a mental health condition, recent interest in mental health has been welcome, but mental health is only one of the many issues that can affect those with complex needs. Commissioners must make sure that contracts and funding encourage service providers to provide individuals with whole-person care.

In addition to integration within services, it is essential that health and social care organisations in a given community have the flexibility and freedom to work together. This is especially relevant to children and young adults, who may have seen substance misuse within the family. It’s vital that young people’s services are given adequate priority within organisational design and commissioning specifications, both to safeguard vulnerable individuals in the short term, and to prevent inter-generational dependency in the longer term.

Hannah Shead, chief executive, Trevi House

In considering what I hope to see from the next government, my first response will always be about funding; specifically a greater commitment to interventions that work with the wider family. When we approach recovery as a single issue, we miss a trick. For every person receiving help, there are countless loved ones also in need of services.

The provision of effective support for family members and friends can prove a sound investment; they often provide the longer term love and care for people in recovery and can boost the fabulous work being carried out within mainstream services. It is sad to see the future of so many people determined by cost, as opposed to need. At Trevi House, the majority of our residents state that they would never have even considered entering residential treatment if it had meant separation from their children, yet cost invariably seems to be a barrier for so many others I speak to.

Funding is not all I would like to see. Politians, alongside the media, create a narrative around substance misuse, and have a key role in helping services to challenge the prejudice and stigma of dependency. I frequently hear people discussing addiction in moralistic tones; this is especially the case when we talk about mothers who are drug or alcohol users. I would invite the new government to come into our services – not with the press officer or the media advisor, but to come in and try to understand the work we do. I would ask them to be brave enough to declare their own previous drug use, or their personal battles with alcohol; to stop treating substance misusers as ‘them’ and not ‘us’.

I would ask the government to come and talk to women who have battled to recover from drug use, who have managed to break free from domestic abuse, who have managed to raise their children with little support and much judgment. I would invite the government to come and hear the real stories of people out there in recovery.

And you just never know, once they have done all that, the dream of more, better funding, might become a reality.

Yasmin Batliwala, chair, WDP

The government’s priority should be to ensure that adequate funding is available for both drug and alcohol services, and such funds should be supervised to guarantee that they will reach these important services. The government must also focus on prevention regimes that work. Solutions can be sought without reinventing the wheel on one hand or repeating past mistakes on the other.

In addition, it is essential to build confidence in commissioners. The quality of commissioners’ decision making directly affects the quality of service provision, so it is vital that the former is addressed in order to safeguard the latter. This requires accountability, which can only be promoted by making commissioners’ decision-making processes more transparent.

As a field, we should be campaigning for the destigmatisation of drug use. This is at the core of all the work we do, and could mean the difference between someone in trouble seeking help or struggling in silence.

Brian Dudley, chief executive, Broadway Lodge

Where is treatment going wrong? I believe the fault lies in common sense being ignored and not looking at the whole picture. Overall, community treatment in the UK is good – mainly from a few big national providers. The issue for me lies with the more complex clients and those who have repeatedly failed in the community.

Residential rehab is on the whole an ‘out of area’ placement, so common sense would be commissioning nationally rather than locally. Why would a local commissioner want to spend their budget sending someone to a completely different area from which they might never return?

Also community treatment is purchased in three- to five-year blocks, whereas residential treatment on the whole is spot purchased. How can a rehab plan and improve with no guarantee of income?

But by far the biggest waste of taxpayers’ money is local authorities using NHS services for services, especially inpatient detox. The outcomes for people being put in mental health wards at up to £500 a day are at best poor, and at worst putting people’s lives at risk. Specific units run by third sector organisations are shown to produce significantly better results for less than 50 per cent of the price, and are registered with CQC to ensure quality is not compromised.

When is an incoming government going to listen to those in the field with the actual knowledge and experience, rather than the big organisations looking out for themselves without the best interests of the clients at the forefront?

Sarah Vaile, founder and director, Recovery Cymru

If I had one message to the incoming government regarding how we give people the best chance of achieving and sustaining recovery, it would be to plan ahead and invest in aftercare and the recovery community. These are so often the missing links in a successful, recovery-oriented system of care that achieve the best outcomes for individuals and their families – as well as a return on investment.

Aftercare and community support have traditionally been an afterthought. This doesn’t make sense as a coordinated and planned approach to people leaving treatment, building lasting recovery capital and integrating fully with communities are primers for sustaining change and not returning to treatment.

Ultimately, investing in aftercare and the recovery community will ensure the efficacy and value for money of treatment services, stopping the revolving door and reducing dependency on treatment services.

At Recovery Cymru our ‘recovery centre hubs’ are 365 days a year. It’s about living life – a community not a service. Our members include families and recovery advocates, as well as people ‘in’ or seeking recovery. But we are also a valued part of the treatment system in South Wales, offering support to people on all stages of their recovery and treatment journey, and working well with practitioners. This is exemplified by our recent collaboration with a treatment (Solas) and training (Newlink Wales) provider to deliver integrated aftercare, volunteering and recovery community support to people in Cardiff and the Vale of Glamorgan. We have been commissioned to do this, recognising the value and impact on efficacy of treatment services this will have.

The incoming government needs to promote this model, understanding the importance of a coordinated approach to collaborative aftercare and the recovery community. Developing the culture of recovery nationally would help to avoid black and white thinking and be a true investment in the workforce.

Martin Powell, head of campaigns and communications, Transform

The incoming government will find a situation changed beyond recognition compared with 2010, nationally and internationally. In the UK, polling shows a majority of the public in favour of decriminalisation of possession, or legal regulation, of cannabis, and over two-thirds in favour of a comprehensive review of our approach to drugs. Support runs across party political affiliations, and most media outlets – including the Sun – now back reform.

Internationally, taking an actively prohibitionist line is becoming increasingly difficult for the UK. Latin American trade partners, including Mexico and Colombia, are criticising the drug war and calling for alternatives to be explored. Multiple US states have legally regulated cannabis, and if California legally regulates it in 2016 then cannabis prohibition in the US will be over. A swathe of countries across the Americas and Caribbean will follow suit – as Uruguay and Jamaica already have – and European states will join the anti-prohibition wave.

So the door is open for the incoming government to make a commitment – real this time, not rhetorical – to deliver evidence-based policy nationally and internationally. To that end, we would like to see them build on the Home Office’s international comparators report that showed harsh drug laws do not reduce use (DDN, December 2014, page 5), by initiating a comprehensive independent review of UK drug policy, comparing our current approach with alternatives like Portuguese decriminalisation and models of legal regulation. This would lay out the evidence for reform and provide political space to develop cross-party support to implement it.

So what should we be campaigning for? A number of groups in the field, including service providers like Blenheim CDP, Westminster Drugs Project and Kaleidoscope have already signed up to our Count the Costs campaign for a review (www.countthecosts.org). But whether through that coalition, or other routes, we would like to see all groups in the field pressing the incoming government and all UK political parties to support a review.

The resulting report will make it much harder for politicians and media to blame drug users for the failings of their prohibitionist approach, or conflate drug use harms with those caused by our punitive drug policy. As a result, we will genuinely be able to manage drug use and misuse in a way that is just, effective and humane, and campaign more effectively for the true root causes of the ‘drug problem’ to be addressed.

Alistair Sinclair, director, UK Recovery Federation (UKRF)

The UKRF held its first event in May 2010 one day after an election that brought the Coalition to power, bringing with it five years of ‘austerity’. Ten days away from our next election the Guardian reports that ‘Britain’s billionaires have seen their net worth more than double since the recession, with the richest families now controlling a total of £547bn’, an increase of more than 112 per cent. The Equality Trust says that ‘the richest 1,000 families have more money than the poorest 40 per cent of British households combined’ with their wealth increasing last year by £28bn, the equivalent of £77m a day. Meanwhile the public sector has seen massive restructuring and rebranding, creeping privatisation and huge cuts.

The most vulnerable victims of a neo-liberal agenda that has put profit before people for decades, have found themselves disregarded, sanctioned and vilified as responsible for their woes. While those that work within our economic ‘recovery’ find themselves increasingly trapped in insecure jobs and zero hour contracts, the unemployed (the antithesis of ‘hard-working families’) are categorised within a new deserving and undeserving poor narrative. Nowhere is this more evident than in the DWP and the words and deeds of Iain Duncan Smith, the principal proponent of a politicised ‘recovery’ that puts abstinence before social justice and economics before equality.

Five years on, we live in a more unequal society and the gap is growing. As Professor Hanlon of Glasgow University put it, ‘modern society: unequal, inequitable and unsustainable’. So in an ‘age of dislocation’, as our communities fragment and fray and people reach for comfort in all sorts of unhealthy ways, I think the government’s priority should be honesty as to the roots of the problems we all face, and the wider community recovery we all need. Perhaps then we’ll begin to find real solutions?

Organisations working with offenders at increasing financial risk

News

By

DDN

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May 5, 2015

Voluntary sector organisations working with offenders continue to be dogged by financial uncertainty, according to the latest State of the sector report from Clinks. A survey of organisations ranging from small volunteer-led community groups to those employing upwards of 2,000 staff found that many were now relying on their reserves, putting them ‘at risk of closure’, and that the majority rarely recover their costs on the contracts they deliver.

While the needs of service users are becoming increasingly complex, organisations are having to rely more and more on volunteers, says the document, with an average of nearly two volunteers for every member of paid staff. Policy changes such as welfare reforms, meanwhile, had also had a negative impact on service users’ mental health, financial stability and ability to find appropriate accommodation.

‘The tension between increasing demand for services and decreasing access to funding continues to erode the sector’s ability to provide quality at the required scale,’ said Clinks director Clive Martin. The reality of this situation needs to be acknowledged; otherwise it will become too burdensome for staff and the communities they work in.’

Commissioners could help address the situation by making sure that procurement processes were accessible and efficient, he added, while initiatives like payment by results (PbR) – although still relatively limited – took up a ‘large amount of policy rhetoric and staff time’ and created ‘unwelcome uncertainty’.

State of the sector 2015 at www.clinks.org

Charities welcome home HIV self-testing

News

By

DDN

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May 5, 2015

The first legally approved home HIV self-testing kits have gone on sale in the UK. The kits are able to detect antibodies in small drops of blood and can provide a result in 15 minutes, although positive results must then be re-confirmed at a clinic.

Manufacturers BioSURE claim their self-test kit is more than 99 per cent accurate from three months after suspected exposure, although it cannot detect infections that have occurred within the last three months. The single-use, disposable device ‘has gone through extensive scrutiny’, says BioSURE, and is the only one so far approved for sale in the UK.

The ability to test outside of a clinical setting has been welcomed by HIV organisations, although they stress the importance of fast access to support after a positive result. ‘We campaigned for a long time to secure the legalisation of HIV self-test kits which happened in April 2014, so it is great to see the first self-test kits being approved,’ said Terrence Higgins Trust chief executive Dr Rosemary Gillespie. ‘We know that if people are diagnosed with HIV and start treatment early then they can avoid serious complications and lead long and healthy lives. Unfortunately 24 per cent of people living with HIV in the UK remain undiagnosed, so we have to do much more to encourage people to test.’

‘We currently have a long way to go when it comes to diagnosing people with HIV on time,’ added National Aids Trust chief executive Deborah Gold. ‘Over 40 per cent of people living with HIV are diagnosed late, meaning they have been living with HIV for at least four years. People diagnosed late are eleven times more likely to die in the first year after diagnosis. To address this public health challenge we need to look at new ways for people to test, and self-testing is an important and welcome additional option.’

Meanwhile, the Terrence Higgins Trust has called on the incoming government to commit to four key changes in HIV policy, including training to help end stigma in health and social care settings, making HIV prevention a national public health priority and ensuring appropriate financial support for people affected by HIV-related illness.

A third of Scottish drug related deaths are parents

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May 5, 2015

More than a third of Scottish drug-related deaths in 2013 were parents or parental figures, according to figures from ISD Scotland – affecting more than 270 children. The proportion of deaths in over-35s, meanwhile, increased from half in 2009 to two thirds in 2013. The figures represent a further analysis of the drug-death statistics published last year (DDN, September 2014, page 4).

As with previous years, three quarters of those who died were men and half were living in Scotland’s most deprived areas. More than half had been in contact with drug treatment services, while just over a quarter had been admitted to hospital for an acute or psychiatric stay in the previous six months.

The percentage of Scottish drug related deaths where heroin was present was unchanged from the last two years, although the percentage with methadone present fell from 56 per cent to 47 per cent between 2011 and 2103. There were more than 200 cases where new psychoactive substances (NPS) were present in the four years to 2013, more than half of which were in 2013 alone.

‘By providing further context around these deaths, and by studying the contributing factors, we can ensure that more families in Scotland can avoid the painful loss of a loved one to drug use,’ said community safety minister Paul Wheelhouse. ‘These figures also show that Scotland is dealing with an ageing cohort of drug users. We are continuing to work alongside our sponsored organisations to investigate the health and social care needs of this vulnerable group and look at how we can improve the quality and range of treatment and support available to them throughout the country.’

It was also becoming ‘increasingly clear’ that NPS represented a significant challenge for health, justice and third sector organisations, he stated. “The Scottish Government are in early discussions with the Home Office on how we will work together to create new legislation to control the sale and supply of NPS, both here in Scotland and also around the rest of the rest of the UK.’

National drug related deaths database (Scotland) report 2013 at www.isdscotland.org

New government must help those with multiple needs

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May 5, 2015

The incoming government should launch a national programme of improved and coordinated support for those with multiple and complex needs, according to charity the Revolving Doors Agency. Any new government would be unable to afford to continue a situation where ‘shrinking public funds are tied up paying for the consequences of repeated failed interventions’, it says, with the organisation estimating the cost of ‘severe and multiple disadvantage’ at more than £10bn per year.

There are ‘a minimum’ of 58,000 people in England alone experiencing a simultaneous combination of substance problems, homelessness and offending, frequently linked with mental health issues, the charity says, with health and welfare systems designed to tackle single issues struggling to respond.

The agency is calling on the government to prioritise support for long-term recovery – including ‘the journey towards employment’ – which should include an immediate review of the impact of welfare sanctions on vulnerable groups. It also wants to see improved opportunities and provision for service user involvement, as well as effective community-based rehabilitation for offenders with multiple needs, including specific services for groups such as under-24s and women.

‘In a period of falling spending and rising demand on our public services, tackling the complex problems faced by individuals caught in this negative “revolving door” cycle must be a priority for whoever forms the next government,’ said chief executive Christina Marriott. ‘We cannot continue in a situation where public money is tied up paying for the consequences of repeated failed interventions – the financial, social and, above all, human cost of this failure is too great.

‘We want to see a system where people facing multiple and complex needs are supported by effective, coordinated services in every area, and are able to tackle their problems, reach their potential and contribute to their communities,’ she continued. ‘The evidence shows this could save public money while improving outcomes for some of the most excluded people in our society. We know what works. Now is the time for action.’

The Revolving Doors Agency manifesto 2015: Five priorities for an incoming government at www.revolving-doors.org.uk

News in brief – May 2015

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May 5, 2015

Who’s responsible?

Responsible drinking messages in advertising are being used by the alcohol industry to promote their brands rather than help consumers ‘make sensible choices about their drinking’, according to a report from Alcohol Concern. The charity wants to see ‘ambiguous’ messages replaced with factual health warnings, after its research found that responsible drinking messages had ‘frequently been expanded to include the brand name or drink type, or some other extra wording added to fit the wider theme of the advertising campaign’.

Drink responsibly (but please keep drinking) at www.alcoholconcern.org.uk

More NPS banned

Five more ‘legal highs’ have been banned under temporary powers by the government. Compounds related to methylphenidate – including ethylphenidate, which is sold as Gogaine or Burst – are now subject to a temporary class drug order (TCDO) for up to 12 months while the ACMD decides whether they should be permanently controlled. ‘Users have been known to inject the drug, putting themselves at risk of blood-borne disease and infection,’ said the Home Office.

Hep awareness

A new film about hepatitis C designed to raise awareness and improve confidence in diagnosis among GPs and other primary care staff has been launched by the Royal College of GPs, HCV Action and the Hepatitis C Trust. ‘Despite the fact that hepatitis C affects so many hundreds of thousands of people in the UK, we frequently hear of low awareness and knowledge of the virus among GPs,’ said Hepatitis C Trust chief executive Charles Gore. ‘GPs will be increasingly relied upon in the future to manage and detect the virus, so this really is a must-see film.’

Detecting & managing hepatitis C in primary care available to view at hcvaction.org.uk

Cannabis care

Provision of effective cannabis treatment is likely to become more vital in European drug policy, according to a new report from EMCDDA. The document analyses the interventions most likely to be successful, based on evidence from a range of treatment programmes across Europe. ‘With large numbers entering cannabis programmes every year in Europe, largely paid for by public funds, treatment effectiveness is a key consideration for policy,’ said EMCDDA director Wolfgang Götz. ‘With this report we hope to offer experts and policymakers a firm basis for their decision-making.’ Treatment of cannabis-related disorders in Europe at www.emcdda.europa.eu

Drink violence down

The number of violence-related A&E attendances in England and Wales last year was down by more than 100,000 compared to 2010, according to figures released by Cardiff University’s violence research group, with a fall in binge drinking rates among young people thought to be partly responsible. ‘Reductions in alcohol consumption (litres per capita) and in high episodic drinking (more than eight units per session for males and six units per session for females)’ among 16 to 24-year-olds were a likely contributory factor to the reduction in violence – ‘much of which takes place in urban centre streets at night’, says the document.

Violence in England and Wales in 2014: an accident and emergency perspective at www.cardiff.ac.uk

Codeine codes

Codeine should not be used to treat coughs and colds in the under-12s, the European Medicines Agency has stated. Codeine’s conversion into morphine in the body can cause side effects including breathing difficulties in some children. The ruling, which follows a previous review of the use of codeine for pain relief in children, has been endorsed by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA).

May 2015

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May 5, 2015

In this month’s issue of DDN…

‘Take drug and alcohol treatment seriously.’

In this month’s issue: DDN canvasses opinion from the drug and alcohol sector on what the new government’s priorities should be.

Click on the links below to read more, and don’t forget to join the discussion by commenting, tweeting and liking our Facebook page.

PDF Version / Mobile Version

Local news – May 2015

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May 4, 2015

Veterans’ service advances to South West

A new treatment service for military veterans with drug and alcohol problems is being expanded into the south west of England.

Right Turn, launched by Addaction and funded by the Forces in Mind Trust, is already available to veterans throughout Scotland and the north of England. It aims to offer ex-service men and women support during their transition back to civilian life.

The programme also hopes to influence policy makers and improve services by providing a detailed evaluation both of the project and the scale of the problem.

Meanwhile, initiatives to help ex-service personnel continue at Liverpool’s Tom Harrison House (DDN, December 2014, page 6) where a new national conference learned from US colleagues about developing veteran-specific addiction treatment.

‘We have a lot to learn about how we support our veterans who are experiencing active addiction or alcoholism,’ said head of service, Jacquie Johnston-Lynch.

BDP and students embrace technology challenge

A team of students from the University of Bristol, working with the addiction charity Bristol Drugs Project (BDP), have won the 2015 Tata Consulting Services (TCS) Tech Challenge.

In its second year, the TCS Tech Challenge is designed to inspire young people to get creative with technology.

The team from Bristol University collaborated with BDP to create an IT solution that targeted and engaged recreational drug users. Researching the project by working with the university’s student counselling service and attending BDP group sessions with service users, the team developed a prototype app that combined a questionnaire, examples of users’ stories and personal diaries.

Each member of the winning team has been awarded a paid one-month internship at TCS, while BDP has received a £1,000 donation.

Restoration enterprise heads for new heights

A social enterprise in London has celebrated more than a year of successful business with an event to thank its supporters and recognise the conclusion of a successful pilot phase.

Restoration Station, a project of the Spitalfields Crypt Trust (SCT), is now providing work experience restoring vintage furniture for six people in recovery, as well as making original pieces from reclaimed and recycled materials.

The project is popular with both shoppers and other local businesses looking for bespoke creations, and gives individuals in recovery the opportunity to build their confidence and develop new skills.

‘It’s a fantastic project,’ said Della Tinsley of the East London Design Show. ‘I think that the power to have a skill and make something is incredibly restorative… something that really has an ability to change lives.’

Free training for family members

Adfam is offering free training to friends, family members and carers of individuals with substance misuse problems.

After a pilot in the London Borough of Greenwich, Adfam has now extended the training to services in Kent that support people affected by others’ substance use.

The one-day training programme aims to empower individuals to become Family Recovery Champions, who would in turn be able to offer support and advice to others using the service.

For more information or to book training contact Bex Peters, r.peters@adfam.org.uk

Sponsored bike ride honours Barry’s memory

Staff from Addaction Cornwall have taken part in a sponsored bike ride to raise money in memory of a volunteer at the service.

Barry Marsh died in November last year of cancer after dedicating many hours of his time to offering other people support and sharing his own story.

The team of staff organised and completed an 11-mile cycle route, and the money raised has been donated to Cornwall Hospice Care, which supported Barry towards the end of his life.

Service user champion wins management award

Sunny Dhadley, service user involvement officer at the Wolverhampton Service User Involvement Team (SUIT), has been awarded an Award for Excellence from the Chartered Management Institute (CMI).

The award recognises his management and leadership skills, and was presented to SUIT at the recent CMI Midlands annual conference and awards event at Birmingham’s ICC.

‘I’m delighted to have been given this award by CMI in recognition of my management and leadership abilities,’ said Dhadley. ‘At one point in my life I didn’t think that anything was achievable. This award has shown me – and others – that everything is.’