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Reducing the supply of high strength alcohol

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DDN
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Drink smart

DDN hears about the results from three city-wide schemes aimed at reducing the supply of high strength beers and ciders

Reducing The Strength IpswichIpswich

Simon Aalders, public health engagement manager, Suffolk Public Health

The Ipswich ‘reducing the strength’ scheme was piloted in 2011, then launched in September 2012. Ipswich had 75 street drinkers and 40 per cent of violent crime was alcohol-related. Street drinkers were involved in almost daily call outs for anti-social behaviour. There were four murders in 18 months within the group, and street drinkers were suffering ill health from high alcohol consumption.

The Constabulary, East of England Co-operative Society, Ipswich Borough Council, Suffolk County Council, homeless charities, drug and alcohol treatment agencies, street drinkers and the community have been essential to the campaign. The Licensing Committee supports the voluntary nature of the scheme and considers evidence regarding breaches of licensing conditions.

Successes in Ipswich 

By December 2014, 100 out of 148 alcohol retailers in Ipswich had signed up to ‘reducing the strength’, up from 53 at launch. The East of England Co-op was a trailblazer, removing products above 6.5 per cent ABV. They experienced no loss of income.

By March 2015, the street drinking group reduced from 75 to 14. Many accessed treatment, accommodation or returned to their local area. Antisocial behaviour dropped by up to 75 per cent. Crime is almost non-existent amongst the group. Our evaluation reports shows no loss of income for local traders who have signed up.

The key principles to success are: increasing enforcement; reducing supply; and improving routes out of street drinking.

Lisa’s experience
Lisa is 39. After her mother died, her marriage broke down. She became alcohol-dependent and homeless. Her sons were taken in by family. Lisa was drinking three litres of super strength cider or ten cans of super strength lager everyday. Lisa developed diabetes, her liver function worsened and she has an alcohol-related skin condition.

With treatment and support, Lisa achieved sobriety. She was housed and attended a NORCAS recovery programme, supported by the Anglia Care Trust and the police. She re-established contact with her sons.

‘I fully support ‘reducing the strength’. I was drinking huge quantities to block out my pain. I don’t want other people to suffer the serious effects from super strength alcohol. It can ruin your life,’ says Lisa.

Challenges in Ipswich

One retailer had many street drinkers as customers. Despite shoplifting and abuse, he resisted the scheme fearing loss of earnings. He was observed breaching his licensing regulations, selling alcohol to intoxicated people. He agreed to a voluntary removal of cheap strong alcohol, resulting in reduced disturbance and no profit loss.

The main challenge now is that people think the problem is solved. The worst outcome would be for Ipswich shops to stock these products again, leading to an increase in street drinkers. We have established the Start Afresh group to maintain momentum.

 

Sensible on Strength BrightonBrighton

Jesse Wilde, senior business and partnership manager, Equinox Brighton

‘he Brighton ‘sensible on strength’ scheme started in November 2013. The worst hotspot had up to two-dozen street drinkers, with incidents of anti-social behaviour. Equinox Brighton’s street drinking audit in July 2013 counted 93 street drinkers over one week. Before ‘sensible on strength’, we regularly saw people consuming alcohol up to 9 per cent ABV.

The key partners are Brighton and Hove City Council public health, Equinox Brighton, Sussex Police, street drinkers and alcohol retailers.

Since the launch, St James St MACE have reported a ’better working environment, increased profits and new customers who had previously been put off’. Sainsbury’s and the local licensees association are part of the Alcohol Programme Board and have been supportive.

Some other national chains have resisted the scheme because the products are legal. We are now at a critical point in Brighton, where many retailers have signed up, but some key off licences are holding out.

Tim Nichols, head of regulatory services, Brighton and Hove City Council public health

Brighton and Hove City Council’s Licensing Authority launched ‘sensible on strength’ to reduce the availability of cheap super-strength beers and ciders. We now have 123 retailers signed up.

82 per cent of high profile street drinkers have moved to alcohol below 6 per cent ABV. More clients are engaging with treatment centres, and the scheme is breaking up hotspot drinking areas. We have received significant positive feedback including from businesses on improved trading environments and from health professionals.

Equinox Brighton’s street drinking audit in July 2014 showed a 22 per cent reduction in street drinking since the previous summer. ‘Sensible on strength’ was a key factor in this. 

Dr Tim Worthley, lead GP, Brighton Homeless Healthcare

I care for many of the most entrenched street drinkers. We strive to combat the problems of severe alcohol dependence on the individual and the community. Despite our best efforts, a significant number of our patients die young each year due to alcohol dependence.

I am consistently told by my patients that it is now much harder to obtain high strength lager and cider. Many now drink lower strength alcohol. This has reduced their number of seizures, their ‘confusional state’, and improved their liver function. They are now more able to access general medical care and care specific to their alcohol dependence.

In my professional opinion, ‘sensible on strength’ has been one of the most significant public health measures in Brighton in recent times.

 

Reducing the Strength PorstmouthPortsmouth

Robert Anderson-Weaver, community safety project officer, Portsmouth City Council

Portsmouth’s ‘reducing the strength’ campaign launched in November 2013. Groundwork started in September 2013, including a research questionnaire sent to all Portsmouth off licences.

In Portsmouth, there were two main factors:

  • Street drinking and associated anti-social behaviour – on one Portsmouth road, for example, over 100 incidents were attributed to street drinkers in one month.
  • Health and wellbeing – approximately 40,000 people in Portsmouth were drinking above the recommended units. Portsmouth has one of the highest rates of alcohol-related hospital admissions in the south, costing an estimated £74 million annually, with £10 million NHS spend on alcohol harm.

The Safer Portsmouth Partnership and Police licensing unit have taken the lead with ‘reducing the strength’, directing the campaign at the worst affected areas. They include alcohol nurses, paramedics, licensing practitioners, community wardens and police.

Successes in Portsmouth 

There are 184 off licences in Portsmouth. Over 100 retailers have signed up. In some stores, this means removing one product, often targeted for theft. In others, it’s much higher. One retailer removed 17 products to reduce street drinkers and aggressive beggars targeting his store.

Overall, street drinkers decreased by 39 per cent over 12 months. This shift resulted in a 43 per cent drop in incidents associated with street drinkers, with some individuals seeking help. Four have been the focus of ASBOs, breaking up problem groups.

The campaign’s effects have been especially visible in areas where street drinking was most prevalent. In Cosham, street drinking incidents dropped by 81 per cent. In Albert Road, where aggressive begging was occurring daily, we have seen a 50 per cent reduction. A survey of 25 alcohol-dependent clients, conducted by the alcohol intervention team, found 60 per cent would find it easier to quit if super-strength alcohol was less available.

The public response to the campaign has been excellent. Liver disease is one of the city’s biggest killers. Men are 50 per cent and women 47 per cent more likely to die from the disease than the national rate. Community engagement activities have allowed residents to ask questions about the campaign and show support for retailers who remove super-strength products. This has been a great opportunity to educate the public on unit intake.

Another breakthrough happened in 2014, with a large high street retailer removing super-strength products from over 20 Portsmouth stores.

Challenges in Portsmouth

One retailer sells a 7.5 per cent white cider cheaper than anywhere in the city: £7 for six litres (approx 45 units). This is 16p per unit, almost three times cheaper than health experts recommend, the equivalent of 45 shots of premium whiskey.

Despite shoplifting and health harms, staff say the company would never remove this product due to sales. Their Portsmouth stores are in impoverished areas, with the Cosham store on a street with the largest amount of street drinking incidents in the city. We have shared evidence of problems near their stores, but they see the scheme as penalising responsible drinkers.

The alcohol industry also sees the scheme as penalising responsible drinkers. We have invited producers, manufacturers and distributors to come and see our work to reduce alcohol harm, to show we have a thorough approach to conventional treatment-based initiatives. Not all strong alcohol is targeted by ‘reducing the strength’, just the products found at scenes of crime and disorder.

The challenge now with ‘reducing the strength’ is to achieve consistency across Portsmouth, encouraging even more retailers to sign up. The campaign remains voluntary and issues with competition law hinder communication with the trade as a whole.

For further information or to contact the Ipswich, Brighton or Portsmouth teams delivering these schemes, please email Charlotte Tarrant at Equinox Care: charlotte.tarrant@equinoxcare.org.uk.

Sport in recovery

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DDN
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Pat Berry Ron BellGood sports

Pat Berry and Ron Bell talk about how they help service users improve their wellbeing and build self-confidence from exercise

Playing sports on a regular basis requires discipline, which builds much needed structure into daily life. Being part of a group of like-minded peers, and the natural high gained from exercise, may help raise self-esteem – a key component of good social interaction.

The relationship between sport and improved mental and physical wellbeing is well established. The key is to get people with complex care issues to participate in these positive activities.

The uniqueness of Sporting Recovery is the combination of team and individual sporting activities and lifestyle advice (SMART Recovery) along with the opportunity for clients to gain nationally recognised sports qualifications. As an evidence-based exercise programme, we support adults on their recovery pathway back into their communities.

We focus on people who are marginal, high risk and hard to reach, who often have concerning co-morbidity problems. These adults have difficulties accessing, trusting and re-engaging with traditional services.

The hardest part of any exercise course is starting, particularly when you’ve been inactive for a prolonged period. To overcome this inertia, our programmes are available in the form of transferable season tickets, with the first six sessions free to encourage participation.

We are keen to support successful treatment completions and recommend that service users attend the exercise programme for 42 sessions. The sessions are weekly and include a free lunch, with the opportunity to obtain voluntary and paid work within, and outside, Sporting Recovery.

We believe that if we provide a safe, friendly and fun environment we can engage these hard to reach adults. The first thing is to treat them like regular people with the same desires to enjoy and succeed in their chosen sport. The focus is on self-development and inner peace – something we all need!

Pat Berry and Ron Bell run Sporting Recovery, www.sportingrecovery.org.uk

Drug poisoning deaths highest ever

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DDN
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Drug poisoning deaths hit highest level ever

Last year saw England and Wales register the highest number of drug poisoning deaths since records began more than two decades ago, according to figures from the Office for National Statistics (ONS).

There were 3,346 drug-poisoning deaths registered in 2014, almost 70 per cent of which involved illegal drugs. The figures came just over a week after Scotland also recorded its highest ever number of drug-related deaths for the same period (DDN, September, page 4).

Deaths involving heroin and morphine increased sharply between 2012 and 2014 – from 579 to 952 – while deaths involving cocaine also jumped dramatically, from 169 to 247 in the space of a year. Cocaine-related deaths have now increased for three years in a row, reaching an all-time high of 4.4

per million population. However, while England saw a 17 per cent increase in its drug misuse mortality rate – to 39.7 per million population – Wales saw its proportion drop by 16 per cent to 39.0 per million, the lowest figure for almost a decade.

In England, the north east had the highest mortality rate and London the lowest. As was the case in Scotland, most deaths occurred among older people, with the highest mortality rate in the 40-49 age group, followed by those aged 30-39.

Treatment charity Addaction said the stark figures meant the government now needed to rethink its proposed cuts in local authority health spending (DDN, September, page 4). ‘Drug treatment services across the country have seen an increase in the number of people seeking help for opiates and/or crack cocaine, and this is only likely to increase further as the effect of increased opiate availability and purity is felt,’ said chief executive Simon Antrobus. ‘Meanwhile, the Department of Health are proposing a £200m reduction to the public health grant, which will hit the capacity of drug services commissioned by local authorities.’

The government needed to ensure local authority health spending was given the same amount of protection as that promised to NHS-commissioned services, he stated. ‘The stakes are simply too high to do otherwise.’ 

Deaths related to drug poisoning in England and Wales, 2014 registrations at www.ons.gov.uk

Changing negative behaviours in treatment

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DDN
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Promotional feature

Peter BentleyChallenging attitudes

A decade of experience has shaped Intuitive Thinking Skills’ successful approach to attitude change, as Peter Bentley explains

In 2003, I was coming to the end of a week-long alcohol detox in Manchester’s Smithfield Centre. I was determined to never return there and it was apparent to me that the best way to ensure that was to stop drinking and using drugs for good.

I got a fabulous detox, professionally delivered and with a refreshingly short waiting time to start. What happened afterwards however was far less impressive.

Newly detoxed, I leapt into the post-detox services that were available in 2003. These were pretty much exclusively the fellowships and a kind of quasi fellowship daily support model. There was a unifying thread that ran through all the services then – namely that you were a patient, that ‘treatment’ would take a long time and that there were no guarantees. This was when I was first told that I had a ‘relapsing condition’, that people rarely conquered the problem and that I should not give myself a hard time if I failed.

What was happening in front of my very eyes was the state trying to replace substance dependency with service dependency, and to this day I have proudly railed against the duplicity of this.

So here we are, ten years on, and in May 2015 Intuitive Recovery changed its name to Intuitive Thinking Skills to celebrate its anniversary and to reflect on the increased number of courses we deliver across the UK.

We realised our speciality was attitude change, whatever that attitude may be. Dependence is a curious word, often used to justify the place that a person is in rather than the solution to help move them on. All our courses are designed to enable a person to gain independence – not just from their own negative behaviours but also from public services they are engaged with.

We believe we are a truly unique organisation, entirely peer-led and promoting abstinence, education, training, employment and self-determination within our learners. The fact that we have been there and got the t-shirt means that we deliver hard-hitting, no-nonsense education which cuts through the treatment and recovery jargon that has become so prevalent.

Our staff are all graduates of our programmes and have left services, fully ‘recovered’, employed and enjoying the world of work and all the benefits it brings.

The message? Change looks and feels great and is entirely do-able.

Beliefs

Whether it is beliefs and attitudes that support future substance use, inactivity in employment and education, or negative attitudes to community engagement, our programmes all target these beliefs, presented as negative thoughts, outlooks and attitudes and allow learners to see that they create their own obstacles through their learned thought patterns.

Once people learn that we all have negative thoughts and that we are all selective in choosing which of these we act upon, change becomes easy. After a little practice, the new set of choices becomes second nature.

 

Our programmes

Intuitive Recovery

An accredited educational programme that promotes abstinence as achievable and easy to maintain. Delivered over six sessions, it provides skills and tools to recognise and control addictive desires and to take responsibility for choices, behaviours and change. Install a plan to never use again; it feels great to know you will never go back.

Skills-Tu Employment

Our accredited educational course designed to skill people into employment. The course targets atti­tudes of dependence on state benefits and low or unrealistic aspirations regarding future employ­ment. We deliver in a classroom setting over a short yet intensive period with follow-up sessions supported by sensible yet challenging targets.

Thinking Comm-Unity

Thinking Comm-Unity is an educational course aimed at improving any individual’s knowledge, sense of belonging and understanding of their community. By recognising and valuing each person’s skills and abilities, we demonstrate how these can be coordinated to give people the power and responsibility for their future.

The course helps to identify how attitude, knowledge, skills and abilities can affect not only your life but the lives of those around you. By examining different types of communities, we gain an understanding of the importance of diversity. Through community-focused personal development, we achieve our goals while overcoming challenges and helping to improve the lives and wellbeing of others.

Key Interventions Tools

KIT training offers a simple and effective tool aimed at complementing or refreshing the knowledge and skills of professionals, volunteers or mentors. In fact this is for anybody wishing to gain insight and wanting to improve their work with individuals involved within drugs and alcohol, back to work, criminal justice and social housing sectors. The key objectives of this training are to both raise insight and awareness and encourage independent action towards abstinence, desistance, rehabilitation and employment. Partnership focused, we bring together key stakeholders within an area and look at how system-wide structures can cause blockages and obstacles for our shared service users.

Peter Bentley is managing director at Intuitive Thinking Skills

For more information, visit www.intuitivethinkingskills.com or email info@intuitivethinkingskills.com

Intuitive Thinking Skills – The Specialists in Attitude Change

Drug use in prisons

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DDN
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Promotional feature

Mark NapierA new profile of drug use in prisons

Mark Napier talks to DDN about the emergence of the complex problem of novel psychoactive substances, and some responses that commissioners and providers can adopt to tackle this issue

Health needs assessments

The Centre for Public Innovation (CPI) has been involved in research and supporting the commissioning of substance misuse services since its inception in 2000. The company is a social enterprise with more than a decade of experience working in the field of substance misuse, both with commissioners and providers, helping them to understand their clients and provide better services.

Recently, we completed a series of health needs assessments (HNAs) for a number of prisons, on behalf of NHS England. As with all HNAs, there was much interest among commissioners and prison staff with regard to substance misuse – in terms of the need for treatment and the profile of the drug-using population in prison.

CPI were able to bring together a mix of specialist knowledge of substance misuse treatment, along with in-depth knowledge of how prison healthcare works, alongside robust research skills to help explore the issue of substance misuse.

Novel psychoactive substances

Having completed prison HNAs on many other occasions, the CPI research team were struck by a pronounced shift in the findings on this occasion, as compared to work we had done previously.

From the outset, it was clear that the use of novel psychoactive substances (NPS) was an issue that the HNAs needed to cover. NPS is the catch-all term for a raft of new and emerging drugs that cover ‘legal highs’ to recently banned substances and club drugs.

Prison staff reported concerns about the impact of NPS on the health of prisoners, citing a rise in aggression and other behavioural changes among inmates. Healthcare providers were concerned about the demands that NPS were perceived to be putting on their services as well as the need to send prisoners to A&E following apparent adverse reactions to NPS.

Prison professionals were united in their assessment that the use of NPS was a significant and growing problem that had yet to be fully understood.

The prisoner’s perspective

In consultation with prisoners, there was a clear consensus that NPS were now the ‘drug of choice’ and that their use had overtaken that of other drugs, including cannabis.

Some prisoners interviewed by CPI researchers reported that use of NPS was driven partly by mandatory drug testing. Knowing that NPS could not be detected via existing tests, using NPS enabled them to consume drugs whilst working around the prison system.

What was striking was that, while prisoners were well aware of the use of NPS, they were as unclear about the nature of NPS as prison professionals. Whilst prisoners referred to ‘Spice’ it was clear that this was being used as a catch-all term to describe a range of new drugs with a variety of properties and effects. In essence, prisoners were consuming unknown and untested psychoactives.

Defining the problem

The picture that emerged from the HNAs was of a rapidly changing shift in the use of drugs in the prison but with little hard evidence to determine the impact that NPS were having. Existing systems were not geared to collecting data on NPS. In the absence of data, responses were ad hoc, driven by anecdotal assessments, and lacked a basis upon which to determine what was and what was not effective.

The National Offender Management Service is aware of the issue of NPS and is undertaking research to create a substantive evidence base for use in the prison system, but this work will take some time to report.

What can be done?

Until the NOMS research is available, CPI determined that a number of steps could be undertaken immediately to start responding to the problem:

  • Prison healthcare providers should record any health incident in which NPS is felt to be a causal or associative factor – either where use of NPS is self-reported or determined by health staff
  • Prison healthcare providers should follow Public Health England guidance advising that the appropriate response is to address symptoms rather than the specific drug
  • Substance misuse treatment providers should seek to understand the extent to which their clients are using NPS
  • Substance misuse treatment providers should determine the extent to which existing provision can be adapted to meet the needs of this group of drug users

Understanding about the nature of NPS and how treatment should respond to these drugs is still emerging. The work of CPI can provide some immediate steps that commissioners and providers can consider, while the evidence base develops to determine the nature of the issue and how best to manage it.

Mark Napier is managing director of the Centre for Public Innovation (CPI). For more information about how CPI can help your organisation, visit www.cpi.org.uk or call 020 7922 7820

DDN September 2015

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DDN
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DDNsep2015In this month’s issue of DDN…

‘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.’

In the September DDN, Dave Marteau discusses whether or not it’s time for us to reappraise our relationship with the life-saving drug methadone.

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 / Virtual Magazine

Drug-related in Scotland

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DDN
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Paul WheelhouseScots record highest number of drug-related deaths ever

 

Scotland recorded 613 drug-related deaths last year, the highest figure ever, according to new statistics from National Records of Scotland. The figure was 16 per cent higher than the previous year, with three quarters of the deaths among males.

The increase comes after a 9 per cent fall in 2013 (DDN, September 2014, page 4), following 2011’s record-high figure of 584 and just three fewer the following year. The average age of those dying from drug-related causes has also continued to rise, and now stands at 40 – 12 years older than when recording began in 1996. Sixty-seven per cent of last year’s deaths were among the over-35s, with just 8 per cent occurring among those under 25.

One or more opioids (including both heroin and methadone) were implicated in almost 90 per cent.

The figures showed that, while there had been some progress, Scotland still faced a ‘huge challenge in tackling the damaging effects of long-term drug use among an aging cohort’, said community safety minister Paul Wheelhouse. ‘This group of individuals often have long-term, chronic health problems as a result of sustained and, in many cases, increasingly chaotic drug-use issues. We need to better understand the needs of particular sub-groups and to better understand what role the purity, or strength, of illicit drugs is playing in increasing fatalities.’

The statistics were confirmation that the outcomes for drug users ‘not engaged in treatment or care’ were becoming ‘increasingly concerning’ added chair of the National Forum on Drug-Related Deaths, Roy Robertson.

‘Older drug users are most susceptible because their often frail health cannot sustain a life of poly-substance misuse, including alcohol use, and injecting-related problems,’ he said. ‘Although the final mechanism of death may be recorded as an overdose, years of high-risk drug use, blood-borne virus infections, smoking and alcohol consumption combine to increase their vulnerability. Stigma, a life course of traumatic experiences, social exclusion and feeling the brunt of austerity leaves many pursuing a risky, hopeless existence, often extinguished ultimately by suffering a drug-related death.’

Drug-related deaths in Scotland in 2014 at www.nrscotland.gov.uk 

E-cigarettes ‘safer than smoking’

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DDN
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E-cigarettes ‘safer than smoking’

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.

Local news from the substance misuse field

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DDN
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Life Skills EventCornwall service users celebrate life skills

Service users in Cornwall have successfully completed a new accredited course, ‘life skills in action’.

The course, designed by Cornwall Life Skills, offers skills coaching in education, training, voluntary work and employment – such as developing self-confidence and improving interpersonal skills. Course completion leads to a level 1 AptEd award in progression qualification, which is nationally recognised.

A celebration event was held to award certificates to the ten graduates who completed the course, where they were able to share their progress since finishing it. Other attendees were also given the opportunity to enrol with the service.

 

Spectrum earns Purple Star for learning support

Spectrum, a drug and alcohol service run by CRI in Hatfield, has been awarded a ‘purple star’ in recognition of its communication with people with learning disabilities.

The purple star scheme aims to improve relationships between health and social care services and adults with learning disabilities by ensuring all organisations taking part undergo training and service checks to ensure that standards are met.

Spectrum staff took part in specialist training, including how to make their buildings more accessible.

Steve Smith, Spectrum county services manager, said, ‘We are proud of our commitment to support everyone who seeks help to improve their health, or that of a loved one. The purple star award is the result of a proactive effort to make sure all our services are as accessible as possible.’

 

Phoenix kennelsPhoenix residents can bring canine chums to rehab

A block of kennels has been opened at Phoenix Future’s Wirral residential service, Upton Road, to allow service users to bring their dogs along with them to rehab.

The kennels were opened after an increasing number of people with drug and alcohol problems raised concerns that they could not access help as it would mean they would have to give up their pets.

‘Many people in active addiction build strong ties with their dogs. Their dogs keep them warm and safe during periods of homelessness, give them unconditional love through the worst points in their lives and a reason to keep going when all other relationships appear irrevocably damaged,’ says Karen Biggs, Phoenix Futures’ chief executive.

The dogs will be cared for by their owners, trained professionals and others at the service, and the kennels will enable people to live with their dogs while receiving treatment.

 

Naloxone campaign launched in North Somerset

A ‘Keep Calm and Carry Naloxone’ campaign has been launched to help save lives in North Somerset.

Addaction staff in Weston have been offering training on how to administer the life-saving drug, as well as sending participants home with naloxone kits.

The campaign was launched in support of international overdose awareness day on 1 September. ‘Lives will be saved due to this training. Taking heroin is a high-risk activity and our service works hard to show people another lifestyle,’ said service team leader James Brazier.

‘But, while the risk is still happening, users and their significant others should make sure they have a naloxone kit.’

 

Defib trainingOldham project installs life-saving defibrillator

Acorn Recovery Projects have installed a defibrillator at their Brunswick House Oldham centre that will be available to both staff and members of the public.

The ‘defib’ could potentially save the lives of clients, staff and casualties in the wider community, and although no formal training is required to operate it, safety manager Tom Berry delivered training to four Acorn staff at the Acorn Recovery Projects centre.

 

Edgy production in East London

A new production from Outside Edge theatre company uses personal testimonies and live cabaret to explore the ‘splintered, chaotic and at times absurdly comic’ world of people affected by addiction’. Rockston Stories can be seen at Hoxton Hall, east London, from 29 September until 17 October.

The cast have a ‘dynamic creative energy, cutting humour, and an infectious desire to share the truth about addiction,’ said director Susie Miller. http://edgetc.org

 

IMAG0275 bee keeping 3Bee-keeping promotes recovery  

A new bee-keeping project has been launched to promote skills development in Calderdale.

Calderdale in Recovery has received a grant from the Kathleen Mary Denham Fund to purchase hives, safety equipment and the first colony of bees for the project, after the local recovery community was consulted on what kind of project they would like to become involved with.

The aim of the project is to help those taking part develop husbandry skills, with a view to producing ‘recovery honey’ that can be sold to fund local community-led initiatives.

 

 

Benefit sanctions for refusing treatment

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DDN
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Government to consider benefit sanctions for refusing treatment

The government has reignited 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.

Psychoactive Substances Bil

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DDN
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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 reworded to include the word ‘novel’, whADMDich 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

National news from the substance misuse field

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DDN
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A round-up of national news – September 2015

Black books

The government has reignited the debate over whether benefit entitlement should be linked to accepting treatment, with the publication of its review by Dame Carol Black. The review will look at the ‘legal, ethical and other implications’ of linking benefit entitlements to the take up of treatment, with a final report to be published later this year.

An independent review into the impact on employment outcomes of drug or alcohol addiction, and obesity at www.gov.uk

Sudden impact

Government plans to reduce the public health grant to local authorities by £200m over the course of the financial year will ‘clearly impact’ on councils’ ability to improve the health of their communities, the Local Government Association (LGA) has stated. ‘Giving councils the ability to make a real impact to the health of local people was a positive step, but local government can only continue its important work such as reducing smoking or excessive drinking and tackling obesity if we are adequately resourced to do so,’ said chair of the LGA’s community wellbeing board, Izzi Seccombe.

Mixed picture

Last year, 38 per cent of 11 to 15-year-olds reported that they had tried alcohol at least once, according to figures from the Health and Social Care Information Centre (HSCIC), the lowest proportion since the survey began. While this ‘downward drift’ was encouraging, however, those who were drinking were drinking more, stressed Alcohol Concern. ‘Looking at the broader picture it’s a case of more alcohol down fewer throats,’ said head of policy Tom Smith.

Choice publication

A booklet on new psychoactive substances and other drugs has been published by Turning Point, aimed at drug users, their families and professionals. The aim is to educate people to make their own choices, says the charity. ‘Substances that are taken in a predominantly recreational context, like novel psychoactive substances, cocaine, steroids and alcohol, place a heavy burden on the health system,’ said director of operations for substance misuse, Jay Stewart. ‘This new guide aims to provide useful information on the risks associated with substances such as these, to dispel some of the myths associated with certain drugs, and to outline the range of support available.’

A useful guide to psychoactive substances, steroids, cannabis and alcohol at www.turning-point.co.uk

New regime

The Care Quality Commission has published a handbook setting out how it will inspect substance misuse services, following a wide-ranging consultation (DDN, February, page 4). ‘Our new regulatory model will put the experiences and views of users of specialist substance misuse services at the heart of how we judge these services, so people can be clear about the quality of services they are receiving,’ said CQC’s deputy chief inspector of hospitals Dr Paul Lelliott.

Download the handbook at www.cqc.org.uk

Prison problem

New psychoactive substances are a source of ‘increasing concern’ in prisons, according to a report from the prisons and probation ombudsman, with links to suicide, self-harm, violence, intimidation and debt. The document looks at 19 deaths in prison between April 2012 and September 2014, where the prisoner was ‘known, or strongly suspected, to have been using NPS-type drugs’. New psychoactive substances at www.ppo.gov.uk

Crops circled

Coca bush cultivation in Bolivia fell by more than 10 per cent last year, according to a UNODC report, with the total area under cultivation down by more than a third since 2010 to the lowest level since monitoring began. The reduction is the result of government efforts to reduce the surplus of coca crops in areas where cultivation is permitted, says UNODC, and to eradicate crops in prohibited areas. Seizures of coca leaf were also up by 22 per cent on the previous year, while seizures of cocaine hydrochloride increased by more 150 per cent.

Coca crop monitoring survey at www.unodc.org

Hep course

A new PHE-commissioned hepatitis C awareness course for people who work with drug users, but who don’t have a medical background, has been developed by RCGP. The free online course takes about two hours to complete.

Find it at elearning.rcgp.org.uk/course/info.php?popup=0&id=175

Giving voice

A new project that aims to ensure that the voices of service users are properly heard is to be headed by ex-NTA chief Paul Hayes. Collective Voice is a joint venture between major service providers including Addaction, Blenheim, CRI, Phoenix Futures and Turning Point. ‘Leadership of this project will require influencing skills, political astuteness and experience of building successful partnerships and links with key stakeholders at the highest level, and the board were clear that Paul Hayes was the outstanding applicant to provide this,’ said a project spokesperson.

 

 

 

 

 

 

 

 

 

Comment from the substance misuse sector

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DDN
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Letters and comment

LettersDDN 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.

Game changer

I was brought up in the care system due to my mother committing suicide. Mum was an addict and dad was an alcoholic, so my childhood was pretty messy. By the time I was 13 years old, I had lived with ten different foster carers, including two kids’ homes.

I was running from the pain of my past, hurting others and myself. I was a heavy drug user and always in trouble with the police. I have lived in prison for two years and make no excuses for my crime – however I do believe there is a strong link between crime, addiction and mental health. Before coming to prison I tried so hard to get help, but my funding to rehabilitation was blocked because I was unstable.

While living in prison I have been shocked at the lack of interventions to cure people of crime and drugs. It is too focused on punishment, rather than using the time for great work. More than 70 per cent of people in prison have addiction issues and many suffer mental health problems.

The government drug strategy sets out ambition to tackle substance abuse by building recovery communities within prisons and beyond, but I am saddened at the lack of recovery groups, which could seriously reduce the reoffending rate. Is it really so difficult to start some serious joint working? It breaks my heart to think of men locked in a cell 23 hours a day when we could be using this time to help them – not to mention the annual £40,000 cost to the taxpayer.

Askham Grange is the prison that has changed my thinking and behaviour because staff encourage you to believe you can be a constructive member of society. It has a six per cent reoffending rate compared to the national 60 per cent and was awarded ‘outstanding’ by Ofsted twice within two years. Our prisons should be places where people recover, rehabilitate and move away from crime. The staff here make us realise teamwork is essential in keeping our environment friendly, safe and secure. I feel I now have a future away from crime, drugs and poverty.

The prison has a project called ‘Me, No Way’, where prisoners talk to kids in schools – an emotional experience that really makes you feel part of our community.

We also have a mother and baby unit and the gym courses are excellent – an opportunity that also steers people away from crime and drug-fuelled hostels.

I now have a university degree and would like to develop a social enterprise that employs ex-offenders. Askham Grange has made me believe I am a winner, not a loser, and that I can help others. On behalf of all prisoners, I would like to thank the staff here for seeing us as human beings who have the power to change and become better people.

I hope this letter reaches the eyes of those who have the power to change things. Politicians and commissioners could learn so much from the long-term benefits of Askham Grange.

Paula Wainwright, HMP Askham Grange

 

Where’s the logic?

I’ve just been reading the latest in a long line of letters by Ken Eckersley, CEO of Addiction Recovery Training. In the recent letter (DDN, July/August, page 9) he is onside with Neil McKeganey, calling for ‘regular’ and ‘exhaustive’ drug-testing in UK prisons.

Having worked with class A drug using offenders for over five years it’s clear that something is wrong in our prison system, but I staunchly believe more prohibitive measures are not the answer.

Where does it begin and where does it end? Do you propose testing for every single drug? Because, in my experience, if folk want to use, addict or not, they will find a way. One only has to look at the extensive list of illicit prescription drugs that are currently being used and abused. Or are we to outlaw the use of every pharmaceutical drug too? Prohibition is not a deterrent and I don’t believe it ever truly will be.

It’s a cliché, but change comes from within. Good people can be around that person before they are ready – and good people can be around them when it’s time to help realise that change, but no amount of therapeutic coercion or ‘immediate transfer’ will support that change. I have never heard of demoralisation and lack of autonomy being supportive factors in people’s recovery.

Another thing to note is that when mandatory testing for cannabis was introduced, the fallout was such that many inmates who had never used anything but cannabis in jail turned to heroin, as it left their system quicker. What happened next was they left prison with a heroin habit to feed and, for many, this began the ‘revolving door’ of years in and out of prison. So I fail to see how the proposals are either ‘effective’ or ‘logical’.

Ken ends his letter on a real bum note when he cites China and the US as countries to look to; China with human rights violations galore and the latter being the proud offender of incarcerating more people than anywhere else in the world, many of whom are serving time for non-violent drug offences, with some on life without parole for possession.

For an alternative DVD recommendation please watch The House I Live In and check the logic.

Support don’t punish!

Jesse Fayle, student mental health nurse and former criminal justice recovery practitioner/DIP worker

 

Khat question

What has been the outcome of the UK government’s khat ban? This is an example of the sort of research question that home secretaries like Theresa May are typically uninterested in, and which is therefore far less likely to receive public funding.

By contrast, successive governments encouraged reports that aimed to demonstrate that khat chewing was dangerous and should be banned. When the reports concluded that a ban wasn’t necessary, they waited a bit then commissioned another report. In the end, khat was banned irrespective of research that was ambiguous about the harms at best.

But if the harms were so serious that culturally embedded traditions of British Somalis and Yemenis should be criminalised, it seems equally important to find out whether the policy has been effective and whether these harms have now been reduced. Not to do so might even be construed as a racist oppression of these minorities by the British state.

For example, has khat dependence among the affected adults declined? Or have people just switched to illicit khat, or alternative stimulants that increase harm? Has there been a decline in community cohesion (because khat chewing is traditionally a social activity; not unlike going to the pub for many other British people)? How does the ban mediate the drug-taking careers of second generation Yemeni and Somali youth ie was khat chewing protective against the use of other widely available illicit drugs, or did it provide a gateway to more problematic drug taking?

I have no expectation that these questions will ever be deemed worthy of the sort of public funding considered necessary before khat was banned. But I think they are interesting to highlight, because of the way they add to the evidence that knowledge production is biased towards answers that serve a specific agenda. Bias that – in this case – can contribute to forms of cultural oppression, which might even be relevant to broader narratives on the production of terror.

Neil Hunt, Kent

 

False results

I see that you reported the drug-driving figures from the Institute of Advanced Motorists (IAM) as have other publications (DDN, July/August, page 4). They give the numbers arrested, not charged, and not the number found guilty or not guilty.

At this stage if they have tested presumed positive roadside, they would have a further test to confirm the result.

Are these figures available? They should be – after all, some would have been arrested and put through the courts in March.

My concern is that the initial tests are prone to false results, and in this case it would be false positives. (You will never know of the false negatives!)

David Mackenzie, by email

 

 

Views from the substance misuse sector

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DDN
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Media savvy

The news and views from the national media

Buying ethically produced food, and making a statement about yourself by doing so, is now so easy it requires little or no thought. Thinking about where your narcotics come from, on the other hand, is so difficult it’s simply easier not to do so… We are, it seems, living in the age of the wonky moral compass: of middle-class couples who swear by their weekly organic veg box, and yet relax after dinner with a line of something produced by impoverished, subjugated Bolivian peasants.

Jay Rayner, Guardian, 19 August

Creating a fug of confusion, Public Health England suggests e-cigarettes should be dished out by the NHS, while the Welsh Government says they should be banned in enclosed public places. The Mail believes both are wrong… In different ways, both Public Health England and Labour-run Wales are behaving like nannies. How about treating the public like grown-ups?

Mail editorial, 20 August

The ‘public health’ lobby is a lumbering beast that goes from one extreme to another. If it is not trying to ban something, it is trying to subsidise it. What e-cigarettes and their users really need is to be left alone.

Christopher Snowdon, Telegraph, 19 August

Tobacco is the largest single cause of preventable deaths in England – e-cigarettes may have a part to play to curb tobacco use. But the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency’s peer review process. PHE claims that it protects and improves the nation’s health and wellbeing. To do so, it needs to rely on the highest quality evidence. On this occasion, it has fallen short of its mission.

Lancet editorial, 29 August

Our descendants will wonder if we were ourselves drugged as well as unhinged when, in future times, they mourn and regret our irreversible folly in legalising this dreadful poison [cannabis]. Haven’t alcohol and tobacco done enough damage, and made enough profit for cruel and greedy people?

Peter Hitchens, Mail on Sunday, 23 August

As someone who chooses to not drink, I have become acutely aware of how alcocentric the UK is, and how drinking is consistently tied in with having fun and being happy and relaxed. The predominant message is that alcohol is a prerequisite for letting your hair down and living it up.

Lucy Rocca, Guardian, 12 August

tobacco plain packaging

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DDN
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NeilPlain talk

Has tobacco plain packaging actually worked, asks Neil McKeganey

Since announcing in 2012 that all tobacco products had to be packaged in plain form, bearing large graphic health warnings, but with no brand imagery, the Australian government has been under a legal requirement to provide a review of the impact of the policy.

The clear aim of the plain packaging policy was to reduce smoking prevalence by – reducing the appeal of branded cigarette packs to young people, by removing the brand imagery that might make it that much harder for smokers to quit their habit, and by removing the various logos and colouring that might convey the impression that some cigarettes are less harmful than others.

Siggins Miller, a private consultancy firm funded by the Australian government to contribute to the review, has been carrying out a survey of Australians asking them about their views of plain packaging. But the Siggins Miller review is all about what people think plain packaging may have achieved in changing smoking perceptions, rather than assessing whether it has worked to reduce smoker numbers.

Professor Simon Chapman, one of Australia’s leading tobacco control advocates and a bullish supporter of plain packaging, has stated that plain packaging ‘might well function as a “slow burn”, distal negative factor against smoking, [rather] than as a precipitating proximal factor.’

Dr Olivia Maynard, one of the UK’s leading tobacco control researchers, is now echoing the line being taken by Chapman and others that plain packaging should not be seen as a stand-alone policy in itself: ‘Despite the expected benefits of plain packaging, it is important to remember that it will be most effective as part of a comprehensive tobacco control strategy that includes other policies, such as access to stop-smoking services, restrictions on sales to young people and effective taxation.’

If Chapman and Maynard are right, we may never know what impact the policy has had over and above the other tobacco control measures that have been robustly adopted in Australia. Not knowing whether it has actually reduced smoker numbers will not satisfy countries that are considering whether they too should follow the Australian government in implementing a similar policy.

Neil McKeganey is director of the Centre for Drug Misuse Research, Glasgow

Prescription opioids in the US

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DDN
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Chris FordToo scared to prescribe

Dr Chris Ford finds that in the US, new restrictions have had negative consequences for patients in pain

I was recently discussing the increase in use of prescription opioids in the UK and the US with Alex, an American doctor, who specialises in pain treatment, and I asked whether their new restrictions were helping the situation and was shocked to learn of the negative consequences of these Drug Enforcement Administration (DEA) actions.

He began by telling me about his patient John. ‘John had returned from Iraq in 2013 in a very bad way. He had lost both his legs and part of his left hand, as well as having internal injuries and severe depression. John was very determined and progressed well in rehab, soon became mobile and his mood began to lift. But the thing that didn’t really improve was his pain. He tried everything but nothing helped until we hit on hydrocodone. With his pain under control, John was able to continue his rehabilitation, start a part-time job and even began to play football.’

Then Alex told me the regulations around hydrocodone had changed and so did John’s life. He had always regulated his own intake and sometimes took more and sometimes less, but always within the parameters of the prescription. His pharmacist was ever helpful but was now nervous of the new regulations and wanted John to go to another pharmacy. This unsettled John and he had again become suicidal.

Alex explained further that it is now much harder for him to prescribe opioids, leading to a dramatic reduction in his ability to provide appropriate care for his patients in pain.

In 2014 hydrocodone combination products were ‘rescheduled’ to be like codeine and oxycodone, which were already Schedule II under the US Controlled Substances Act. In the US, there are over 60,000 kg of hydrocodone prescribed a year, a medication that is essentially only available in North America. Primarily available as a combination product, the maximum dose per day has been limited by the amount of paracetamol in the combination. Rescheduling now means that the medicine cannot be called into pharmacies and refills are no longer allowed on a prescription.[1] Additionally, in some states prescribing authority will be limited to physicians, not nurses or physician assistants.

Add to this the increasing restrictions on pharmacies in some states. Many can’t serve their customers who need opioid analgesia because the wholesalers who supply the pharmacy will no longer distribute the amount of medications that is needed. In some areas DEA agents have visited pharmacies to review the quantity of opioids being dispensed. Some pharmacies have reported being warned of increasing DEA review, if the quantity of dispensed medication was greater than the state average. So pharmacies make adjustments to stay in line and that is why John was sent away from his pharmacy. None of this is based on patient need, demographics or doctors but is quite simply a policy developed by bureaucrats, who have no understanding of the problem. Alex has also heard of pharmacists asking patients if they could reduce their dose or change to a non-scheduled alternative. In some cases, patients with advanced cancer have had difficulty filling their opioid prescriptions.

Yet the DEA say they are ‘simply enforcing the law, taking bad people off the street and essentially, trying to interrupt the supply of illegal prescriptions.’ But the agency takes no responsibility about the effect on people who need these medications.

Neither Alex nor I are saying that there isn’t a problem with prescription opioids. But it is complex, and punishing patients who need pain relief is not the solution. There has been an increase in the USA in opioid associated deaths (causality is not often established). However 60 per cent of the deaths are associated with poly-pharmacy (opioids, benzodiazepines and alcohol) and 30 per cent are associated with methadone, although it only represents 3 per cent of pain prescriptions. These deaths are almost all from using methadone as pain relief, not from OST. Some states mandate the use of methadone as a second line opioid after morphine in order to save money, although most physicians have little education in its prescribing.

Concurrently some people who have become dependent on prescription opioids are turning to heroin, which is becoming increasingly available in US. There has been much in the press about this but the increase in deaths is only partially related to this change and more to do with increasing purity of heroin.[2] People then using this heroin-prescription drug combination are not the traditional population of people who use drugs. This problem is increased dramatically among white people and especially among young white men. Eliminating or restricting opioid analgesics doesn’t make the problem of dependency go away.

Khary K. Rigg, Assistant Professor of Mental Health Law and Policy, University of Southern Florida; and Shannon Monnat, Assistant Professor of Rural Sociology, Demography, and Sociology, have recently published on the complexity of this problem and identify three groups of opiate users, who are distinct demographically, socioeconomically and psychologically. While heroin use is typically characterised as being a problem in black, poor and urban areas, an increasing number of people who use heroin and prescription opioids are white, employed and live in rural and small urban areas. The third group they identified are people who are addicted to prescription opioids alone and tend to be the most socially connected of the three groups. This group is the least socioeconomically disadvantaged and have better physical and mental health[3].

Professionals who treat people with drug problems should recognise the unique needs of each group of addicts, according to the researchers.

So what is happening in the UK? Prescription opioid dependence is a growing problem here and best-practice management is as yet not well defined.[4] In 2013, 757 people died with a prescription opioid in their blood stream, almost the same number as for heroin and illicit morphine (765) and more than for methadone (429).[5] It is critical that we understand this problem and respond appropriately, and avoid falling into the trap that the US has set for the people caught up in this situation.

[1] DEA Schedule II rules. http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm

[4] Bernadette Hard. BMJ, 2014

[5] Office of National Statistics, 2014

Dr Chris Ford is clinical director of IDHDP, www.idhdp.com. Full version at www.drinkanddrugsnews.com

 

Bereavement and addiction

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DDN
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John RossingtonCause and effect

Last issue, we reported on a set of guidelines about supporting those bereaved through drug and alcohol related death. John Rossington looks at how a personal loss can in turn lead to addiction

I have been employed in the substance misuse field for many years and I have always been struck by how often bereavement has been the precursor to a period of active addiction to drugs or alcohol. Two years ago, I was propelled into the nightmare world of bereavement and was given insight into how personal loss and society’s reaction to such loss leaves an individual so vulnerable.

I have never had a family to speak of and for 20 years, I lived with my soulmate Michael. On 9 March 2013, I returned from work in the evening and found him unconscious on the sitting room floor. By 10 o’clock that night he was dead.

In an instant my life had changed completely and I had been tossed into a world of complete isolation. It felt as if the world was embarrassed by my grief and turned its back on me.

When I eventually returned to work, emotionally drained, I was stung by most people’s reactions. It was clear that most of my colleagues wanted not only to ignore Michael’s death, but to wish away his very existence.

We must ask ourselves why we have reached such a state in society where we are unable to engage in each other’s pain and provide comfort to those in distress. If we cannot address this, then many others will mistakenly seek comfort in the oblivion of drugs or alcohol.

Michael’s death and people’s reaction to it have changed me. For the first time in my life outside of work, I am quite reclusive. I worry that I am a nuisance to other people.

There are signs of hope. I am impressed by how so many people in the recovery community are committed to creating meaningful communities where we engage with each other in a supportive and nurturing way.

In the meantime, I take some comfort in the fact that I have not succumbed to addiction and hope that I can be more effective in supporting others for whom profound loss has been the cause of their drug or alcohol issues.

John Rossington is manager at Big Life Pathways Drug and Alcohol Service

CQC inspections

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DDN
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DFinneyGet in gear

David Finney guides you through the new CQC inspections

The Care Quality Commission has just published guidance on the new way in which treatment services will be inspected. The process will be very different from before, because the inspections are now organised by the Hospital Directorate.

The first major change is the introduction of a ‘briefing and planning session’ with an inspector at the outset of the inspection process. This will be an opportunity for you to explain how your service works, and will enable the inspector to plan the site visit appropriately.

At this stage you will also be asked for contact information for your stakeholders, who will be surveyed by CQC. These will include commissioners, local authorities, referrers from drug and alcohol teams, doctors, social workers and care managers.

Then an ‘intelligent monitoring’ phase will start, during which CQC will gather data. Some of this will be provided by you, such as:

  • Outcome data, eg on completion or return to treatment, abstinence rates, safeguarding alerts.
  • Information from service users and the public (usually obtained through surveys).
  • Information from and about staff, eg turnover, stability, sickness rates and concerns raised.

Furthermore, you will be asked questions in a ‘provider information return’, which will include specific questions about:

  • Safety and effectiveness, including serious incidents, DoLS (Deprivation of Liberty Safeguards) or medication errors.
  • Complaints and how governance is exercised (do you learn from incidents and mistakes?)
  • Equality and diversity, ie examples of how it is evidenced, or data to show that specific groups are not discriminated against.
  • How improvements are made in the service.

Another major change is that you will be given a date for a site visit and CQC will seek information about your service in the intervening period. This will give you an opportunity to audit your service thoroughly before the site visit takes place.

At the beginning of the visit, there will be an opportunity for you to give a ‘provider presentation’, in which you can:

  • Outline the background to your organisation. I suggest that you include an explanation of your treatment philosophy.
  • Show that you provide quality care. Demonstrating an understanding of the five key questions (safe, effective, caring, responsive and well led) will be helpful.
  • Demonstrate what is working well or is outstanding. You could focus the success rate in terms of completions and the compliments you have received.
  • Highlight any areas of concern or risk. For example, you could mention any boundary issues such as transition, or any issues you may have with mental health teams.

Then, during the visit, the Inspection team will observe interactions between staff and service users, talk with service users, staff and the manager, and look at some records.

There are actually very few questions in the methodology that are specific to substance misuse treatment. However, those that are include:

  • Identification of drug and alcohol-related harm, and deteriorating health.
  • An opportunity to explain the restrictions on movement usually imposed as part of a treatment programme.
  • The involvement of recovery champions.
  • Processes in place for unexplained or unplanned discharges.
  • The planning of services to take account of people with complex needs or vulnerabilities – such as dual diagnosis, multiple drug use, homelessness, pregnancy, or criminal justice involvement.

Finally, it has now been decided that CQC will not be able to give ‘ratings’ for substance misuse treatment services. This is because they were not included in the list of services given to the Department of Health when drafting the regulations, so CQC has no legal power to provide ratings. This decision applies to everyone in the sector, so no specific group of services will be disadvantaged by it.

The full information about the new inspection process can be accessed at www.cqc.org.uk/content/guidance-providers. I wish you the very best of success in navigating this new system and will continue to update you through DDN as and when new information becomes available.

David Finney is an independent social care consultant. His workshop is on 6 October in London, details at www.drinkanddrugsnews.com/CQCtraining

European Network of People who Use Drugs

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DDN
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Mags MaherHands 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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Steve TaylorReady 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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David LiddellStark 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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Dave MarteauKill 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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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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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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JulAug15In 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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DATwo 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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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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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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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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Swasnwell-download

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 gamesRecovery 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.

 

TwelveArt 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

 

Outreach busNew 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.

 

SCT eventEvent 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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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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Letters and comment 

LettersDDN 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 DickinsonJames 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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Media savvyMedia 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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Keep nagging on naloxone, says the naloxone action Group

naloxone injecting kit

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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Bereavement groupA 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.

Bereavement guidelinesThese 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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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.

SMMGP conferenceOpening 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.’

SMMGPFrom 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

By
DDN
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Mark Gilman Ray JenkinsRecovery 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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Andy IrvingSharing 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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Electrical Storm

ecigarettesWith 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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Helen SandwellHidden 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.’

Sugar risks

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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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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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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Screen Shot 2015-06-08 at 14.22.14The 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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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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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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June15In 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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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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Screen Shot 2015-06-08 at 14.28.43Live 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/

 

Screen Shot 2015-06-08 at 14.28.49Photographer 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

 

Screen Shot 2015-06-08 at 14.29.01Project 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.

 

Screen Shot 2015-06-08 at 14.29.12Service 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

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DDN
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Get real

Prison Door - illustrating drug use in prisons

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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Screen Shot 2015-06-08 at 13.55.29The 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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Screen Shot 2015-06-08 at 13.48.57Media 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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Steve-Brinksman_w01WEBWhy 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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KFNatural 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.

Screen Shot 2015-06-08 at 13.26.20I 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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Women firstAS

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.

Screen Shot 2015-06-08 at 13.21.31‘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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A dog’s life

James Dickinson shares the story of Screen Shot 2015-06-08 at 11.45.37Bert, 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

Screen Shot 2015-06-08 at 11.47.04 Screen Shot 2015-06-08 at 11.47.26

Prepare for your CQC Inspection

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DDN
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DFinneyDefinitely, 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:

  1. 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.
  2. 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:

  1. Intelligent Monitoring: CQC will aim to gather information from a range of sources about the operation of your service.
  2. They will scan information provided by organisations such as Safeguarding Boards, Public Health England, Healthwatch, and Clinical Commissioning Groups.
  3. 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.

  1. 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.

  1. 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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Jim McVeighA 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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Screen Shot 2015-06-08 at 10.48.59Share 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.
Screen Shot 2015-06-08 at 10.46.47Paul 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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Naloxone distribution campaigner Philippe Bonnet
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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Tracy 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.

Screen Shot 2015-06-08 at 10.28.33BoomTown 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.

Screen Shot 2015-06-08 at 10.28.07The 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.

Screen Shot 2015-06-08 at 10.28.40Although 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

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