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Drug strategy will fail without new money, say critics

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3460 (Published 17 July 2017) Cite this as: BMJ 2017;358:j3460
  1. Matthew Limb
  1. London

The government’s plans to reduce illicit drug use and improve rates of recovery from dependence are unlikely to succeed without new investment, as local councils struggle to provide services with reduced budgets, experts have warned.

The new drug strategy, published on 14 July by the home secretary, Amber Rudd, is the first since 2010, but it seems to carry no new funding.1

Rudd will chair a new cross government drug strategy board to oversee a supposedly more balanced approach, designed to ensure that fewer people use drugs in the first place, prevent escalation to more harmful use, and provide more effective, individually tailored treatment options.

She said that coordinated action by the police, health professionals, and local authorities would protect people most at risk of harm, including homeless people, victims of domestic abuse, and people with mental health problems.

“I am determined to confront the scale of this issue and prevent drug misuse devastating our families and communities,” she said.

Drug service specialists have welcomed key elements of the strategy but highlighted significant omissions and the need for more investment.

A new analysis by the health think tank the King’s Fund, published earlier this month, found that councils’ spending on substance misuse will fall by more than £22m (€25m; $29m) this financial year, a 5.5% cut since 2013-14.2

Ian Hamilton, a lecturer in mental health at York University who works with people who have drug and alcohol problems, told The BMJ, “It’s difficult to know where local authorities are going to find the money to meet the ambitions that the strategy lays out. This isn’t the first year there’s been a cut to public health budgets, of which drug treatment is one part: it’s been cut after cut after cut.”

He added, “I think we’ve reached the limit of how efficient local authorities can be in commissioning drug treatment, and now what we’re going to see is less drug treatment, not more efficiently provided drug treatment.”

Adam Winstock, a consultant psychiatrist and specialist in addiction medicine at University College London, said that drug treatment services had had their money “slashed” and that people were leaving the profession “left, right, and centre.”

He told The BMJ, “They [ministers] have dodged the hard questions: drug law reform, social inequality, poverty, racism, the pointlessness of banging up people in jail for personal possession of drugs. All the things that might suggest the government is fundamentally willing to look at drugs differently, there’s nothing there about that.”

In 2015-16 around 2.7 million people (8.4%) aged between 16 and 59 in England and Wales took illegal drugs, down from 10.5% a decade ago. But the number of deaths from drug misuse rose by 10.3% to 2479 in 2015 from the year before. This followed substantial increases in 2013 and 2014. Deaths related to heroin, which accounted for around half the deaths, more than doubled from 2012 to 2015.

The government’s new drug strategy said that there had been a decline in the proportion of opiate users completing treatment and much variation between local authorities in treatment outcomes. It aims to reduce demand for illicit drugs by deterring use and through education programmes, and to restrict supply through strong law enforcement and strengthened border controls. It also aims to increase the proportion of users who recover from dependence.

The strategy proposes better measurement and monitoring, with health services checking the progress of those in recovery at 12 months, as well as after six, to ensure that they remain drug free.

A new national recovery champion will be appointed to make sure that adequate housing, employment, and mental health services are available, to “help people turn their lives around.”

The plan aims to deliver more effective commissioning and improved quality of treatment.

Hamilton said that it contained many good elements with which clinicians and researchers would agree. But he said that it omitted evidence based measures that would reduce drug mortality, such as assisted treatment for heroin use, drug consumption rooms, or supervised injecting facilities.

The strategy will target emerging threats from new psychoactive substances (formerly known as legal highs); image and performance enhancing drugs, such as steroids; misuse of prescribed drugs; and “chemsex” drugs, taken before or during planned sexual activity to enhance the experience or disinhibit the user.

Although few people use new psychoactive drugs, they are proliferating on the market and are a growing problem among particular groups, such as homeless people and prisoners.

A new intelligence system will try to identify threats to health from new psychoactive substances and to more rapidly deliver better treatment responses.

Tom Freeman, a senior academic fellow at King’s College London, said that new psychoactive substances were often more harmful than the drugs they mimic, as people were unable to verify what they were actually taking.

He added, “The government’s new strategy misses a crucial point. Drug testing facilities have the potential to save lives and should have been incorporated into the strategy.”

Winstock said that the latest plan was better than the 2010 strategy and focused less on abstinence as the only acceptable outcome but said that it “could have been so much better.”

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