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US signals softer stance on drug sentencing for non-violent offenders

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The US administration has indicated a softening of its stance on drug sentencing, with proposals to abolish mandatory minimum sentences for non-violent drug offenders.                                        

The country has long been the subject of criticism for its drug policies, with around a quarter of the 2m people in its jails estimated to have been convicted of a drug offence.

US attorney general Eric Holder announced plans to abolish the use of mandatory sentencing in certain drugs cases in a speech to the American Bar Association. The Obama administration previously indicated an intention to divert non-violent drug offenders away from the prison system in its 2012 national drug control strategy (DDN, May 2012, page 5), while earlier this year an open letter to the US government signed by more than 175 civil rights leaders, celebrities and business figures called for more alternatives to incarceration for non-violent drug offences (DDN, April, page 5). Holder said in a radio interview before the announcement that ‘unintended consequences’ of the war on drugs had included ‘a decimation of certain communities, in particular communities of colour.’

Executive director of the Drug Policy Alliance, Ethan Nadelmann, called the announcement ‘incredibly significant – the first time a US attorney general has spoken so forcefully or offered such a detailed proposal for sentencing reform, and particularly notable that he framed the issue in moral terms.’

Scots record second-highest number of drug deaths

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Scotland recorded its second-highest number of drug deaths in 2012, although the number of deaths in under-25s was down by a fifth, according to new figures from the Scottish Government.

Overall drug-related deaths stood at 581, three fewer than 2011’s record number (DDN, September 2012, page 4). More than 60 per cent of deaths were in people over the age of 35, while the number among people under 25 fell by 20 per cent to 46. 

Methadone was implicated in 38 fewer deaths than 2011 – at 237 – including 12 deaths where methadone was the only drug present and 68 where it was the only drug implicated apart from alcohol. There were also 47 deaths where new psychoactive substances were present – the first time they have been included in the report – including five where they were the only drug present.

‘The Scottish Government is dealing with a legacy of drug misuse which stretches back decades and, as in previous years, the statistics published today show that many of these deaths are older drug users who have become increasingly unwell throughout the years,’ said community safety minister Roseanna Cunningham.

The high level of deaths among older opiate users re-emphasised the need for services to be ‘more targeted towards the needs of this group of people, who are likely to have a range of complex needs’, said Scottish Drugs Forum director David Liddell. ‘The Scottish Government’s programme to distribute naloxone – an emergency antidote for opiate overdoses – is one of the measures to help cut the drug deaths toll in Scotland but more needs to be done to ensure greater distribution and take up across Scotland. Our view is that at least 40 per cent of the estimated 59,600 people with very serious drugs problems in Scotland need to be provided with naloxone in order to make a substantial impact on the deaths.’

The number of deaths in 2011 involving methadone led to much debate in the Scottish media and a call for a parliamentary enquiry. However, the report of the government-commissioned Independent Expert Group Review of Opioid Replacement Therapies in Scotland has concluded that the use of opioid replacement therapies – particularly methadone – should continue as part of a range of treatment options. ‘Opioid replacement is an essential treatment with a strong evidence base,’ says the document. ‘Its use remains a central component of the treatment for opiate dependency and should be retained in Scottish services.’ The report also recommends that local information systems be improved to identify people’s progress towards recovery and more consideration be given to addressing the link between health inequalities and problem substance use.

‘Opioid replacement therapies, including methadone have had a beneficial effect in preventing the spread of viruses among drug users,’ said Scotland’s chief medical officer, Dr Harry Burns. ‘However, they often simply switch one form of drug use for another, albeit a safer one. That’s why we need to find more ways of helping people access a range of treatments and support, tailored to their needs and their aspirations for sustained recovery.’

Meanwhile, a report from NHS Health Scotland has found that while alcohol sales in Scotland fell by 3 per cent between 2011 and 2012, Scots still drink around a fifth more than the English or Welsh. Nearly 90 per cent of the difference in ‘per adult sales’ was the result of higher off-trade sales, particularly spirits, says MESAS alcohol sales up­date 2013. ‘Cheap vodka’ was ‘fuelling much higher levels of harm, which results in 100 alcohol-related hospital admiss­ions a day and costs Scotland £3.6bn each year – £900 for every adult’, said public health minister Michael Matheson.

Drug-related deaths in Scotland at www.gro-scotland.gov.uk

Delivering recovery-opioid replacement therapies in Scotland – independent expert review at www.scotland.gov.uk

MESAS alcohol sales update 2013 at www.healthscotland.com

September issue 2013

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September issue

In this month’s issue of DDN… 

‘What we try to do is listen and support as opposed to tell and regulate, in the belief that recovery is not owned but shared. We also try to help those who wish to design and develop recovery support networks to realise their aspirations.’

 This September issue, read about how the Unity service in Cumbria made recovery visible and relevant to a diverse community – as well as all the latest news and comment. 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

 


Opportunity knocks

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ryancampbellKCA chief executive Ryan Campbell talks to David Gilliver about how services can take advantage of the new commissioning landscape.

‘There’s a great deal of potential for the sector to start to see ourselves as less of an isolated world of “we only do substance misuse interventions”, and much more as a part of an overall health and wellbeing public service,’ says Ryan Campbell, who took over as chief executive of KCA in April.

KCA provides mental health and troubled families services alongside its drug and alcohol work, and he believes there’s enormous potential for organisations to make more of their skills and capabilities – against, of course, the backdrop of financial uncertainty. ‘Most organisations in the sector are going through a process of change to adapt to the new commissioning arrangements and the new contract formats, and KCA, like everybody else, is working out where we fit into that new environment.’

The same features that made the KCA role attractive to him will, he hopes, make the organisation attractive to commissioners and communities, and KCA has been working on its new three-year strategy, which goes live next April. In the meantime, priorities are to work in partnership with other providers to meet ‘more public health needs’, as well as to support the professional and personal development of its own staff. ‘One of the by-products of the contracting and retendering culture, mixed with financial constraints and uncertainty about the future, is that organisations have been under pressure to minimise their cost base, and that can sometimes threaten the amount of support and development they’re able to give staff. But to support the health and wellbeing of our service users we need to be committed to the health and wellbeing of our own staff.’

Dual diagnosis

The organisation remains unusual in providing both substance use and mental health services, and he’s also chair of mental health charity Mind. Does he think there’s enough support for people with a dual diagnosis? ‘No I don’t, and I actually take issue with the term “dual diagnosis”,’ he states. ‘It’s another form of compartmentalising people. Very few people fall into the technical definition of dual diagnosis – you tend to have to have very severe and entrenched needs in both substance misuse and mental health, and of course if you have entrenched needs in both of those areas the chances are you’ll have some quite considerable needs in other areas too. So to parcel up a small number of people under the label “dual diagnosis” I find quite problematic.’

Is it limiting people’s access to support? ‘I think it certainly is,’ he says. ‘The other thing that limits access is that dual diagnosis tends to operate on the basis of different kinds of organisations coming together, so it’s unusual for most mental health services to be delivered by a substance misuse provider, and vice versa. That means that a client who’s got a range of needs – and they’re not different facets of your situation – has to get those interventions from different organisations in what’s often quite a complex series of pathways and protocols and strategic meetings. It isn’t the best experience for the client or the most efficient way of delivering a service.’ 

Distinct specialism

The recent Brighton and Hove drug commission recommended that adult and young peoples services be kept separate, so that young people get age-specific care and aren’t in contact with older service users (DDN, May, page 5). As KCA does both, what’s his take on that?

‘At the moment [the services] are quite separate, although there’s quite a considerable hinterland between the two,’ he says. ‘If we’ve got someone who’s been in young persons’ substance misuse services, to just say on their 16th or 18th or 24th birthday or whatever that they have to enter an adult service can be quite difficult, so we try to make sure there’s access into both so they get the service that’s most appropriate. I don’t see any reason why those services can’t be delivered under the same umbrella, but overall I’m very supportive of the idea that working with young people is a distinct specialism.’

One reason is that adults and young people tend to present at different stages, he says. ‘Not many young people think of themselves – or should be thought of – as entrenched, serious drug users and to try to put a young person through a typical adult pathway just isn’t appropriate. It’s more about how they manage the risks in their lives and their own behaviour, and how they manage their substance use within that. That’s quite a distinct specialism.’

He’s been in the voluntary sector for more than 16 years and came to KCA after five years at RAPt, which he joined from Age Concern. But he also has personal experience of both mental health and addiction issues. ‘I think it’s quite important that people in recovery are open about being in recovery,’ he says. ‘It’s part of the agenda for tackling the stigma around both substance misuse and mental health. The general population often get messages about substance misuse and mental health which are purely around chaos, harm caused to self and others, and which really don’t focus on the recovery aspect. There are a lot more people in some form of recovery than there are in those chaotic phases, and I think it’s really important that that’s visible. I’ve always been very open about my own recovery status.’

Grand ambitions

KCA has doubled in size in the last five years to employ around 450 people, and one of his ambitions is to be able to broaden the support it offers. ‘I think we’re missing a lot of opportunities to help people to the fuller path of recovery, so I’d like KCA to be seen as part of a health and wellbeing approach where we support people and families into full recovery, which isn’t just isolated into 12 weeks of treatment and a little bit of aftercare.’

Another ambition is to continue to develop in ‘what is quite a difficult environment with additional risks – as well as opportunities – around payment by results and all those sorts of things,’ he states. He’s previously said that one of the downsides of PbR was a growing culture of secretiveness – is that still the case? ‘I think people are starting to open up a bit more but I think it’s still a risk, and not just around payment by results – it’s around the commercial confidentiality that enshrouds contract tendering in general,’ he says. ‘But it can be particularly prevalent in payment by results contracts.

‘I’ve always worked in the voluntary sector, so I can remember in my days with Age Concern there was rivalry and competition for grant funding, but I would take it as a point of pride that if my organisation was doing something really well I wanted every other organisation to do it. Yes, I wanted us to get some credit for it, but I wanted everyone else to do it. Now my fear is that we’ve got this atmosphere where if your organisation is doing something well you keep how you do that very closely guarded secret so that you can take someone else’s contract off them in the next couple of years. That does worry me – that we’ve got a way of working that limits the dissemination of ideas, which has always been a strong feature of the voluntary sector.’

Signs of improvement

So is the risk that things will become even more cutthroat? ‘I’m a born optimist, and I think things will get better,’ he says. ‘That’s partly because no one wants to work in a system that’s inefficient or unpleasant to work in, and where it has happened I believe it’s been accidental.’

There are already signs of improvement, he feels. ‘There was a time around three or four years ago, for instance, when no provider or commissioner would have an open discussion about whether wholesale re-tendering of services did or didn’t add value, whereas that now seems to be a feature of discussion at conferences and policy forums and the like – people are actually examining what we’re doing and asking whether it’s good or bad.’

There’s also a sense of regret in the sector about smaller organisations going under, he says. ‘Sometimes that’s the way of the world, but if it happens as a by-product of a system then it’s a tragic shame because it’s difficult to build something like that back up. So we’re now having open discussions around how we can protect the real jewels of the voluntary sector, who are sometimes quite small and unable to compete in a massive contract, payment by results world. I can really feel a movement to make sure that doesn’t happen, and make sure we have a well-functioning system that puts the needs of our clients above the needs of our individual organisations.’

It’s even possible that financial constraints could make that more likely, he believes. ‘One big area of growth in the voluntary sector was in the 1970s when charities started to not be run in that parochial, slightly patronising hangover from the Victorian, “worthy poor” type way, and instead became more organised, grassroots organisations. That happened at a similar time of political uncertainty, severe financial uncertainty and poor outlook. There’s something about a financial crisis or recession that brings out in the voluntary sector, and people as a whole, their will to work together and make the absolute best of the limited resources they’ve got.’ 

Into the matrix

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Editor Mike Ashton gives a guided tour of Findings’ new matrices, which offer a vast resource of addiction treatment evidence that no practitioner should be without. 

The evidence base for addiction treatment is enormous, hard to encompass, and even harder to assess. Wouldn’t it be great if we could somehow identify the major documents practitioners should read, even if they read nothing else? Just such a discussion took place in a sub-group of the Substance Misuse Skills Consortium (www.skillsconsortium.org.uk), the sector-led partnership that aims to develop the substance misuse treatment workforce in England. I participated as editor of the Drug and Alcohol Findings Effectiveness Bank site (http://findings.org.uk).

Findings had already constructed a matrix for the consortium, which mapped the evidence-base universe, though for a different purpose. Funded via the National Treatment Agency for Substance Misuse (now absorbed in Public Health England) Findings undertook to develop this framework into matrices, presenting the most important documents and resources for treatment practitioners and commissioners to understand the evidential basis for their work and to implement its most important lessons.

Important groundwork

The level of ambition involved can hardly be overestimated. Despite the obvious need, no agency, no matter how well funded or expertly staffed, from multi-million dollar US government institutions to the European Union’s drug centre or the UN’s World Health Organization, had attempted such a project.

In Britain it could only be envisaged within a reasonable time frame and limited resources because for the past 16 years Drug and Alcohol Findings had been monitoring and collecting evaluation research, assessing the studies, and selecting and analysing those of greatest relevance to the UK. Along the way, seminal research had been identified and analysed in its own right (the Old Gold series in Findings magazine – see http://bit.ly/19MCk6l) and as the backdrop to understanding more recent work. Reviews were collected and read to help understand the significance of each individual study and guidance documents helped make sense of what they might mean for the UK.

This work had accumulated into the largest live drug and alcohol library in Britain, holding 17,000 documents relevant to the ‘what works’ agenda. The managing committee’s experience in collating and disseminating information about addiction and its treatment preceded by decades the advent of Findings – in the case of the editor, back to 1975. With the groundwork already done, this ambitious superstructure could be constructed.

Understanding the matrices

In May 2013, the result was the Matrices – one for harm reduction and treatment of problems related to the use of illegal drugs (http://bit.ly/1ca1bA3), and one for brief interventions and treatment of alcohol-related problems (http://bit.ly/12aGdQd).

The best way to envisage them is of course to take a look. We liken them to a grid-map of territories in the alcohol and drug treatment worlds, segmented to reflect practical divisions in the delivery and organisation of services. Across the top are five columns, moving from the intervention itself (Is it feasible? Does it work? How does it work?) to the contexts within which interventions are implemented – by practitioners, who are managed and work in organisations, which coalesce into whole treatment systems. All of these affect the treatment’s feasibility and impacts – contexts variously of greatest interest to frontline staff, supervisors and managers, management committees and commissioners.

Intersecting the contexts down the side are five rows. Choose whether your interest is harm reduction (drugs only), brief interventions (alcohol only), cross-cutting treatment issues, medical treatments, psychosocial therapies, or criminal justice work.

For both drugs and alcohol, the result is a five-by-five grid totalling 25 cells. Within each cell are the major historical and contemporary research landmarks in that territory, reviews offering a panoramic view, expert guidance based on this research, and an option to explore beyond these dozen or so selected documents by searching the Drug and Alcohol Findings Effectiveness Bank. Each document entry can be clicked on to access the original document, either directly or via the Effectiveness Bank’s analysis of the study.

Some cell territories have only rarely and partially been explored, while others are relatively well mapped. As well as signposting the achievements, the Matrices expose the gaps in the evidence base. Arrangements are being made to update the Matrices, probably on an annual basis, piggybacking on the work Drug and Alcohol Findings continues to do to identify and analyse documents for the Effectiveness Bank.

‘Terrific stuff’

So what can you do with the Matrices? As a manager, they list the documents you could advise your new staff to read to help them understand the basis of addiction treatment, those you could commend to your existing staff to advance their professional development, as well as giving you practice-improvement clues from the world’s leading researchers.

They will help practitioners understand the most important foundations of their work and how to build on them, and help commissioners appreciate the different ways they can influence effectiveness. Familiarity with these relatively few documents could be seen as an indicator of an important dimension of the quality of an organisation and its staff – an appreciation of the key evidence on which practice has been built and can be improved.

As Audrey Freshman, director of professional development and continuing education at Adelphi University, said: ‘Wow – this is terrific stuff.’  DDN

Mike Ashton is editor of Drug and Alcohol Findings (http://findings.org.uk), a national UK collaborative project involving the National Addiction Centre, DrugScope and Alcohol Concern and supported by Alcohol Research UK and the J Paul Getty Jr Charitable Trust.

Mike explains the Matrices’ development at Lifeline’s FEAD video bank: http://bit.ly/16JqzJu

An updated version of the presentation’s slides is available at: http://bit.ly/17lxiMd. This drills down to one study in one cell of the Alcohol Matrix – a seminal study from the 1950s that demonstrates that such work still has considerable current relevance.

Equal in the eyes of the law?

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Picture 3A new report from Release and LSE says police stop and search policy is exacerbating racial inequality in the criminal justice system.

Black people are not only six times more likely to be stopped and searched for drugs by the police, but more likely to be charged – and receive a harsher sentence – if drugs are found, according to a powerful new report from Release and LSE. 

As well as analysing the government’s own figures, the authors of The numbers in black and white: ethnic disparities in the policing and prosecution of drug offences in England and Wales sent freedom of information requests to police forces across the country, and carried out a particularly detailed analysis of the Metropolitan Police Service, which carries out half of all stop and searches for drugs. 

‘Discussion of stop and search is usually about knife and gun crime, but that’s actually a tiny proportion – 0.8 per cent last year in London for guns and just about ten per cent for offensive weapons,’ Release executive director and co-author of the report, Niamh Eastwood, tells DDN. ‘Overwhelmingly stop and search is about drugs, and it’s about low-level possession offences. That was also identified in Her Majesty’s Inspectorate of Constabulary (HMIC) in their last report, so it’s not just us saying it.’

Differential treatment

Was she surprised by the report’s findings – the actual extent of the differences in the figures for black and white people? ‘There were some things that we anecdotally already knew,’ she says. ‘In terms of the actual stop and search rates, because of the sheer number of times that the young people in London we speak to are repeatedly stopped and searched, we weren’t that surprised. What we were surprised by was the differential treatment that black people faced in relation to charging for drug possession offences. That was really shocking, because obviously you’re talking about like-for-like and the police making a decision to treat people in a significantly different way.’

What may also come as a surprise, despite some media commentators arguing that drug possession is essentially de facto legalised, is that 2010 saw more prosecutions for possession than ever before. One reason was the reclassification of cannabis to class B the previous year, she believes, while another was ‘the targets that had been set under the previous government and now lifted – but that performance indicator, target-driven culture is still embedded within police behaviour’.

‘Low-hanging fruit’

The notion that the police find it easy to go after the ‘low-hanging fruit’ of low-level possession offences is backed up by the experiences of another of the report’s authors, Daniel Bear, who spent time with one London force. ‘He’d go out in a patrol car at the start of a shift and the police officer would say “right, we need to go down to the park and pick up some kids who’ve got cannabis so we can get our sanction detections”,’ she says. ‘Then for the rest of the night they could actually focus on policing that the community cares about. They used it as a tool to meet the targets. I don’t know whether the police actually want to do that, but it’s a very easy way to justify your performance to your senior officers.’

The cumulative effect is an erosion of trust and confidence in the police and an undermining of the criminal justice system itself, the report argues. ‘We would like to see the decriminalisation of drug possession,’ she states. ‘If you look at other jurisdictions that have had similar experiences with drugs policing and the aim to contain and control certain groups – for instance the black and Hispanic population in New York – you’ve seen senior politicians saying that policy needs to change. They’ve recognised that the police can’t overwhelmingly change their behaviour, and we would argue that that’s the same here. Despite controversy after controversy, the police have just not adjusted their practices to reduce the levels of racial disparity.’

Not far enough

The Home Office is conducting its own review of stop and search at the moment. Is she hopeful that the document will have an impact? ‘We are, especially coming on the heels of the HMIC report,’ she says. ‘The Metropolitan Police have put forward some proposals, including 50 per cent reductions in stop and searches overall and in negative stop and searches, but we’re really concerned that, one, that doesn’t address racial disparity and, two, it could lead to the police actually going out to target those they know will be in possession of drugs in order to avoid the negative stop and searches. So they’ll continue to police the usual suspects, if you like. And also that we could have a situation where police officers aren’t properly recording stop and searches where no drugs have been found. We don’t believe that the approach taken by the Met will have any significant impact on police behaviour.’

Even a reduction of 50 per cent would be from a peak of 280,000 people stopped for drugs to 140,000, she points out. ‘And that’s if they reach their target. It would just bring us back to 2006 figures. It doesn’t go far enough.’

Report at www.release.org.uk

Spreading roots

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How do you make recovery visible and relevant to a diverse community? Ashley Gibson of the Unity Drug and Alcohol Recovery Service shares Cumbria’s experience.

roots11In early 2012 Cumbria DAAT decided to go out to tender for a recovery-oriented, asset-based service with one lead provider. Those of us involved in Cumbria service provision felt it to be a forward thinking step – we really wanted more people to get well and we liked how the focus on recovery had impacted on other areas of the country, and the North West in particular. It was also clear from consultations with people accessing services that they wanted change too, and the tender specification accurately reflected the needs of those surveyed.

Back then Cumbria, like many other parts of the country, was struggling with the numbers in treatment. Having learned to bring people into treatment and minimise harm, we were finding it difficult to move people through the system, despite service provision that encouraged uptake of support programmes. We weren’t wholly unsuccessful – the Straight Ahead programme and Bridging the Gap were proving themselves as recovery building assets – but there were question marks over the necessary visibility of recovery in Cumbria.

Bridging the gaps

Obstacles to change included the geographical distances between local communities, Cumbria being pretty much the same size as the rest of the North West. It has a mixture of affluence and rural poverty, with pockets of high unemployment in areas like Barrow and the west of the county, and some significant housing challenges. Centralised approaches to working in the diverse communities of Cumbria were just not demonstrating enough relevance to local needs.

As a treatment system made up of different providers, we struggled to pay enough attention to what happened to people who were leaving treatment and we were not proactive enough regarding feedback that there was no aftercare available. We supported the set-up of Smart Recovery but at that time we didn’t have enough people at that level of recovery to sustain it. We had a lot to learn – and still do. Our contact with, and knowledge of, 12-step recovery was sporadic at best.

Cumbria had three main providers, covering prescribing and clinical, criminal justice, and structured day care services. This created some really positive joint working and some not so positive competition. Everyone recognised the importance of keeping people who access services at the heart of the process – but I am not sure that this always happened, however hard most of us tried.

Recovery focused

Greater Manchester West Mental Health NHS Foundation Trust were successful in their bid to provide a recovery-focused asset-based service in Cumbria, with a contract beginning on 1 July last year. For those like myself, whose previous experience had always been with third sector organisations, it was an interesting prospect. GMW senior management were very clear with us all that recovery would be at the heart of the way forward and that we would be working with an asset-based approach. It sounded exciting; in my role as a third sector service manager in Cumbria I had already been involved with asset-sharing ideas, particularly in Barrow, and had previously attended a John McKnight asset-based community development seminar in Kendal. I am also in recovery and the prospect of what felt like going back to my own roots in my work was a really inviting one.

As the result of a consultation exercise, Unity, with a strapline of ‘recovery in your community’, became the new name for the ‘one provider’ service. The name reflected the need of people from the previously separate services to unify with people already in recovery and those accessing services. It also felt like a message to ourselves as we built the foundations of our co-productive approach within Cumbrian communities.

roots22Flexible approach

Taking an innovative approach, and recognising that recovery networks are key to people getting and staying well, Unity set up an asset building fund. This takes bids during each year of the contract from groups and organisations that wish to contribute to recovery and its further development in Cumbria. As well as this, a new role of community development lead (my role) was introduced into the Unity management structure. Its purpose was to support recovery development by letting us share assets through joined-up work between people and services in the community. We recognised  – and it was also commented on in Cumbria DAAT’s modernisation consultation with service users – that both drug and alcohol services and recovery support needed to be relevant to local communities. One size definitely does not fit all in Cumbria.

Different recovery groups and organisations with local connections were already set up or were starting to develop their ideas. These groups were encouraged to apply for support from the Unity asset-building fund – a great opportunity for them and for Unity to start to build a co-productive approach. Those successfully shortlisted would be invited to participate in a ‘friendly Dragon’s Den’ – a nod to the popular TV programme.

Key to the accessibility of the asset-building fund was Unity’s recognition that the process needed to be very straightforward. Although bid-related goals were agreed, these would be flexible according to the specific local requirements of the group needing funding. Unity, through my role, and also the commitment of the local recovery service teams, support all groups, whether they are funded yet or not, to play their part in the local community.

Local involvement

What we try to do is listen and support as opposed to tell and regulate, in the belief that recovery is not owned but shared. We also try to help those who wish to design and develop recovery support networks to realise their aspirations. The growing mutual respect was highlighted by the contribution that different recovery groups from around the county made to our recent workforce development training. They played a major part in helping Unity staff teams develop their understanding of recovery and this co-working continues to bear fruit.

In practical terms, Unity work closely with local groups – Vulture Club in Whitehaven, New Beginning in Workington, Cumbria Gateway and Jigsaws in Carlisle, ReFocus in Penrith, and New Roots in Barrow – to develop their ideas further and make the groups more visible. These organisations are all inspired to support recovery in Cumbria and choose to work closely with Unity to develop strong and meaningful links with other organisations in their local communities.

In Barrow and Workington we have recently taken our next step in recovery asset building. Following an inspirational visit to friends at the Scottish Recovery Consortium and some practice at our workforce development days, we have joined the brave new world of ‘recovery conversation cafés’, inviting people who access local services, carers and people from the community to talk about what recovery means locally. This is a great way to have everyone who supports recovery get together, make use of the links we have, forge new ones and decide on actions that relate to recovery in the local communities of Cumbria.

The informal café atmosphere is designed to help everyone feel at ease and talk openly about real ideas that will support recovery networks and their development. It is ideally suited to the asset-based approach as it brings focus to the sharing of strengths and assets in a positive environment. So far the Barrow and Workington conversation cafés have been vibrant and full of ideas that have included such things as social media development, ways to challenge stigma and sharing of workspace.

Community connections 

We have also begun work to build relationships with 12-step and other mutual aid organisations. North West representatives from Narcotics Anonymous came out to Barrow-in-Furness to put on a ‘myth-busting’ event to support positive, reality-based links that ensure people accessing treatment services get a full range of recovery choices, and Unity are now working to support the set up of new NA meetings in Cumbria. In Carlisle the Unity team and partners linked with an Alcoholics Anonymous public meeting, building important relationships to facilitate more informed choice for people accessing services. This linkage has been further developed after Mark Gilman’s visit to the city to promote mutual aid facilitation, as AA will be hosting an open meeting to introduce the 12 steps at Unity’s Botchergate centre from September. In HMP Haverigg we will soon have Smart Recovery meetings taking place, with staff members currently in training. 

To mix metaphors for us, recovery is not a bull at a gate but a rising tide, as it becomes more visible in Cumbria. What I love about it is its diversity – each locality doing its own thing, demonstrating, I think, that we were right not to centralise our ideas. The beauty of it is how, as the varied organisations and their members develop in their own local communities, there is increasing talk of wanting more contact with each other, and we hope to help everyone get together this month for our very own Cumbria recovery walk. 

The next recovery conversation café is planned for 24 September in Carlisle.

Ashley Gibson is community development lead at Unity Drug and Alcohol Recovery Service, Cumbria.

Soapbox

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DDN
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Get them young

It’s time to overcome our paralysis on tackling young people’s drug use, says Kate Iorpenda of the International HIV/AIDS Alliance. 

Article 3 of the UN Convention on the Rights of the Child declares that in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. With this in mind, the issue of drug use among children – and in particular injecting drug use – is one that raises a number of ethical dilemmas and consequent heated debate among practitioners.

Perhaps it’s because we find the reality of children and adolescents using drugs too difficult to face. Or perhaps it’s because supporting young people to use drugs more safely seems irresponsible and contrary to the values of protecting children. Whatever the reason, the comprehensive services that are available to young people in some countries are not currently translating into service provision in poorer countries.  In such contexts we need to be asking ourselves: have we consulted with young people to find out what they want and are we well enough informed about the types of drugs they take and their patterns of use? Otherwise we run the risk of being paralysed by the ethical dilemmas and conflicting values about what it might mean to be providing teenagers with clean needles.

Injecting drug use is a key driver of HIV epidemics in regions like Eastern Europe and Central and South East Asia, and the little available data we have indicates that in some countries children start injecting at a very young age. The lack of funding and attention to the needs of young people who use drugs has resulted in a situation where we lack concrete data on the extent of their drug use. However we do know that children with histories of abuse, mental health problems, and drug dependence in the family are among those at higher risk.

Adults have rights and choices about services and can be helped to seek other support – counselling, debt advice, housing – but with children there is a duty of care, and so service providers need to think both about safeguarding that duty of care and about how far it extends, given the complex and multiple needs of many young people who inject drugs.

Children and young people are often hidden within harm reduction services due to age restrictions and fears around asking and documenting age. In some countries, legal systems criminalise children as young as eight for drug use but deny them access to harm reduction services until they are 18. Additionally, service providers are often poorly prepared to work with young people, running programmes that don’t meet their needs and which have been designed without their input.

What kind of system punishes a child for drug use by incarcerating them in an adult prison? So many rights are being denied while we make up our minds on such issues. We need to know so much more about young people and their drug use and to recognise the diversity involved: different ages, different contexts, different genders, different drugs. We have to find ways within existing legal frameworks, good or bad, to ensure that we listen and respond. We need to collectively challenge the systems that continue to deny young people access to evidence-based interventions because of their age, but we also need to go beyond global policies.

Instead we must face the problems head on and listen to young people, find the missing data, face the unpalatable truth about the extent of their drug use and the systems that violate their rights. We need to confront uncomfortable choices to ensure that young people have access to information and services that they need and respect, and to support and protect their ability to make decisions. Easy to say and so much harder to do, but we are going nowhere unless we get over our paralysis.

Kate Iorpenda is senior advisor on children and impact mitigation at the International HIV/AIDS Alliance, www.aidsalliance.org

The International HIV/AIDS Alliance is supporting the Support. Don’t Punish campaign (supportdontpunish.org) which calls on governments to bring an end to the criminalisation and punishment of people who use drugs.

Policy scope

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Marcus-Roberts_2webWhat’s going on?

 What is happening to the commissioning landscape and how will it affect us, asks Marcus Roberts

 With the new commissioning structures now starting to kick in at local level, what, if anything, do we know about the impact on drug and alcohol services?

Recent figures from the Department of Communities and Local Government (DCLG) suggest that investment in our sector may have risen slightly this year compared to 2012-13. The unappetisingly titled Local authority revenue expenditure and financing: 2013-14 suggests that 37 per cent of the local public health budget is going into drug and alcohol services.

The figures are described, however, as ‘the latest national statistics on budget estimates’ rather than a record of the actual spend. At least one unitary authority is recorded as budgeting nothing on substance misuse, while others record surprisingly large rises. It is also unclear what significance the government attaches to this analysis. It appeared like a bolt from the blue without herald or fanfare (although DCLG is required to ‘share’ the findings with PHE which will ‘review’ them on behalf of the secretary of state for health).

DrugScope has also been dipping into joint health and wellbeing strategies emerging from health and wellbeing boards. We can report that some of them have more to say about drugs and/or alcohol than others. It’s more difficult to know how to interprete this. It is a worry if key strategic documents are muted or silent on substance misuse. But some local areas could be developing their strategies to hone in on areas where they want to innovate or improve (or they could be developing separate strategies for particular types of service). From this perspective, a lack of reference to drug and alcohol services could be more a signal of broad satisfaction with local provision, than a mark of indifference. Again, it’s hard to say. 

We can also report that it is messier out there in local authorities than an organogram derived from national policy might lead one to expect – although I guess that is what one should expect from ‘localism’. DrugScope has, for example, been in contact with the London boroughs to find out how their commissioning structures may be morphing post April 2013. Only three said drug and alcohol commissioning was now located in public health.

DrugScope is currently developing an ‘observatory’ as part of work with the Recovery Partnership to monitor what is happening in local areas. Perhaps the main message from our initial forays is that marshalling and analysing current resources can feel a bit like a combination of wrestling jelly and sitting a particularly vexing exam. Still, landmarks and signposts are beginning to emerge from the fog, and, hopefully, a clearer sense of what is happening will take shape in the months ahead. The truth is it may be 2014-15 (or the year after) before all the pieces fall into place and a full picture of the overall impact takes shape.

The DCLG statistics referred to in this column are at http://bit.ly/15uXGDH

Marcus Roberts is director of policy and membership at DrugScope, the national membership organisation for the drugs field, www.drugscope.org.uk

News in brief

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DDN
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Talk it over

A guide for parents on how to talk to their children about club drugs has been published by Adfam, the Angelus Foundation and Chelsea and Westminster Hospital’s club drugs clinic. ‘The involvement and support of parents and families can make a big difference to someone’s health and how they deal with taking legal highs and club drugs,’ says Talking to your children about legal highs and club drugs: a parent’s handbook.

 Available at www.angelusfoundation.com

 

TB capital

London has the highest TB rates of any western European capital, according to a report from Public Health England (PHE). Thirty-nine per cent of the 8,751 cases of TB reported in the UK in 2012 were in London, although UK rates have remain­ed ‘relatively stable’ since 2005. More than 7 per cent of cases had ‘at least one social risk factor’ such as problem drug or alcohol use, imprison­ment or a history of homeless­ness, says Tubercu­losis in the UK 2013 report. ‘TB remains a critical public health problem, particularly in parts of London and among people from vulnerable communities,’ said PHE’s medical director, Dr Paul Cosford.

 Report at www.gov.uk

 

Styal-ish service

A new drug and alcohol recovery service has been launched by the Lifeline Project at women’s prison HMP Styal in Cheshire. The fully integrated programme will operate in partnership with Delphi Medical and Acorn Treatment and include ‘ambitious recovery outcomes relating to health and wellbeing, employment and self-esteem’.

 

Your very good health

The World Health Organization (WHO) has published a report on alcohol and health in Europe, looking at consumption levels and harm as well as the effectiveness of recent policy developments. Meanwhile, nearly 40 per cent of ten to 17-year-olds who use social networking sites had seen images of their friends drunk, according to research from Drinkaware. ‘Children as young as ten are seeing drunkenness normalised,’ said Drinkaware’s marketing and communications director Anne Foster.

 Status report on alcohol and health in 35 European countries 2013 at www.euro.who.int

 

New release

Release has launched its new website, featuring a dedicated harm reduction section as well as enhanced policy and legal advice pages. ‘We’re really excited about the new website, which we believe is one of most comprehensive and informative sites in respect of drug information, harm reduction and legal issues faced by people who use drugs and their families,’ said executive director Niamh Eastwood. ‘The format is attractive and accessible and we hope people will sign up to the newsletter to keep up to date with Release’s work and developments in the field.’

 

Re:Cover your talent

Phoenix Future’s Re:Cover music project wants to hear from people who have been affected by drug or alcohol addiction – whether their own or someone else’s – and have ‘a passion for making music’. Those selected to take part will get an expenses-paid day in a studio with an industry mentor to record songs offering an insight into addiction, with the final versions posted online for a public vote. Winners will receive a prize package worth £1,500.

 Details at www.phoenix-futures.org.uk

 

Making connections

A report on homelessness and substance use has been launched by the London Drug and Alcohol Network (LDAN) and DrugScope. Statistics suggest that only a quarter of rough sleepers in central London do not have support needs relating to drugs, alcohol, mental health or a combination of the three, says Making connections to build recovery.

 Available at www.drugscope.org.uk

 

Care cash

Voluntary sector funding to help ‘improve people’s health and wellbeing’ has been announced by care and support minister Norman Lamb. The Innovation, Excellence and Strategic Development (IESD) fund will be awarded to organisations that can demonstrate a commitment to personalisation and choice of care, compassion and improving public health.

 Details at www.gov.uk/government/publications/voluntary-sector-funding-available-for-health-and-care-projects

Your letters

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DDN
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On the bandwagon

As a community-based provider of substance misuse services I was interested to read John Jolly’s views on procurements and tendering which will no doubt resonate with many in the field (DDN, August, page 20). He clearly makes some valid points.

Throughout the years there have regularly been calls for the substance misuse field to unite and work together so as not to pit one provider against another to the detriment of, as John puts it, the ‘local third sector organisation operating and attuned to local communities’. However, we all know this hasn’t happened and we all probably know why, when ‘profit motivation’, ‘survival’ or ‘growth’ have got in the way of ethics.

But isn’t it best not to put all the blame on commissioning when organisations have been so keen to jump on this bandwagon. Maybe it would be better to make sure our own practices are in order first and that we too aren’t, in some way, a part of the demise of a vibrant local provision, before we point the finger elsewhere.

Sue Kenten, CEO, DASL

 

High and dry 

I’m worried about the hidden alcoholics. They have always been left out of the loop. They don’t come under Supporting People because they don’t have housing issues as they own their own houses. They don’t come under peer mentoring as they don’t need education, training or employment as they work or own their own businesses or are retired. They don’t come under DIP as they don’t have a criminal record. If they score under 20 or have come out of detox or rehab, they are no longer seen by the substance misuse service. There is no aftercare or relapse prevention for them. They are left high and dry, worried that they will relapse (which in most cases they do) without support.

We need empathic support workers who can offer relapse prevention and who can visit them in their own homes where they feel more comfortable. Hidden alcoholics are proud people who don’t understand why they have reached rock bottom. They are too embarrassed to admit it to their families. In most cases they want instant support, because they don’t know the procedure or system that they have to go through to get help.

We also need sympathetic, empathic people to visit service users in hospital. Some have never been under the treatment services (this world is alien to them) when they are left by their families, partners (who don’t understand why they drink or take drugs) to languish for weeks on end. With no one to speak to, in some cases they come across unsympathetic medical staff who don’t realise that most alcoholics drink because of something that has happened in their lives.

I’ve spent hours sitting by the bedside of clients who just want to see a friendly face. I founded AGRO because there was no support for service users in the evening and weekends. I’m now in the process of helping to start something similar in Pembrokeshire called The Peer Project with a lady called Leigh Proctor.

As a recovering alcoholic myself, I spend a lot of my spare time thinking of ways to support fellow service users to make their lives easier. Every new project I come up with has come from what I have seen and heard while working as a substance misuse support worker for more than ten years.

Huw Harries, co-founder/chairman, Anglesey & Gwynedd Recovery Organisation (AGRO)

 

Seeing red

As a supporter and practitioner of most Green Party topics, I have considerable respect for Caroline Lucas, but not in regard to her attitude towards addiction issues.

The fact that in 2013 she still ‘wants the government to acknowledge that current policy is flawed’ (DDN, August, page 16), and also that she would ‘like to think that there’s a point at which ministers have to change course’, is strong proof that she has not read the current coalition government’s 2010 drug strategy.

For some 61 years, the sort of policies she rightly condemns have been condoned by successive governments of all colours – until the election of this government, who immediately acknowledged that the existing policy was flawed and declared that the country had to change course in major ways to head us towards a drug-free society. 

And the strategy they announced was fabulous when compared to what had gone before for six decades, ie pretty much what Caroline Lucas appears to look for.

The first strand of their new policy is ‘reduce demand’, which they are striving for by seeking to recover addicts from their addiction – because they have understood that it is addicts who create demand, not non-users.

They have also set a goal for ‘recovery to lasting abstinence’ in place of ‘habit management’, and underlined this by disbanding the NTA and introducing Payment by Results based on a certified outcome of ‘12 months free of addictive substance usage’.

But it takes time to dismantle and replace the deeply embedded failed policies of more than 60 years, especially as there has been not only the usual inertia and natural resistance to change, but also determined efforts both overt and covert by the long incumbent treatment providers, commissioners and prescribers to protect their jobs, incomes and the tolerant lack of real results they have long enjoyed.

So let’s avoid uninformed calls for changes until the current 2010 drug strategy is actually out of the starting blocks and into delivering a return to the natural state of relaxed abstinence into which 99 per cent of the population is born.

Kenneth Eckersley, CEO Addiction Recovery Training Services (ARTS)

 

Are you a social worker?

Or perhaps you have a colleague who is? The British Association of Social Workers (BASW) Special Interest Group (SIG) in Alcohol and other Drugs is looking to establish a database of social workers specialising in substance use. 

The SIG is keen to ensure its events and resources meet the needs of professionals who specialise in substance use as well as those who specialise in other areas of social work practice and who want to learn more about responding to substance use.

We would use the database for consultation on policy responses, as well as consultation on future events and resources.

If you would like to be added to our database, please contact Sarah Richards at BASW on s.richards@basw.co.uk or the chair of the SIG, Sarah Galvani, on sarah.galvani@beds.ac.uk.

Sarah Galvani

 

Make music

The Phoenix Re:Cover Music Project, is looking for anyone who has been affected by addiction and want to use their passion for making music to communicate their experience and story.

The project will give a small number of people the chance to record two songs, one original and one cover, both of which tell a story or give an insight into addiction. Each solo artist or group will have a day in a recording studio to record their songs  with the help and support of an industry professional mentor. The final recorded songs will be posted online for the public to vote on their favourite and the solo artist or group with the most votes will receive a prize package worth £1,500 (to spend on, for example, making a music video, vouchers for musical equipment, or music training sessions).

Have you or someone you know been affected by drug or alcohol addiction? Do you have a passion for making music and want to communicate your story? If so you can apply today.

Any support for the project is really appreciated; we need people to spread the word and we’d also be interested in speaking to anyone who’d like to partner with us for an even more ambitious Re:Cover in 2014.

To find out more about supporting, or applying to, the project, visit www.phoenix-futures.org.uk/recover or contact me at recover@phoenix-futures.org.uk.

Vicky Holdsworth, marketing officer, Phoenix Futures

 

Legal Line

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DDN
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Kirstie ReleaseReader’s question:

Last year I was badly beaten up, and the police never found the person who did it. I have been in and out of hospital for operations; I am still in pain and am very anxious when I go out by myself.  I applied for compensation but was refused because the police said I had been drinking and taking drugs and ‘provoked what happened’. I had a few pints that night and smoked cannabis earlier in the day but wasn’t drunk or stoned, and was minding my own business when I was attacked.

Kirstie says:

Compensation for criminal injuries is dealt with by the Criminal Injuries Compensation Authority (CICA). There are rules that decide if someone should get any money, and if so how much. Each injury has an amount of money attached to it, and this can be decreased for a variety of reasons.

An award might be refused or reduced because of the way the victim behaved during the incident.  CICA will look at police reports, witness statements and other documents to decide what happened and if you contributed to what happened in any way. It may be that witnesses have said that you started the fight or were acting aggressively before being attacked. The use of drugs and alcohol alone isn’t enough to refuse or reduce an award but, combined with the behaviour described in statements, it might lead to CICA deciding not to give you compensation. Being under the influence of drugs or alcohol can’t excuse a victim’s actions.

The character of the victim will also be considered, and involvement with illegal drugs is one of the factors here. This does not necessarily mean convictions for drugs offences, but unspent convictions for any offence will also play a big part in whether an award is made.

You can ask CICA to review their decision within 56 days of the date the decision was made. You will need to provide supporting evidence, which might include statements from independent witnesses, medical tests showing the level of alcohol and drugs in your system at the time and expert reports on the effect of this. A different claims officer will look at your application again and decide if you should get the full amount for your injuries or a lower amount.

If you still disagree with the decision after review you can appeal to an independent tribunal within 90 days of the new decision. You should think carefully about this as the panel can withdraw any offer that has been made. Legal aid is not available for these appeals, but some solicitors offer representation on a no win, no fee basis where you only pay them if they win the case. CAB or local law centres might also be able to advise you.

Will you share your issue with other readers? Kirstie will answer your legal questions relating to any aspect of drugs, the law and your rights through this column. Please email your queries to claire@cjwellings.com and we will pass them on.

Family Matters

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DDN
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Joss-Smith_0042_2WEBVoices of strength

While the sun is still shining and we enjoy the rest of the summer at Adfam HQ, our thoughts have turned to chillier festive times as we start to plan our annual carol concert. Each year this event is lit up by the words of families who have lived through a loved one’s addiction and entered our Family Voices competition. It always serves as a wonderful reminder of their strength and resilience to get through the dark times, but also in speaking out to share their stories.

Last year’s winners aged from seven years to in their 60s, highlighting the huge impact drugs and alcohol can have across the whole life journey of family members. Our winner last year was a grandmother who shared the pain of seeing her grandson grow up with parents who use drugs.

MY GRANDSON

A tiny baby wrapped up so tight

Crying helpless through the night

What’s wrong? He looks fine to me

But his pain is deep where we cannot see

A pain that was put there by his mummy

Because she took heroin while he was in her tummy

This tiny baby is growing up strong, looks around and thinks ‘what’s

gone wrong’?

Why has my life been so sad when all I want is a mam and dad?

A mam and dad he needed most but instead he was passed from pillar

to post

First his dad, then his mam, but he always had to go back to his gran

His gran was the one who held him tight, kept him safe through

the night

But he knew this wasn’t how things should be, why could one of them

not see?

They tried and tried but all in vain to rid themselves of all the pain

One would duck one would dive one would run one would hide

One way out… they had to split to rid themselves of all of it

They did the thing they thought was right

But one won the battle… one lost the fight

Now 16 years and college bound that tiny baby won’t look around

He’s come through so much but he’s not sad

Today he’s happy… he lives with his DAD

Joss-Smith_0042_2WEBIf you would like to enter this year’s competition you can find the details on our website or email your entry to carols@adfam.org.uk. 

Joss Smith is director or policy and regional development at Adfam, www.adfam.org.uk

Black people six times more likely to be stopped and searched for drugs

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DDN
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racerelease11

 

 

 

 

 

 

 

  

 

 

Black people are stopped and searched for drugs at 6.3 times the rate of white people, according to a new report from Release and the London School of Economics and Political Science (LSE). Asian people are also stopped at 2.5 times the rate and those identifying as mixed race at twice the rate, says The numbers in black and white: ethnic disparities in the policing and prosecution of drug offences in England and Wales. 

Black people are also more than twice as likely to be charged if any drugs are found, it says. In 2009/10, 78 per cent of black people caught in possession of cocaine by the Metropolitan Police were charged and 22 per cent given cautions, while among white people 56 per cent were given cautions and just 44 per cent were charged. Black people are also five times more likely to be charged for possession of cannabis. 

Members of the black community are also more than four times more likely to be subject to court proceedings and found guilty than white people for possession offences, and five times more likely to face immediate jail, states the document.

The Crown Prosecution Service brought more than 43,000 prosecutions for drug possession in 2010 – the highest since the introduction of the 1971 Misuse of Drugs Act – 60 per cent of which were for cannabis offences, while 1.2m criminal records were issued for drug possession offences between 1996 and 2011. More than half of all stop and searches are for drugs, compared to 10 per cent for offensive weapons and less than 1 per cent for guns. 

‘The policing and prosecution of drug offences is not being equally applied to all those who use drugs,’ the report concludes. ‘It is impossible for the state to police the estimated 3m people who use drugs annually in the UK. Instead, certain groups are the focus of enforcement,’ with the ‘deliberately inflicted pains of drug control’ falling most heavily on ‘poor and visible minorities’.

‘This research shows that stop and search is not about finding guns or knives but about the police going out and actively looking for people who are in possession of a small amount of drugs, mainly cannabis,’ said Release executive director and co-author of the report, Niamh Eastwood. ‘Black people are more likely to get a criminal record than white people, are more likely to be taken to court and are more likely to be fined or imprisoned for drug offences because of the way in which they are policed, rather than because they are more likely to use drugs. Despite calls for police reform of stop and search little has changed in the last three decades – this is why the government needs to take action and change the law.’ 

Release has called for drug possession offences to be decriminalised in order to ‘eliminate a significant source of discrimination with all its damaging consequences.’

Available at www.release.org.uk

Government consults on proposals for new drug-driving offences

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DDN
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Drug-drivingThe government has published plans to make it easier to prosecute people who drive under the influence of drugs. A new offence of  ‘driving with a specified controlled drug in the body above the specified limit for that drug’ is to be introduced, designed to ‘reduce the wasted time, effort and expense’ of failed prosecutions.

The proposals are contained in a consultation document, which also looks at penalties for driving when impaired by certain prescribed drugs, although the government has stressed that drivers who had taken ‘properly prescribed’ medicines would not be penalised.

The consultation sets out a ‘zero tolerance’ approach to driving under the influence of cannabis, MDMA, cocaine, ketamine, LSD, methamphetamine, benzoylecgonine, heroin and diamorphine, with limits set at the ‘lowest level at which a valid and reliable analytical level can be obtained’ but designed to rule out ‘passive consumption’ or ‘accidental exposure’.

There will also be a limit for amphetamine, as yet to be confirmed, along with limits for eight controlled drugs that ‘have recognised and widespread medical uses’ but which can also affect the ability to drive, including methadone, morphine, temazepam and diazepam. Penalties will include an automatic driving ban of at least a year, as well as a maximum fine of £5,000 and potential custodial sentences.

Although police will not be able to conduct random tests, they will have the power to administer a preliminary drug test if someone has been in an accident, committed a traffic offence, or if the officer ‘suspects that a driver has a drug in his body or is under the influence of some drug’. Police will be allowed to administer up to three preliminary saliva tests, to be followed by arrest and the requirement for a blood test if positive.

‘Drug driving is a menace which devastates families and ruins lives,’ said roads minister Stephen Hammond. ‘That is why we are proposing to take a zero tolerance approach with those who drive under the influence of illegal drugs and sending a clear message that this behaviour will not be tolerated.’

The government has also launched a consultation on the prescription drug tramadol, saying that it wants to make it a class C drug while ensuring it remains ‘available to those who need it as a prescription medicine’. The announcement follows a recommendation by the Advisory Council on the Misuse of Drugs (ACMD) that the painkiller should be placed in Schedule 3 of the Misuse of Drugs Regulations, which allows controlled substances to be prescribed and legally possessed.

The ACMD had expressed concern at the misuse of tramadol, with the number of deaths involving the drug nearly doubling – from 83 to 154 – between 2008 and 2011.

Drug driving consultation at www.gov.uk/government/consultations/drug-driving-proposed-regulations, until 17 September.

Tramadol consultation at www.gov.uk/government/consultations/scheduling-of-tramadol-and-exemptions-for-temazepam-prescriptions, until 11 October.

 

Minimum pricing ‘will not be taken forward’

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DDN
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MUPMinimum unit pricing will ‘not be taken forward at this moment’, the government has announced in a statement on the outcome of its alcohol strategy consultation. There will also be no ban on multi-buy promotions.

There was not enough ‘concrete evidence’ that minimum pricing would help reduce alcohol harm without penalising responsible drinkers, crime prevention minister Jeremy Browne told MPs. However alcohol sales below the level of alcohol duty plus VAT would be banned from next spring, meaning it would no longer be legal to sell a can of lager ‘for less than about 40 pence’.

There was also ‘a lack of convincing evidence’ that a ban on multi-buy promotions would have a significant effect on reducing consumption, he said, adding that its introduction would be unreasonable ‘at a time when responsible families are trying hard to balance their household budgets’.

The government would tackle irresponsible promotions by making mandatory licensing conditions more effective, he stated, and promote responsible drinking by ‘raising customer awareness of the availability of small servings’. It would also work with ‘high harm local alcohol action areas’ to improve enforcement, strengthen partnerships and ‘increase good practice of what works locally’.

The alcohol industry now had ‘an opportunity to demonstrate what more it can do to reduce harms associated with problem drinking’, he continued. ‘We want fair and effective policies,’ he said. ‘We are not in the business of making laws that do not work.’

The statement was instantly welcomed by industry bodies. British Beer and Pub Association chief executive Brigid Simmonds said that the decision not to ban multi-buy promotions recognised ‘the lack of evidence that this encourages over-consumption, rather than providing value and convenience for shoppers’, while Portman Group chief executive Henry Ashworth said that ‘through a series of voluntary pledges aimed at improving public health, the industry has proven itself to be committed and willing partners and welcomes the opportunity to continue this successful approach going forward.’

The industry’s win, however, was a ‘grave loss for the public health of the nation’, said Alcohol Concern chief executive Eric Appleby. ‘The alcohol industry must be congratulating themselves on their success at lobbying government to bin minimum unit pricing.’

Abandoning the plans amounted to a public health ‘catastrophe’, he said. ‘In the government’s own alcohol strategy it committed to tackling alcohol misuse by making tough decisions, including introducing minimum unit pricing, a policy proven to cut crime and save lives. Sadly, with this announcement, cheap alcohol will continue to be sold at pocket money prices.’

The government’s decision also led to an announcement by Cancer Research UK, the Faculty of Public Health and the UK Health Forum that they were pulling out of the government’s public health responsibility deal alcohol network, along with network co-chair Dr Nick Sheron, head of clinical hepatology at the University of Southampton. ‘Talk of “punishing the hard worker” who can afford few other pleasures than a pint of mild is a red herring,’ said a joint statement. ‘It is our most deprived communities who pay the highest price for cheap alcohol through the consequences of street crime, violence and younger people developing alcohol-related health problems.’

Organisations including Alcohol Concern, the British Medical Association, the Royal College of Physicians and the British Liver Trust refused to sign up to the controversial deal in 2011, accusing the government of allowing the drinks industry to dictate health policy.

PMA in ecstasy tablets warning

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DDN
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PMADrugs agencies have reacted with concern to the number of recent deaths thought to involve PMA, which can be present in ecstasy tablets or pills being sold as ecstasy. Deaths have been reported in England, Scotland and Northern Ireland in recent weeks.

PMA can take longer to have an effect than ecstasy, with the risk that people take repeat doses in the belief that the drugs are not working. The Department of Health has issued a health alert to NHS and public health networks about ‘reports across regions in the UK of cases of hospitalisations and sudden deaths linked to the use of ecstasy-like pills. It has been reported that pills taken by those affected have contained, either alone or in combination, para-methoxyamphetamine (PMA), MDMA (the usual active ingredient expected in “ecstasy” pills), or other ecstasy-like stimulants.’

The pills reported in recent cases have ‘been described with a variety of colours and with a variety of different logos stamped on them’, says the document, with warnings issued about ‘pink ecstasy’ tablets and, in Scotland and Northern Ireland, ‘green Rolexes’.

‘With the festival season under way, those who are using ecstasy need to be extra vigilant,’ said DrugScope chief executive Martin Barnes. ‘There is no way of knowing whether or not a pill contains PMA.’

Meanwhile, new figures from the Home Office have led the government to claim that drug use in England and Wales is at its ‘lowest level since records began’. Just over 8 per cent of adults are estimated to have used an illicit drug in the last year, compared to more than 11 per cent in 1996, according to Drug misuse: findings from the 2012/13 crime survey for England and Wales. In 2012-2013, 2.8 per cent of 16 to 59-year-olds were defined as frequent drug users – based on having taken any illicit drug more than once a month on average – down from 3.3 per cent in 2011-12.

The statistics are based on Crime survey interviews with around 21,000 adults aged 16 to 59. Questions on use of the legal drugs salvia and nitrous oxide were added for the first time and revealed that more than 6 per cent of 16 to 24-year-olds had taken nitrous oxide in the last year and more than 1 per cent had taken salvia.

‘It is worrying that the report shows there is a disproportionate number of people aged between 16 and 24 taking these types of drugs, compared to the overall number of 16 to 59-year-olds using legal highs,’ said regional development manager at Swanswell, Jo Woods. ‘We welcome this report and are pleased to see the Home Office recognising the developing problem.’

Report at www.gov.uk

Enterprise Corner

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DDN
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Amar_smallWEBNola and Jackie are living proof that you can turn life’s adversities into business opportunities, says Amar Lodhia.

Our vision statement guides our work: ‘Our vision is to create an enterprising and entrepreneurial society that does not hold people back from becoming successful.’

 When you hear from people like Nola and Jackie you feel that we all can bridge the gap between aspiration and inspiration and you reiterate the fact that we all can make an impact and a difference in people’s lives. Lest I bore you with my motivational talk, let me delve more into the real stars of this tale, Nola and Jackie – two of the participants from our City of London E=MC2 programme.

 When Nola left prison, she came back home and looked for a job to no avail, but since she joined the TSBC programme she has started her own business, an initiative to get ex-offenders into work, called ‘Wanna work’.

 When Nola completed her prison sentence, she came back home and looked for a job to no avail. She believed she was being stereotyped by employers because of her past criminal history, then thought: ‘I have served my time and I am a better person but why does society want to hold me back?’

 In her new life chapter, TSBC’s E=MC2 programme has inspired her to start her own community interest initiative for those who have left prison and are searching for work. ‘I think the course is excellent, well delivered and practical learning models were used,’ she said. ‘I have been able to put my ideas into practice and make steps towards starting my own business.’

 We see a serial entrepreneur in the making, as Nola has several other start-ups in the pipeline, including an organic food catering business.

Jackie had been unemployed for years after she had finished serving her probation and was on benefits. However unhappy, she continued teaching drama classes to children, although she knew she had more to offer society.

 She was invited to the TSBC E=MC2 programme by a friend and it created a world of hope and opportunities for her. She has started her baby clothing business and has stopped collecting benefits. ‘I enjoyed the fact that E=MC2 helped me to push myself a lot and gain more business skills,’ she said.

 Jackie’s future is filled with aspiration and hope. She now feels independent and in control of her future, and is not dependent on government benefits or even employment anymore. She is very excited about her baby clothing manufacturing business. She has her business plan, design prototype and the support of her TSBC mentor, and is ready to take on the world.

 To enquire more about our work please contact me at ceo@tsbccic.org.uk and follow me on Twitter @amarlodhia or @tsbclondon – don’t forget to use the #tag DDNews when tweeting!

Amar Lodhia is chief executive of The Small Business Consultancy CIC (TSBC), thesmallbusinessconsultancy.co.uk

Nothing to declare

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In the sixth and final part of his personal story, Mark Dempster experiences an unlikely epiphany

It had been a choice between prison or detox and treatment.

I took detox and treatment. After a while prison began to seem like the choice I should have made: I had a drug counsellor who was constantly getting in my face and I had to sit in circles with idiots talking about ‘feelings’. I hadn’t had a feeling much other than sick or numb for years, let alone have a discussion about them. The only thing that kept me there was that my drug counsellor was like me; Scottish, feisty and had been a junkie and criminal.

They made me go to 12-step meetings. I had been detoxed from alcohol and drugs and four months later I was at one of these 12-step conventions. There were hundreds of addicts like me, but they looked happy – I couldn’t understand what they had to be happy about. Then I heard a woman talking on stage. It was the same as all the others – took drugs, got bad, got clean. I was zoning out.

Then she said something that woke me up: ‘In recovery, I got tested and was diagnosed with HIV’. She stopped what she was saying and started crying. She broke down on the stage, in front of everyone. I was embarrassed for her. Then somebody behind me shouted ‘we love you’. Then another, and another – until the entire hall of addicts were shouting and whooping and clapping.

That’s when it hit me. This is where I am meant to be. All those years, all those scams, all those drugs – all I wanted was this. I wanted to belong.

It wasn’t all plain sailing after that. Detoxing was the easy part. I was 32 and had no idea how to live like normal people. Everything, from making a cup of tea to getting a part-time job, was a first without drugs. Slowly, one day at a time, I learnt how to live without a drink or a drug. I was able to make amends to the people I had hurt. I was able to look my dad in the eye and make peace with him before he died. I was able to be a son to my mum again.

Seven years after getting on my knees and begging for help in St Thomas’s toilet, I found myself in the same cubicle after the birth of my son. I looked at my reflection in the mirror and compared my happiness and joy with the despair and dereliction of myself seven years before. I started to cry. This time they were tears of gratitude. I was alive and I was happy.

It’s been 16 years since I went into that detox. In that time I’ve made some mistakes, but I’ve never picked up a drink or a drug. I’ve got two beautiful children, a loving girlfriend and my own counselling practice in Harley Street.

Most of all I have a peace of mind that I never thought possible.

Mark Dempster is author of Nothing to Declare: Confessions of an Unsuccessful Drug Smuggler, Dealer and Addict, available now on Amazon.

Mark runs a Harley Street counselling practice and is an expert consultant and trainer in addiction, www.markdempstercounselling.com

Prescription for action

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At a parliamentary debate, ADS brought together experts to tackle the pervasive problem of addiction to prescription drugs. prescription2

Last month Addiction Dependency Solutions (ADS) held a seminal event in parliament, Addiction to prescription drugs, with the Labour shadow health secretary, Andy Burnham.

The event was a Question Time style debate on this topical issue and consisted of a panel of clinicians, service users and experts in their respective fields, with direct experience of addiction to prescription drugs and treatment services.

It was the first time an event on this issue had been held in parliament and marked a momentous day for many people in the room who had been campaigning for many years for increased awareness of the debilitating effects of addiction to prescription drugs such as benzodiazepines. Addiction to these drugs has devastating and lasting effects on individuals and their families, and the event highlighted the need for increased provision of direct and targeted treatment services for those who are addicted.

Little treatment available

Currently, there is little treatment available for those who suffer from prescription drug addiction, with only a handful of services dedicated to this issue in the UK. As a progressive charity, ADS aims to represent those who need help the most. Working with Oldham PCT and Barry Haslam of Oldham Tranx (a voluntary support group for those suffering from addiction to prescription drugs) ADS started providing an addiction to prescription drug service in Oldham in 2004, and – by working with dynamic commissioners – now provides another service in Derby that was recognised as a model of best practice at the Westminster event. 

The event was chaired by Andy Burnham MP and consisted of a panel with Lady Rhona Bradley, chief executive of ADS; Dr James Davies, lecturer in social anthropology and psychotherapy at Roehampton University; Dr Jack Leach, consultant in substance misuse; Dr Richard Martin, assistant director of Public Health for Derby Council; James Sutherland, lead commissioner for public health for Derby Council; Barry Haslam, chair of Oldham Tranx and John, service member of Oldham Tranx. Each panellist had time to outline their own background, experience and views on addiction to prescription drugs before the debate was widened, and questions taken from the floor.

All the panellists were of the opinion that addiction to prescription drugs was an issue that had been buried under the carpet for too long and agreed that centralised action was needed on a national scale to offer guidance and results. Barry Haslam drew on his own experience of addiction to prescription drugs, describing the lack of help he received and the resultant health problems he had suffered. This had spurred him on to campaign vociferously on the issue for the past 20 years.

‘Placed’ on prescription drugs 

ADSOne of the most striking comments of the day came from Dr James Davies. In discussing how people were often ‘placed’ on prescription drugs without getting to the root of the problem – often as a result of anxiety and stress – he said: ’Fifteen per cent of the British public at one time are on some form of prescription medication as a result of mental health issues.’ This statistic highlighted the scale of the problem, with many of these drugs addictive within four weeks and resulting in dependence in as little as six weeks.

The panel’s consensus was shared by the audience, with questions reflecting the need for increased political awareness and action. One audience member, Dr Malcolm Lader, drew on years of experience to highlight the divisive role prescription drugs were playing in our society, and called for direct treatment to curb their long-term ill-effects.

With a member of Public Health England in attendance, it was left to Andy Burnham to ask why current guidelines and protocols for services for prescription drug addiction were so weak. The PHE response was, ‘It is up to local authorities to take action on the issue following guidance from Public Health England.’ Andy Burnham responded: ‘That doesn’t answer the question. Clearly more needs to be done.’

As panellists drew on their expertise and personal stories from the audience mirrored their views, there was little doubt about the scale of the problem. Summarising, Burnham said it was time to take action on an issue that had been too long ignored in parliament. As Labour shadow health secretary, he would aim to realign health and social care as part of the NHS.

Lady Rhona Bradley said ADS would continue to ‘champion a cause that has clearly affected many in this country, and an issue that should be acted upon without haste.’

Report from Tom Whiting, development and grants officer at ADS

A vision to serve

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At an event organised by the London Drug and Alcohol Policy Forum, the challenge of not losing sight of the individual in the new public health landscape emerged as a prevalent theme.

GPs‘We were created as a response to what was a frankly appalling drug and alcohol treatment system in Sunderland,’ CEO of Counted 4, John Devitt, told delegates at the London Drug and Alcohol Policy Forum’s recent Our friends in the north event. ‘There were six- to nine-month waiting lists and very rigid prescribing regimes. We were set up to serve the people of Sunderland – it’s about treating people in the community in the normal way, without ghettoising them.’

A clinically led organisation and community interest company (CIC), Counted 4 employed doctors, nurses and drug workers, and provided a range of services in the home. It also tried to work in partnership with key providers, such as pharmacies, he said, and aimed to be client-focused, non-judgmental, accessible and community-based.

‘We’re living in a very interesting world – it’s a time of huge social change,’ he said, with welfare reform, funding cuts and the move to Public Health England all having an impact. While there had been positive changes – such as the focus on recovery – the poor were now being widely demonised, he stressed, which was having a profound effect on vulnerable people.

Sharing an ethos

Treatment staff were also worried about their job security, he said. ‘But the real question is who’s worrying about the clients? It’s also a unique situation in that the main political parties seem to agree on pretty much everything when it comes to these changes, and many charities are just toeing the line. Everybody talks about working in partnership, but partnership is about sharing an ethos, sharing working practices, sharing the good and bad times. Everyone’s going to have to move much more in that direction because we’re going to have to make the most of the resources we’ve got in the community.

‘The key thing is to stop bringing people into services,’ said the organisation’s recovery and tier 4 lead, Brian Hindmarch. ‘Take the services into the community.’

One of the biggest problems facing treatment was translating its founding vision across the workforce and to partner organisations, said Counted 4’s medical director, Dr Martin Weatherhead. ‘We can often say, “for this group of people we provide a fabulous service”, but I’ve not really come across a system that provides that across the board.’ 

While there had been no major change in the evidence base, there had been changes in the interpretation of that evidence base, he continued. ‘What we’re guilty of is extrapolation – there have been changes in emphasis, but no huge changes in fact.’ 

Keyworking was vital, he told the event. ‘Prescribing is just a little bit of oil in the engine of treatment – you can’t build everything around that. The medication hasn’t changed, the facts haven’t changed, but everyone’s now terrified of being seen as “parking” people on methadone. But there are people who need those higher doses. We’re moving back into a more regimented treatment world, and that does concern me.’ 

First priority 

Personal serviceOne problem that treatment needed to overcome was that NICE guidelines were constantly employed as obstacles, said one delegate. ‘If they don’t want to do something, or if they do, then you hear, “ah, it’s the guidelines”.’

‘As an industry, our customers aren’t our first priority,’ said another participant. ‘The drug treatment system has been awash with money for years, but no one ever says that everything’s working well.’ However it was impossible to commission ‘perfectly individualised’ services for everyone, replied another. ‘It’s a pipe dream. What you can do is get what’s best for that individual at that time, because it changes over time – people change, systems change, money flows change. You need flexible services that are responsive. A lot of it is about relationship management and being human – it’s a patchwork.’

While the recovery agenda contained a great deal of pros and cons, ‘one positive thing to come out of it is to try to get the best for your clients,’ commented another delegate. ‘But changing the ethos of an organisation can be like turning a tanker.’

‘Get to know the client,’ stressed one participant. ‘On paper they may look like one thing, but you need to get to know them. And continuity is vital.’ Having the right people with the correct skills set was vital, added another. ‘The right person for the right role.’

Personalised service

An obvious problem facing the sector was that budgets were no longer ring-fenced, a delegate stressed. ‘So we need to show that the things we commission are meeting what they’re supposed to. Ultimately it comes down to whether we’ll continue to be funded – and if the service is cut, that doesn’t meet anyone’s needs’, while others commented that disinvestment was already happening.

There were also significant problems around recruiting specialist GPs, Martin Weatherhead told the event. ‘The areas where you have the most problems recruiting doctors are deprived areas. Doctors are herd animals – they’ll go where the herd is grazing. There’s a huge recruitment crisis in general practice – the GPs who are working are overwhelmed and the last thing they want to do is make their lives even more difficult by working with people with substance problems.’

Risk was often used as an excuse not to act, commented one delegate. ‘Senior politicians need to have the ability to trust people to deliver, so they can prove the impact. You’ve got to protect your funding streams, but there’s no trust that things will actually be delivered. There’s got to be a better way than just telling us to tick boxes.’ 

‘You have to bring hope and aspiration into it,’ said John Devitt. ‘If you can’t do that – because you’ve had a crap day or whatever – then you’re messing with people’s lives and you shouldn’t be in this profession. We’re defining people by their symptoms, so you’re not designing the system for individuals. The key is personalisation – you’re providing a service here. It’s a privilege to be looking after these clients, and if you really believe that you’ll get the results.’ 

Green zone

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Caroline LucasGreen Party MP for Brighton Pavilion Caroline Lucas explains why she wants the government to acknowledge that ‘current policy is flawed.’

‘As an MP for a city with such high levels of drug-related harm, it would be negligent of me not to ask whether we could be doing things differently,’ says Caroline Lucas. ‘As well as identifying the national policies that get in the way.’ 

A member of the Green Party since 1986, she became one of the party’s first MEPs in 1999 and was made party leader in 2008, before being elected the UK’s first ever Green MP – ‘a privilege’, she says – for the constituency of Brighton Pavilion in 2010.

She’s currently enthused about a Private Members’ Bill she’s about to present calling for the railways to be brought back into public hands as franchises expire – ‘potentially saving the Treasury more than a billion pounds a year’, she says – but she’s long been interested in drug policy as well, sparked by a sense of injustice at seeing people ‘pointlessly criminalised’ and by frustration at what she considers to be doomed policies. ‘On an intellectual level it’s clear that current policies are failing,’ she says. ‘But I’ve also seen first-hand the terrible effects that’s having.’

‘Drug-death capital’

Brighton is famous for many things, but the grimmest was always the number of drug-related fatalities in the city, earning it an unenviable reputation as ‘drug-death capital of the UK’. Recent signs are encouraging, however. From 50 drug-related deaths in 2009, the number fell to 35 the following year, and, according to the Independent drugs commission for Brighton & Hove report from earlier this year, the indications are that ‘the trend is being continued through 2011 and 2012’. 

Problem drug use is still clearly a major issue in the city, but does she think it’s fair to say that the situation is improving? ‘Levels of drug-related harm and deaths in Brighton and Hove are still worryingly high, but good progress is being made,’ she says. ‘In the last few years we’ve seen, for example, a 17 per cent increase in numbers of people leaving treatment successfully, compared to the 7 per cent national average.’

Some of these improvements can be attributed to ‘different approaches being taken locally, in particular through intelligent commissioning,’ she says. ‘And we are saving more lives thanks to initiatives like making naloxone more widely available.’

In terms of different approaches taken locally, while the Brighton and Hove drug commission’s report included 20 recommendations – among them increased training in naloxone administration, better data collection on drug use trends and improving services for those with a dual diagnosis – the one the national media inevitably seized on was the call to establish consumption rooms. Or rather, to quote the actual wording of the document, to ‘convene a working group to explore the feasibility of implementing a form of consumption room, targeting those who are hard to reach and not engaged in treatment, as part of the range of drug services in the city’.

Mainstream media

Does she find that a frustration – are the press dictating the terms of the debate? ‘It would have been great for all of the drugs commission’s recommendations to have received the attention they deserved, but the press stories were always going to be about drug consumption rooms, and that at least put the report in the public eye,’ she states. ‘But I do think some of the popular press make it very difficult to have a nuanced debate about drugs policy. It’s clear that mainstream politicians won’t go near certain solutions – no matter how evidence-based they are – because they’re worried about the headlines in the Daily Mail.’

Nonetheless, decriminalisation is an increasingly mainstream topic of discussion in the media these days, something that was unthinkable a few years ago. ‘We’re not there yet – the immediate goal is the impact assessment,’ she says, referring to the call for a comprehensive review of the 1971 Misuse of Drugs Act. According to the petition she’s created on the government’s e-petition website, ‘nobody is checking whether Britain’s current approach is value for money or money wasted’.

It’s primarily about ‘getting the government to at least acknowledge that current policy is flawed,’ she stresses. ‘However, I don’t think decriminalisation in the future is out of the question, by any means. Some societies that you might think of as socially conservative – Portugal and Switzerland, for example – have introduced decriminalisation, or other policies based on health not crime, and seen positive results. If you believe in evidence-based policy-making and want to reduce drug-related harm, this is the logical first step.’ 

Global effort

Screen shot 2013-07-05 at 12.54.14She recently coordinated an open letter to the Times which, along with urging the government to agree to an independent review of the Act, exhorted the coalition to join ‘the global effort towards an alternative strategy based on evidence’. How confident is she that messages like that are going to be taken on board. 

‘I’d like to think that there’s a point at which ministers have to change course, just because the evidence is so compelling,’ she states. ‘But it’s difficult to say when. Certainly we’re making the case very strongly, and in terms that should appeal to ministers – our arguments are all about reducing the harms caused by drug addiction and using taxpayers’ money more effectively.’ 

On that note, does she feel that moving drug and alcohol treatment to local authorities, overseen by Public Health England, was the right thing to do? ‘It’s vital that everyone gets the drug and alcohol treatment they need,’ she says. ‘I think this is undermined by the fragmentation of the NHS, and there’s a risk that services will be poorly integrated and people will fall between the gaps. I just hope that – as in Brighton and Hove – local authorities will continue to make drug and health services a priority.’

The UN’s International Day against Drug Abuse and Illicit Trafficking on 26 June saw her donning a Richard Nixon mask outside the Houses of Parliament, as one of those protesting to ‘reclaim’ the date as part of the Support. Don’t Punish day of action. What made her decide to back the campaign?

‘Because the whole “war on drugs” approach is colossally damaging,’ she says. ‘It has meant the mass imprisonment of people who use drugs. It has allowed the international trade in illegal drugs to thrive. And, after decades, it has completely failed to reduce drug-related harm. Governments need to adopt approaches based on evidence, which deal with addiction as a health issue.’ 

Letters

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LettersThe DDN letters page, where you can have your say.

The August issue of DDN will be out on 2 September — make sure you send letters and comments to claire@cjwellings.com by Wednesday 28 August to be included.

 

 False dichotomy

In her open letter to Anna Soubry MP Dr Chris Ford draws an erroneous and largely unhelpful distinction between treating drug misuse as a health issue and treating it as a criminal justice issue.

In peer-reviewed research evaluating the impact of major drug enforcement operations on street-level drug markets it was found that the proportion of drug users contacting a methadone prescribing clinic increased massively from 30.2 per cent in the weeks in advance of the operations to 84.3 per cent in the weeks following the police operations (McGallagly and McKeganey 2012).

This research shows that drug enforcement operations can have a welcome positive impact on encouraging drug users into drug treatment. Instead of claiming that drug use is either a health or a criminal justice issue we need effective joint working between health and criminal justice agencies and a recognition that both domains have an equally important contribution to make in tackling drug misuse.

Ref: McGallagly, J., McKeganey, N. (2013) Does robust drug enforcement lead to an increase in drug users? Drugs: Education, Prevention, and Policy, 2013, Vol. 20, No. 1: Pages 1-4.

Neil McKeganey Ph.D, director, Centre for Drug Misuse Research, Glasgow

 

Self-help salvation

It is ridiculous for Ford and Soubry to be battling it out over whether addiction is a criminal or a health issue. It is the failure of the law and of medicine to understand and cure addiction that gives neither of them the right to even have an opinion.

Addiction is simply a current condition initiated by an individual making the mistake of choosing to use an addictive substance in an attempt to solve a ‘personal’ problem. It is straightforwardly a personal decision, made alone or in agreement with advice, which proves to be a mistake, and for which medical ‘treatment’ has never been an answer. Nor, as history shows, can criminal punishment resolve the country’s addiction problems.

When the coalition chose as the first strand of their 2010 drug strategy ‘reducing demand’, they knew what they were doing, because they were focusing on the source of our addiction problems – the individual addict. As they move towards ‘localism’ they are again focusing on the individual addicts that all inevitably exist in their local community.

It follows that reducing demand is achieved solely and only by curing individual addicts, and this is just not occurring other than sporadically as a result of medical treatment or criminal labelling or trying to restrict supply.

But it can be achieved by recognising that life is a do-it-for-yourself activity, that deciding to use drugs is also a do-it-for-yourself activity and that quitting addiction is most often achieved on a self-help basis.

Seventy to 75 per cent of addicts who have used for three days, three weeks, three months, three years or 30 years have tried, often daily, to quit and have failed – but still want to quit.

All they lack is the knowledge of how to attain lasting relaxed abstinence, and we know from the results of addiction recovery training delivered since 1966, and now at 169 centres (including prison units) in 49 countries, that 70-plus per cent can cure themselves.

So lets give addicts and the drug strategy a chance – by training drunks and addicts to cure themselves.

Kenneth Eckersley, CEO, Addiction Recovery Training Services (ARTS)

 

 35 years strong

Norwich charity NORCAS are celebrating 35 years of working in the region with a huge birthday party – all welcome!

Since 1978 when NORCAS opened its first alcohol service in Norwich they have gone on to provide drug, gambling and welfare rights services for many thousands of people across East Anglia. Now working in partnership with national substance misuse charity Phoenix Futures under the name Phoenix + NORCAS, the party will be an opportunity to hear inspirational stories of recovery, meet staff, volunteers and service users, past and present and to learn more about the plans for the future.

The party to be held on 22 August at OPEN, 20 Bank Plain, Norwich NR2 4SF, between 10.30am and 3.00pm, is open to all who want to drop in. Lunch and (of course birthday cake!) will be provided.

As Paul Hammond, Phoenix and NORCAS service manager says, ‘Over the last year alone NORCAS has worked with 8,342 adult and youth clients across Norfolk and Suffolk, and positively impacted the lives of many more through educational events. We want to thank the local community for the support they’ve provided us to help so many local people make positive changes in their lives.’

For more information go to www.phoenix-futures.org.uk/phoenix-norcas or contact me on bob.campbell@phoenix-futures.org.uk

Bob Campbell, special projects officer, Phoenix Futures

 

Help the aged

I have been trying to raise the profile of alcohol misuse in older people for some years, particularly as my own clinical service covers a population that has a rate of alcohol-related deaths in the 75-plus age group that is more than twice the national average.

Older people with alcohol problems remain caught between services. Luckily for me, I managed to gain additional skills in substance misuse and integrate these into a mainstream mental health of older adults service.

I would be interested to know whether practitioners see this as a growing clinical and public health problem and what is being done to tackle this problem in their local area or region.

Dr Tony Rao, consultant old age psychiatrist and chair of Royal College of Psychiatrists Substance Misuse Working Group

  

How lucky we are

Reading the coverage of the International Harm Reduction Conference really brought it home how lucky we are in the UK.

Sadly I was unable to attend in person but by reading the DDN Daily updates and the special issue I was able to get a real sense of the genuinely life-threatening situations that users in many countries face. It once again reinforced the indisputable fact that harm reduction saves lives.

To have the luxury of debating the individual nature of recovery and patient choice is something that many of the speakers at the conference must dream about, and we would do well to remember that. While the stories of the ongoing battle to have their drug use recognised as a health issue, and the ongoing human rights abuses were as harrowing as ever, there did seem some cause for cautious optimism.

The, albeit slowly, changing political acceptance that harm reduction works, the increasing high-profile support and, most importantly, the untiring work of the activists working across the world do give you hope that things will get better. I would like to thank both Harm Reduction International for having the courage to hold this unique event, and DDN for providing coverage to everyone unable to attend.

J Spence, by email

 

Making recovery visible

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Thousands of people are gearing up for the fifth UK recovery walk in Birmingham on 22 September. Richard Maunders, chair of the planning group for the walk, talks about what the walk means to those taking part.BRW

In recent years I’ve learned that recovery becomes contagious within communities when it’s visible, when it’s seen and felt, and hope and inspiration are passed on to those still struggling, still trying to define what recovery means to them. This is most apparent at the UK recovery walks.  Anyone who attended last year’s walk in Brighton will have seen and felt how powerful the walk, a mobilisation of hope and optimism, can be. Looking down the hill in the centre of Brighton last year I saw a crowd packed with happy faces, faces filled with love and hope, faces once etched with pain and misery, now beaming with gratitude in the September sun. Three thousand people marching up from the beach joined in a desire to celebrate recovery in all its diversity. 

Whatever your view, or definition of recovery, it is hard to deny the transformative effect of the recovery walks. While communicating a living message of transformation and inclusion they have quite literally been ‘tipping points’ for lots of people. As one Birmingham walker said to me, ‘I really needed today. I love the feeling of belonging to something. I love knowing that all around the country there are people like me, with the same struggles and fears, and knowing that there is a way through this and I’m not alone.’

He wasn’t alone. I know of many people from the Midlands, where I live, who came back inspired and determined to take control of their recovery. The Brighton walk planning group passed on the baton (or, more accurately, a stick of Brighton rock) to Birmingham. They’ve continued to build recovery in Brighton as ‘creative cascade recovery’, and now it’s Birmingham’s turn to host the UK’s biggest public recovery event.

Enthusiastic community

As the day comes ever nearer I’ve learnt many things about our recovery community in Birmingham. We’ve come a long way together. We’ve had our highs and lows. But what’s overwhelmed me as chair of the planning group is how passionate, determined and enthusiastic our community is. We’ve discovered skills and attributes we didn’t know existed. We’ve learnt to ask different questions – ‘what are our strengths, our passions?’ – and unearthed a community bubbling with strengths and assets. We’ve learnt that we need to look at what we’ve got and not at what’s missing, and find the abundance within our own communities. We’ve learnt that it’s not about what can be done for us but what we can do for ourselves. Together we’ve become powerful and we’re really looking forward to making new friends when we walk together on 22 September. 

The walk is a powerful articulation of visible recovery, but we believe we can do more. The UK recovery walk charity, established in April this year, will be supporting walks from 2014 onwards. After the Birmingham walk I’ll be focusing, in my role as a director with the UKRF, on the promotion and support of a UK recovery month. Inspired by the recovery movement in the US, we want to see September established as a month that makes recovery visible in every city, town and village, speaking to everyone, offering hope to all.

This year we’ve taken some small steps in preparation for 2014 when UK recovery month will launch. We have some learning to do along the way and we’ve decided to start the mini 2013 recovery month on top of a mountain. Recovery walk

Flying the flag

On 1 September, groups from all over the UK will gather at the top of Snowdon in Wales for a cuppa and a chat. We’ll plant a purple flag (the colour of recovery) at the top and we’ll reflect on what we’ve gained and what we’ve lost. People will make their way to the summit in different ways, symbolising the many different paths they have taken on their recovery journeys.

This social gathering, for the UKRF, will mark a new beginning – a shedding of past differences and an embracing of our common humanity. We all have mountains to climb at some point in our lives. In coming together around our similarities as human beings and in recognition of the validity of all paths we hope to support the emerging UK recovery movement. Making the path as we walk it.

There will be other events in 2013 recovery month (that we know of) in Derbyshire, Gloucestershire, Rochdale, Hertfordshire, Birmingham, Norfolk, Lancashire, Kingston, Somerset and Cumbria. It’s a beginning and it will grow.

To register for the UK recovery walk in Birmingham: www.ukrw2013.co.uk/register

For more info on 2013 Recovery Month: www.facebook.com/groups/UKRecoveryFederation/ or contact: alistair@ukrf.org.uk and richard.maunders@ukrf.org.uk

Richard Maunders is chair of the 2013 UK recovery walk Birmingham planning group and UKRF director Alistair SinclairUKRF Director

Media savvy

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Who’s been saying what..? DDN‘s round-up of what’s being said in the national papers.

Have you been stopped and searched by the police recently? If you are a white, middle-class resident of, say, Tenterden or Totnes, then almost certainly not. If you are a hoodie-wearing black teenager, often to be found out on the streets after midnight in Tottenham, then the chances are pretty high that you have. So, is this a function of ethnicity or of relative crime rates? Common sense would suggest the latter.

Philip Johnston, Telegraph, 1 July

Azelle Rodney was a violent drug dealer on his way to rob a rival gang at gunpoint when he was shot dead by police. Oh dear, how sad, never mind. …Naturally, the usual suspects are lining up to turn this vile little gangster into the latest cause célèbre to bash the Old Bill. BBC London, Channel 4 and the Guardianistas are filling their boots… In his line of work, getting shot is an occupational hazard. If it hadn’t been the Old Bill, it may well have been a Colombian hitman. Or one of his closest associates, off his face on heroin.

Richard Littlejohn, Mail, 8 July

Why Theresa [May] takes advice on drugs at all is a mystery. I suppose it’s nice to get out and have some meetings with experts, even if their input is superfluous.

Grace Dent, Independent, 3 July

While tabloid coverage of the mephedrone craze focused mainly on the risk of death, the less extreme side of the story – that people who wouldn’t have touched illicit chemicals began hoovering up legal ones with gusto – went largely unreported… Perhaps legalisation remains the best solution for society as a whole – but, at least through my anecdotal periscope, it won’t result in nirvana. British people like to boogie, and aren’t too good at stopping.

Memphis Barker, Independent, 1 July

In a complete inversion of morality, modern welfare punishes the diligent and rewards the feckless. That profound unfairness is why the coalition has been so right to embark on a major programme of welfare reform under the combative Iain Duncan Smith, through sanctions on the workshy, limits to housing benefit claims and the withdrawal of subsidies for spare bedrooms.

Leo McKinstry, Express, 18 July

Criminals will not stop their crimes, change course and become honest tax-paying citizens if drugs were legalised. Although there may be freedom of choice to use dangerous substances there can be no freedom from the consequences. International drug control is working; fewer than 6 per cent of people globally use drugs regularly and legalisation is not the answer.

Ian Oliver, Herald Scotland, 16 July

How many times do we keep trying to save people who don’t want to be saved? How many times do we bring them back from the brink to show them what a decent life is, only for them to vomit all over it after yet another bottle of gin?

Carole Malone, Mirror, 14 July

 

Is minimum pricing dead in the water?

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The ‘will they, won’t they?’ saga of minimum unit pricing for alcohol continues after the government announced it was shelving plans for its introduction. What might happen next?Picture 2

When the government published its alcohol strategy last year, many people were surprised to find that it contained a commitment to introducing minimum unit pricing (MUP) now, almost 18 months later, MUP is once again seemingly off the agenda.

Although it remains ‘a policy under consideration,’ according to crime prevention minister Jeremy Browne’s carefully worded statement to the House of Commons, it will ‘not be taken forward at this time’. While lack of evidence has been cited as the reason, even the government’s own Public Health England body has expressed disappointment and pledged to ‘take forward a comprehensive and scientific review of all the available evidence’ to inform any final decision.

The University of Sheffield has also published research claiming that the government’s alternative measure – a ban on selling alcohol below the level of the tax payable on it – would have a ‘small impact’, as just 1.3 per cent of units sold would fall below the threshold.

Lobbying campaign

When the rumours started earlier this year that the government was planning to abandon MUP, much of the talk was about the rise of Nigel Farage – often photographed with a pint in his hand – and UKIP, and the desire to not be seen as ‘anti-booze’ or out of touch with ordinary people. But now the discussion has turned back to a far more long-standing and intractable obstacle – the sheer might of the drinks industry – with a joint statement from Cancer Research UK, the Faculty of Public Health and others saying that it was ‘perfectly clear that MUP has fallen victim to a concerted and shameful campaign of lobbying’ by sections of the industry happy to put profits ‘before health and public safety’. 

‘One thing is undoubtedly the power and influence of the industry,’ Alcohol Concern chief executive Eric Appleby tells DDN. ‘We know they’ve put massive resources into lobbying. But it also appears that MUP is a bit of a victim of internal divisions in the Conservative party, with certain ministers in favour and then against. When the news first came out that they were thinking of dropping it, it coincided with a bit of caballing between various people like Theresa May, Andrew Lansley and Micheal Gove, so there’s internal politics in this as well. But what it all boils down to, again, is that public health is way down at the bottom of the agenda when it comes to what’s important to them.’

What does his organisation make of the commitments the government has made, such as banning the sale of alcohol below the level of duty plus VAT, or ‘facilitating local action’? ‘Banning sales below duty has absolutely no impact whatsoever,’ he states. ‘It will just do nothing. I think the reckoning [from researchers at the University of Sheffield] was that it would save 15 lives a year, instead of the 3,000 you’d get with MUP. It’s just a very flimsy fig leaf.’

‘Good local people’

Local action, meanwhile, relies on ‘good local people’, he points out. ‘There are some good examples around, obviously, but not everywhere are there people with the understanding and resources. We know that the whole thing with alcohol – and why it’s different to drugs – is that it’s about whole- population approaches, and you don’t get that just from local action. You can’t knock it, but on its own it’s not the answer.’

A vital function of minimum pricing has been to provide a focal point for campaigners and a means of unifying the message. Can it still do that now? ‘I think it can – almost even more so,’ he says. ‘The dropping of it has been done in such a way that it’s almost become a cause célèbre. The government’s arguments that there’s not enough evidence are plainly just wrong. The fact that the government have said they’re not doing it doesn’t lessen the arguments for it in any way, and the very obvious sense that they’ve just bowed down to the alcohol industry is only going to fire people up more.’

He told DDN in June that minimum pricing was ‘not going to go away’. Is that something he still believes? ‘Absolutely,’ he says. ‘And I can tell you that we’re not going to go away either, and other members of the Alcohol Health Alliance are not going to go away. We’re gearing up to take it on even more strongly.’

So what happens now? ‘Obviously we’re going to do some planning over the next few weeks about what we do next, but at the moment we’re looking at things like party manifestos for the next election,’ he says. ‘The Coalition haven’t actually ditched it – they’ve backed off a bit and said that they’re just not doing it right now – so if that’s the case they can at least put it back in their manifestos for the next election.

‘We know those aren’t necessarily worth that much, but nonetheless it’s one way of keeping the discussion going, keeping it in the forefront of debate. And just making sure that – every step of the way – they’re confronted by the fact that there’s evidence that it works, and that none of the alternatives can do the same job.’ 

Modelled income group-specific impacts of alcohol minimum unit pricing in England 2014/15 at www.shef.ac.uk/news/nr/below-cost-selling-ban-1.294086

 

Post-its From Practice

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Steve BrinksmanSome do, some don’t

All GPs should see involvement in drug and alcohol treatment as the norm, says Dr Steve Brinksman.

I became interested in working with people who develop problems due to their drug and alcohol use very early in my GP career.

However a significant number of GPs do not work with people who use drugs and alcohol.

On the one hand there are practices like ours, in which all of us regard this work as a priority and where a few years ago our list was closed, unless the person had a drug problem! This compares with others where, from the outset, it is clear that ‘your sort’ isn’t wanted. Why the difference?

Medical education plays a significant part in attitudes – as undergraduates we receive very little teaching on drug and alcohol problems.  Although this has improved a little over the past few years, there is still a great deal more that could be delivered, as evidence suggests that young doctors are quite happy to engage in this role.

At a postgraduate level it is fairly hit and miss. I was fortunate to have a GP postgraduate tutor, Dr Ian Fletcher, who passionately believed in primary care ‘substance misuse services’ as we called it then. He arranged a session for the West Midland GP registrars and one of his patients agreed to come along and share his experiences with us. This was a real eye opener to me, allowing me to see drug use not as a self-inflicted problem but as an attempt by some individuals to try and deal with the trauma they face or experience as they go through life.

Dr Clare Gerada, the current chair of the RCGP council, has been a leading light in encouraging primary care to provide good quality care around substance use. She is also keen to increase the length of GP postgraduate training from three to four or even to five years. This would provide an ideal opportunity for the RCGP drug dependence and alcohol training – currently optional for both GP registrars and established GPs – to be a part of the core curriculum.

Another problem relates to GP contracts. The vast majority of GP practices have either GMS (General Medical Services) contracts which apply across the country and do not include or specify providing treatment for drug or alcohol problems; or PMS (Personal Medical Services) contracts which are locally agreed for a range of other services above and beyond GMS – but again, many would not have a specific substance misuse category.  This doesn’t mean GPs can ignore the physical or mental health problems of people with drug and alcohol problems but they are not obliged to offer OST, community alcohol detoxifications etc unless they have signed up to specific local contracts.

There also remains a cohort of (often older) GPs in practice who trained at a time when GPs were actively discouraged from getting involved in this field. I hope that as time goes by they are being replaced by more receptive GPs and that it will become as normal to work with those with drug and alcohol problems, as it is to treat someone with diabetes or hypertension.

For this to occur the training needs to be right, the support structures from commissioners, drug workers, and the more experienced GPs need to be in place and the current investment in services needs to be maintained. Given this, my aspiration is that in time, the maverick GPs will be those that are not involved in working with drug and alcohol patients. Until then, I will continue to educate and inform all GPs about providing primary care treatment to this interesting group of patients, giving them the chance to recover from problematic drug and alcohol use in their own communities.

For more information about the RCGP Substance Misuse and Allied Health certificate courses in the management of drug and alcohol misuse, see www.smmgp.org.uk/html/rcgp.php

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

Skills update

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ReviewWhat’s the latest on professional training? Nadine Singh explains the DANOS review.

Skills for Health is undertaking a review of the National Occupational Standards (NOS) for specialist workers who work with adult substance users.

The NOS, first developed with stakeholders in 2005, are being reviewed by a working group consisting of service user organisations and stakeholders who work in substance use services. A steering group is overseeing the project, consisting of members from the four UK nation government departments and chaired by Carole Sharma, chief executive of the Federation of Drug and Alcohol Professionals (FDAP). ‘Stakeholders will welcome the review of the NOS for the substance misuse sector as it is vital that the standards reflect what workers are currently doing as part of their practice,’ she says.

 This review is to ensure that the NOS reflect up-to-date practice in the field of substance use and that workers who wish to use the NOS are working to a set of defined standards. The project working group includes members from the four UK nations, and the revised NOS will reflect common practice right across them.

 The drug and alcohol NOS, commonly known as DANOS are widely used across the health, care and justice sectors. NOS can be used for a variety of purposes, all of which lead to the development of a particular workforce. The DANOS have been used to underpin nationally accredited qualifications, such as:

•                  the level 3 diploma in health and social care and level 3 SVQ in health and social care, which assess competence against the NOS

•                  the level 3 and level 4 awards and certificates in working with substance misuse.

They are also used:

•                  to develop new roles for the sector

•                  in frameworks for staff development

•                  to improve standards of practice across the sector by organisations such as FDAP

•                  to develop a variety of bespoke training and education programmes.

The working group, chaired by John Jolly of Blenheim CDP, has been working to update the standards and they will be available for consultation until 30 September 2013. A consultation for service users will also be available and their responses will inform the final content of the updated NOS. This consultation will run until 12 September 2013. 

Once final versions of the NOS have been approved by the UK Commission for Employment and Skills, they will be accessible via the Skills for Health competence tools.

For further information about both the service user and NOS consultations and the Skills for Health tools, visit the Skills for Health website www.skillsforhealth.org.uk or email danos@skillsforhealth.org.uk

Skills for Health is the sector skills council for all health employers – NHS, independent and third sector – and acts as the voice for employers working in the healthcare sector.

Nadine Singh is manager of NOS, qualifications, apprenticeships, products and services at Skills for Health

 

Downhill slide

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John Jolly of Blenheim CDP questions the procurement, tendering and commissioning processes in the UK.

I’ve been sharing concerns for years with other CEOs and senior managers about poor procurement and tendering in the drug and alcohol sector – usually just quietly, over meetings with coffee. When I spoke recently to Martin Barnes, CEO at Drugscope, the umbrella organisation for the field, we shared long-standing worries about the state of commissioning in many areas.

To really address the issue, however, we need evidence of the impact on staff and organisations, and examples of poor practice and waste. How much does it cost service providers to tender? How much money do commissioners spend on consultants? We cannot just complain about the process; we have to demonstrate its impact, unfairness, and consequences for service users and on service provision and quality. It is perfectly legitimate for local authorities to retender work provided to them by contractors, but in the context of Big Society there needs to be a level playing field for the third sector and local third sector providers. 

Poor and frequent commissioning has a number of serious consequences, not least of which is the cost. An exercise to quantify the costs of tendering services more than years ago came up with a figure of £300,000 expended by all bidders and the commissioner per tender.

We have to accept that tendering of services is here to stay and that providers will all win and lose contracts. However, I think there is a case to be made to increase from the standard three-year contract to a seven- to- ten-year minimum contract length – or possibly longer.

The contracts are often very one sided and allow cancellation with three or six months’ notice. Often providers are asked to agree to the contract as a condition of being allowed to tender, which is clearly unfair. Contracts need to be far less easy for local authorities to wriggle out of, with an expectation that any but the most major changes required are done via contract variation rather than retendering, except where there are clear performance issues.

At Blenheim we are concerned about the minimum turnover requirements that are beginning to affect the ability of small providers to tender for contracts they currently hold. This is where to bid for work you have to have a minimum turnover of, say, £5m or £10m. I am aware of many smallish and medium-sized charities that have not been able to bid for their own contracts back in their own right, forcing them into shotgun marriages with other providers as junior partners. This has on occasions included Blenheim, despite us being in the top 750 charities in the UK by income out of 66,000 charities.

Partnerships have a lot to offer and Blenheim is in many great and highly effective partnerships, but they rarely work well when they are marriages of convenience.

Blenheim is concerned that we are starting to see the demise of local third sector organisations operating and attuned to local communities, and their replacement by profit-motivated or organisational-survival-motivated or growth-driven organisations. This I already hear and see impacting detrimentally on service provision. 

Blenheim is concerned about minimum standards in the drug and alcohol sector, with the move to local authority commissioning and the demise of the National Treatment Agency. Providers are all being forced to compete on price rather than quality, and this has a direct impact on who is employed or made redundant. The people that service providers employ and their skills and ability is what makes the difference to the mothers, fathers, children, sisters, uncles, neighbours, friends and grandparents with a drug or alcohol problem that we are here to help. These people deserve a quality service, delivered against exacting standards of performance and staff competence, not the cheapest available. 

Blenheim is deeply troubled about the many instances of poorly managed tendering processes which create huge wastes of time and effort both at commissioning level and within provider organisations. This is now a regular occurrence and issues have included unfair decisions, lack of transparency about the process, and lack of knowledge about tendering and procurement within tendering teams. A number of tendering processes have to be suspended due to flaws in the process, and there is complete lack of understanding by many commissioners of TUPE rules.

There are attempts to dump significant pension liabilities on incoming organisations where the NHS or local authority is the outgoing organisation, and there are sometimes completely ludicrous and unworkable specifications. Local authorities often transfer risk to providers via payment by results with poor data to assess risk – often in relation to performance targets the provider has little control over.

At Blenheim we think its time we should stop talking and start acting, as a provider and a sector, to raise these concerns via DrugScope and other forums.

John Jolly is chief executive of Blenheim CDP

A case for e-cigarettes

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A case for e-cigarettes

Professor Gerry Stimson  takes a closer look at electronic cigarettes and asks – if e-cigarettes can save lives, why are we jeopardising this public health breakthrough?

Until recently, an end to cigarette smoking looked like a long and slow business. Year on year only small reductions have been made in reducing smoking prevalence in developed countries.

The arrival of electronic cigarettes (e-cigarettes) and other new nicotine delivery devices changes that. These new devices are a disruptive technology, just as the invention of the cigarette-making machine was in the 1880s. There are now real prospects of helping smokers shift from smoking tobacco to using nicotine by less harmful routes.

The Medicines and Healthcare Products Regulatory Agency (MHRA) and the European Commission (EC) now want to regulate e-cigarettes as medicines. Will this advance the sale of e-cigarettes, or push back the progress that has been made?

First introduced to the UK in 2006, uptake of e-cigarettes has been a relatively quiet consumer-led revolution. There has been no public health input or encouragement, and no spending of NHS resources – no taxpayers have been harmed in this process. There has been little expenditure on marketing. The growth in popularity has come about by word of mouth and internet advertising. Unlike many public health measures, there is a population ready and eager to change – most smokers want to stop smoking. Until e-cigarettes there was no viable option but to quit smoking altogether or to use nicotine replacement therapy (NRT).

The MHRA estimates that 1.3m people are using e-cigarettes in 2013. The proportion of smokers using them rose from 3 per cent in 2010 to 11 per cent in 2013. The European market is estimated at around EUR 400-500m, and sales of e-cigarettes now equal those of NRT. The market has been dominated by mainly small and medium-sized distributors, but this will change as most major tobacco companies are already selling or investing in the development of new nicotine delivery devices.

Most anti-smoking organisations aim for an end of the tobacco industry. Ironically – for many public health experts – an end to tobacco smoking may be hastened not through the end of the tobacco industry but through its transformation. In the next couple of decades, tobacco companies, under pressure from anti-tobacco legislation, will move towards becoming nicotine companies. Wells Fargo stock analysts predict that revenue from e-cigarettes will overtake ordinary cigarettes by 2021.

E-cigarettes v smoking tobacco

E-cigarettes have major advantages over smoking tobacco. More than 4,000 chemical compounds are found in tobacco smoke, and it’s the products of the burnt organic material that are so harmful to health. Around 80,000 people in England die every year from smoking-related disease. Smoking is the single most common cause of preventable illness and death. As Mike Russell noted long ago, people smoke cigarettes for the nicotine but die from the tars.

e-cig3 

E-cigarettes contain nicotine, propylene glycol (a carrier that creates the vapour when heated) and flavourings. They deliver nicotine but without the dangerous toxins found when tobacco is burnt. They are used by people who want to stop smoking but who do not want to or cannot stop using nicotine.

A visit to e-cigarettes and vaping websites indicates extraordinary testimony of their successful use by long-term smokers. E-cigarettes contain some potentially harmful constituents but at traces very much lower than found in regular cigarettes, within the safe limits for consumer products, and indeed at similar levels to potentially harmful constituents found in NRT. And their attraction for many users is precisely that they are not medicines.

Where to with tobacco policy?

Harm reduction is central to current tobacco policy in England. This will be welcome news to those in the drugs field who feel rather beleaguered and browbeaten by the drugs recovery agenda.

The history of tobacco harm reduction is tied in with the development of NRT. In 1990 there were only three NRT products, all prescription-only. Pharmacy sales started in 1991, expanded to all products by 2000, and since 2009 all NRT products have been on general sale. Initially NRT was only indicated for abrupt quitting, and later extended for people who wanted to cut down more gradually before stopping. But in 2009/2010 the MHRA agreed it could be used for harm reduction, including temporary abstinence and a reduction in smoking with no intention to quit.

 

The Department of Health’s 2011 tobacco control plan committed to encouraging tobacco users who cannot quit to switch to safer sources of nicotine and to encourage manufacturers of safer sources of nicotine to develop new types of nicotine products. In 2012 the Cabinet Office’s behavioural insights team – the so-called ‘nudge unit’ – urged the use of e-cigarettes.

The most recent piece of the story is the work of the National Institute for Health and Clinical Excellence (NICE) which gives a strong endorsement for tobacco harm reduction for people who do not wish to quit smoking altogether, and for people who want to quit smoking but are unable or unwilling to quit using nicotine. The NICE group concluded that nicotine does not pose a significant health risk.

Enter MHRA and the European Tobacco Products Directive. The MHRA has decided to regulate all electronic cigarettes as medicinal products by 2016, and the European Tobacco Products Directive – currently going through the European legislative process – proposes that all e-cigarettes should be regulated under medicines legislation.

‘Smoking cessation’ or ‘smoking sensation’? 

cigarette3

Those in favour of medical regulation argue that electronic cigarettes are currently unregulated products, that they are accessible to children, that there is no control over advertising, that they contain potentially dangerous constituents, and that the devices themselves, including the batteries, pose a threat to user safety.

Medicines regulation, they argue, will improve safety, quality and efficacy, and make them work better as a smoking cessation product.

There is another thread going through the political argument however, which is that electronic cigarettes are just another way to feed addiction to nicotine, and that they send the wrong message and undermine attempts to drive down tobacco use. Some claim that electronic cigarettes are contrary to efforts to ‘de-normalise’ smoking. There are already scaremongering stories about schoolchildren using them. Certainly they might be a short-term fad amongst some children who wish to challenge authority, but the e-cigarettes market is made up of long-term smokers and surveys by Action on Smoking and Health (ASH) show minimal use by non-smokers and by young people.

Consumers do not want medical regulation. There has been extensive comment on the proposals on social media sites, Twitter, and letters to members of the European Parliament – current users insist that these are consumer products, a safe way of enjoying nicotine, rather than a therapy. These products are popular precisely because they are not medicines. As one user put it – these are not ‘smoking cessation products’, they are ‘smoking sensation products’.

Getting the balance right

The problem is the trade-off between making the product safe enough, but also sufficiently attractive to achieve widespread uptake. On balance more weight should be given to attractiveness, given their relatively low risks and the huge consequences of continued smoking.

The argument that these products are currently unregulated is false. The Electronic Cigarette Industry Trade Association has shown that they are covered by the General Product Safety Directive and various other EC directives covering electrical safety, chemical safety, weights and measures, packaging and labelling, commercial selling practice and data protection.

Applications to MHRA are costly, including the licence fee and the required studies, analyses, documentation. There are fears that few companies will be able to afford this, that the process will favour big players and drive many products off the market. There are further problems with medical regulation in that e-cigarettes include a big range of products and product combinations. Not all of them are simple pre-packaged cigarette lookalikes, but many are customisable, where the user can vary the delivery device and the nicotine strength and flavourings. It is likely that medical regulation will prematurely limit the range of products and stifle innovation.

Even the announcement of future medical regulation has created uncertainty among retailers, current and potential e-cigarettes users.Picture 5

How this will play out is uncertain. Given that MHRA has put the deadline as 2016, by then there will be a much larger market and it will be harder to limit and control products. Already there have been four successful legal challenges against classing these products as medical products (two in Germany, and one each in Estonia and the Netherlands).

At the end of the day the potential public health gains from e-cigarettes will be determined by the decisions about how to regulate these devices. There is right thinking about tobacco harm reduction, but a risk of making significant mistakes in the way this is played out in regulatory frameworks.

The danger is a classic regulatory trap: making safer products harder to obtain than their unsafe counterparts. The regulatory proposals are tougher on e-cigarettes than on tobacco cigarettes. The framing of electronic cigarettes within a regulatory context misses the point that the public health drive must be to promote, endorse and facilitate their use.

Prof Gerry Stimson is visiting professor, London School of Hygiene and Tropical Medicine and director of Knowledge-Action-Change.

 

August issue 2013

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August 2013 issue

In this month’s issue of DDN… 

‘It is a project that is consistent with the practice and principles of harm reduction, and its street-based focus provides culturally relevant opportunities for interaction and communication…’

 This August issue, read about The Ana Liffey Project’s innovative harm reduction response to street-based injecting drug use in Dublin. 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

Getting streetwise

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The Ana Liffey Project is a national addiction service dedicated to harm reduction – Stephen Parkin talks to director Tony Duffin about their innovative street -based outreach work in Dublin.

Ana Liffey Project

 If you’ve visited Dublin recently, you may have noticed that something innovative is afoot on the streets of Ireland’s capital city – quite literally. The Ana Liffey DrugProject has recently expanded its peripatetic needle and syringe programme (NSP) as part of a progressive form of innovative outreach work. The 2013 version of the project, which was originally launched in June 2010, combines old-fashioned footwork with telecommunications, emerging technologies and high-visibility promotional material on the streets.

The project was brought to my attention during a recent visit to the Republic of Ireland and I was fascinated by the initiative because of its relevance to topics that I have spent almost six years researching in various towns and cities throughout the UK – namely street-based injecting and drug-related litter. I was so impressed by the project that, on my return to England, I contacted the director of the Ana Liffey Drug Project, Tony Duffin, to find out more about this potentially groundbreaking venture. 

Street-based injecting

Ana Liffey Drug Project is a national addiction service with a low threshold harm reduction ethos. The organisation receives 

funding from a number of sources, including the Health Service Executive, drug and alcohol task forces, the Probation Service of Ireland, other local authorities and government departments. One of the ways Ana Liffey engages with drug users and other stakeholders is in the reduction of drug-related harm associated with episodes of street-based injecting, which often takes place in public places throughout Dublin city. As an indicator of the frequency of public injecting in the city centre, a recent report (Re-establishing contact: A profile of clients attending the health promotion unit – needle exchange at Merchants Quay Ireland) highlighted that 14 per cent of the 388 injecting drug users attending a fixed-site city centre NSP reported regular injecting in public places ‘in the last month’. This translates to approximately 55 individuals of the cohort regularly involved in episodes of street-based injecting in concealed alleyways and side streets throughout the city.

Furthermore, as there are few public conveniences in Dublin city, street-based injecting sites are located in what I have termed category B and category C settings, such as alleyways, doorways and secluded settings hidden from public view, or in ‘opportunistic’ settings concealed within business premises. These are places that are among the most harmful environments for street-based injecting drug use. For these reasons, Tony Duffin made the case for introducing medically supervised injecting centres to Dublin at a recent safer city for all seminar (http://www.aldp.ie/resources/video).

‘If You Bang it, Bin It!’

Bang it, Bin It

In the meantime, the Ana Liffey Drug Project is continuing to provide a proactive outreach service as part of an ongoing harm reduction response to street-based injecting drug use. This involves two outreach workers walking the streets of central Dublin equipped with, among other things, a pink vanity case for carrying out street-based interventions. The case makes it easy for clients to locate the staff, who often deliver the service in busy city centre locations. Within it is a range of injecting equipment and other paraphernalia that would be available from a more orthodox (static) NSP.

As such, water-amps, swabs, filters, steri-cups and a range of ne edles (including Exchange Supplies’ ‘NeverShare’ variety) and barrels can be provided, along with harm reduction brief interventions. Each NSP pack given out also has an adhesive label on it that promotes safer disposal with the peer-designed slogan, ‘If You Bang it, Bin It!’ – itself an illustration of dynamic, creative and innovative outreach work that challenges many drug-related outreach projects’ reluctance to walk the streets with injecting equipment for wider distribution.

Dotted around the city centre on many of the public litter bins are dedicated advertising slots that have been provided by Dublin City Council at no cost to the Ana Liffey Drug Project. Duffin explained that these prime advertising sites provide the ideal opportunity to publicise and promote the project’s outreach work, and its 1800-78-68-28 Freephone line gives callers information and signposting to services.

Lifeline

Staff at Ana Liffey have combined the telephone service with the outreach service to create a genuinely innovative and rapid response NSP throughout the city centre. As Duffin says, ‘All our staff are very client focused – we’re constantly seeking new ways to reach marginalised clients, or to improve accessibility to existing services.’ In the case of the NSP, individuals may call the 1800 number free of charge and be transferred to an outreach worker’s mobile phone. The client and workers arrange a mutually convenient time and location to meet, giving an opportunity to discuss injecting paraphernalia and how the client can obtain new equipment and return used paraphernalia. They are also offered sharps boxes in an attempt to minimise drug-related littering. As with conventional NSP, this meeting also provides opportunities to conduct some form of limited intervention, such as checking an individual’s physical injecting sites and inspecting any related injuries, and providing a referral to the blood borne virus nurse at Ana Liffey’s medical surgery.

Provision of equipment takes place in a discrete manner and does not involve the open distribution of injecting equipment for all to see. As with conventional NSP, activity data is collected by the outreach team, including documenting the interaction and what items may have been distributed and returned. In the first five months of this year, 381 NSP interventions were done under this system of outreach, including telephone referrals.

Pioneers

 Further developments in this street-based project are to pilot the use of a tablet, or other portable device, that can be linked to a centralised system for recording similar Syringesdata within static sites of NSP and have the ability to show harm reduction videos relating to safer injecting. This would help to feed live data to a master-monitoring system and provide immediate up-to-date information regarding process, performance and outcome of all relevant activity. Ana Liffey also intends to promote its Freephone number across the 12 counties of Ireland where they currently provide direct client services through a telecommunications hub, linking Freephone callers throughout Ireland to satellite Ana Liffey outreach teams that can best respond to the caller’s needs.

 This street-based form of NSP is innovative because, as far as I am aware, it is the only service where the caller is directed by internal transfer within the offices of a central location to an outreach team’s mobile phone. However, what struck me most about Ana Liffey’s outreach project is the pioneering and inventive application of old and new methods – combining peer-based outreach with portable telecommunications that in turn are advertised by traditional methods using street-based furnishings (litter bins). As the latter are positioned in street settings they are more likely to be noticed by the target population of this particular project – people who are homeless and/or those participating in street-based injecting.

 Simplicity and technology underpin the initiative to provide a method of actively engaging with street-involved individuals who may not necessarily be in contact with mainstream drug services. I am further impressed by how the project genuinely reflects the original street-based ethos that defined harm reduction throughout the UK during the 1980s.

In terms of drug-related outreach work, however, the project ticks all the required boxes. In addition to engaging with hard-to-reach populations, it also involves participation, intervention, advice and information, and creates opportunities for referral to other services while complying with the need for confidentiality. In short, it is a project that is consistent with the practice and principles of harm reduction, and its street-based focus provides culturally relevant and environmentally significant opportunities for interaction and communication.

 Indeed, this is a project that should be given some consideration in other settings and could very easily be emulated throughout the UK and beyond, made easier by Ana Liffey’s culture of sharing their resources, knowledge and expertise as much as possible. 

 Stephen Parkin is a research fellow at the University of Huddersfield and is the author of Habitus and drug using environments (published by Ashgate Sociology, 2013). Email: s.parkin@hud.ac.uk

Tony Duffin is director of the Ana Liffey Drug Project. Further details of the street work described above are available from tony.duffin@aldp.ie


News in brief

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Not foiled again

The government has accepted the ACMD’s advice to allow for the provision of foil by treatment providers ‘subject to the strict condition that it is part of structured efforts to get people into treatment and off drugs’, home secretary Theresa May has announced. The government would also introduce mechanisms to monitor take-up and adherence to conditions, she said. ‘The provision of foil in needle exchange and drug treatment services can contribute to a reduction in drug injecting and associated health risks, such as exposure to blood born viruses, vein collapse and overdose,’ said DrugScope chief executive Martin Barnes. ‘Support that enables heroin and other drug users to reduce the risks to themselves and others can be the catalyst for engaging with treatment and support for recovery.’

Hep C help

A free, confidential helpline for prisoners has been launched by the Hepatitis C Trust. The helpline, which will be open five days a week on 0800 999 2052, allows the trust to ‘reach out to a highly affected population’, said head of patient support services, Samantha May. ‘What we offer is the facility for prisoners to speak with their peers who can empathise with the stigmatisation that someone can face when they have the virus,’ she said. ‘We can answer their questions and tell it like it is.’ The trust has also produced a new briefing for London’s health and wellbeing boards which urges local authorities to improve commissioning, promote testing and encourage training. Councils had an ‘unprecedented opportunity’, said trust chief executive Charles Gore. ‘If we diagnose and treat those infected, we could virtually eradicate the virus within a generation.’ Reducing health inequalities in London by addressing hepatitis C at www.hepctrust.org.uk

 Get networking

A new website has been launched by the Alcohol Health Network to help reduce alcohol-related harm in workplaces and the community. Founded by former Alcohol Concern chief executive Don Shenker, the network works with companies and public health teams to help drinkers understand and reduce their drinking levels via online self-assessment tools, training and advice. www.alcoholhealthnetwork.org.uk

 Marijuana move

As DDN went to press, it was announced that Uruguay’s House of Representatives had passed a bill to legalise marijuana. If approved by the Senate, Uruguay will be the first country to regulate the sale, production and distribution of marijuana.

HIV warning

A ‘significant’ increase in injecting rates among gay men could lead to sharp rises in HIV levels, according to a report from the National Aids Trust (NAT). Earlier this year NAT wrote to London councils warning of the ‘rapid rise’ in the use of drugs like crystal meth and mephedrone in parts of London’s gay scene, coupled with high rates of needle-sharing and lack of appropriate services (DDN, April, page 6). ‘We need drugs and sexual health services to work together to meet the needs of gay men,’ said NAT director of policy and campaigns, Yusef Azad. HIV and injecting drug use at www.nat.org.uk

Separate lives

The Netherlands’ approach to drug policy helped to keep cannabis users separate from ‘hard drug dealers’, according to a report from the Open Society Foundations (OSF). Just 14 per cent of Dutch cannabis users reported being able to obtain other drugs from their suppliers, compared to more than 50 per cent in Sweden, says Coffee shops and compromise: separated illicit drug markets in the Netherlands. ‘As other countries and local jurisdictions consider reforming their laws, it’s possible that the Netherlands’ past offers a guide for the future,’ said director of the OSF’s global drug policy programme, Kasia Malinowska-Sempruch. Report at www.opensocietyfoundations.org

 What is recovery?

Birmingham-based UK Recovery Radio (DDN, March, page 17) has released its second ‘Purple Bull’ podcast – What is recovery? – which focuses on the role of harm reduction. Listen at recoveryradio.blogspot.co.uk 

Bereaved by addiction

DrugFAM’s fifth annual Bereaved by addiction conference will take place in High Wycombe on 12 October.

Details at www.drugfam.co.uk, or email administrator@drugfam.co.uk

 

Recovery in the community 2013

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Sheffield Alcohol Support Service

The Megacentre – Sheffield 

Friday 11th October 2013

Cry for help

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Cath

 

Painkiller addiction is a growing issue. In the first of­­ a three-part series, DDN asks, are we responding?

 

Read here

 

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Mark Archive

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Mark Dempster’s uncompromising story of drug dealing and addiction.

Part 1: Growing up in Glasgow, the young Mark already starts to push the boundaries

Part 2: Mark leaves for London, takes tips from a terrorist and heads towards the ‘big time’

Part 3: Mark tries his luck with smuggling hash and finds some unsavoury new ‘friends’

Part 4: Mark pushes his luck to the limits abroad and comes home for a dose of harsh reality

Part 5: Mark Dempster reaches crisis point as he realises his luck has finally run out

Part 6: In the sixth and final part of his personal story, Mark Dempster experiences an unlikely epiphany

Marie Archive

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Marie’s journey of self-discovery.

Part 1: Marie explains how an incident in her childhood turned her world upside down and sent her down the path to addiction

Part 2: Marie finds herself falling deeper into addiction and has her first brush with the law

Part 3: Marie books into rehab and allows herself to start dreaming of a future

Part 4: Marie gets her first real taste of family life – but will it last?

Part 5: Marie’s family life goes well and truly off the rails

Part 6: Marie picks herself up from her lowest ebb and grabs hold of life

Part 7: In the final part of her story, Marie takes hold of her future

Homepage Features Tab

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Don’t miss any of the latest magazine features

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Going Public

The UK’s public health bodies have added their voices to the call for decriminalisation.

 

 

Cath

Cry For Help

Painkiller addiction is a growing issue. In the first of­­ a three-part series, DDN asks, are we responding?

 

 

ElaineRoseBehind Closed Doors

Encouraging clients to talk about their childhood can help to release them from the long-suppressed trauma of abuse, as psychotherapist Elaine Rose explains

 

 

Screen Shot 2016-07-08 at 14.44.10Force For Change

How can we develop our work­force against a backdrop of cuts and challenges? DDN reports from the FDAP conference.

 

 

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Promotional Feature: Made to Measure

It’s time to ditch the ‘one size fits all’ approach and be ready to respond to clients’ needs – whatever stage they’re at.

 

 

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Safe Space

Wales is gearing up to offer medically supervised injecting centres – an initiative that can’t happen soon enough, says Ifor Glyn

 

 

PGHouse2romotional Feature: Embracing Change

Andy had been using alcohol and drugs for more than 20 years before he was admitted to Gloucester House Rehabilitation centre

 

 

Jobs friends and housesBuilding a future

Steve Hodgkins is the founder and CEO of Jobs, Friends and Houses – a multi award-winning social enterprise offering employment, peer support and accommodation to people in recovery from addiction.

 

 

Griffith EdwardsA helping hand

Phoenix Futures has launched the Griffiths Edwards Fund to champion his belief that ‘no one size fits all’

 

 

Kenneth Robinson

Promotional feature: An honest relationship

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

 

 

mike ashton

Identity crisis

UK governments agree that above all what they want out of treatment is ‘recovery’.

 

 

 

Russel Brand

Work, rest and play

Changes UK chief executive Steve Dixon has ambitious plans for Recovery Central in Birmingham

 

 

hepc

Promotional feature: Stigma: Hepatitus C and drug misuse

An understanding of existing barriers to hepatitis C care is important to help empower people with the virus to access help.

 

 

 

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Damp squib?

Sector’s reactions to last month’s event in New York, and DDN hears from one of the architects of President Obama’s drug policy

 

 

Screen Shot 2016-05-06 at 12.26.07False economies

Is the focus on recovery undermining a highly skilled workforce?

 

 

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Promotional Feature: Complex Care 

Pulse Addictions provides tailored training, consultancy and clinical management in the field of substance misuse and associated areas to organisations across the UK.

 

 

damecarolblackBarriers to work

Last July the government asked Dame Carol Black to conduct an independent review into the challenges of getting and staying in work for people with drug and alcohol problems, or who are obese.

 

 

Screen Shot 2016-05-06 at 11.02.06Capturing quality

How can a system designed to ensure the quality of car parts help us in the substance misuse sector?

 

 

FinneyPromotional feature: The inspector calls

David Finney gives the latest essential chapter on preparing for Care Quality Commission inspection

 

 

NACOA’s (the National Association for Children of Alcoholics)

Painful inheritance — NACOA’s annual lecture 2016

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

 

 

hepcPromotional Feature: Hepatitis C: New hope, old problems

People with hepatitis C in the UK have a greater chance of being cured now than at any other point in the history of the disease.

 

 

Kit Caless

Different wavelengths

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

 

 

Michael Linnell1

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

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

 

 

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Emotional rollercoaster

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

 

 

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Picture this

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

 

 

Giving voice logoGiving Voice

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

 

 

getthepicture

Get the Picture

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

 

 

bigbusinesslogoBig Business

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

 

 

leeAre you involved?

Here members of the Nottingham team tell us about a system they believe is working well. We’re relying on you to let us know what’s happening in your area

 

 

BC_IMG_8492ody and soul

Delegates enjoyed demonstrations on complimentary therapies and healthy eating

 

 

oscarddnbaby

Meet Oscar, the DDN baby!

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

 

 

 

Naloxone in prisonsTake-home naloxone in prisons

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

 

 

Conference collage

From little acorns…

There’s still time too book your place for the 9th annual DDN conference, 25th February 2016, Birmingham.

 

 

Julie BreslinGeneration Drink

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

 

 

Drugwise DuoWords for the wise

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

 

 

Richard Johnson

Learning for life

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

 

 

Kit Caless

Tough measures

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

 

 

BuEsther Harriesrden of grief

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

 

 

Alex StevensHIT Hot Topics

Stigma, misunder­standing and a lack of communication cloud our policy and practice on drugs, said speakers at HIT Hot Topics.

 

 

DarkDark days days

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

 

Josie Smith and Chris EmmersonBucking the trend

Unlike in England, drug deaths in Wales have been falling since 2010 – a result that can be traced to Welsh public health policy and harm reduction practice, say Josie Smith and Chris Emmerson

 

 

Paul Hayes

Leaner and keener

In a climate of austerity the new drug strategy must grow from our successes, says Paul Hayes on behalf of Collective Voice

 

 

adfam conference

Playing safe

Are we doing enough to protect children from their parents’ drug and alcohol use? At a recent safeguarding conference there was plenty of cause for concern

 

 

Public Health NursesTread softly

How can we tackle child safeguarding without risking disengagement? DDN hears a cautionary perspective from public health nurses.

 

 

Erin O'Mara

The state we’re in

Forcing stable people off their heroin scripts and into chaos is evidence of a British drug treatment system in terminal decline, says Erin O’Mara

 

 

Karen BiggsNo place like home

Phoenix Future’s new report Building recovery friendly communities makes the case for specialist recovery housing as a pathway to long-term recovery. Karen Biggs tells DDN why this is an opportunity not to be missed

 

 

Homepage Letters and Comment Tab

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Be part of the the debate with the latest letters and comment

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What next for prison reform?

At a VolteFace event in London, journalist Philippa Budgen asked panelists: ‘How can we have meaningful prison reform with drug policies that aren’t working? What would be your messages for justice secretary Michael Gove?’

 

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Reasons to be cheerful

Paul Hayes is determinedly upbeat in the aftermath of Brexit

 

 

 
people places and things

Mark Reid reviews the play People, Places and things

‘People, Places and Things is an excellent look inside the world of a 12-step-style rehab…’

 

 

keith stevenson

View from the coalface

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

 

 

paul urmstonRecovery Capital

New government funding of £10m has just been awarded to drug and alcohol services ‘committed towards improving recovery outcomes’ across England – capital funding that was distributed by PHE via local authorities.

 

 

paul hayes

Voice on the stairwell

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

 

 

Anne MarieGet real

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

 

red roseRed Rose Recovery

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

 

 

Chris Rintoul

Reach out 

Chris Rintoul reports positive results from a Northern Ireland naloxone programme

 

 

ColdChris Robin caller 

A craving is the salesperson we can choose to ignore, says Chris Robin

 

 

Shahroo Izadi

First impressions

The pressure to collect data from new clients should not replace essential rapport, says Shahroo Izadi

 

 

Richard Homer

The writing’s on the wall

Literacy issues can be a barrier to participant engagement and successful outcomes in substance misuse treatment programmes. Richard Homer explores the reasons why

 

 

Graham Marshall

The times they are a changin’

As Spitalfields Crypt Trust (SCT) celebrates 50 years of helping people in recovery, CEO Graham Marshall looks back at the changing landscape of addiction and recovery in East London

 

 

Letters

Letters

‘Difficult though the challenge of the emergence of new substances is proving, and whether or not you agree with the recent legislation, I feel that an opportunity has been missed to rename these substances…’ – Peter Young, Hampshire

 

Media savvy

Media savvy

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

 

 

 

 

Media Savvy

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Who’s been saying what..? DDN‘s round-up of what’s being said in the national papers

Is there a link between life on welfare and the vile crimes which appear on our daily news schedules?… Of course the vast majority of welfare claimants are genuinely in need of help and would prefer to stand on their own feet. But for some it’s a lifestyle choice that puts them outside the norms of conventional society. Not having to work frees up time, which, for those with few intellectual resources and low self-respect, sometimes leads to a reliance on alcohol, drugs and pornography. Killers [Mick] Philpott, [Stuart] Hazell and [Mark] Bridger were all, to some degree, assisted in becoming monsters by the welfare benefits system. Peter McKay, Mail, 3 June

 

Drug use is a morally neutral subject in the British press. It’s the identity of those concerned that dictates the tone. When aristocratic models are involved, it’s glamorous; when powerful politicians are, it’s youthful folly, and when anyone else is, it’s a serious criminal offence. Working-class-girl-done-good Tulisa [Contostavlos] belongs to a group which the press takes particular relish in taking down a peg. Ellen E Jones, Independent, 3 June

 

The saga of the Care Quality Commission (CQC) has progressed from tragedy through scandal to farce, and has now plumbed astonishing new depths of moral and political squalor… But the CQC cannot now be put right because the NHS cannot be put right. For the root of this moral and professional corruption is that the entire bureaucracy of the NHS – up through the secretary of state to the prime minister himself – conspires to tell the public the big lie that the NHS remains a national treasure because no other system matches it for decency and compassion. In fact, the opposite is true. Melanie Phillips, Mail, 24 June

 

Specialist care can pull people back from the brink of the most devastating consequences of alcohol misuse, especially alcohol-related liver disease, give them back their self-respect and restore them to their families and communities. The development of high-quality, integrated prevention and treatment services for those with alcohol-related disease would be a wise investment for the future health of our nation, especially that of our young people. Kieran Moriarty, Guardian, 3 June

 

All the evidence is there that we as a nation have a drinking problem, and we cannot handle it. Visiting tourists, including those from the US, gaze openmouthed at our heavy drinking culture. And yet the government, for fear of being branded nanny statists, has failed to take action. Jane Merrick, Independent, 4 June

 

After 50 years of prohibition, drugs are cheaper and more available than ever before. The collateral damage – particularly to countries that produce the drugs and those through which they pass – is devastating. Surely the governments of the world can do a better job of limiting harms than the cartels, whose only motivation is profit, and who are the principal beneficiaries of the present approach? Amanda Feilding, Guardian, 14 June 

 

Sometimes, I feel as if the greatest barrier to ending the nightmare is political inertia maintained by the hunger of political leaders to dip into the billions of dollars in funding earmarked for drug-war operations. Javier Sicilia, Observer, 2 June

 

Amar Lodhia

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Amar_smallWEBThree-pronged approach

Partnership working is showing promising results for London’s keen entrepreneurs, says Amar Lodhia.

Over the last six months, the TSBC team and I, City of London Corporation staff and high profile entrepreneur guests have all been involved in the delivery of an inspiring self-employment programme, which was 50 per cent funded by our foundation. It has resulted in eight new enterprises being formed and 15 City of London staff engaging in mentoring and volunteering their time to the programme – all of which has contributed to participating adults already coming off benefits and creating a job for themselves in a climate where jobs are more difficult to find, particularly for those with convictions and other barriers to employment.

The 20 residents (mainly female ex-offenders) from across Islington, Southwark, Tower Hamlets, Camden and Westminster participated in this programme, which was made up of ten weeks of core delivery and will end in December 2013, following a year of mentoring and post-programme support.

The programme was unique and its success can also be attributed in large part to the City of London staff from different departments, such as housing, media and economic development, who were trained as mentors and also co-delivered activities within the sessions.

On 14 May, the City of London Corporation, and its chief executive John Barradell, hosted their annual employee volunteering reception, in which charity partners and employees met up to celebrate and encourage volunteering. During the event, he commended the work of TSBC and his Economic Development Office as well as the corporation’s employees. As part of their commitment to promoting corporate responsibility and economic regeneration, the City of London Corporation gives all staff the opportunity to take the two days (or equivalent) of volunteering leave each year.

TSBC is calling on other local authorities to learn from this prime example of employee engagement in the public sector, particularly those within which it operates, including Islington, Southwark, Tower Hamlets, Hounslow, Barking and Dagenham, Newham, Haringey, and Melton Mowbray.

This programme showed the ‘tri-sector’ approach on the front line, with real partnership working between entrepreneurs, public sector workers and charities. In my February column, I wrote about how participants also heard from award winning entrepreneurs like Seema Sharma – Channel 4’s Slumdog Secret Millionaire and local Tower Hamlets dentist.

 Wendy Lunn, City of London Corporation’s employee volunteering programme officer said, ‘The main focus of our programmes over the last six months has been our flagship E=MC2 programme. This programme has involved 20 unemployed local residents taking part in workshops to help boost their employability skills and to help those that wish to set up their own business to develop their enterprise skills. The workshops engaged more than 15 volunteers in sharing their expertise and helping the participants to develop their skills.’

To enquire more about our work please contact me at ceo@tsbccic.org.uk and follow me on Twitter @amarlodhia or @tsbclondon – don’t forget to use the #tag DDNews when tweeting!

Amar Lodhia is chief executive of The Small Business Consultancy CIC (TSBC) 

Family Matters

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Screen shot 2013-07-05 at 14.11.28No hiding place 

Adfam’s conference highlighted the urgent need to understand the impact of alcohol on the whole family, says Joss Gaynor.

Hosting our conference, Hidden Harm 10 years on, gave delegates the opportunity to consider not only the progress that has been made but also the distance we still have to travel to protect and improve the quality of life for children affected by parental substance use. Back in 2003, Hidden harm didn’t address parental alcohol use and its specific impacts, but one strong theme from the presenters and delegates this year was the real and urgent need to improve our understanding of alcohol use on children. Sir Ian Gilmore from the Alcohol Health Alliance urged the audience to start thinking about the idea of ‘passive drinking’ and its potential impact on the children and other family members.

Some could suggest in policy terms that there is a lack of coherence around children, families and alcohol and the alcohol strategy does not offer any clarity or action on how to address this issue. What’s clear is the significant needs of these children. The Office of the Children’s Commissioner report, Silent voices, published last year, identifies that the size of the problem is relatively unknown. However, we do know that there are high levels of parental alcohol use in serious case reviews and children affected often come to the attention of children’s services later and through different pathways than those impacted by parental drug use. Silent voices also goes on to point out that many children are coping with the alcohol use in their families – some of them very well – but this does not equal resilience. Resilience suggests a recovery from the adversity, which is often a far cry from the behaviours and actions children employ to keep themselves safe and cope with alcohol in the family. 

One of the other strong themes from the conference was that parental alcohol use rarely sits in isolation and often children are impacted upon by a range of other inter-related issues, including conflict and violence. Delegates suggested that when parental alcohol use and family conflict co-exist that the negative long-term impact on the child could be magnified. It was also felt that the focus of some policy and strategic thinking concentrated on alcohol as a single issue, rather than looking at the cumulative effects of the wider social issues, leading to inadequate management of the family.

One of the differences between parental alcohol and drug use is alcohol’s legal and socially accepted place in society. Our culture of drinking in this country can cause confusion and a reticence to understand and explore what might be harmful to children and their safe family life. Silent voices found that it cannot be assumed that higher levels of consumption equate to greater harm and that some less frequent, episodic binge drinking behaviours can be very impactful on children.

What is clear is that we need to do a lot more research, thinking and development to better understand the needs of children affected by alcohol misuse. Both national and local policy needs to be improved to pay more account of these children and not just those at the high-risk end. Those working in services need to be vigilant to the needs of children who are faced with the harms from parental alcohol misuse.

Joss Gaynor (formerly Smith) is director of policy and regional development at Adfam, www.adfam.org.uk

Steve Brinksman

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Steve-Brinksman_w01WEBFamily matters

Always look beyond the symptoms at the wider picture, says Dr Steve Brinksman.

I have just returned from the RCGP/SMMGP annual substance misuse conference in Birmingham. The theme of the conference was ‘Joining the dots’, encouraging us to look at the wider picture and consider the impact of substance use on more than the individual. I was asked to talk about the role of families and their impact – positive and negative – on someone who uses substances problematically, but also the effects that their addiction can have on their family.

If you have read this column before, you will know that I am a passionate advocate of the role that primary care can play in working with those using drugs and alcohol, and a key part of this is the continuity that helps build a relationship with a patient, sometimes over many years. 

Despite this I can be a bit slow on the uptake at times! I had been seeing John for about three years for his heroin and crack use; he was fairly chaotic, injecting and funding his use through acquisitive crime and borrowing money from family. His engagement with treatment at that time would be best described as tangential and he was a frequent non-attender. After a couple of consecutive failures to keep appointments, I found out from our shared care worker that he had been sentenced to 18 months in prison for drugs-related offences.

Over the same period I had been seeing Linda, a 40-year-old woman who had significant anxiety and depression. I had started her on citalopram – an SSRI antidepressant – and referred her to our primary care based counsellor, and she had had a couple of short courses of diazepam over the last few years when she had presented ‘at the end of my tether’.

I saw her one day and she seemed much more relaxed than usual. She told me that she felt much calmer as her son had been sent to prison for 18 months and she felt this would give her the chance to try to sort herself out – and it was then that the penny dropped. She was John’s mother, and although they shared the same (albeit relatively common) surname, I had not made the connection as they were registered at different addresses and I hadn’t thought to ask her if her anxiety related to caring for someone with substance misuse problems.

I had made the common mistake of focusing on Linda’s symptoms and not exploring the wider context of things happening in her life by direct questioning. Instead I assumed I would be told all the issues by the patient. Linda felt stigmatised because her son was someone who uses drugs. She had lost friends, and she also expected us to treat her as if she wasn’t worthy because of this, so she didn’t volunteer the information. 

The time John spent in prison did help him to make some progress and he engaged with treatment services. Over the five years since he was released he has been more compliant with medication and (usually) keeps his appointments, but he does still use a couple of times a week. However Linda feels she has the ability to cope with the situation and no longer blames herself for all of his problems. Interestingly, as John has had more appointments, she has had less. 

As for me, I hope I try to look at a wider picture when seeing those patients presenting with anxiety and depression – even if this means sometimes asking difficult questions.

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

Policy Scope

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Screen shot 2013-07-05 at 14.30.31Right terms

Using appropriate language is an essential step in supporting women involved in prostitution, says Marcus Roberts.

I was in the House of Lords on 3 July for the launch of DrugScope and AVA’s report The challenge of change on improving services for women involved in prostitution and substance misuse. The findings and recommendations of the report are covered in this issue, but I wanted to add a couple of general reflections.

The Drug strategy 2010 talks about ‘recovery’ as an ‘individual, person-centred journey’, but is largely silent on matters of difference and identity. I was surprised to find, for example, that there are no direct references to ‘women’ or ‘girls’ in the strategy. There is a lack of intermediate space between abstract generalisations like ‘treatment’ and ‘recovery’ and invocation of the specific needs of particular individuals. I suspect this encourages a tendency to think and plan in terms of adult males as a ‘default setting’ unless gender is highlighted.

Evidence and experience suggest that gender is vital for engagement, treatment and reintegration. St Mungo’s Rebuilding Shattered Lives campaign is highlighting the extent to which recovery is ‘gendered’, with women tending to place a greater focus on rebuilding relationships, including with children. Most obviously, women’s involvement in substance misuse (and supply) is often framed by abusive and exploitative relationships with men, including domestic and sexual abuse. Local approaches therefore need to link up drug and alcohol strategies with violence against women and girls initiatives, for example.

Conversely, I wonder if thinking about some women with drug or alcohol problems as ‘sex workers’ or ‘prostitutes’ can obscure the extent to which this group shares needs, aspirations and characteristics with other people in treatment (that’s why we were very careful about language in our report, incidentally, opting after much discussion for ‘women involved in prostitution’). For example, the women we spoke to valued the harm reduction services that were targeted at them (needle exchange, condoms and ‘scripts’) but equally they spoke about their aspirations for a decent place to live, a ‘normal’ job and a future for their children, and felt services sold them short when it came to reintegration and recovery.  It is also striking how often the women we spoke with fitted the profile we associate with ‘multiple needs’ (including homeless­ness, recent imprisonment and mental health issues), and yet how marginal they have been to the recent evolution of – and investment in – this agenda. 

The terminology of ‘prostitution’ can bring so much cultural baggage  – and such a weight of stigma – that the risk is, as it were, that, paradoxically, we only see the particularities and miss the generalisations. While attention to the former is absolutely vital to providing good services, ignoring the latter risks selling women involved in prostitution short.

The ‘challenge of change’ is at www.drugscope.org.uk/POLICY+TOPICS/Prostitution+and+substance+use.htm

DrugScope/LDAN has also produced a report on domestic violence and at www.ldan.org.uk/PDFs/DVReport.pdf

Marcus Roberts is director of policy and membership at DrugScope, the national membership organisation for the drugs field, www.drugscope.org.uk

 

 

Support. Don’t punish

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On 26 June 2013 – the UN’s International Day Against Drug Abuse and Illicit Trafficking – 26 cities around the world came together to participate in the Support. Don’t punish campaign. Raising awareness of the need for better drug policies and calling for a more humane public health approach to drug use, the the Global Day of Action aimed to promote ‘reform, alternatives and more human responses’.

Members of Parliament, including Caroline Lucas, Green Party MP for Brighton and Julian Huppert, Liberal Democrat MP for Cambridge, joined the Day of Action.  

‘Governments now need to take an approach based on evidence – and one which deals with drugs as a health issue, not a criminal one,’ said Lucas.

Below are some of the best photos from the day.  More images and information can be found on their website and Facebook pages:

www.supportdontpunish.org/day-of-action

www.facebook.com/events/388699341241159/

 

Bosnia and Herzegovina Bangkok2 London3

 

 

 

 

 

 

 

 

 

 

 

 

 

Letters and comment

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The DDN letters page, where you can have your say.

The August issue of DDN will be out on 5 August — make sure you send letters and comments to claire@cjwellings.com by Wednesday 31 July to be included.

 

 

Open letter from Dr Chris Ford to Anna Soubry MP

Dear Anna Soubry,

I would like to continue our discussion begun at the 18th RCGP working with people who use drugs and alcohol conference, Joining the Dots in Birmingham in May, when you took questions from the stage.

I said I felt it was vital that drug use is treated as a health issue, not as a criminal issue and I was truly shocked to hear you say that you are in complete disagreement with this. Your view is at odds with the recent BMA report Drugs of Dependence: The role of the medical professionals which clearly states the that the emphasis on health has been lost as the focus instead has been on the legal and criminal justice aspects of drug misuse. With the report, the BMA aims to refocus the debate on this as a health issue, led by the medical profession, which is well placed to take such a key role. To quote Professor Mansfield, ‘The medical profession should look squarely at the issue and debate it as a medical problem’. Professor Mansfield adds: ‘The BMA believes that drug users are patients first. That’s why we want health to be at the heart of the debate about drugs policy’.

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Harm Reduction International Conference

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This year’s Harm Reduction International Conference in Lithuania brought together delegates from across the globe to discuss the need to provide sufficient political and financial support for harm reduction. 

More reports can be found here.

To read the full HRIC daily update magazines, please click here.

 The conference was an opportunity for different voices from many different countries to be heard. Below are reports that were not featured in the July 2013 issue of DDN magazine.

‘Our policies are not our own’

 Corruption and weak institutions are driving forward drug problems in Africa

Weak institutions and high levels of corruption were exacerbating the drug problem in Africa, Isidore Obot of the Centre for Research and Information on Substance Abuse in Nigeria told delegates in the final day’s opening plenary session.

Sub-Saharan Africa had a very youthful population, which had implications for drug use, and there were also obviously significant issues of poverty. ‘There is economic growth and rapid urbanisation,’ he said. ‘But basically the rich are getting richer and the poor are staying poor.’

West Africa had become a drug trafficking hub, and although less than 0.5 per cent of Africans had reported use of heroin or cocaine, there was increasing availability of both, along with amphetamine-type substances, he stated. There were also significant levels of injecting reported in Kenya, Mauritius, South Africa and Tanzania, alongside high levels of HIV and hepatitis C.

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Obituary

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Peter McDermott remembers friend and colleague, Alan Joyce

It is with great sorrow that I announce the death of Alan Joyce.

I first came across Alan when he started working as a volunteer for the Methadone Alliance. He popped up on some of the harm reduction mailing lists, full of passion for his new role, and with an interest in politics and post-structuralist philosophy.

An ex-art student, Alan had studied Fine Art at St Martin’s College and had had a career in the London theatre before his drug use eventually got the better of him. He’d been struggling with the implications of the policies of his local treatment provider when he learned about the Methadone Alliance, and had Bill Nelles, the Alliance’s founder and director, advocate on his behalf. It wasn’t long before Alan was volunteering for the Alliance himself, and then shortly after that he was appointed as senior advocate, handling the most complex advocacy cases across the UK. 

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Nothing to declare

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Screen shot 2013-07-05 at 14.30.00In the fifth part of his personal story, Mark Dempster reaches crisis point as he realises his luck has finally run out

I had gone to India to sort myself out – kick the heroin and get some hash to smuggle back to London once things had calmed down. Several years later and I was begging on the streets, scamming tourists, and my heroin addiction had gone from smoking to injecting. India wasn’t turning out to be my saviour. I was dying and it had nothing to do with where I was. It was the alcohol and drugs killing me – but I couldn’t stop.

I remember the moment of clarity. It was in a seedy bed and breakfast with my junkie girlfriend Debbie, her neck stuck out begging for a hit, a prostitute and her pimp boyfriend in the corner. For the first time I was watching myself from above. I didn’t recognise me. I wasn’t a big time dealer. I wasn’t a popular guy. I wasn’t even a half decent petty criminal. I was a junkie. A junkie with a needle in my arm and no friends who were any different. Worse than all that – I had a full-blown disease that needed medication every minute of every day and what was cheap before was now becoming impossible.

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Safe from harm

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Last month saw the 23rd International Harm Reduction Conference take place in Lithuania. DDN reports on a gathering of activists, policy makers and service users from across the globe.

More reports from the day can be found here.

To read the full HRIC daily update magazines, please click here.

Reclaiming harm reduction

Screen shot 2013-07-05 at 13.47.26HRI executive director Rick Lines explains the reasons for mounting the event in Eastern Europe

‘Eurasia is one of the regions that’s been most severely hit by the HIV epidemic related to injecting drug use,’ says HRI executive director Rick Lines of the decision to stage this year’s conference in Lithuania – the first time the event has been held in the Baltic States, and its first time in Eastern Europe since 2007.

‘It’s also a region where the harm reduction response is underdeveloped,’ he says. ‘There are high levels of need and a lot of countries with generally poor harm reduction services, severely repressive drug laws and human rights violations against people who use drugs. Having the conference in the Eurasian region was an important way to call attention to these issues.’

Lithuania is also home to HRI’s partner organisation, the Eurasian Harm Reduction Network. ‘They approached us with a proposal to hold the conference here and they’re a fantastic organisation so we jumped at the chance,’ he says

 

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Lines of communication

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Screen shot 2013-07-05 at 13.47.26HRI executive director Rick Lines has been making the case for a human rights-based approach to vulnerable populations for more than two decades. He talks to David Gilliver about getting the harm reduction message across

‘Harm reduction is consistently having to re-fight battles that we’ve won in the past,’ says Harm Reduction International (HRI) executive director Rick Lines. ‘Because in many ways it can seem counter-intuitive to the dominant zero- tolerance, abstinence-based narrative.’ This means those working in harm reduction having to explain ‘again and again’ to politicians, policy makers and the public about where it fits in ‘a continuum of comprehensive health services’, he says.

And he’s been arguing these points for a long time, having become involved in harm reduction through prisoners’ rights work. An activist in the late ’80s and early ’90s, in 1993 he took a job in what remains the only community-based HIV project in Canada working exclusively in prisons.

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Family focused

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Family focused

With 2013 marking the ten-year anniversary of Hidden harm, social care professionals gathered at the Adfam annual conference in London to reflect on the progress so far and what the future might hold. Kayleigh Hutchins reports.

 Children don’t care about the substance – drugs and alcohol are all the same,’ said Adfam chief executive Vivienne Evans, introducing the day by highlighting the improved focus on the family since Hidden harm. But, she emphasised, much more work was necessary to ensure that families were getting the support they needed.

‘Alcohol is a drug – it’s a drug of dependence,’ said Ian Gilmore of the Alcohol Health Alliance UK, highlighting the effects that changing drinking patterns in Britain were having on families. A combination of new products appealing to children and teenagers, low pricing at supermarkets and an ‘alcogenic’ environment had led to 10 to 15-year-olds being exposed to 10 per cent more advertising than adults.

‘So long as we have alcohol 24/7, children are going to think it’s normal to drink,’ he said. Alcohol killed more people under 60 than drugs, tobacco, and unsafe sex. ‘When put in context of harm done to families, there is public support for alcohol reforms,’ he said, adding that the harms of passive smoking ‘paled in comparison’ to the harms of drinking.

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On the margins – news focus

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Little specialised support exists for women who use drugs and are involved in prostitution, says a new report from DrugScope.

‘I’ve been raped, I’ve been beaten up, fucking sodomised, punched the fuck out of,’ says one woman interviewed for The challenge of change: improving services for women involved in prostitution and substance use, a powerful new report from DrugScope and Ava (Against Violence and Abuse). She also once had to knock on random doors after having been stripped and thrown from a car. ‘How humiliating can it get?’ she says. ‘Once that happens you don’t fucking forget.’

The report looks at current service provision and makes recommendations for both policy makers and services. Violence was an issue for most of the women interviewed, whether from partners or ‘punters’, and added to this were mental health issues – often from past physical or sexual abuse – poor physical health, increased HIV risk and ‘very low’ self-esteem.

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News in brief

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Care consultation

The Care Quality Commission (CQC) is carrying out a consultation to get feedback on its plans ‘to help ensure that people receive high-quality care’. The consultation, which is open until 12 August, is ‘the next step towards making the changes needed to deliver our purpose’, the organisation says. The regulator’s chair recently stated that the organisation’s previous board was ‘totally disfunctional’ in the wake of a number of high-profile scandals.

Consultation at www.cqc.org.uk

Educate and prevent

A new Alcohol and Drug Education and Prevention Information Service (ADEPIS) has been launched by Mentor UK, in partnership with DrugScope and Adfam. As well as a website with free resources and guidance for schools and others working with children and young people, the DfE-funded service is developing a set of standards and good practice guidelines.

mentor-adepis.org

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UN highlights ‘alarming’ rise in new drugs

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New psychoactive drugs are proliferating at an ‘unprecedented’ rate and pose ‘unforeseen public health challenges’, according to the United Nations Office on Drugs and Crime (UNODC) 2013 world drug report.

While use of traditional drugs appears to be declining in parts of the world, there is an ‘alarming’ rise in the use of new psychoactive substances, it says, with the number reported to UNODC rising by more than 50 per cent between 2009 and 2012 and new formulations ‘outpacing efforts to impose international control’.

Seventy-three new psychoactive substances were notified for the first time in Europe last year (DDN, June, page 5) and a total of 158 in the US, and for the first time their number is now greater than the total number of illicit drugs under international control. ‘What is actually known today, however, may be just the very tip of the iceberg,’ says the report, as systematic studies on the spread of the substances do not exist.

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Glamourised ‘lifestyle’ promotions must be banned, says Alcohol Concern

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Alcohol advertising that promotes ‘lifestyle’ images of drinkers or scenes that glamourise drinking should be banned, according to a report from Alcohol Concern. The recommendation is one of several in Stick to the facts, which maintains that self-regulation is failing.

The charity wants to see a ban on alcohol sponsorship of all sports, music and cultural events as well as on cinema advertising for everything except 18-rated films. The report also calls for restrictions on advertising content, so that only images and messages related to ‘the characteristics of the product’ – such as origin, ingredients and means of production – are allowed. The measures are necessary to ‘protect children and young people from excessive exposure’ to alcohol advertising, the charity says. 

Regulation also needs be statutory and independent of the alcohol and advertising industries, with meaningful sanctions such as fines for non-compliance – based on ‘the size of marketing budget and estimated children’s exposure’. Regulating digital and online content presents a particular challenge however, the document states, with self-regulation failing to adequately protect the young. Advertising body ISBA responded by saying that self-regulation was effective and that the UK had ‘some of the toughest advertising rules in Europe’.

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Alcohol dependency prescriptions up three quarters in a decade

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Prescriptions to treat alcohol dependency have risen by 73 per cent in a decade, according to figures from the Health and Social Care Information Centre (HSCIC). More than 178,000 prescriptions were issued in 2012, compared to just under 168,000 the previous year and fewer than 103,000 in 2003. 

The 2012 figure is the highest number ever recorded by HSCIC, with a ‘net ingredient cost’ of £2.93m, says Statistics on alcohol: England, 2013. The report illustrated ‘the impact of alcohol misuse on hospitals in England’, according to HSCIC.

‘It is extremely important that patients who are dependent on alcohol have access to drugs that can help them recover,’ said Royal College of Physicians advisor on alcohol, Dr Nick Sheron. ‘However, the rise in prescriptions of drugs to treat alcohol dependency is indicative of the huge strain alcohol abuse puts on our society.’

While the report looked at the number of prescriptions being used to treat dependency, the ‘real issue’ was ‘the vast numbers of people who are not getting help for their alcohol addiction’, said Alcohol Concern’s director of campaigns, Emily Robinson. The charity estimated that just one in sixteen people with an alcohol problem received specialist help, as ‘there is just not enough treatment available’, she said. 

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July issue 2013

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In this month’s issue of DDN… Picture 21

‘It’s very strange to sit in a harm reduction conference and realise that the last needle exchange programme in Romania will close this year. We in harm reduction will increasingly be at the cold intersection of austerity and social exclusion.’

The July issue reports from the International Harm Reduction Conference 2013, which brought together activists, policy makers and service users from the across the globe. 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 

UN highlights ‘alarming’ rise in new drugs

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DDN
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New psychoactive drugs are proliferating at an ‘unprecedented’ rate and pose ‘unforeseen public health challenges’, according to the United Nations Office on Drugs and Crime (UNODC) 2013 world drug report. 

While use of traditional drugs appears to be declining in parts of the world, there is an ‘alarming’ rise in the use of new psychoactive substances, it says, with the number reported to UNODC rising by more than 50 per cent between 2009 and 2012 and new formulations ‘outpacing efforts to impose international control’. 

Seventy-three new psychoactive substances were notified for the first time in Europe last year (DDN, June, page 5) and a total of 158 in the US, and for the first time their number is now greater than the total number of illicit drugs under international control. ‘What is actually known today, however, may be just the very tip of the iceberg,’ says the report, as systematic studies on the spread of the substances do not exist. 

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