Treatment threatened by constant re-procurement, warns ACMD

Annette Dale PereraThe quality of treatment for heroin users is being threatened by diminishing funds and ‘disruptive re-procurement processes’, according to a new report from the Advisory Council on the Misuse of Drugs (ACMD).

Treatment quality now varies significantly across England, says the document, and is being further compromised by ‘frequent re-procurement and shrinking resources’. The report stresses that investment in drug treatment needs to be protected, as it is cost-effective and beneficial to society, and it calls for the implementation of a national quality improvement programme. It also wants to see more done to create a ‘culture of stability’ and reduce ‘churn’ in local systems.

The document, which also considers issues such as how to tackle low expectations of recovery, how to prioritise resources to achieve better social reintegration, and how to address misuse and diversion of OST medication, is the final of two ACMD reports into opioid substitution therapy commissioned by the Inter-Ministerial Group on Drugs. The first, published late last year, firmly rejected the idea of time limits on substitution treatment (DDN, December 2014, page 4).

‘Everyone with heroin dependency should have access to high-quality drug treatment,’ the document states, expressing concerns about lack of progress on helping people ‘achieve employability’. More effort is required to achieve this, it says, including vocational training, supported work placements and ‘targeted employment schemes’, including tackling stigma among employers.

However, a ‘significant number’ of heroin users new to treatment appear to be able to complete that treatment and not return, it stresses, particularly if they ‘stop using heroin within six months of starting OST’. Those who are stable and remain in OST for more than five years or more, meanwhile, should ‘be positively regarded as in “medication-assisted recovery”,’ which should ‘not hinder access to healthcare interventions, peer-led recovery interventions and social integration’. This group should not be discriminated against simply because they are in OST, the report warns.

‘Government has done well to achieve widespread recovery-orientated drug treatment for heroin users,’ said co-chair of the ACMD’s recovery committee Annette Dale-Perera. ‘Treatment protects against drug-related death, ill health, chaos caused by addiction, and crime and can help people turn their lives around. We need to act to improve, and not lose, this valuable asset to society.’

How can opioid substitution therapy (and drug treatment and recovery systems) be optimised to maximise recovery outcomes for service users? at