While the frequently hot-tempered harm reduction/abstinence debate that had characterised previous years finally appeared to be morphing into something more measured, 2012 still saw the sector negotiating upheaval on all sides and dramatic shifts in patterns of drug use.
Perhaps fittingly for early January, 2012 begins with a call from the cross-party science and technology committee to review the government’s sensible drinking guidelines, including a recommendation for at least two alcohol-free days a week. The government launches its controversial ‘troubled families’ agenda and, in what is to become one of the year’s defining characteristics for policy debates – celebrity endorsements – Sir Richard Branson writes in the Telegraph that it’s time to end the ‘failed drug war’.
The UK has reached an ‘alcohol death tipping point’, warns the Royal College of Physicians’ special advisor on alcohol, Professor Sir Ian Gilmore, with the next 20 years potentially seeing more than 200,000 avoidable deaths. Meanwhile, the fifth national service user conference, Together we stand, sees another day of vibrant debate and vital networking at its brand new venue, Birmingham’s NEC.
The government launches its long-awaited alcohol strategy, which contains something many people thought they’d never see – a commitment to a minimum price per unit of alcohol – while north of the border the Alcohol Minimum Pricing Bill passes its first stage in the Scottish Parliament, although Labour abstains. Methoxetamine, the ‘legal high’ sold as a ‘safe’ version of ketamine, becomes the first substance to be banned under a temporary class drug order (TCDO), the NTA publishes research showing that the number of crimes committed by drug-dependent offenders fell by almost half after successful completion of treatment, and the Home Office publishes its ‘recovery roadmap’, Putting full recovery first.
Putting public health first, a statement signed by around 40 organisations and individuals, attacks the ‘recovery roadmap’ for ignoring ‘decades of evidence’ and potentially putting the wellbeing of clients at risk, while the Obama administration publishes a drug strategy stating that ‘outdated policies like the mass incarceration of nonviolent drug offenders are relics of the past that ignore the need for a balanced public health and safety approach’. A new synthetic drug is being detected in the EU at the rate of roughly one per week, says a report from EMCDDA and Europol – a ‘global phenomenon developing at an unprecedented pace’.
‘The government has spent £3bn on moving the deckchairs around the Titanic,’ is how RCGP chair Clare Gerada describes the health service reforms at the organisation’s Managing drug and alcohol problems in primary care conference, while work and pensions secretary Iain Duncan Smith hints at plans to cut the benefits of people with drug and alcohol problems who refuse to enter treatment. Ex-governor of Brixton and Belmarsh prisons, John Podmore, meanwhile, tells DDN that, ‘We know, but we won’t accept, that we use remand to deal with social problems’ – locking up people with substance and mental health problems to get them off the streets. ‘The least we can do is provide that in some form of supported housing, not a prison.’ The Scots finally pass their Alcohol Minimum Pricing Bill, declaring that ‘cut-price alcohol will become a thing of the past’ and prompting threats of legal action from the industry.
UNODC predicts 300m drug users globally by the end of the century and, in what may be a taste of things to come, a bitter row breaks out over the transfer of drug services from the NHS to the charity sector in Manchester. Meanwhile, the war of words over the government’s welfare reforms continues in the press, with the liberal media calling for an end to the ‘invidious moral crusade against the poor’ while other papers continue to act as cheerleaders with articles about ‘junkies’ and ‘scroungers’. ‘The government caricatures poor people in terms of the worst cases they can find,’ writes Polly Toynbee in the Guardian. ‘So far they have won the argument.’
Two years on from the largest UK ‘common source’ anthrax outbreak in humans for half a century, NHS Lanarkshire issues a chilling confirmation of an anthrax infection in an injecting drug user, and EMCDDA reports cases in Germany, Denmark and France. Meanwhile, Professor John Strang’s expert group delivers its final report, rejecting the idea of time limits for treatment but recommending that substitute prescriptions be regularly reviewed and more priority given to ‘the desire of individuals to overcome their dependence on drugs’. The government’s focus on binge drinking risks sidelining public health in alcohol policy, warns the House of Commons health committee, while a UNAIDS report states that, despite a 20 per cent reduction in new HIV infections worldwide between 2001 and 2011, Eastern Europe saw 170,000 new infections in 2011 alone, largely the result of contaminated injecting equipment.
‘I believe we are approaching the point where we can achieve a genuine consensus that will be of benefit to practitioners and patients,’ Professor Strang writes in DDN of the harm reduction versus recovery debate, adding that ‘well-delivered OST provides a platform of stability and safety that protects people and creates the time and space for them to move forward in their personal recovery journeys’. A fatal anthrax infection in Blackpool brings the number of cases across Europe to eight, and Scotland records its highest ever number of drug-related deaths, with the number of cases potentially involving methadone leading to calls in the press for a parliamentary inquiry. ‘We throw away £36m every year doling out more and more methadone in the face of less and less evidence that it achieves anything but line the pockets of those involved with dispensing it,’ thunders the Daily Record.
Blackpool sees a second fatal anthrax case, and Public Health Wales confirms a case in Gwynedd. As a new report reveals that rates of premature death from liver disease are higher in the North West than anywhere in England – and have doubled since 1995 – British Liver Trust chief executive Andrew Langford tells DDN that ‘we really do have to educate the health and wellbeing boards, and particularly the directors of public health’, about the importance of investing in treatment.
UKDPC calls for a wholesale review of the Misuse of Drugs Act and the classification system in its Fresh approach to drugs document, while the NTA reports that the number of young adults needing treatment for heroin or crack has plummeted to the lowest recorded level, making the over-40s the only group whose numbers in treatment are increasing. ‘Young people are savvier about heroin and crack than they were in the ‘80s,’ says chief executive Paul Hayes. The Scottish Government commissions an independent expert group to look at the evidence for opiate replacement therapies and new Public Health England chief executive Duncan Selbie tells the City health 2012 conference that relocating public health in local government is a ‘stroke of genius’, pledging that his organisation will make sure drug treatment is ‘evidence-led’.
The EMCDDA reports that Europe may be entering a ‘new era’, with declining heroin use but a bewildering and ever-growing array of new synthetic drugs, while the American states of Colorado and Washington vote to legalise and regulate marijuana, although the drug remains illegal at federal level. Area manager of Islington Community Alcohol Service Hazel Jordan writes in DDN that swamped alcohol services are ‘only scratching the surface of need’, while Neil McKeganey and colleagues call for a reevaluation of Suboxone, currently prescribed to only a fraction of the number of people who are prescribed methadone.
The sector prepares for the year when all the talk, and Public Health England, becomes a reality. As DrugScope chief executive Martin Barnes tells conference delegates, the sector has ‘the passion, savvy and maturity’ to respond to challenging times. ‘We’ve just got to hold our nerve.’