When a \u2018general in the war of drugs\u2019 calls the campaign a complete failure, it\u2019s time to listen. DDN reports from the GPs\u2019 conference. \u2018For the last 40 years we have been fighting a war on drugs. I\u2019ve been a general. We sought to deal with it through the hammer blow of the criminal justice system and I am sorry for having supported this war. It has been an utter failure.\u2019 Lord Charles Falconer was addressing an audience of GPs at the recent RCGP\/SMMGP conference on managing drug and alcohol problems in primary care. The former minister under Tony Blair\u2019s government, whose roles had included justice secretary, said: \u2018It\u2019s time for us to acknowledge our failure and examine the evidence-based alternatives.\u2019 \u2018Addiction knows no class barriers \u2013 everybody knows somebody who is affected,\u2019 he said. Post- EU (and the conference was held on Britain\u2019s withdrawal day), \u2018the connection between those who know what they\u2019re talking about and politicians has to be restored.\u2019 One of the most obvious ways of \u2018protecting the public from the cruel consequences of an obviously wrong policy\u2019 would be to legalise and regulate drugs, taking them out of the hands of criminals. He referred to the 1961 Single Convention on Narcotic Drugs, \u2018whose base was xenophobia\u2019, and the 1971 Misuse of Drugs Act, a \u2018pernicious policy\u2019 which the UK has continued to support \u2018even though it has brought death to thousands\u2019. \u2018You only need to look at overdose deaths compared to those countries who have moved away from punishment, such as Portugal, to see this approach is catastrophic,\u2019 he said. Politicians were terrified of moving away from this approach because they were \u2018worried about being characterised as flip-flop wearing liberals\u2019. \u2018We have produced some terrible soundbites \u2013 tough on crime, tough on the causes of crime\u2019, he said, and the reliance on prohibition as the main tool had \u2018gifted profit to criminals\u2019. The main casualties had been the poorest, with not enough treatment and \u2018terrifying numbers\u2019 dying \u2013 most of these deaths preventable. Furthermore, we were trapped in a drug policy war: \u2018Every pound we spend on prohibition, the more we spend on clearing it up.\u2019 So what could be the way forward? There was a clear need for evidence-based policy, he said, and we had to take a harm reduction approach that was \u2018holistic and non-judgemental\u2019, giving access to services. \u2018The government has to direct significant investment in drug services as a matter of urgency,\u2019 he said, with funding made available to ensure heroin-assisted treatment, needle exchanges, naloxone, and consumption rooms (on a pilot basis, with evaluation), as well as testing at festivals. \u2018The first priority must be to strengthen drug treatment services and develop harm reduction,\u2019 he said, \u2018and also improve the life chances of people who are recovering\u2019. At the same time, we should review commissioning of services and look at improvements to the local model. He suggested setting up a central body for drug policy, reinstating a drug czar and considering a national agency to overview commissioning. The other vital call to action was to address the \u2018crisis in the drug treatment workforce\u2019, which included the drastic reduction in psychiatrist numbers. \u2018People are no longer interested in high blown rhetoric, they want solutions,\u2019 he said. \u2018If people don\u2019t like the way drugs affect their families and community, change will come.\u2019 Ten year rollercoaster Six months into his role as national recovery champion, Dr Ed Day reflected on the run-up to his appointment and the progress he had been able to make so far. He was realistic about the capacity of his part-time unpaid role (alongside his other jobs), but also optimistic that his experience as a consultant addiction psychiatrist and knowledge of the sector contributed to evidence-based practice. He talked of the \u2018rollercoaster\u2019 of the last ten years \u2013 first, the halcyon years of the Tony Blair decade, when there was a massive expansion of services around criminal justice and the advent of the NTA, \u2018which drove a real interest in the evidence base\u2019. GPs were able to drive up the quality of prescribing. Then came the \u2018crash\u2019 of 2008, followed by the sweeping movement of recovery. \u2018The positives that came out of that included peer support \u2013 but somehow it was couched as against what we did before,\u2019 he said. \u2018We need to combine harm reduction and recovery.\u2019 \u2018We also need to try to change the system to a chronic care model,\u2019 he said, citing Maslow \u2013 \u2018you don\u2019t reach actualisation unless you have something stable underneath\u2019 \u2013 which could begin with needing methadone, for example. The current threats loomed large \u2013 the reduction in budgets and turbulence in the commissioning system, combined with workforce issues that saw an exodus of skills and opportunities. But \u2018in the rush to manage risk and KPIs we forget how to relate to people,\u2019 he said, with harm reduction and recovery both vital parts of the equation. \u2018The development of peer-led recovery communities has stalled,\u2019 he said, neglecting an opportunity for engagement and strategy. \u2018We need to find a way to kickstart self-sustaining systems.\u2019 Peer-led initiatives could help to tackle stigma head-on: \u2018The real key is meeting someone who\u2019s had the problem and recovered,\u2019 he said. \u2018It\u2019s about giving people the key to change the situation themselves.\u2019 Huge amount of instability Speaking in the final session of the conference about the future of addictions treatment, Dr Emily Finch referred to the \u2018huge amount of instability\u2019. \u2018All addictions treatment tends to be in a silo in local authorities,\u2019 she said. \u2018People don\u2019t believe it when you say \u201cwe\u2019re not running that service anymore\u201d.\u2019 There was also \u2018a real loss of skills in the sector\u2019. \u2018When addiction psychiatrists retire, there will be no more in training,\u2019 she said. Constant retendering had contributed to their reluctance to enter the workforce, and there were \u2018almost no psychologists in addiction anymore\u2019. Survival functions Dr Stephen Ryder, who gave a talk on liver disease, said that there was \u2018a mismatch between what industry wants and what health and social care wants\u2019. The fact that England was \u2018still waiting for an alcohol strategy\u2019 demonstrated this, and he encouraged GPs to keep working on survival functions. \u2018The government won\u2019t do anything, so we have to do something,\u2019 he said. Despite high hospital admissions for alcohol-related diagnosis of liver disease, there were \u2018significant deficiencies in action\u2019 with essential early diagnosis not happening and more than half of people dying within two years of a late diagnosis. In a conference called \u2018Navigating the storm\u2019 there was an atmosphere of battling through and looking for the patches of blue sky. But as seen in the conference message, the overwhelming response from GPs was \u2013 enough\u2019s enough. Health and sensible policy must be first priority in this cash-starved sector to stop the scandal of drug and alcohol related deaths. DDN Conference statement We deplore that in 2020 drug-related deaths are the highest on record and now a public health crisis. We call on the College to work with policy makers to not criminalise people who use drugs and implement all evidence-based harm reduction measures to reduce drug deaths including consumption rooms and heroin assisted treatment for those who need it. We call on the council to: \tRecognise the devastating impact of lack of funding to drug and alcohol services since the 2012 Health and Social Care Act, with consequent destruction of shared care services and lack of workforce of those able to work effectively with people who use drugs. \tSupport minimum unit price for alcohol as the single most important harm reduction measure to reduce health inequalities and save lives for people who have alcohol problems.