Druglink Magazine Blog

Media muddle over mephedrone

noreply@blogger.com (Anonymous) — Fri, 19 Mar 2010 11:21:00 +0000

Mephedrone (aka meow meow, M-Cat etc) clearly has harmful effects - our Druglink magazine recently reported on a case where several young people were hospitalised after using it, and the internet is full of chat about bad experiences under the influence of the drug.

But it is perhaps not surprising that having discovered the latest ‘new drug scare’, the media should have got many aspects of the story wrong either because it didn’t fit what they wanted to write or because one piece of misinformation is picked up and repeated time and again until is becomes enshrined in ‘the facts’. So are what some of the myths about meow-meow?

Mephedrone is plant food
No it isn’t. Try putting it on your tomatoes and see what happens. In fact, mephedrone could have been marketed as shoe polish or anything. This is simply a ruse used by sellers to try and dodge medicines and poisoning legislation by saying that the substance is not being sold for human consumption. Earlier this year a spokesman for the European Fertiliser Manufacturers’ Association said: “It [mephedrone] is never used in any products that people would use to fertilise plants.”

Mephedrone is responsible for drug deaths in the UK
Media reporting has ‘linked’ mephedrone to fatalities, but that isn’t the same thing as the drug being directly attributed as ‘the cause of death’. In fact, the closest to a death directly attributable to mephedrone has been reported from Brighton: toxicology reports on a 46 year old man who died from a heart attack revealed high levels of mephedrone, although the inquest wont take place until the end of May.

Media reporting on the deaths of two young men from Scunthorpe have declared mephedrone as the cause of death. But currently Humberside police are investigating the possible role played by alcohol and methadone as well as mephedrone in the fatalities. Late last year, it was widely reported that the death of a 14-year old girl also from Brighton had been caused by mephedrone. The eventual inquest and toxicology tests determined that the girl had died of natural causes following a "cardiac arrest following broncho-pneumonia which resulted from streptococcal A infection". Despite this, some media coverage is still reporting the case as a ‘mephedrone death’.

Teachers are powerless to act because the drug is legal
Teachers are perfectly entitled to confiscate any item they wish from school students if the item breaks school rules or in any way puts the students or others at risk.

The government is dragging its feet over banning the drug.
No it isn’t. The government is obliged by law to consult its drug experts as part of the process of deciding whether or not a drug should be controlled. If they decide it should be controlled, then the legislation has to be drafted and put through the parliamentary process. Because the Misuse of Drugs Act is a legal instrument, this has to be done carefully and so naturally does take some time. It is simply mischievous to suggest ‘lives could have been saved’ if the government had acted more quickly

Banning the drug would remove the problem
It does seem that some young people who are not normally part of the drug scene have been encouraged both to use and sell the drug because it is legal. It is reasonable to assume that if mephedrone was banned, this group would probably stop for fear of prosecution or because of its illegal status. Banning the drug would address its open sale. However, it is clear from internet postings that regular drug users have been using mephedrone both because it is legal and because the purity level is more guaranteed than drugs like amphetamine or cocaine.

If the drug were banned, it is less likely this group would stop using, unless the very act of banning means that with less of the drug in circulation, it just becomes part of the regular illicit dealing network where all drugs are cut. The additional problem with controlling mephedrone is stopping internet sales from the sites located in countries where the drug is not banned, although imports into the UK would be illegal.

http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Good%20Practice/DruglinkJanFeb10.pdf

http://www.drugscope.org.uk/resources/drugsearch/drugsearchpages/mephedrone.htm

And here is your starter for 2010

noreply@blogger.com (Anonymous) — Mon, 18 Jan 2010 10:20:00 +0000

The January/February issue of Druglink, the first for 2010 in this, DrugScope’s 10th anniversary year, focuses on the changing landscape of drugs in the UK. Former legal highs Spice, BZP and GBL are legal no longer. Another ex-legal high, ketamine is now proving to be a real problem for more entrenched users, while the Maudsley Hospital in south London has opened a special clinic for those dependent on GBL. But the biggest surprise has been the rise of mephedrone which has come from the backwaters of internet chatting into the mainstream. Back in March ’09, Druglink highlighted growing interest in the drug; recent media interest reportedly saw online shops selling out. Although the death of a girl in Brighton proved not to be the UK’s first mephedrone-related death, even so there are now several reported incidents of hospital admissions and other problems associated with its use.

In that article, back in March, we suggested that the internet may begin to challenge traditional dealing networks for drugs and this certainly seems to be the case with mephedrone. It also highlights the problems of enforcement. Should the drug be controlled, as seems very likely before the end of the year, this will probably help stifle supply within the UK; shops will stop selling it and those who seem to be dabbling in dealing because mephedrone is currently legal, will probably stop as well. But that still leaves the internet trade and the problems of trying to stop mephedrone coming into the UK through the post . Mephedrone will still be legal in many countries of the world where it will not be illegal to host websites selling it.

There was a time, when years might elapse between new drugs appearing on the scene – the arrival of smokeable heroin, crack and ecstasy was spread over nearly a decade. But the internet offers opportunities for global high speed information exchange and for the wholesale and retail delivery of new substances which can only complicate control efforts and may hasten consideration of alternative enforcement regimes.

The issue of control of course, leads us to the role of the ACMD. Professor Les Iversen is now the acting Chair while his predecessor has established a rival council based at the Centre for Criminal Justice Studies. Professor Nutt has announced that in effect his group will ‘take care of the science’, leaving the ACMD to consider aspects of social policy and treatment. Yet the Independent Scientific Council on Drug Harms will be operating outside government. Irrespective of how many eminent scientists it has in its ranks, it will still be down to the ACMD to make recommendations to government on drug control, including considerations of the scientific evidence.

The big danger is that the new group and the ACMD will be left jousting over analysis of all future drugs which hove into view, such as mephedrone - and the media will lap up any contradictory recommendations. It is important therefore that the work of the ACMD does not become limited to discussions about drug classification. It has a proud tradition of producing landmark reports which have been instrumental in shaping UK drug policy and needs to develop an equally dynamic agenda for the future.

And of course, it is Election year. But we will save that for next blog.

Wither the ACMD?

noreply@blogger.com (Jackie Buckle) — Mon, 16 Nov 2009 12:43:00 +0000

The sacking of David Nutt has laid bare some uncomfortable truths for the future of the ACMD. The meeting with the Home Secretary and officials focused on protocols, principles and generally clearing the air. But it remains that whoever wins the next election, any recommendations that a drug be re-graded downwards will likely be rejected, allowing only for initial control or more punitive penalties, very much against the spirit of the three tier classification system.

As Professor Nutt acknowledged in the lecture that prompted his departure, there are many factors other than objective scientific facts which help determine the decisions on individual drugs and the general momentum of drug policy including political drivers and public opinion. But as we all know, the use of drugs is a highly emotive issue, riven with deeply held ideologies and beliefs; for some drug use is a moral issue – all use is bad and the nuances of relative harm are irrelevant. Even so, the Act is a legal instrument and not a vehicle simply for sending out public messages. In all the storm-tossed waters of the drugs debate, it is critical that policy is firmly lashed to the evidence mast, and if government does go against those charged with giving advice, there should be transparent reasoning behind it. Otherwise we face slipping into the American model where the Drug Enforcement Agency for example plays a key role in determining policy and there is hardly any pretence that independent advice has any role at all.

An idea whose time has come

noreply@blogger.com (Anonymous) — Fri, 11 Sep 2009 12:18:00 +0000

This year’s Druglink survey of street drug trends found that a drop in the quality of drugs could be accelerating a longer term trend towards poly drug use – taking a variety of different substances in combination or at different times – as users look to ‘top up’ on low quality drugs or experiment with alternatives. In turn, some survey respondents suggested that the shift towards people using a more varied menu of drugs means users are less concerned about the quality of each individual substance.

In some areas older teens and younger adult recreational users are swapping or combining substances including cocaine, ketamine, GHB/GBL, ecstasy, cannabis and alcohol. At the same time, some areas reported an increase in young users turning their back on crack and heroin. Problem drug users in most areas are often using heroin and crack cocaine alongside cheap, strong alcohol, skunk-like cannabis, tranquillisers and, in some cases, ketamine.

The trend is a reminder of one of the issues that came out of our Drug Treatment at the Crossroads report. If we persist with too narrow a definition of ‘problem drug use’ that focuses on heroin and crack cocaine we are unlikely to be equipped to meet new challenges as drug trends change.

Recent discussions we’ve had with young service users, drug education and drug treatment professionals as part of our forthcoming Young People at the Crossroads work have reinforced the fact that the next generation of ‘problem drug users’ appear to be developing issues linked to cheap alcohol cannabis, cocaine, ecstasy and tranquilisers. To what extent are services equipped for this and how flexible can they be?

Survey respondents expressed concerns that the low quality of stimulants such as cocaine, crack, speed and ecstasy pills could be contributing to a growing interest in other substances. Ketamine, the hallucinogenic anaesthetic, was reported as being used by a growing number of older teens and young adults in 18 out of 20 areas surveyed. For the first time in the survey’s five year history, some drug services raised concerns about the use of the so-called ‘legal highs’ GBL and mephedrone.

Although still low on the radar, ‘legal highs’ are set to play a far bigger role in complicating the picture of drug use that frontline treatment workers will be dealing with. And it won’t just be a potential problem for health. A recent EU-funded survey revealed over 300 compounds which mimic the effects of illegal drugs, so the control of Spice, BZP and GBL could just be the start of a very busy time for the ACMD. But with the prospect of many more new drugs appearing quickly on the market, the example of Spice serves to emphasise the need for a review of the Misuse of Drugs Act, promised but not delivered by the government in 2006.

The ACMD concluded that primarily on the basis of the potential harm from the synthetic cannabinoids found in some samples, Spice should be a controlled drug. But they deliberately did not recommend a classification. Why? Because against ACMD advice, cannabis had been reclassified to B. The ACMD clearly did not think that Spice warranted Class B penalties any more than cannabis did – but kept quiet on the matter. Inevitably (and within the logic of the Act) Spice will be made a Class B drug so now we have the bizarre situation where Spice is legally deemed more harmful than the addictive and lethal GBL, not to mention tranquillisers and anabolic steroids.

But it isn’t simply a question of where any particular drug sits in the ABC grading. In the light of an ever-increasingly complex drug landscape coupled with questions over the capacity of the police to enforce the laws and what constitutes a threshold of ‘harm’, we need a root and branch review of the Act.

http://www.drugscope.org.uk/ourwork/pressoffice/pressreleases/Street_drug_trends_2009.htm

http://www.drugscope.org.uk/Documents/PDF/SepOct09DSDaily.pdf

A message to the President

noreply@blogger.com (Anonymous) — Mon, 17 Nov 2008 14:36:00 +0000

Barak Obama will come into office on 20th January with a hefty in-tray, not least a global financial crisis and a war on two fronts in Afghanistan and Iraq. It is unlikely that international drug policy will figure highly in the pile, but here is a reason why it should.

Less than two months after President Obama takes up his post, the UN will be reviewing its ten year drug strategy. The political rhetoric of 1998 was a 'drug-free world we can do it', specifically a commitment to rid the world of coca, opium and cannabis. Not surprisingly, it has proved an 'aspirational' target; the $6n US investment to clamp down on coca production in Colombia, for example, has seen a 15% rise in cultivation according to a report requested by the incoming Vice-President Joe Biden, chairman of the Senate Foreign Relations Committee.

Since around 2004, the language of international drug policy has been shifting; phrases such as 'proportionality' in relation to drug offences and 'the unintended consequences of international drug policy' have been creeping into UN official documents and public statements. The European Union has been increasing its contribution (and therefore its influence) to the UN drug control budget while at the same time offering a less fundamentalist approach than traditionally associated with the United States who have dominated the discourse since the first international drug conference a hundred years ago next year.

It is that history that President Obama should revisit because as many historians have pointed out, racism lay at the root of much of what became universally accepted laws against the use of drugs. Simply put, drug laws were crafted at least in part as a way of controlling minority communities. The laws against opium use targeted the Chinese community brought over to build the US rail network. Southern sheriffs demanded larger calibre guns to mow down 'cocaine-crazed' black men, the same cocaine given to slaves working the plantations and the docks to make them toil longer and eat less. And (again) 'drug crazed' Mexican migrants were cited as a primary reason for controlling cannabis use in the USA when most of the population had hardly heard of it, much less use it.

This is not a plea for wholesale and instant drug law reform; as unrealistic an aspiration as 'a drug free world' etc etc. But at least, the genesis of drug laws in America, a narrative of demonisation and stigma exported round the world, should give the President some food for thought. With the UN poised to review its drug policy, much of it actually at odds with the UN's own policy on human rights, he could use his considerable influence both as US President and as a declared champion of inclusion to shift the balance of drug policy away from a century of law enforcement and towards public health and human rights.

noreply@blogger.com (Unknown) — Fri, 14 Nov 2008 12:29:00 +0000

Who is driving Tory drug policy?

"With a few brave exceptions...drugs policy is an area where British politicians have feared to tread."
Home Affairs Select Committee, 2002

"I feel extremely strongly about this subject and desperately want to see a reduction in drug abuse and better paths to enable people to get out of it. If one takes a slightly progressive - or, as I like to think of it, thoughtful - view, one can sometimes be accused of being soft. I reject that utterly."
David Cameron MP, 2002

The phrase 'a week is a long time in politics' is a truism. Given the fast moving, uncertain and increasingly surreal times we live in, 'at the time of writing' is a helpful proviso for any prediction of the outcome of the next general election. Despite a recent boost in approval ratings for the Prime Minister, the Conservative Party maintains a healthy lead in the opinion polls - so what might drug policy look like under a Conservative government with David Cameron as Prime Minister?

Within weeks of becoming an MP in June 2001, Cameron joined the influential Home Affairs Select Committee. A month later, the committee announced an inquiry into the effectiveness of drug policy and the government's ten-year drug strategy.

Published in 2002, the committee's report concluded that drugs policy should primarily deal with problematic heroin and crack users, 'rather than towards the large numbers whose drug use poses no serious threat either to their own well being or to that of others'.

The committee's recommendations included support for the reclassification of cannabis from Class B to Class C, ecstasy from Class A to a Class B drug and a review of Section 9A of the Misuse of Drugs Act ('with a view to repealing it, to allow for the provision of drug paraphernalia which reduces the harm caused by drugs'). On drug treatment the report declared that 'all treatments and therapies should have abstinence as their goal', but also called for a substantial increase in spending, an expansion of methadone so that it became universally available and stated that 'there is still an urgent need for harm reduction actions...both a treatment strategy and harm reduction strategy are necessary...' The report concluded by recommending that the government discuss with the United Nation's Commission on Narcotic Drugs alternative ways of tackling drugs globally 'including the possibility of legalisation and regulation'

Cameron did not vote against any of the recommendations in the report - indeed, he voted against several amendments proposed by another Conservative Party member. In a parliamentary debate on drugs policy in December 2002, he spoke specifically in support of heroin prescribing and the use of safe injecting rooms. His comments on drug treatment are particularly pertinent in light of the recent polarisation of the debate between 'harm reduction' and 'abstinence': "I understand that there is no single method of treatment that always works. we need to have a variety of methods....Although residential places are not the only answer...I support the proposal to increase the number, while retaining all the existing treatment options."

In October 2004 the then shadow home secretary, David Davis MP, announced to his annual party conference that a Conservative government would make the fight against drugs a 'top priority'. Accusing the Labour Government of presiding over an 'epidemic' of drug use and of 'standing aside' from the problem he said: "Some people say we have lost the war on drugs, I say we have not begun to fight it." The Conservatives pledged to "accelerate" random drug testing in schools, increase drug rehabilitation places ten-fold (from 2,000 to 20,000) and reclassify cannabis from Class C to Class B. The speech alarmed advisers in Downing Street.

It was probably no co-incidence that a few weeks later - with an eye to the general election expected the following year - Tony Blair announced new measures to 'crack down' on those who "peddle the misery of drugs". What became the Drugs Act 2005 was born. To many, the 'tougher than thou' stances on drugs underlined the crude politics of the issue.

Has Cameron kept faith with his progressive and open approach since becoming party leader in December 2005? One of his first acts as leader was to commission a number of policy reviews. A Social Justice Policy Group was established, chaired by Iain Duncan Smith MP. It established a separate 'addictions working group', chaired by Kathy Gyngell, to look specifically at drug and alcohol policy.

In light of Cameron's publicly stated support for a more 'progressive' approach to drugs policy there was the possibility that the policy review would nudge party policy closer to the views of the party leader. Cameron's response to the Joseph Rowntree Foundation report on drug consumption rooms, published in May 2006, echoed his previous stance. While the Government barely blinked before saying no to consumption room pilots, Cameron did not rule them out: "...because anything that helps get users off the streets and in touch with agencies that can provide treatment is worth looking at." The issue was to be looked at as part of the party's policy review.

The addictions working group report was published in July 2007 - and delivered a damning verdict on the Government's drug policy: 'Under ten years of Labour's drug strategy, policy itself has become an intrinsic part of the problem. It has been a costly investment in failure.' Both barrels were fired: "Spending is often wasteful, unwise and misdirected...bureaucracy has grown dramatically...has further entrenched addiction...[Treatment is a] misguided system of social control [with] counterproductive targets...Enforcement appears weak...drug education in schools...could be doing more harm than good." And so on. Although the report accepted that methadone has a "useful and positive role in the treatment of addiction", methadone prescribing was branded as a "harm reduction" measure and harm reduction approaches were attacked. A criticism was that the rapid expansion of methadone prescribing has been politically and target driven rather than need driven, and that abstinence-oriented treatment had been intentionally marginalised. What could have been a measured call for an expansion in residential rehabilitation and a greater focus on abstinence got caught up in the polarised and 'either/or' tone of the report and its presentation.

The addictions working group report has not been formally adopted as party policy, but by filling a vacuum its headline theme of 'abstinence-versus-harm reduction' has continued to gain traction. It has set the mood music for the Conservative Party's responses to critical media reports on the drug treatment system over the past 12 months, notably by the BBC's Home Affairs editor Mark Easton, on the relatively small proportion of people leaving treatment 'drug free'. In October 2007 David Davis wrote as shadow home secretary to the chair of the House of Commons Public Accounts Committee asking for an investigation into drug treatment, describing the investment as “massive failed expenditure" - "This is an absolutely shocking revelation which speaks volumes about the Government’s incompetence and distorted priorities. It is yet more evidence why we should focus spending on getting addicts off drugs, and not just spend money managing their addiction.” In response to more recent drug treatment figures (October 2008) shadow home secretary, Dominic Grieve, said: "the Government's entire approach of simply trying to manage addiction is wrong...these figures show that despite a significant increase in investment there has been a paltry increase in the number of addicts going clean. This failing approach is compounded by Labour's mixed and confused messages on the dangers posed by cannabis and ecstasy."

The latest official Conservative Party statement on drugs policy can be found in Repair - Plan for social reform published in October 2008. It accuses Labour of an approach of "maintenance and management, which has failed" and promises to introduce an abstinence-based Drug Rehabilitation Order and "residential-abstinence orientated programs" including day-care programs. There is no further detail.

As to what the commitment to increase abstinence based treatment may cost, the Scottish Conservative Party pledged in its manifesto for the 2007 Scottish Parliamentary Election that it would spend an additional £100 million a year on drug rehabilitation (saving, it claimed, £1 billion a year on policing, prisons and healthcare services). If the commitment were replicated in England - assuming an additional spend rather than a reallocation within existing budgets and matched on a population basis - the drug treatment budget would have to increase by up to £1 billion a year.That is, of course, extremely unlikely.

To date, the only recommendation in the Select Committee report Cameron has stepped away from is on the classification of cannabis, justified on the grounds that the drug "is so much more powerful than it use to be." The government's decision to go against the advice of the Advisory Council on the Misuse of Drugs and reclassify cannabis back to B has neutralised Conservative Party attacks on the issue.

When Cameron talks about "compassionate Conservatism" and the need to fix "broken Britain", he usually refers to the problems caused by drug and alcohol misuse - but stops short of specific pronouncements on drug policy. In a recently published book, Cameron on Cameron, when challenged on cannabis classification he said: "...I think the whole classification system is in need of a major overhaul because it seems to me that the ABC method does not really get it right...These evaluations are all based on the 1971 Misuse of Drugs Act, and a lot has changed since then. And I think without in anyway weakening the illegality of drugs that the classification system needs a major overhaul." An interesting return perhaps to the backbencher who supported "thoughtful" drug policy reform.

There are both punitive and progressive strands within Conservative Party drug policy, to some extent embodied, respectively, by successive Conservative shadow home secretaries on the one hand, and the party leader, David Cameron, on the other. Just as 'only Nixon could go to China', a right-of-centre government may adopt a progressive approach to drugs policy, but to date there are few signs of Conservative drug policy moving closer to the views of its leader. It will be interesting to see how this contradiction plays out over the coming months. Unless Cameron changes his views, he could be leading a government with a drug policy he does not believe in.

Author: Martin Barnes, chief executive of DrugScope

This is an extended version of an article published in the November/December edition of DrugScope's Druglink magazine.

Drowning by Numbers

noreply@blogger.com (Jackie Buckle) — Wed, 06 Aug 2008 13:13:00 +0000

When are we going to be able to do the jobs we trained for
without having to play childish numbers games, asks drug
worker ‘Beth’, in her second instalment on the reality of
working in frontline drug services.

It’s that time of the month again. I am feeling tired, irritable
and generally frustrated. It’s affecting my colleagues as well.
Unfortunately no herbal remedy or HRT will help this. It’s time
to send off the National Drug Treatment Monitoring System
report (‘NDTMS’ for those in the know).

“There are three kinds of lies: lies, damned lies, and
statistics." I am sure most people recognise these words of
Mark Twain and I suspect that other drug and alcohol workers
will groan with recognition on hearing them.We can use
statistics effectively to support any point we want to make.

I chatted with a colleague who is under great pressure to
increase the numbers of drug users on the day programme he
runs.

“That’s good, 33 per cent of the clients in this group are
drug users,” he said.

“Great,” I replied. “How many turned up for the course
then?”

“Three,” he replied. (Well done to Jim for being 33 per cent
of the clients on the course.)

So when I check I have got everything ‘right’ for the latest
NDTMS report I ponder on what is the purpose of these stats.
Actually, as anyone I work with will tell you, I don’t ponder: I
mutter and swear quite a lot.

I think about one client I have been working with, off and
on, for most of the time I have been a drug and alcohol
worker, or probably far too long in official terms.

What has our positive outcome been? Well, he is not dead
and he is not in prison and he has not attacked anyone. These
have all been very real risks over the years. At the moment
our harm reduction focus is to shift him from bingeing on
amphetamines to go back to regular cannabis use and to stay
of booze. His last brush with the law, about ten years ago, was
when he stabbed someone when he was drunk. He knows that
alcohol brings out a violent aspect to him which he does not
want to risk re-emerging. The cannabis, although he can get
rather depressed, is a better option because he eats and sleeps
on this, unlike the amphetamine binges which leave him
gaunt, exhausted and occasionally psychotic. My hope is that
he could envisage life without any substances but that is a
goal too far at the moment. Still, in terms of our NDTMs at
least he is a drug user. Tick. Very good.

I understand something of how statistics are used to
analyse social trends and experiments in social science.
People are very varied and rather unpredictable, and changes
happen for all sorts of reasons: some people even stop using
substances without any professional intervention (but don’t
spread that rumour around too much).

So if we try to establish if any particular event has an effect
we need to measure the difference between what would have
happened anyway by natural variation or chance, and what
has happened in the group affected by the event.We look for a
significant difference between the results for the group left
alone and the group being subjected to whatever we are
looking at.

Statistics can compare, for instance, the number of adults
smoking, using drugs, driving a car today to how many were
doing it, say, five years ago. These sort of figures are the ones
that often appear in the news along with speculation about
why this is and what it means for the future. They are often
accompanied by inaccurate and meaningless extrapolation,
using them to show that, possibly, by 2030, 90 per cent of us
will be watching the television for 22 hours a day while
smoking home grown skunk.

Then we have stats as a marketing tool. ‘Eight out of ten cats
prefer…’, ‘Visible wrinkles reduced by 25 per cent’, and so
forth. Any one who has a cat and /or wrinkles (I have both)
will know that cats are always a law unto themselves and if
they have a mind to turn up their noses at fresh salmon and
go and chew on a dead mouse instead, they will do so. As for
wrinkles, well you stand as much chance of stopping them
with face cream as King Canute did commanding the tide to
halt.

Which of these is the use to which our NDTMs statistics are put?

As service providers, we are set goals. I have no problem
with that. I want clients not to have to wait for appointments.
I want clients to engage and attend long enough to achieve
their goals. I want them to be discharged for positive reasons.
My work matters to me. My clients matter to me and I want to
offer them the best and most effective service I can.

So am I totally in tune with our local DAAT and the NTA?
No, because I am expected to achieve unattainable goals (100
per cent positive discharges – how is that ever going to
happen?). But more than this I am expected to provide the
statistics required, not by improving and developing the
service, but by what can best be described as ‘constructive
accounting’. I have become a ‘spin doctor’.

Perhaps I am going a bit mad at this time of the month but
I have a strange and rather wonderful dream. My dream is
that the role of the regional DAATs and DATs would be to
develop and support services. My dream is that the NTA
would use statistics not to show 8 out of 10 clients prefer
Models of Care so as to sell their product, but to collect good
quality, accurate information that would open debate and
contribute towards identifying how we can achieve
challenging goals. I mean achieve them by making changes to
services, not by learning how to give the right answer.

At school I learnt a couple of things about cheating. One
was that anyone who got 100 per cent in an exam was always
suspect, because people don’t. The other thing was about
getting the right answer in the wrong way. As I struggled with
maths I would sometimes try, when I got to the end of a
problem, adding another line of fake working out. In this way I
would turn my wrong answer of say, 8, to the right answer of
10 (taken from the answers at the back of the book) by
slipping in the line 8+2=10. It rarely worked. It could work with
teachers who were lazy markers but of course it never helped
me to work out how to get 10. What I did learn eventually,
from a better teacher, was that understanding the working
out, even if you go a bit wrong with the numbers, is a better
way to develop an understanding of maths.

Who is doing the ‘working out’ with drug and alcohol
treatment services?

We are under constant threat. I have to make 8=10 because
if I don’t, I will lose my job. My colleague is delighted at his 33
per cent drug users group because he has been told that
alcohol users ‘don’t count’.We have a regional Drug and
Alcohol Action Team but we are being threatened with
decommissioning – not because we don’t have enough clients
(we all have full case loads) but because about two thirds of
them are people with alcohol problems.Why are there more
alcohol clients? I would enjoy a meaningful discussion with
our commissioners about this, but meaningful discussions
don’t seem to be wanted, only statistics. Where does the
Alcohol Harm Reduction Strategy for England (AHRSE) fit into
this? I think Jim Royle of the Royle Family would be able to
answer that.

I have been in this business long enough to remember the
days when we provided few statistics, collected funding from
a hotchpotch of charities and grants, had sparse records and
muddled through in a way that would cause any DAAT
commissioner to spontaneously combust. (Now there’s a thought).

Despite the wrinkles and the cat, I don’t want to go back to
the good old days because I know that we often worked in a
risky way. The thing was that disasters didn’t happen and
many clients did engage and did make positive changes,
because we provided ‘an opportunity for the service user to work
towards living in a way he or she experiences as more satisfying or
resourceful’. Sometimes that happened in a week or two,
sometimes in a year or two. Sometimes it involved detailed
care plans sometimes not. Sometimes it was tier two work,
sometimes tier three, but mostly a bit of both. What we did
was that we tried to provide what the client needed, not try to
make the client fit what the service needs them to be and do.
We could have provided a much better service then and we
could provide a much better service now, but how can we get
there?

If you want to find the quote above in italics look in Models
of Care. It is the definition of counselling provided by the
British Association for Counselling and Psychotherapy, used in
Models of Care in the description of tier three, one to one work.
I am not a maverick. I do look at Models of Care. There is a lot
of thoughtful, well-researched information and guidance in
there. However, I feel I am swimming against the tide.

That ‘time of the month’ feeling is spreading and the ad in
our local paper for a trainee estate agent at a salary much the
same as mine looks very attractive. When are we going to be
able to be honest about what we do, varied and unpredictable
as its outcomes might be? Until we can we are going to carry
on ticking boxes with one eye on our expiring contracts and
struggling to find the energy to do the jobs we trained for,
with the clients we want to help.

In The Flesh

noreply@blogger.com (Anonymous) — Mon, 02 Jun 2008 11:41:00 +0000

This article appears in the latest issue of Druglink. It is written by a drugs worker under a pseudonym and delivers a poignant reality check right into the heart of the current debate about treatment and recovery

I work in the real world of drug and alcohol treatment. I wouldn’t say it is totally unrecognisable from the interventions, policies, procedures and guidelines published in Models of Care, NTA guidelines and DAAT policies, but it has to be translated to fit. Perhaps at best the guidelines and the reality are as similar to one another as classical Latin is to Italian slang in the slums of Naples. They’re clearly connected but they need a lot of interpretation.

I work in a smallish combined statutory and non-statutory agency in a smallish northern town. The service offers structured, care-planned, psychosocial, one-to-one interventions for drug and alcohol users with complex needs (Models-of-Care-speak). In other words I sit down with people so lost, confused and generally f****d up that most of the other workers in the agency don’t know what to do with them. Either that, or they’ve tried and feel they aren’t getting anywhere.

Of course, I can speak the ‘classical Latin’ of the people who have the power to give us more (or more likely, less) funding, those who give us our targets and then threaten us with being put out to tender if we don’t achieve them. I can ‘strut my stuff’ when needed and present the work of the agency at meetings in the way that I know people want to hear. I can talk about tier two and tier three, behavioural focus, cycle of change, relapse prevention, coping strategies, self-efficacy and (lets throw in a name to impress here) Zinberg. If pushed, I can talk about Rogers, Freud, CBT, cognitive dissonance, constructivism, node mapping and I can even suggest I have a fair idea about DBT and personality disorders. So gosh, what a lovely ‘toolbox’ I have and how well supported I am by the agreed assessment and monitoring tools provided by my local DAAT!

Right. Back to reality. Here is a day at the sharp end. I have seven clients booked in to see me today. In order to satisfy the target set by the DAAT for our tier three caseload, I should make sure that I see five in a day, so I must allow for DNA’s (Did Not Arrive). I have challenged the powers that be over these unrealistic targets by reminding them of the FDAP guidelines for supervision, the time I need to liaise with other services, the time needed to put notes on the frustrating and complex database that churns out the stats to prove our worth. However, and here comes the stick yet again, I have been told that jobs will be cut if targets aren’t met.

So it is fair to say that I am ambivalent about the attendance of these clients. I want them to attend because I want to carry on helping them as best I can. There may also be clients here who have not attended for the magic 12 weeks, which apparently ensures that treatment will be effective. I know that retention rates are another target that we must satisfy to get our funding.

I look at the seven names and see seven complicated and struggling people who need my total concentration in these sessions. If they do all attend I will be exhausted at the end of the day and may struggle to find time for a lunch break. So, hand on heart, I hope they don’t all come.

The first one does come – highly anxious, low self-esteem, continued drinking, peculiar thinking patterns, strange and possibly abusive relationship with her husband. I guess she could be labelled dual-diagnosis, but as the only dual diagnosis worker has an 18-month waiting list and doesn’t accept anyone who might be labelled personality disordered (as this client might) the dual-diagnosis label has no value anyway. She has been coming to see me for about six months and has had a dysfunctional life involving heavy drinking for about 30 years. I know that change will be slow, but I don’t know at what point the guidelines will decree that she should be better.

We revisit two of our regular topics – her relationship and her fear of not drinking. I get out a bit of paper and draw diagrams on the basis of what she tells me. “It’s a vicious circle isn’t it?” she says. I smile and nod. Week by week I try to nibble away at her irrational thoughts and dysfunctional behaviour by offering her a safe place and a safe person to question what’s going on in her life. She would benefit from some community support, but our community support worker post was axed about a year ago.

I get a break at this point, as the next client doesn’t appear to be coming today. I know that he is still drinking, waiting for a detox (let’s hope we are within our waiting time targets). He suffers from mood swings and serious depression. Mental health services have passed him on to us because he drinks heavily – not because he doesn’t have a mental health problem. He is on a scary mix of prescribed medication, about which his GP seems to be far less concerned than I. The client denies any suicidal intentions, but I suspect this is to ensure his medication is not challenged. His life is made particularly difficult by living alone in the roughest part of town, but with the housing problems we have here he is lucky, frankly, not to be on the streets. By the way, our housing support worker post has also been axed. Anyway, last week this client turned up a day late, so maybe that will happen this week.

Client three arrives. My first challenge is to consider how much of my horror about her appearance I reveal. She has been beaten-up by her ex-partner. She sits and shakes and tries to pull her hair over the dent in her forehead. Her hair covers some of the bruising but her face is black and blue and swollen all down one side. He has held her by the hair and punched her repeatedly in the face. She is frightened he is going to kill her. So am I.

I sit and listen. No tools, no techniques, just genuine human compassion and concern. I want her to be safe and ask if I can contact Women’s Aid to ask about a refuge. She agrees. “I’m still not drinking and I’ve only had one spliff”, she says with a somewhat bent smile. Am I doing relapse prevention? I want to capture the perpetrator and lock him away for a long time. I want to send her out with a bodyguard. When she has gone I fill out a risk assessment, ticking a lot of boxes.

Another session follows immediately with another client with a black eye. He is quite cheery and gives me a big smile. As he talks I notice the scrapes and bruises on his knuckles. He has been in a fight, but it was just “male bonding”. He also tells me about another violent incident which he feels was justified, but nonetheless has some concerns about. This acceptance of violence as a way of managing life is hard to hear after the last client. I become far more directive and challenge him to think about the implications of this. We’re like Pinocchio and Jiminy Cricket – I am his conscience. I wonder if this is what he is looking for, and I wonder if this helps him to take responsibility for his actions. Remarkably he goes on to tell me he has reduced his drinking and has not used cocaine for six days. I wonder what intervention accounted for that.

The next client is a woman I worked with through her child protection proceedings. Despite having had one of the worst histories I have ever heard, including violence, abuse and the murder of a close relative, she managed to stop drinking and using drugs during the proceedings. Her daughter was “the only good thing that had ever happened”. Despite this, her child was removed and put up for adoption. Her GP has now referred her back in again. I have never seen such despair. At several points in the session, tears flow silently down her cheeks. She is pale and thin and has lost a tooth since I last saw her. I should be doing a health care assessment which asks if the client has a dentist, but there are no dentists in town willing to pick up NHS clients. It would be an insult to ask her. She sees nothing of any value in her life. My impression is that she is only still alive because she does not have the energy to kill herself. I put my forms to one side and ask questions to try to find some glimmer of hope. She is coping with life by using alcohol and crack cocaine. She is most definitely pre-contemplative in the cycle of change. What would be on her decision matrix? Reasons to change: ‘I might die’, reasons to continue: ‘I might die’. The only hope I can see is that she has attended her appointment.

I want her to know that I care about what happens to her even if she doesn’t. I want to form a therapeutic relationship with her but I don’t know what to offer. What therapy label would make her feel that life was worth living? The best I can do is to say I am here and I want to offer whatever support I can. She makes another appointment, but in my heart I don’t know if I will see her again. Another risk assessment to complete and a letter to the GP spelling out my concerns – will those things help? I suppose I feel I have done what I can but it is nowhere near enough. Oh – and I failed to complete a TOP (Treatment Outcome Profile) form.

Four clients. Great, almost up to target and at last the chance for a lunch break. I chat briefly to some of my colleagues. There is always a lot of humour here. I suspect it is part of our coping strategy. It fits with the resilience model I learnt about recently – another tool to hone. Walking through the town centre in my break I think about the model of how we should work. Assessment, health care assessment, risk assessment, care plans, shared care meetings, treatment outcome profile, sessions x 12, client better, discharge. Have any of the people who compile the theory experienced the sense of powerlessness that I feel right now.

Back in the office the next client arrives, not bruised or crying or in crisis. Great. Actually, he was unlikely to DNA as I have a prescription for methadone to give him. I definitely have something to offer here. I have picked this client up from another worker who is off at the moment so before he gets his prescription I ask him to tell me a bit about himself. I am a bit surprised to hear that he has been on methadone for eight years and is still using street heroin on top. Am I just a legal drug dealer? I can’t honestly say if it is my ego (wanting to show the other worker I can do better) or a concern for the client, but I slip into motivational mode. “So is the heroin use working quite well for you then?” By the end of the session he is saying he wants to “knock it on the head”. Sounds good, but I have been in this business long enough to know that one hour in a weekly session has 167 hours elsewhere to compete with. However, I come out of the session feeling quite up-beat.

The last one is here. It is my first meeting with this guy. Referred to me with problems controlling his anger and cocaine use, he has mentioned briefly to another worker about being beaten by his drunken parents as a child. He is leaning forward in his chair. He looks anxious, smiling with an almost childlike desire to please. I have on my lap a 27-page assessment form, a risk assessment and a TOP form.

I introduce myself and he tells me, nervously wringing his hands, that he has never really talked to anyone before about the difficult things in his life. I put the forms on the floor and say: “Would you like to tell me about yourself?”

To subscribe to Druglink go to: http://www.drugscope.org.uk/publications/drugscopeshop/druglinkuksub.htm

Cannabis: the real message?

noreply@blogger.com (Jackie Buckle) — Thu, 08 May 2008 07:03:00 +0000

The driving force behind the government’s decision to ignore the recommendation of the ACMD on cannabis was to send a message to young people about the dangers of the drug But arguably there is another message coming across with more worrying implications.

In the summer of 2007, in the wake of fears about the increasing availability of strong cannabis, it was announced that the ACMD was to be asked once again to consider the classification of cannabis. But unlike the two previous occasions in 2003 and 2005 - and for the first time in the history of the ACMD - the government, in the shape of the incoming Prime Minister, was publicly stating that it had every intention of changing the law.

So what was the evidence to support this view going into the latest round of ACMD deliberations? There was no new clinical evidence linking cannabis with severe mental health problems. Despite claims that young people were confused about the classification of cannabis to the point of thinking it was legal, there was no evidence of rising use – quite the reverse. There was no evidence that reverting cannabis to Class B would deter use. As the penalties for trafficking in Class B and C drugs were the same, it could not be argued that this would be a way of cracking down on the gangs growing indigenous cannabis in commercial quantities.

And what about the evidence provided to the ACMD during the proceedings? The latest forensic evidence suggested that on average cannabis available in the UK might have doubled in strength in the past ten years due to the rise in commercial indoor growing – although no clinical evidence was presented as to what that might mean for users. And actually it is possible that declining use among people is linked to the greater strength of the drug – they just don’t want to smoke it. ACPO claimed that commercial growers had been encouraged by the reclassification to set up shop here, but offered no evidence to support this. And as for mental health issues, research using GP records indicated that there had been no increase in cases of schizophrenia since between 1996 and 2004. Incidentally, since the ACMD sent their report to the government, ACPO have said if the law was changed, it would not be revising it guidance on the policing of cannabis, meaning that there would be no shift in police priorities to arrest people for simple possession.

So in those circumstances, the ACMD delivered the only reasonable conclusion - there is insufficient evidence to support a reversion of cannabis to Class B. Yet the government has chosen to ignore the advice in favour of a political message which will in turn be ignored. But the government will be sending another, potentially far more damaging message: it is not interested in evidence when it doesn’t suit political or moral expediencies.

Desperately tragic stories about lives lost or damaged by drugs take centre stage in the media. Emotions run high against which pleas on behalf of the evidence-base can appear singularly inappropriate.

But the idea of robust evidence as a key driver for drug policy must be protected and all assaults on its integrity strongly challenged. Why? Because those with serious drug problems are among the most vilified and unprotected in society. The shrill voices of the media and the moral absolutists regularly combine to drown out the humane and compassionate policy options often revealed by impartial and dispassionate research. As Mike Ashton reminded us during the recent DrugScope treatment debates, addiction does not happen because something goes ‘wrong’ in the brain of an individual – it is the result of a dysfunctional relationship between the person and the environment around them. Change the environment and you go a long way to helping change the person. We can only learn how to do that by a scrupulous attention to the best that research can offer.

Red carpet or red herring?

noreply@blogger.com (Anonymous) — Mon, 10 Mar 2008 15:39:00 +0000

Last week two United Nations drug agencies – the International Narcotics Control Board (INCB) in its annual report and the UN Office of Drugs and Crime (UNODC) through an article in the Observer (9th March) criticised celebrities for glamorising drug use. The Prime Minister added his weight to the proposition that our celebrities are role models for young people and that they have a duty to act responsibly.

The most vitriolic attack came in the Observer article by the UNODC chief Antonio da Costa. The main thrust of his argument was that young westerners who use cocaine and who might otherwise have concerns about fair trade, third world debt, globalisation and so on, conveniently forget the violence and corruption across the world caused by their increasing demands for the drug. The legalisation lobby argue that Mr Costa similarly forgets that it is the international drug prohibition structure that he is charged with upholding, that causes most of the problems in the producer and transit countries. Yet, he does have a point: if everybody stopped using cocaine, that particular drug problem would be solved.

But can we seriously lay the blame for the generally high level of cocaine use in the UK and the rest of Europe at the feet of a few high profile individuals? The current levels of cocaine use have their roots back in the 1980s. Simply put, up until then, the top end British villain concentrated on armed robbery; bank vaults, bullion trucks and the like. Then as enforcement action hotted up and the gangsters ran the risk of getting shot by armed police, they fled to Spain. There they met up with criminals linked into the cocaine cartels of South America and began to realise that drug trafficking (including heroin and cannabis) was hugely more profitable than turning over banks and carried much less risk. This began the flow of cocaine into Europe, so that even by the early nineties, more cocaine was being seized by British customs than heroin. Ironically over time, the death in 1993 of Pablo Escobar, the world’s most notorious cocaine trafficker and the break-up of the two main cocaine cartels in South America, the Medellin and the Cali actually made matters worse. Far from crippling production and supply, the amount of cocaine coming out of the region increased because there were now many more middle-levels traffickers who needed to expand their trade beyond the already crowded US market. The US federal government responded with the hideously expensive Plan Colombia which has patently failed to stem the tide of cocaine; indeed some observers believe US intervention has made the situation worse by its focus of military rather than infrastructure solutions.

Yet still the charge remains that the pied-pipers of pop are leading our young people by the nose leaving a trail of death and devastation in their wake. So how do young respond? A group from Mentor UK were asked this very question by MPs at last week’s meeting of the All Party Parliamentary Substance Misuse Group – as were listeners to the youth-oriented radio station 1Xtra. And what did say? ‘We’re not that stupid’ - and it is symptomatic of our patronising attitudes towards young people that we should think them so gullible. In fact, fans of pop stars with drug problems generally feel sorry for them and wish they could get their lives back together again.

But what about the perennial charge that celebrities have a social responsibility to their fans? There are thousands of young people who dream of getting a record contract and making a career in music. They aspire to becoming entertainers, not role models. But for the very few who get there, they can quickly become entrapped by the media obsession with celebrity, snapped not only by paparazzi, but anybody these days with a camera in their mobile phone. The tabloids fall over themselves to get front-page candid shots. Who, you might ask, is doing the glamorising?

So the question remains. Why this constant harping on about celebrity drug use, especially by international drug agencies? Back in 1998, the UN declared that their goal by 2008 was to eradicate all opium and coca growing under the slogan, ‘A drug-free world. We can do it’. Aspirational would be a polite term for this goal, and of course with poppy and coca yields at record levels, the UN is as far away from its vision as it ever was. So we get a tirade against easy targets garnering even easier headlines.

Meanwhile we might consider if the crack users of the Brazilian slums, the chronic heroin and opium users of the Middle East, Pakistan and Afghanistan and those facing another bout of state terror against users in Thailand, have ever heard of Amy Winehouse.

Changing the script on drugs

noreply@blogger.com (Jackie Buckle) — Wed, 20 Feb 2008 16:22:00 +0000

A recent article in The Independent (13th Feb) contrasted industry and media responses to two high profile individuals who have had equally high profile drug problems. The music industry showered Amy Winehouse with awards at the Grammys while her standard media soubriquet has become ‘troubled Amy Winehouse’. Compare this to Dwain Chambers. He was caught taking anabolic steroids, served out his ban and wanted to return to athletics. What was his industry’s response? Having won a race in Sheffield, he was entitled to be selected for the World Indoor Athletic Championships. He was duly selected, but in a press statement, UK Athletics made it clear they had done so very reluctantly. And for the media, the standard tag for the athlete is ‘drug cheat Dwain Chambers’. The Independent suggested the difference was that Amy Winehouse presents as a white female waif -like victim, while Chambers is strong, feisty and above all, black.

But writing for the online magazine Spiked (14th Feb), Tim Black had another take on this and one that might be closer to a wider truth about society’s general response to drug users. He pointed out that in Chambers’ own words, he had become a ‘leper’ within athletics. Black believed this was because Chambers hadn’t been sufficiently contrite enough; “What should have been a legal matter, that is, a finite punishment for transgressing a rule, has become something else entirely. It is now a moral crusade’. Chambers, says Black, is not being judged for what he did, but who he is. “For the British Athletics establishment, Dwain Chambers has become a necessary sacrifice”.

But the scapegoat metaphors extend way beyond one story of an athlete caught using banned drugs. Drug users are society’s modern day lepers. They are the new scapegoats – and while it can be argued that the plight of users is made inexorably worse by the drug laws, the deeply held antipathy towards drug users goes back into the Temperance years of the 19th century when drugs like heroin, morphine and cocaine were still legal.

Look back into the earliest days of the tabloid press in America and you will find all the iconography of the modern day red-tops – junkies, dope fiends and drug fiends populated the stories of the so-called Yellow Press. The stories were made more potent by the use of vivid illustrations – demons, skeletons, vampires and the Grim Reaper. The message was clear – drug users are in thrall to a supernatural power that can only slake its thirst by feeding on the lives of the innocent. While the Victorians talked of the ‘demon drink’, drug users were themselves ‘fiends’. In other words, the evil was inherent in the person, not the substance they were using.

Flash forward to the plight of Mrs Elizabeth Burton-Phillips. She had twin sons both addicted to heroin, one of whom committed suicide. She wrote a book and has been seen on many conference platforms and in media studios telling her tragic story. Did any interviewer or conference delegate opine, ‘But your sons were just evil drug fiends, they were rotten to start with!’. Of course they didn’t - because of course they weren’t.

But this is the media-driven narrative on drug users. Sadly it is also embedded in the attitudes of many professionals in health and social welfare, underpinned by the overweening emphasis on crime in the current drug strategy. Here in the UK, drug users are seen as lesser members of society; their drug use can deny them access to housing, healthcare, education, employment but above all, dignity. If you look abroad, examples of serious human rights abuses against drug users – including the imposition of the death penalty - are legion. After all, how can a sub-human have human rights?

Evidence not Ideology must prevail

noreply@blogger.com (Anonymous) — Fri, 21 Dec 2007 08:26:00 +0000

While statistically flawed, recent revelations from the BBC have raised doubts as to whether the taxpayer has been getting value for money from the treatment system.

Many of the dedicated people who work in drug treatment will have plenty of stories of people who have been helped to the point where they have re-established relationships, found a job and somewhere to live and have something to look forward to.

But the government has failed to communicate these successes and not only laid the system open to criticism, but also allowed the fault lines in the treatment debate to widen.

Talk is good and we need much more open debate about treatment effectiveness (see below), but nobody should believe they have come down from the mountain with the stone tablets of treatment truth.

You have to be in severe crisis to present yourself to the treatment system. You are admitting to yourself and others that you have hit rock bottom, you need help, your situation cannot continue. If somebody shows you a door marked ‘treatment’ you will go through it, apprehensive about what is on the other side, but certain in the knowledge that something has to be done. And ask any user at that point what they want and they will say that they want to get back some control of their lives.

But here the commonalities end. Drug addiction is not like diabetes: the gold standard treatment for diabetes is insulin. Nothing like that exists for drug treatment. Indeed some will find their way back from the brink without any official intervention at all.

So one-size does not fit all. It never has done and never will. And so, it is fine for different services to be offering different approaches – that’s called patient choice – and proper assessment and care planning will help people navigate their way along the twisted paths of the treatment ‘journey’.

But critically, what is delivered has to be based on a forensic examination of the evidence – and if the evidence isn’t there or isn’t robust enough, then it behoves the government to make sure it is – and if it is, then it must over-ride all other considerations. Just believing something to be true does not make it so.

The next issue of Druglink features a major article by Mike Ashton deconstructing the evidence base around treatment. As a follow-up, DrugScope and Conference Consortium are planning three half-day debates in three locations across the UK on the issues raised by the article. This is still in the early planning stage, but places are going to be limited and on a first-come, first-served basis. There will be a modest charge. If you would like to register your interest please e-mail consultations@drugscope.org.uk putting "treatment debate" in the subject box. We will be in touch in due course.

What does treatment 'treat'?

noreply@blogger.com (Anonymous) — Sun, 04 Nov 2007 19:20:00 +0000

If you stopped somebody on the street and asked them the purpose of treating people with drug problems, would they answer:

a. To help people get better
b. To break the link between drugs and crime

Chances are that (a) would win hands down which explains why some awkward questions were being asked in the media when it was revealed by the BBC’s Mark Easton last week (BBC 30th October) that very few people actually left treatment ‘drug free’ despite the huge cash investment. The National Treatment Agency was quick to point out correctly that the BBC had screwed the figures up by not comparing like with like across recent statistics. But even allowing for that adjustment, the impression given to the general public is that drug treatment has been a costly failure. Is that fair? No it isn’t. Those working in the field, users and families know that the treatment journey can be long and arduous with many slips on the way and that outcomes of success will differ from total abstinence to a regular methadone script. This was borne out by the Radio 5 Live session following the BBC revelation where several people who had been through treatment phoned their story in and of course, no two people had the same story to tell – but the end result for all those people was a life back on track however that was achieved.

The problem maybe that the successes of individual treatment are buried under the workings of a treatment system and a set of success criteria that do not play to the public perception of what treatment is about i.e. health improvement and not crime reduction - and which also unravel at the slightest challenge.

Back in the 1990s, the National Treatment Outcome Research Study (NTORS) determined that simply engaging in treatment without coercion reduced criminal activity. Latching onto this, the government decided to up the ante, concluding that if more people were forced through the treatment system, government could make a big impact on crime. Ever since – and certainly since the updated strategy published in 2002, the emphasis has been to push more and more people into treatment. But then you hit a snag. Can the system actually bear the load? Do you have enough treatment places to cope with demand even though you have significantly ramped up the investment? If the answer is ‘no’ then to prevent blockage, the imperative is for people to come out the other side of treatment as quickly as possible. And you can do that by taking the evidence that people do best if they are in treatment for at least twelve weeks and making that one of the exit benchmarks for treatment success against which agencies desperately tick the boxes to keep the funds flowing. You have to keep people for at least twelve weeks (which might account for some agencies who might be otherwise failing doling out extra drugs over and above therapeutic need as the BBC highlighted the week before). But then you might be encouraging them out of treatment so you can tick the ‘drug free’ box .

But what does ‘drug free’ really mean? It can’t mean much because a study from the north west of England showed that most of those who leave treatment ‘drug free’ in one year, are back in treatment the next. And what about those crime figures? It is commonly accepted that the crime drug users are most likely to commit to fund their habit is acquisitive crime and in particular, shoplifting – and that a large percentage of shoplifting is committed by drug users. So when the government announced in the House of Lords during last week’s debate on the government drug strategy consultation (Hansard 29th October) that drug-related crime had fallen by 20%, you would assume that figures for shoplifting are included in the calculation. You’d be wrong. According to the Home Office research department, the government doesn’t routinely collect data on shoplifting. There was one general survey of commercial crime in 1994 and another in 2002, but that’s it. That wouldn’t matter so much if shoplifting figures were going down. Yet according to data also published last week from the British Retail Consortium, consumer theft has been rising right through the life of the drug strategy. So what does that do to the government’s assertion that drug-related crime is falling as a result of the drug strategy? Hard to say when key data is missing – a calculation further complicated by the fact that rates of acquisitive crime were already falling before the strategy kicked in.

So where does that leave us?

Lots of people are being helped by the treatment system, but it feels like this is just a fortunate by-product of the prime directive to cut crime using a set of criteria that doesn’t stand up to much scrutiny making the whole treatment system look suspect.

We need to re-engineer the system so that it is geared more to helping people than reducing crime (which it may not be doing anyway). And this is not necessarily the hard political sell that ministers might think it is. But it won’t come cheap. If the imperative became sustainable effectiveness rather than bums on waiting room seats - so quality rather than quantity - then you are looking at a substantial investment in training for staff dealing with people in the treatment system - followed by another big investment to address all the housing, employment and education issues.

The chief executive of the National Treatment Agency once theatrically tore up a ten pound note in front of a conference hall full of drug workers saying that if you challenge the crime-focus of the treatment system, that’s what you are doing to your wages. On the basis of the headline data about treatment success, voters could be forgiven for thinking that’s exactly what’s happening to a large chunk of the current treatment spend.

Harm Reduction: what's in a name?

noreply@blogger.com (Anonymous) — Sun, 21 Oct 2007 14:00:00 +0000

On 3rd October, the Parliamentary Assembly of the Council of Europe “ unanimously proposed preparation of a European convention to promote public health policies aimed at fighting drug abuse”. Such policies specifically include the promotion of substitute prescribing and needle exchange programmes across Europe. In other words, ‘harm reduction’. Yet nowhere in the accompanying documentation is that phrase obviously used.

The concept of harm reduction is simple enough. It is based on the humane and civilised notion that if a drug user dies prematurely, then the chances of treatment success are severely limited. A much better idea is to try and keep people alive to give them a chance of recovery when they are ready.

The idea was a response to the arrival of HIV in the UK and the discovery that one of the highest risk groups were injecting drug users. Government experts told the Conservative administration of the day that it was more important to stop the spread of disease than get people off drugs. The net result was that the UK had the lowest HIV rates in Europe – a situation which still prevails, although there are signs that we are losing ground especially when considering the rates of Hepatitis C infection in this same group.

But harm reduction remains a controversial subject. The USA and the organs of United Nations drug control remain implacably opposed to most aspects of harm reduction. Those on the political and religious right routinely declare that HR is tantamount to condoning drug use and is simply a conspiracy among drug law reformers to sneak in legalisation through the back door. Well, if it is, then all UK administrations back to Margaret Thatcher stand accused of being fifth columnists for the legalisers – as do the Iranian government which allows needle exchange in its country and now the Council of Europe.

But there are problems with HR. Nowadays, everybody says they are committed to ‘harm reduction’ including the police and the Serious Organised Crime Agency. It has become a drug strategy catch phrase without any clear idea what this means outside the health context. Exaggerating to make a point – harm reduction for a community blighted by street drug dealing could mean a police policy of ‘shoot to kill’.

And as mentioned above, harm reduction has morphed from a front-line health intervention into an ‘ideology’ - which is now positioned ‘against’ the prohibitionists. Politically it may be necessary to carve out a very specific landscape which is diametrically opposed to the view of those who not only support the status quo, but who want to see the ‘war on drugs’ significantly ramped up.

However, the fact that the Council of Europe does not appear to be adopting the phrase while at the same time backing the concept, means perhaps it is time to think of another form of words. One phrase which immediately resonates with the public while at the time pulling HR firmly back in the health arena, is ‘Health and Safety'.

As a society we are becoming unrealistically risk averse, but people nevertheless understand that there is inherent risk in virtually all human activity and the idea of ‘Health and Safety' is to minimise risks that exist. Wearing a seat-belt is a health and safety measure – nobody talks about a ‘harm reduction’ strategy for minimising road accidents. One advantage in rethinking the terminology is to help reduce stigma. Health and Safety is a much more inclusive, positive and familiar term than ‘Harm Reduction’ which of itself is ‘drug industry’ jargon meaning little if anything to the general public.

http://assembly.coe.int/ASP/NewsManager/EMB_NewsManagerView.asp?ID=3241

Contingency Management

Quite a billy-do this week about another even more excrutiating piece of industry jargon – often helpfully redefined by the tabloids as ‘I-pods for junkies’. Only this time it was extra drugs for treatment compliance. It kicked off with an investigation by the BBC’s Mark Easton who uncovered a report commissioned by the National Treatment Agency and published in April revealing that some agencies were increasing methadone doses and the provision of other drugs to those clients presenting with clean urines. An initial interview with NTA boss Paul Hayes was cut short while he was briefed by his staff and then he returned to denounce the practice.

It turned out that there was an element of misrepresentation here, because the study was not looking at service clients generally, but at those who were being treated both for crack and heroin problems. And as another NTA report from this year admitted, many of those services providing specifically for crack users are not performing well. So there may be a case for going the extra mile to encourage an especially challenging client group to stay in treatment.

But as another interviewee on the Today programme pointed out, contingency management could easily be a device utilised by poor services to retain clients so they are able to tick all the right boxes in our target-driven treatment system.

Only a summary of the research is available on the NTA website. But it might be illuminating to be able to map those agencies providing additional drugs against an appraisal of their overall performance.

Vor Sprung Durch Menschheit (Progress through Humanity)

noreply@blogger.com (Anonymous) — Thu, 20 Sep 2007 08:18:00 +0000

Back in 2006, a Home Office official was briefing that the arrival of the new drug strategy would be an opportunity for a root and branch evaluation of ten years of UK drug policy. Earlier this year, officials from that same department were quietly trying to dampen down expectations. And they were right: the resulting document has caused slack-jawed disbelief among thoughtful observers from within the sector – not a draft strategy, not a concrete set of proposals which allow for similarly grounded debate, but simply a re-iteration of the government’s own evaluation of success and a set of questions bewildering in their lack of focus.

The explanation has been that the incoming Prime Minister wanted input into the final document – and Gordon Brown did announce that indeed there would be a radical review of policy. Yet not only has the resulting document caused confusion, but because it does not contain any proposals, it is hard to see how a radical dimension can emerge from the consultation. There has also been criticism of the consultation process itself with formal complaints made to the Home Office that the process contravenes government guidelines and criticism that the successes heralded by the government do not stand up to much scrutiny.

There are real fears that we will end up with a cut and shunt drug strategy bolted together from yesterday’s ideas and tomorrow’s gesture politics. Instead what we need is a policy with real build quality, engineered from a thorough understanding and acceptance of the evidence base and properly balancing the human rights and civil liberties of those with drug problems, their families and carers and the wider community.

Please use this blog to record your views and opinions of the consultation document and the process together with your hopes and fears for the next phase of British drug policy – or email consultations@drugscope.org.uk

Just Say Go

noreply@blogger.com (Anonymous) — Mon, 13 Aug 2007 12:55:00 +0000

Last week the Scottish Executive was under fire when an evaluation of the Know The Score campaign aimed at preventing cocaine use revealed that 12% said they might now try the drug having seen the ads. But a third said they would be deterred while 58% said it didn’t alter the likelihood of them trying the drug. In other words, this didn’t mean that they would snort cocaine, simply that other factors would determine whether they did or not.

Which makes sense because if the benchmark for success is fewer people using drugs, then there is no evidence that mass media campaigns alone have any impact. People choose to use drugs, stop using drugs or not use drugs at all for a whole raft of reasons which have little to do with government advice. Raising awareness and knowledge is achievable, but the Holy Grail is to change behaviour.

This can work where the individuals perceive that failure to follow properly judged advice puts them at immediate risk, especially if those around them have become ill or died. A good example would be the safer sex campaigns aimed at gay men in the 1980s. But when it comes to recreational use of drugs like cannabis, ecstasy, ketamine and so on, this doesn’t appear to work. Why not?

One difference is that the risk is perceived as not immediate – and the same applies to warnings about drinking and smoking aimed at young people. Another is the source of the information – government. At its most extreme, such information can be pure propaganda and nothing more, apart from a fistful of dollars. In 2006, the US Government Accountability Office (GAO) published an evaluation report on the government’s anti-drug campaign conducted between 1998-2004 at a cost of $1.2m. Its stunning but not surprising conclusion was that “the campaign was not effective in reducing youth drug use, either during the entire period of the campaign or during the period from 2002 to 2004 when the campaign was redirected and focused on marijuana use” http://www.gao.gov/docsearch/abstract.php?rptno=GAO-06-818. This was when the Federal government tried to guilt-trip American teenagers into believing that every spliff smoked was another bullet for Al-Qaeda.

Fortunately our government has never been so crass with its efforts to educate the public, although the recent example of the cannabis ‘brain warehouse’ campaign revealed a trend away from the potentially life-saving advice of the rave years, when (Conservative) ministers were signing off on information about harm reduction in the club environment.

Which leads us to the next problem – politics. All government-derived public health campaigns have to be signed off by ministers. And for most part, these are not especially controversial – ‘five a day’, ‘get more exercise’, ‘don’t drink and drive’ and so on. Drugs, of course, are different: trying to walk the tightrope of credible advice without being accused of condoning an illegal activity.

Government can it seems do little to bring down the use of most drugs; the levelling off of ecstasy use (albeit at a high level) is all do with the cycle of drug fashions and wider popular culture, even if politicians are ticking it off in their success box. Therefore relatively little money is spent on specifically public health campaigns about drugs; the bulk of funds are allocated to breaking the link between drugs and crime - and supply-side efforts. It’s the role of FRANK to pick up the slack and cover off the world of recreational drug use. A cocaine campaign is slated for England, although that may well be re-evaluated after the snow-storm which blew down from the North.

So what should government do? It depends on what the requirement is. If the main imperative is political with more sophisticated versions of ‘Just Say No’, then things will carry on as before. If however, the government is serious about providing credible harm-reduction based information on drugs then it could do worse than turn to voluntary sector agencies. If government could bring itself to deliver adequate, but arms-length funding, then there are agencies both at national and local level, maybe acting in concert (rather than fighting over a tender) who could deliver real public health information about drugs.

Tubby or not tubby: that is the question

noreply@blogger.com (Unknown) — Sun, 29 Jul 2007 14:41:00 +0000

The Patients’ Association was up in arms this week because the National Institute of Health and Clinical Excellence (NICE) gave the green light to offering material reward for compliance with drug addiction treatment - known as contingency management. NICE have come under fire from patient groups, including the Patients' Association, over decisions not to recommend the prescribing of certain drugs for breast cancer and Alzheimer’s. However, the Patients' Association expressed its dismay by attacking those with drug problems as having brought it on themselves, a product of their own lifestyle choices.

But imagine how much more angry they would be if NICE announced that there would be no more free treatment on the NHS for those whose health problems were brought about by alcohol, smoking and in particular obesity. A recent report by the Foods Standards Agency discovered that obesity was as likely to be found in middle-class families as those on low incomes. And a government-commissioned report leaked to the Observer (29th July) revealed government’s three-year target to reduce unhealthy eating was pie in the sky and that the NHS “will have to spend billions more pounds every year on treating patients with obesity-related illnesses”. Let he or she who is without sin cast the first doughnut.

DoH!

Question 34 in the government drug strategy consultation document asks, how can we improve the effectiveness of specialist drug treatment services…? Well, for starters how about not cutting £50m over three years from the pooled treatment budget as revealed in the Sunday Telegraph? (29th July).

Harry Shapiro

Cannabis: unanswered questions

noreply@blogger.com (Unknown) — Wed, 25 Jul 2007 08:42:00 +0000

In keeping with most commentators and DrugScope, Mary Riddell in Sunday's Observer (22nd July) criticised the decision to review yet again the classification of cannabis as an unnecessary distraction from the real problems surrounding drug use in the UK. The only rationale for the decision appears to be the continuing belief that cannabis is stronger than it used to be and so hence poses a greater threat to mental health. Mary Riddell acknowledges DrugScope's view that there is no 'robust evidence' for this, but points out nonetheless that she knows of young people who have stopped smoking cannabis because they became frightened of the effects. So what might be happening?

It could be that across the board, cannabis being smoked in the UK, either home grown herbal cannabis or imported resin is much stronger than it used to be. But the only way to establish the general level of THC content is to actually spend some money finding out because the Forensic Science Service does not routinely test for cannabis potency - this is not required for the purposes of criminal prosecution. However if government policy (and public perception of risk) is being driven by the potency issue, then surely some simple testing of samples collected nationwide could be done? Obviously you cannot then match the results with samples from five or ten years ago, but you could then search the forensic literature for any indications of trends. This would not produce definitive answers, but at least it would add to the evidence base and help inform the debate.

What else might be happening? Many of those working in the field are familiar with the idea that how drugs might affect the individual is not simply the product of the drug itself. Effects can be influenced by what the user expects to happen (called 'set') and the situation in which the drug is being used (called 'setting'). The literature suggests that of all the drugs, what happens to somebody under the influence of cannabis is particularly susceptible to the drug-set-setting formula. In effect, users have to 'learn' how to react to cannabis and this explains why many first time users say they experienced no effects at all from smoking cannabis. It is not impossible that some young people report experiencing stronger effects from cannabis not because the drug is actually stronger but because they believe it is stronger through a combination of persistent media assertions that it is and the reinforcing beliefs of their friends and those selling cannabis who would want customers to believe that their product was 'the real deal'.

But even with some more flesh on the bones of these issues, we would still be left with unanswered questions about how cannabis toxicity relates to health problems and it may be beyond the scope of medical ethics to answer these points conclusively. Which ultimately brings us to the position that any sensible policy should consider what is most likely to happen to most people who choose to smoke cannabis based on the best possible evidence available and not be unduly influenced by unsubstantiated assertions of risk.

Harry Shapiro

'Radical' change on drugs policy?

noreply@blogger.com (Unknown) — Sun, 01 Jul 2007 16:07:00 +0000

Before entering Number 10 Downing Street for the first time as Prime Minister, Gordon Brown promised “a new government” with “new priorities” and repeated the word “change” six times. What some describe as the most extensive cabinet reshuffle in 60 years was completed within hours.

A honeymoon period (e.g., a becalmed media and/or Opposition) is to be expected, but the phrase “a week is a long time in politics” is no less true for being the cliche it has become. Policy will shape public opinion, as much as obsession with style and how the new PM responds to “events” (already being tested) - so perhaps it was no surprise that the long awaited consultation paper on the next drugs strategy has been delayed. Due on 15th June the Home Office halted publication because the soon to be PM was taking “a close personal interest.”

The consensus among officials is that the PM's interest is a good thing, but views differ as to whether any changes to the document – and the future direction of travel on drugs policy - will be minor or substantial. Either way, the consultation (which must last a minimum of 12 weeks) may not start much before the end of July. A new drugs strategy is unlikely to be published until early 2008.

Speaking at the annual conference of the Association of Chief Police Officers (ACPO) on 19th June, Gordon Brown promised a “radical review” of the drugs strategy. He said, for example: ”…a new strategy needs to reach addicts earlier to get them into treatment, and we need to find what works best in getting them to stay the course. And drugs education needs to reach children at an earlier age in primary, as well as secondary schools, and to help families and communities protect them from the dealers and the gangs.”

Not much detail so far, but Gordon Brown is unlikely to promise a “radical review” unless he means it. It does not necessarily mean that there will be (immediate) radical change following the formal consultation, but it would be naive to rule it out – and the PM knows a potential hostage to fortune when he creates one.

It is difficult to read the runes on future drugs policy by those appointed to new cabinet and ministerial positions. Vernon Coaker MP continues as Under-Secretary of State at the Home Office and may well continue to have responsibility for tackling drugs, but at the time of writing (1st July) the Home Office website does not list individual responsibilities for the new ministerial team. Otherwise, all is change: a new Home Secretary and Secretary of State of Health; Caroline Flint MP, previously at the Department of Health with responsibility for drugs and alcohol, has moved to the Department of Work and Pensions...

But one cabinet change already looks to be significant: the appointment of Ed Balls MP (long-term adviser to Gordon Brown) as Secretary of State for the newly created Department for Children Schools and Families. Bringing together for the first time policy affecting children and young people, the new department's responsibilities include not only "working with the Home Office and the Department of Health on tackling drug use and with the Department for Communities and Local Government on youth homelessness and supported housing", but it will also "lead a new emphasis across government on the prevention of youth offending" [emphasis added!].

Is it surprising that Gordon Brown has, so soon, flagged an interest in drugs policy? On the one hand it could be read in part as a precautionary tactical position, demonstrating 'tough on crime, tough on the causes of crime' credentials before the Conservative Party possibly attempts to seize the agenda when it publishes the report of its Addictions working group. On the other hand, a politician with a keen interest (indeed passion) in tackling poverty and social exclusion cannot but be concerned about the causes and impacts of drug and alcohol misuse, and the marginalisation and stigmatisation of people dependent on drugs and alcohol, and their families.

Although both the Prime Minister and the Leader of the Opposition have been prepared, at different times, to address the difficult issue of drugs policy, it may be naive to hope for less party political posturing and instead a growing consensus. But perhaps not: we live in potentially interesting times. There will be a lot to debate and discuss over the next few months.

There is at least one issue that new ministers with responsibility for drugs and alcohol should look at, and urgently, not least because it goes against the emphasis on improving the lives of young people and the importance of prevention – and that is the cut to the Young People’s Substance Misuse Grant. As we will be highlighting in the next edition of DrugLink magazine, the cut is hurting and is, basically, indefensible.

The true test of family values

noreply@blogger.com (Anonymous) — Mon, 25 Jun 2007 22:01:00 +0000

According to the Liverpool Daily Post, so-called 'pro-family' campaigners are up in arms at the city council's decision to employ ex-offenders, many of whom are former drug users and alcoholics, to act as tour guides during Liverpool's tenure as the European City of Culture in 2008. There have been calls for those responsible for the decision to resign; the plan has been denounced variously as, 'dangerous', 'irresponsible' and 'unacceptable'. One protester said that he would be very uncomfortable at the thought of his children coming into contact with such people.

As well as being ex-offenders, they will also be brothers, sons, uncles, nephews and husbands - and no doubt wives, aunties and daughters as well. So it seems singularly perverse for organisations purporting to support the institution of the family to be railing against attempts to help people back into the community and reconnect with their families.

The second thought is how would anybody know that their tour guide was an ex-user? Would they be expected to wear a badge saying, 'Hi, my name is Dave and I used to be a smack head'. This goes to the nub of the stigma and isolation that so many people in this position feel. And it is why any future drug strategy has to address this by doing much better at paving the way for people to get back some dignity and self-esteem through education, training, a job and somewhere to live. People with drug and alcohol problems are not outsiders, they are part of our communities.

Hopefully Liverpool council officials will ignore the protests because giving ex-offenders this kind of chance will say more about Liverpool as a City of Culture than all the art galleries and concert performances ever could.

War on Drugs and the DMZ

noreply@blogger.com (Anonymous) — Sat, 16 Jun 2007 13:23:00 +0000

Since the last Druglink blog, DrugScope has been accused on live radio of 'taking government money to promote drug use', 'downplaying the effects of drugs' and generally being responsible for the level of drug use in the UK. This is both ludicrous and illuminating.

Back in the early seventies, DrugScope's predecessor, ISDD was accused by the underground press of being a front organisation for Big Tobacco because we had (perhaps unwisely) Sir Harry Greenfield of British American Tobacco as our chair. More recently as DrugScope, we were the subject of a hoax memo sent to MPs and journalists purporting to minute a secret meeting between DrugScope and Big Pharmaceuticals at which allegedly we plotted jointly to lobby for the legalisation of drugs. We have also been accused of exerting undue influence on David Blunkett to reclassify cannabis. But there are those who berate us for not being radical enough, for being too close to government. It seems either we are in the pockets of the prohibitionists or we are the lackeys of legalisation.

All of whch serves to demonstrate that drugs is one of the most contentious and polarised areas of public discourse. In the War against Drugs, if you're not for us, you're 'agin' us. So to extend the metaphor, occupying the Demilitarised Zone is not easy, but it is where the many thousands of people who access our services every year expect us to be - continuing to provide non-judgemental, up to date and evidence-based information.

Thinking sensibly

noreply@blogger.com (Anonymous) — Sat, 26 May 2007 10:21:00 +0000

We have been given to believe that the health components of our drug and alcohol strategies are based on what the consensus of the clinical literature has to tell us. So it is somewhat suprising that the government has just announced that the advice to pregnant women is not to drink any alcohol at all. To date the advice has been that a couple of glasses of wine a week was fine. So what has changed? Nothing. According to the deputy Chief Medical Officer, this new advice was meant to send a 'strong signal' that women who drank more than the recommended limit were putting their babies at risk. But hang on, the new advice does not reiterate the current advice on sticking to the recommended limit, but urges women to abstain completely. So the government advice is confusing from the get-go. On top of which, the Royal College of Obstetricians and Gynaecologists intend to stick to their advice that in moderation, alcohol poses little or no threat for the unborn child. And presumably they should know. So if women weren't confused, chances are they are now.

But of course, they probably never were. Governments tend to assume that unless health messages are written in block captials using red crayon, the nation falls into an abyss of hand-wringing anxiety. Women (even when they are pregnant!) are perfectly capable of making sensible decisions about any lifestyle changes they feel are necessary.

Which is just as well because the clinical evidence of long-term damage to children related to maternal alcohol and drug use is highly contested. The media love to be able to trumpet the latest scare to put the fear of God into prospective parents. But those children in most danger are probably subject to a battery of maternal factors - diet, social status, housing as well as chronic drug and alcohol use. Clinical trials to isolate risk would be unethical so as The Times pointed out (25th May) taking the cautious approach on health advice is 'as much a matter of philosophy as science'.

Prescription for better care

noreply@blogger.com (Anonymous) — Mon, 07 May 2007 08:25:00 +0000

The cover story for the next issue of Druglink (May/June) out this week, concerns heroin prescribing with an exclusive inside look at the workings of the current UK heroin trial. But we also feature an article that looks back to a time when the only treatment for drug problems was a visit to the local GP.

Up until 1968, any GP could prescribe drugs to a user in support of their addiction. No other country allowed this and so it became known as the 'British System'. Of course, the user population was very smaller than today, just about into four figures - and located primarily in London and the south East. And there were some villains among the hero doctors, who were just in it for the money. But the principle was sound - you could see a local doctor who would assess your problem and prescribe if necessary. In fact, the head of the Home Office Drugs Branch at the time, Bing Spear, later called the decision to ban doctors from prescribing as one of the biggest mistakes of British drug policy. He strongly believed that doctors could be trusted in this respect and that the use of the Home Office Tribunal System (never properly implemented) could have dealt with any rogues.

Instead, community doctors were taken out of the treatment mix and it has taken decades to make any inroads into bringing GPs round to the idea that they can treat people with drug problems. Much of the credit for this goes to the SMMGP (Substance Misuse Management in General Practice), who recently held their 12th Annual Conference. The first conference was very sparsely attended: now 600 delegates are turning up with many more turned away. But much work remains: still only around 25% of GPs have any caseload of drug users and the rudimentary nature of GP training in this area doesn't help.

But it could well be the future: the idea that drug treatment becomes more of a mainstream responsibility for health and social care. If drug users are to be brought in from the margins, then GPs should be brought along as well.

http://www.smmgp.org.uk

The battle for hearts and minds

noreply@blogger.com (Anonymous) — Sun, 29 Apr 2007 15:32:00 +0000

As reported in The Guardian (27th April) the Afghan government and NATO have been embroiled in a row after the NATO-led International Security Assistance Force (ISAF) announced to local poppy growers over the radio that ISAF understood why farmers needed to grow opium and that ISAF would not be engaging in crop eradication.

On the face of it ISAF's ad campaign sounds ridiculous; the West have been pressurising President Karzai's government to clamp down on opium production while Afghan heroin supplies virtually the whole of the UK market. Surely ISAF should be in there with flame-throwers at the ready?

But while ISAF have stopped the announcements, it still refuses to become involved in crop eradication. NATO argues that the sight of western soldiers slashing through poppy fields could drive hundreds of farmers into the arms of the Taliban. Western soldiers say their main job is to provide security so the Afghan government can tackle opium growing. To win support from sceptical farmers, British officers are at pains to distance themselves from poppy eradication efforts. "It's all about the civilians. They have to understand that we are here to kill the Taliban, not to cut down their poppy," said Lieutenant Charlie Mayo, a British military spokesman. There have even been rumours that British forces have exchanged fire with personnel under American command trying to attack poppy fields.

The dilemma over Afghanistan's opium economy is emphasised in a new book published by Pluto,'Drugs in Afghanistan: opium, outlaws and scorpion tales' by Dave MacDonald who was a field officer for the UN Office of Drugs and Crime in Kabul. MacDonald demonstrates that opium growing in structurally embedded in Afghan culture - a relationship between people and plant which goes back centuries. As Dr Richard Jones points out in reviewing the book for the forthcoming issue of Druglink, only time and commitment can help resolve the opium issue not just cash - and certainly not Rambo-style military interventions.

The reality gap in drug policy

noreply@blogger.com (Anonymous) — Sun, 22 Apr 2007 15:07:00 +0000

Media reporting of recent overviews of British drug policy has concluded that the drug strategy has failed. And looking at the headline figures, it would be hard for any member of the general public to think otherwise. Indeed, the media gleefully leap on reports such as these for its daily dose of doom and gloom. So despite the investment, we have not seen a decrease in users of heroin or crack, still only a small percentage of drugs bound for the UK are seized, cocaine use has increased, cannabis farms are sprouting up everywhere and drug education must have failed because young people still try drugs. And so on.

So what can we say about this? Well, no drug strategy ever created has succeeded in substantially reducing drug use among any sector of the population or reducing the amount of drugs in circulation however much money has been thrown at it. The results of measuring the success of a policy against such basic indicators are inevitable.

By the same token, government measures of its own success are often equally flawed – and based mainly on quantity rather than quality – numbers in treatment, numbers of hits on the FRANK website, amounts of cash invested. And there are some developments that the government cannot in all honesty take credit for, such the reduction (according to the British Crime Survey and Home Office seizure stats) in the use of LSD, amphetamine and ecstasy which is to do with fashion and the workings of the drug market.

Because the things that maybe make the most difference are those which are difficult or even impossible to measure; the respect shown to a potential service user that persuaded them to come for their next appointment; the probation officer that went the extra mile for a client; the signal moment when a young person could have gone down the wrong road, but for a teacher who had faith in their abilities; the number of users who didn't die because of harm reduction strategies.

Scary for policy makers, but which leads to the thought that while matching investment against outcomes is a highly fraught exercise – this should take nothing away from the efforts of dedicated workers right across the health, social care and criminal justice sectors who are trying to make a difference to those with drug problems, their families and carers and the wider community. They deserve continued investment to support their efforts and so do the people they serve. Let’s start thinking outside the tick box.