Atul Gawande's Reith lectures: building a system that cares

On my wintry walks to work these last few weeks, I’ve been enjoying the 2014 Reith lectures. Each year, the BBC invites a distinguished guest to give a series of talks on an issue of public interest. This time, surgeon and writer Dr. Atul Gawande has been discussing medicine and public health. I’m grateful to my colleague George Garrad, who suggested they might be up my street.

Dr. Atul Gawande (photo: CfAP, Creative Commons)

Firstly, if you have any interest in health (and which of us doesn’t?) I really recommend listening to the four lectures. In them, Gawande makes a passionate yet highly methodical case for how we can improve the health care that people receive throughout their lives, across the world.

He blends stories from his professional and personal life, which are often very moving, with political argument in a way that’s entirely absorbing (I occasionally came close to walking into lampposts). And although his focus is on medicine, I think the issues he discusses are of vital importance for the drug and alcohol sector – and especially its approach to complex needs, which is of particular interest to me through my work at DrugScope with the Making Every Adult Matter coalition.

Why the system matters

Gawande’s basic argument, as I understood it, is this: over the last century, we’ve made huge advances in knowledge about the body and how it works. We’ve also developed technology – surgical techniques, medicines – that can help us treat ever more conditions. However, what we haven’t worked out is how to apply this knowledge consistently across every hospital, country and continent. This helps fuel the dramatic health inequalities we see at all of these levels.

In his second lecture, therefore, he focuses on problems with ‘the system’: the interactions between people and organisations that deliver healthcare. As a surgeon, he uses the example of avoidable deaths in the operating theatre and describes work that he and colleagues are doing to introduce simple checklists for basic tasks. A tiny detail like washing your hands takes on huge importance when it’s one of hundreds of tasks that contribute to a successful operation.

Often, Gawande explains, surgeons and other medical professionals resist the idea of following a checklist – until they see the evidence that it saves lives (you can read more about this in a fascinating 2007 New Yorker article that he draws on in his talk). However, where his argument gets really interesting is in the final lecture, where he discusses the limitations of this approach:

“But just because you have a roadmap does not mean anyone is going to follow it. There are barriers to overcome to execute even the simplest step, and those barriers differ from place to place. In one health centre, staff may not wash hands because they don’t know it’s important; in another, because they don’t have sinks or running water in the delivery rooms; and in another, because they simply have not made it their habit and no one cares.

"That last phrase I think is the critical one: if no one cares when someone takes the trouble to do things right, nothing changes. And the overwhelming message to the people who work at the frontlines of care around the world is that no one notices excellence and no one cares. That is the biggest source of burnout and discouragement for health care workers everywhere.”

What this means for drug and alcohol services

I think this insight is crucial to how drug and alcohol services approach treatment for those with the most complex needs. We often hear calls for ‘system change’ – the demand that services should be re-designed to work better together. That’s clearly a valuable goal – but it’s also vitally important that we take into account the human beings on whom services depend, who are often forgotten in the rush to reform and restructure.

At DrugScope’s conference in November, I ran a workshop with drug and alcohol practitioners (some of whom also had personal experience of recovery) on their experiences supporting people with complex needs. One substance misuse worker observed – to universal nods of agreement – that they often felt they were “mopping up” problems that other services weren’t resolving in the way they should.

Their personal commitment to the people they work with meant they were willing to compensate for the failures of the system they worked in. It’s one of the great strengths of our sector that, on the whole, it attracts people who care deeply about the work they do, and the lives of those they support. I think to a great extent, this stems from the high number of practitioners who have personal experience of substance misuse. (Incidentally, it’s one the few weaknesses of the lectures that they don’t do more to explore the role of people using, rather than delivering, healthcare services.)

Dr. Gawande’s insight is that in making a system work, you need to do more than simply find the most efficient solution to a problem. You also need to work from the behaviour of people who care, and find out how to build a system that supports them and encourages others to follow suit.

Too often, when looking to reform health and social care, we begin from the assumption that the system can make people better – when actually, the opposite is true. I actually find that idea rather hopeful, and offer the lectures – which explore these issues in rich detail – as a diversion over what I hope is a restful Christmas and New Year.

Sam Thomas is the programme manager for Voices from the Frontline. Follow @iamsamthomas on Twitter.

Bite-sized Briefing - Public Health England’s grant to local authorities

As part of the support we offer our members DrugScope's policy team send out a monthly round-up and précis of reports which we believe are of interest to the field.  The following is offered as an example of the content of our Bite-sized Briefing for December.


The National Audit Office have produced an assessment of whether the new public health grant to local authorities is likely to lead to intended outcomes and achieve value for money.

The report makes clear that despite increases in the overall budget allocated for public health (up by 5.5% in 2013-14) allocations within the overall envelope are changing slowly as local authorities exercise their judgement on local priorities.

They report that in 2013-14 local authorities had budgeted 54.3% of spending on sexual health, drugs and alcohol services; in 2014-15 this proportion had reduced to 52.8%.  They also found:

“between 2010-11 and 2012-13 alcohol-related admissions to hospital increased by more than 6% in 26 local authorities. These 26 local authorities spent on average 6% of their public health spending on alcohol services for adults. This was significantly less than the 9% spent by the 26 local authorities where alcohol-related admissions reduced the most.” 

 Other key messages from the report are:

• A survey of stakeholders found that three-quarters of respondents have a good working relationship with PHE, although it is generally too early to tell whether public health outcomes are improving. That said, the report points out that PHE prioritised 54 local authority areas for intensive diagnostic and support work to improve recovery and reduce relapse rates leading to a 1.3% increase in recovery rates.
• The Department of Health has not decided how long the ring-fence for the public health grant will remain in place.
• There have been limitations in the quality of data, for example, 81 local authorities initially reported not spending anything against 1 or more of the 6 prescribed public health functions, and there are lags of at least 18 months for publishing much of the public health outcomes data.
• Some stakeholders think PHE should display stronger system leadership.  However, the formal levers available to PHE for securing better public health outcomes are limited and the autonomy of local authorities gives no guarantee that PHE can secure improvements in outcomes (and at £5 million, the health premium risks being too small to bring about significant change).

Download the full report here.

If you would like to join DrugScope you can do so here.

10 (more) things - late December edition

A final set of slides for the year with 10 more things I saw about alcohol and other drugs and which I thought were interesting.

This time including: data on drug deaths as a proportion of all deaths of adults 15 - 43; the use of naloxone by ambulance crews in the East Midlands; substances people said they were dependent on amongst people in police cells in London; seizures of drugs and mobile phones in HMP Durham; victims of criminal exploitation; number of people using residential rehab; cultivation or illegal drugs in Scotland; number of possession and possession with intent to supply offences recorded in Scotland; global narcotic seizures by the Royal Navy; and % changes to the ABV of alcohol between 2011 and 2013.




As always any misinterpretation of the data you spot are down to me (and please do let me know so that I can fix them).

StreetLink celebrates its second anniversary

Many happy returns, StreetLink

Prior to joining DrugScope in 2012, much of my working life had been spent in homelessness services of one sort or another. Between the mid-90s and 2010, I worked in hostels, supported housing, outreach and floating support, before spending two years at Homeless Link, the membership organisation for the sector.

Despite getting to know the homelessness sector pretty well during that time, I was sometimes perplexed when faced with rough sleeper outside of work. Identifying the relevant outreach team (having first established that there was an outreach team – many areas don’t have one), finding a contact number or email address and then actually getting through (outreach teams generally work highly unsocial hours) could be time consuming and complex. If I was away from my adopted home turf of London, these difficulties were compounded. I thought at the time that if it was a difficult and time consuming process for me, for someone unfamiliar with the way the system works, what services work with whom, what they might be called and so on, it would be even more daunting, if not impossible.

In December 2012, life was made considerably easier for anyone worried about someone sleeping rough, including rough sleepers themselves. Building on the work of the No Second Night Out London hotline, StreetLink was rolled out across England. Developed and run by Homeless Link and Broadway (now St Mungo’s Broadway) and funded by the Department for Communities and Local Government (DCLG), StreetLink provides a single portal for rough sleepers themselves, members of the public, and members of emergency, health and support services to get connected to outreach teams.

What StreetLink does is in some respects quite simple – it takes referrals (and self-referrals) from anywhere in England and passes that information on to the relevant outreach team or local authority. Instead of having to go through the process of researching provision in any particular locality, StreetLink provides a single phone number, mobile app and website and even offers to let people know – in a general sense – what happened to their referral. In contemporary terms, it ‘hides the wiring’ of what remains a complex patchwork of services and provision spanning around 150 local authorities.

About rough sleeping and homelessness

The relevance for drug and alcohol services is in the number of people they support who have housing problems of one sort or another. Around 10% of people starting new drug treatment journeys in 2013-14 had no fixed abode, with a further 14% having other housing problems. The corresponding figures for those starting new alcohol treatment journeys are 4% and 10% respectively.

As those figures have been pretty constant for some years, it seems plausible that over 10,000 people in contact with drug and alcohol services are actually homeless, with around 40,000 having some other sort of housing problem. Looking at it from the other side, we also know that ‘tri-morbidity’ is commonplace – rough sleepers often have coexisting poor physical health, poor mental health and problems involving substance misuse.

Nationally, over 2,400 people sleep rough on a typical night. This number is based on the street counts conducted in winter and reported by DCLG and represents a continuation of an upward trend visible since 2010, when the street count guidance was changed. In London, the CHAIN database used by all the main outreach teams suggests a corresponding significant increase, with new contacts increasing from 1672 in 2007-08 to 4363 in 2013-14.

These numbers are substantial. Figures recently released by StreetLink show that in the two years it has been operating, almost 9,000 people have used the service and been connected with support, just over a quarter of them self referrals from rough sleepers themselves. Of these, almost 1,700 have been supported into accommodation.

There is a discrepancy between those numbers. Of course, some of the referrals may have been inappropriate for StreetLink; for example, people who are street active (begging or drinking on the street, say) rather than rough sleeping, or people who are already known to services.  Some referrals may have been impossible to find, or may have been reluctant to accept the service offered.

Simply being referred to StreetLink doesn’t itself bring any additional entitlement to accommodation. The ‘priority need’ criteria still apply (everywhere apart from Scotland, although the London Assembly has called for it to be abolished in London too) and the rules around benefits and public funds (subject to frequent toughening and revision where non-UK citizens are concerned) can often serve as barriers to services. With UK nationals making up just under half of the rough sleepers in London, that means that many people find their options very limited.

For many foreign nationals, this might mean access to a reconnection service like the one run by homelessness charity Thames Reach, but little more. For the rest, StreetLink faces challenges in both supply and capacity; Homeless Link suggests that while the number of rough sleepers steadily increases, the services that can support and accommodate them are facing tremendous financial challenges as are the local authorities who play such a crucial role.

How you can help

By way of disclosure, I volunteer for StreetLink and from my experience, many (but by no means all) of the people who make referrals themselves in one way or another work with adults with complex needs – treatment providers, off-duty housing and homelessness workers, members of the emergency services and so on. You may be one of those who have made a referral, but if not, please have a look at StreetLink’s website and save the phone number 0300 500 0914 – the phones are staffed 24 hours a day, 365 days a year.

If you have a smartphone, you can also download the StreetLink app which makes reporting easier and quicker and also contains links to information, statistics and other sources of help. It’s available for Android and iPhone. If you’re working with someone from central or Eastern Europe who might benefit from reconnection, the information on Thames Reach’s Routes Home pages might be of interest, although if they're rough sleeping, StreetLink would be the best first point of contact.

Finally, while StreetLink has a small, dedicated team of paid staff, it also relies heavily on a pool of volunteers. If this might be of interest – and please note that while rewarding, StreetLink is closer to call centre work than the coal face of rough sleeping – you can contact the team at the following address: volunteers@streetlink.org.uk 

By Paul Anders, Senior Policy Officer, DrugScope.

Owen Bowden-Jones: If I had my way the government would...

This is a guest blog from Owen Bowden-Jones. 

Owen is the founder of the Club Drug Clinic, the current Chair of the Faculty of Addictions at the Royal College of Psychiatrists (2010-2014), a Consultant in Addiction Psychiatry, overseeing alcohol and drug services in the borough of Kensington and Chelsea and an Honorary Senior Lecturer at Imperial College in the Division of Brain Science.  Owen is also a Trustee of DrugScope.

Invest where the evidence is most robust.

Develop an inspectorate for scrutiny and oversight of commissioning.

Move commissioning of drug and alcohol specialist services from local authorities to Clinical Commissioning Groups.

For both drug and alcohol problems, increase the focus on young people at early stages of harmful use. Early intervention is well established for most illness management and should become a priority for harmful/dependent drug and alcohol use.

Invest in technology to support recovery. Relapse prevention, motivational enhancement and peer support can all be enhanced with online/mobile telephone interventions.

Review the workforce to ensure that necessary skills are retained within the sector. We are facing a brain drain, particularly for addiction psychiatry, which is bad news for the whole sector.

Jan King: If I had my way the government would...

This is a guest blog from Jan King, the Chief Executive of the Angelus Foundation.

We need the government to take positive steps to ensure young people are better informed of the risks to their mental and physical well-being from new psychoactive substances, the so called ‘legal-highs’.

We already have a poor commitment to drugs education in this country and the government needs to ensure that all schools cover some key messages. There has been an understandable trend to schools setting more of their own teaching agenda but this cannot be at the expense of our young people’s future health and well-being.

Compulsory PSHE (Personal Social and Health Education) would be a welcome start and much more proactive means of getting messages to young people. We need well thought out approaches delivered in a range of ways but ideally with young people centre stage saying what works for them.

The emphasis needs to be on equipping them to withstand the myriad of pressures they may face and not rather pointless enforcement messages around potential penalties.

At Angelus we have been visiting schools, universities and festivals showing films of what can happen when people experiment with untested substances with little idea of what they are taking let alone what might be a safe dose, assuming such a thing is possible. When they see the outcomes they are often angry they have not been informed by anyone before that there are new forces at play trying to take advantage of their potential vulnerabilities.

While we are committed to working with young people and their parents so that young people can take informed decisions we need the Government to be taking a much clearer stand on what schools should be doing to stem this pernicious trend.

The Government’s review into NPS goes some way in the right direction but the new Administration will need to ensure that its recommendations are pursued vigorously if we are really to keep our young people safe.

There will be no time to rest on any laurels as we know the industry that knocks out these substances will already be cooking up new ways to get around any changes in the law.

10 things to know about the number of adults in drug and alcohol treatment in England in 2013-14

Here are 10 things I've found in looking at the data in Public Health England's reports on drug and alcohol treatment in England in 2013-14.

1. There were 308,118 adults in treatment for drug (193,198) or alcohol (114,920) problems. Almost half (151,859) were starting new treatment journeys (70,930 for drugs and 80,929 for alcohol). 
2. Amongst those accessing treatment the proportion addressing alcohol problems has increased from 32% in 2008-09 to 37% in 2013-14. 
3. Across drug and alcohol treatment 71% were male and 84% identified themselves as White British. 
4. 45% of those exiting treatment for drug problems did so free of dependency, 59% successfully completed alcohol treatment in 2013-14. 
5. 53% of the estimated number of opiate and crack users (293,879) in England were accessing treatment in 2013-14. 
6. 18% of the estimated number of dependent drinkers (630,000) in England were accessing treatment in 2013-14 - this compares to one in four in Scotland . 
7. Just under half (45%) of those coming into treatment last year were over 40 years (67,952 individuals) - this was particularly true for alcohol where over 60% were over 40. 
8. The number of people in the drug treatment system who are over 40 years old has doubled since 2005-06 - from 32,406 to 69,806. 
9. The biggest source of referrals to the treatment system was by those seeking help themselves (43%), 12% of referrals were through GPs (however, the proportion for drug treatment was only 6.6% compared to 17% for alcohol). 
10. Nearly 10,000 people entering drug and alcohol treatment last year had no fixed abode at the time they started treatment. A further 17,312 were having other significant housing problems (such as staying with friends or family as a short-term guest or residing at a short-term hostel). In total nearly one in five (18.7%) of new entrants were experiencing housing problems.

As always should you spot any errors in the way I've interpreted the data I'd be grateful if you let us know so that I can correct them.

Interesting things about alcohol and other drugs that you may have missed - December 2014

Two sets of slides full of what I hope are interesting pieces of data about alcohol and other drugs that you may have missed this month.

 

Take home naloxone

Stephen Malloy with naloxone

CC Image courtesy of  Nigel Brunsdon on Flickr

Andrew Brown, Director of Policy Influence and Engagement on the case for take home naloxone in England

Last year saw a worrying 32% increase in the number of heroin related deaths in England, which may have been reduced had naloxone been more widely available.

Naloxone is a medicine which is licensed for use in the treatment of suspected opiate overdose.  The medicine is already routinely carried and used by paramedics in the UK.  

In 2012 the Advisory Committee for the Misuse of Drugs called on the government to act to make naloxone more widely available, for instance, by providing drug users and family memebers with supplies of the medication, arguing that it is an evidence-based intervention, which can save lives and:

"fits with other measures to promote recovery by encouraging drug users to engage with treatment services, and ultimately, keep them alive until they are in recovery."

Earlier this year the Department of Health responded saying that regulations would be developed by the Medicines Healthcare Products Regulatory Agency (MRHA), and brought into force by October 2015.

In response to the rise in heroin and other opiod related deaths in England a number of organisations including DrugScope have come together to form the Naloxone Action Group for England.  At a summit hosted called by IDHDP and Blenheim CDP we looked at the learning from the national naloxone programmes in Wales and Scotland and at how a Birmingham GP (Judith Yates) has taken action to increase access to the medicine ahead of the MRHA regulations coming into force in October next year.  We heard from service users, drug treatment providers, NHS staff, academic and legal experts and others from across the sector and discussed actions we would want government, local commissioners, practitioners and manufacturers to take to reduce the number of overdose deaths.

Guest Blog: If I had my way, the next government would…

This is a guest post by Rupert Oldham-Reid, Senior Researcher at the Centre for Social Justice, and reflects some of the ideas that he presented at this year's DrugScope Conference.

The next Government must commit itself to addressing social breakdown. In the field of drugs and alcohol misuse, as with severe debt and worklessness, policy must be ambitious for those currently reliant on the state. It is not enough to maintain people in dependence and consider our duty done. Economically this is in Britain’s long term economic interest but, more importantly, it is the right thing to do by our countrymen.

Invest in recovery 

Fundamentally, the next Government must realise it needs to invest to help people transform their lives. Although social finance initiatives hold a great deal of potential in this sphere, it will be some time before this opportunity can be fully developed. The next Government, therefore, should levy an additional charge upon the alcohol industry for the dedicated purpose of funding rehabilitation and reintegration.

The CSJ outlined one way this might be done in the form of a treatment tax. This small payment, £0.01 initially on each unit of alcohol sold off-license, would raise over £1 billion in the next Parliament.

With such investment, rehabilitation centres (including residential), supported dry accommodation, and other recovery capital-building services, could be expanded to meet the demand of those hundreds of thousands of people dependent on opiate, crack and/or alcohol. With approximately 300,000 children with a parent addicted to drugs and 700,000 with a parent dependent on alcohol, this cannot wait.

Beyond such investment, we need to appoint a Recovery Champion for England. Such an individual would ensure that resources are well spent; that localism delivers for all local people; and, to challenge the stigma around addiction and recovery.

New Psychoactive Substances (NPS – ‘Legal Highs’) 

The rising challenge posed by NPS (legal highs) requires a swift and determined response. The report by the Expert Panel is a good overview for what our response should look like. On enforcement, the CSJ is gladdened to see the Panel agree with our recommendation that the Irish Model provides a guide on how to proceed. This legislation will allow police to close down ‘head shop’ and other establishments which persist in selling NPS. We will also need to see adequate resources flowing into the National Crime Agency to allow online trade to be tackle. This approach, however, must be accompanied by effective prevention and treatment reorientation.

Transforming public services 

We must make more of every opportunity at intervention we get, be it in the criminal justice, welfare, or health services. Although effective at treating the symptoms, we have a poor record on addressing the behaviour which is putting untold pressure on public services.

In our health service, we must address the shocking rate of alcohol-related re-admissions – up 85 per cent in the last five years according to CSJ Freedom of Information requests.

In our welfare system, we must ensure the next phase of the Work Programme has a more supportive offer for those furthest from the job market. For example, we need a mixture of higher up-front payments for service providers and rewards for those who get people nearer employment, if not actually in work, for example, abstinent from drugs. At the same time, we must ensure that with the welcome drive to personal budgeting accompanying Universal Credit, we must ensure that vulnerable people get additional support, for example, through the piloting of welfare cards.

Finally, in criminal justice, action is needed to address the shocking levels of reoffending. Figures show over half (56 per cent) of offenders on community orders given a drug rehabilitation requirement (DRR) reoffended within a year of being sentenced.

Thus we need to build on the success of the Family Drug and Alcohol Court by extending the problem-solving approach to criminal justice. Similarly, we need treatment in prisons which breaks the cycle of addiction and a probation service which provides effective aftercare. To this end, we welcome the Lord Chancellor’s announcement that mental health in prison will be a priority for the next Parliament.

Social justice at the heart of Government 

Pulling all this together, the CSJ hopes that any future Government maintains the Social Justice Cabinet Committee. Chaired by a senior cabinet minister, it is essential that key departments are brought together to drive through policies which can tackle disadvantage in Britain.

Rupert Oldham-Reid is a Senior Researcher at the Centre for Social Justice and is on Twitter at @RupesOR

Bite-sized Briefing - Shooting Up: infections among people who inject drugs in the UK

As part of the support we offer our members DrugScope's policy team send out a monthly round-up and précis of reports which we believe are of interest to the field.  The following is offered as an example of the content of our Bite-sized Breifing for November.

Public Health England (PHE) have updated their 2013 report setting out the current knowledge about levels of infections for people who inject drugs across the UK. As well as the report other resources include an infographic, a briefing for Directors of Public Health and a set of slides.

Key messages from the report include:

• Two in five injecting drug users are living with hepatitis C; half of these infections are undiagnosed.
• HIV levels remain low and the uptake of care is good. Around one in every 100 people who inject drugs is living with HIV.
• One in four people who inject psychoactive drugs report a recent symptom of an injecting site bacterial infection. Fewer (one in six) people who inject image enhancing drugs suffer these symptoms.
• The proportion of injecting drug users who share needles has halved in the last decade but still around one in seven continue to do so and almost one in three had injected with a used needle that they had attempted to clean.
• There has been a recent increase in the injection of amphetamines and amphetamine-type drugs, such as mephedrone, which is associated with higher levels of infection risks.

Perhaps the most important message in the report is that the provision of effective interventions, such as needle and syringe programmes, opioid substitution treatment and other drug treatment, which act to reduce risk and prevent infections, needs to be maintained.

Download here.

If you would like to join DrugScope you can do so here.

Guest Blog: If I had my way, the next government would…

This is a guest post from Steve Broome, Director of Research at the RSA, and reflects some of the ideas that he presented at this year's DrugScope Conference.

Drug policy is headline news again. The initially delayed and much discussed Home Office report on the international experience of approaches to drug misuse and addiction has to some degree reinvigorated public debate about how we perceive and respond to it. Perhaps you take from the report and the subsequent debate the view that drug policy is working, given the downward trend in adult use of illicit drugs (although Public Health England figures show that number of adults using in the last year has not much changed since the 2010 national drugs strategy was introduced). Or perhaps you put more stock in the view that the UK’s drug laws have no effect on curbing illicit drug use. Either way, I think there are underlying possibilities that might be developed.

The shift from a focus on treatment to one on recovery (which I welcome), and this recent, more widespread questioning of the effectiveness of our drug laws, signal that we are continuing, in some ways at least, to move away from a punitive attitude towards substance misuse and progress further towards one that is recovery-orientated.  Recovery, however, cannot be ‘delivered’: the notion of active citizenship implicit in the UKDPC’s consensus statement on recovery, cannot come solely from the top down, or just the individual trying to progress their own recovery.  It requires the participation and commitment of both that individual and a wide set of stakeholders within their communities.  Consequently, it requires a more integrated approach, particularly around housing and jobs.  But there is an important social component too.  The RSA’s Whole Person Recovery model seeks to build, among other things, the social networks and attendant empathy and respect that (re)connect people with their communities and the support, information, and opportunities they can provide.

Stigma is a key barrier to enabling this.  Research by the UKDPC showed that public attitudes towards people affected by substance misuse are much more negative than, for example, public attitudes towards people with mental ill health conditions; and that service users experience significant levels of stigma from professionals.  Such attitudes have the effect of deterring those with substance misuse problems from seeking help, and contribute to worse longer-term impacts for the people concerned and for wider society.

So, taking the above, and as asked for ahead of this year’s national Drugscope conference, here is my suggestion for the next Government.  I’ve tried to draw on recent RSA work, and give a non-obvious suggestion that could be adopted now, and that does not depend, for example, on attitudes to things that divide like the decriminalisation/legalisation debate.  There is much I would change to better join up different policy domains (particularly between substance misuse, mental health and prisons), and to drive more effective co-commissioning, but these issues sit in a wider debate about public service reform.  (You can read the RSA blog platform for ideas on public service reform.)  We have to better respond to the risks presented by new psychoactive substances.  I would make far better use of restorative justice in cases where use of illicit drugs has driven acquisitive crime, particularly if this is a means for the wrongdoer to become motivated to seek treatment.  And I would also take care to protect our successes in a forthcoming parliament that may see austerity take a bigger bite yet out of public expenditure.  While there is further to go, investment in substance misuse services has improved the choice of treatment, the timeframe in which it can be accessed, and has driven innovation. 

You may think the suggestion below is too abstract and beside the point.  For me, it speaks to some of the foundations upon which recovery is made possible.

Building our collective stock of empathic capacity

To address stigma, we need a greater, and more distributed empathic capacity.  In the short term, we might, for example, mobilise along the lines of the Time to Change campaign on mental health.  In doing so, we would need to clearly understand why stigma persists in different contexts: what is it that produces discriminatory and stigmatising attitudes and behaviour in different settings?  For the medium and longer-term, we should continue to grow the focus of public policy on early/childhood years.  Within this, we should question the way we teach Personal, Social and Health Education (PSHE) in schools.  There is currently a scattergun approach to this aspect of education, with insufficient thinking about how to equip young people with the skills, attitudes, values and capabilities necessary to succeed in the modern world.  As the RSA has argued, we need ‘schools with soul’.  PSHE (or rather Social, Moral, Spiritual and Cultural (SMSC) education) should be at the heart of a school’s curriculum and purpose, and address head on questions of inclusion, citizenship and community in relation to issues such as substance misuse.

As the RSA Chief Executive, Matthew Taylor, has argued, empathy is a core competency for modern citizens.  Developmental psychologist Robert Kegan suggests that a successful society with a diversity of values, lifestyles and experiences requires us to “resist our tendencies to make … ‘wrong’ or ‘false’ that which is only strange” to us and outside our own experiences.  Such an approach would not only help to create the conditions in which recovery is better supported, but would similarly support recovery from mental health, rehabilitation from crime, and so on.  It is a key part of valuing people as assets in a shared, interdependent society.

Political scientist Richard Dagger suggests that the job of the legislator should be to design the system to foster citizenship and move people towards collaboration.  Of course, in order to become the next Government, political parties should construct and communicate a compelling vision and account of what it is to be a UK citizen in a collaborative society, and use this as the basis and decision-making framework to design policy and programmes.  This is a vision that must be coherent; that speaks to both responsibilities and the rights of citizenship.  It must live and breathe in individuals and in the public consciousness, and act as a touchstone for how we consider what progress is and how we make it.  If recovery is about hope and about the participation in the rights, roles and responsibilities of society, there should be a realistic, compelling account of what they are, and how they extend to all of us.

Steve Broome is Director of Research at the RSA, and is on Twitter at @smbroome

Access All Areas: DrugScope's 2014 Annual Conference in Tweets

10 things about alcohol and other drugs you may have missed over the last month

These slides are a way of capturing some of the interesting information about alcohol and other drugs that I come across in my reading.

As you'll see this month includes tax revenue from alcohol across Europe, mortality rates for lung cancer, daily doses of OST in Scotland, milligrams of methadone prescribed in Scotland, reasons given for refusing 'place of safety' under the Mental Health Act, calls to the NPIS about drugs, prisoners ability to access drugs and alcohol in England, absconders from prison, re-offending drug offenders in England

It should be clear where I've sourced the information from but if not (and you'd like to know) then do get in touch.

It is also worth saying that if there are any errors in the presentation they are almost certainly mine rather than the original authors.

Is an ounce of prevention still worth a pound of cure?

Andrew Brown, Director of Policy Influence and Engagement offers some reflections on the 2014 annual conference of the European Society of Prevention Research

The European Society for Prevention Research (EUSPR) brings together researchers and practitioners from across Europe across a range of topics including substance use, obesity, criminal justice and mental health.  Last week 180 members and delegates from across the continent attended the society’s annual conference to listen and debate the economics of prevention.

At the heart of this year's conference, at least for me, has been a question of how prevention science works to influence policy.

A number of keynote speakers raised the question of why strongly evidenced interventions remain unused while ineffective prevention continues to have the confidence of policy makers. The answers seemed to focus around three things:

·         Public support for the least evidenced and hostility to interventions that may challenge their existing behaviours,

·         Other actors working actively against the introduction of those policies, and

·         The weakness of prevention science in developing values messages that work with the grain of evidence.

But I also heard researchers and practitioners banding together to learn from approaches that were having traction. Whether that was the Social Research Unit in the UK working closely with the Washington State Institute for Public Policy (WISPP) to build robust benefit & cost models for particular interventions, or by developing international standards for prevention under the wing of either the UN or EMCDDA. I also heard presentations about designing systems that worked from the bottom up, including an impressive attempt to professionalise the workforce in school prevention coming out of the Czech Republic and a group that are in the process of designing a Universal Prevention Curriculum.

October's 10 Interesting Things About Alcohol and Other Drugs You Might Have Missed

Posted by Andrew Brown, Director of Policy Influence and Engagement

These slides are a way of capturing some of the interesting information about alcohol and other drugs that I come across in my reading.

As you'll see the ones below include data on commissioners plans to reduce spending on services, injecting drug users and HIV, smoking prevalence, proportion of new Europol cases relating to drugs, the time spent on OST, regional variation on emergency hospital admissions for alcohol related liver disease, prisoners use of substances and their relationship to the crimes committed, numbers accessing domestic violence refuges, single homeless people's use of drugs and alcohol.

It should be clear where I've sourced the information from but if not (and you'd like to know) then do get in touch.

It is also worth saying that if there are any errors in the presentation they are almost certainly mine rather than the original authors.

Making the case for drug and alcohol services in new times

A blog by Marcus Roberts, Chief Executive of DrugScope

Today DrugScope has launched a new resource called Making the case, as part of our work on behalf of the Recovery Partnership. It's a guide and toolkit to help our members and supporters to make the case for drug and alcohol services at local level - whether that's organising a service visit for elected councillors, marshalling the best evidence to present to local commissioners or working with local media to get positive stories about treatment and recovery out there.  

The days when the political energies of our sector could be focussed mainly on Westminster and Whitehall are gone. The aftermath of the Scottish referendum promises new adventures for devolution and regionalism. This is the latest phase in an emergent politics of 'localism', now de rigeur across the political spectrum (witness, for example, the recent IPPR Condition of Britain report, which is influential within the Labour Party). 

From 2001 to April 2013 substance misuse was the responsibility of a special health authority with a 'ring fenced' budget of around half a billion pounds, topped up by local investment. Both the National Treatment Agency and pooled treatment budget have since been absorbed into 'public health', a migration that has created pressures for both the migrants (pounds and people) and the new host culture (historically inclined to 'prevention' and 'whole populations' - but also with a strong track record of saving and improving lives through 'harm reduction').

The economic and political context for this transition is bracing. The Local Government Association (LGA) calculates that central government funding for councils will fall by 40 per cent over the life time of this parliament (2010-2015). The former LGA chairman, Sir Merrick Cockell, has described 2015-16 as a crunch year, saying 'we expect some councils to be placed in a position where they do not have the money they need to meet their statutory obligations'.

Against this background, an LGA press release on Novel Psychoactive Substances recently expressed concern that 30% of local public health budgets were spent on drug and alcohol services, and hoped for a 'clamp down' on this 'staggering sum'. This shows how our sector might be viewed through the other end of the telescope, and how attractive the budget we have brought into public health is looking to others right now. When Simon Stevens, NHS Chief Executive, declared at Public Health England's Annual Conference that he feared we are 'sleepwalking into the worst public health emergency for at least three decades', he was calling for a radical five year plan to tackle obesity. Priorities are shifting.

Meanwhile recent headlines warn of an NHS funding gap of £2 billion coupled with worries of a 'demographic time bomb' being primed by the ageing population.

The challenges are formidable, but there are positives. DrugScope's State of the Sector 2013 found no evidence of widespread disinvestment in the early months following the changes introduced in April that year. At regional events with our members and other stakeholders the message appeared to be that drug and alcohol services were well-established, with a hard won appreciation of their contribution embedded in local systems and structures ... but also real anxieties about the future.

Last Friday, Public Health England and the Association of Directors of Public Health published a review of the drug and alcohol commissioning intentions of local authorities in 2014-15 and beyond. While the review found ‘little intention to simply disinvest in services’, it reported that over a third of councils were planning to change or reduce funding in the two financial years 2014-15 and 2015-16 (see my blog with Andrew Brown for a summary and analysis).

Our 2014 State of the Sector survey is now 'in the field', with other indications from our members that a significant number of local authorities are investing less in substance misuse services or planning to do so... And recall the LGA's warnings about pressures on local authority budgets coming to a head in 2015-16. The mantra that we hear is 'more for less' and the challenge is to deliver more efficiently without compromising on access or quality. This is a sector with a history of innovation, creativity and resilience and many of our members are actively taking up this challenge… but this is only achievable up to a point.

So how do we ‘make the case’ locally? Let me pick out three key messages.

Firstly, in one of the strongest episodes of the US television series The West Wing, Mrs Landingham is trying to persuade a teenage Jed Bartlett – later to be the US President – to take up the cause of unequal pay for women in the New Hampshire school where his father is the headmaster. Establishing a theme of the Bartlett presidency, he tells her ‘if you want to convince me of something, show me numbers’. Numbers influence decisions. The equation that £1 on drug treatment = £2.50 saved in subsequent costs had an important role in securing the investment that fuelled the expansion of our sector (another example is the major investment in psychological therapies secured by the Layard report on depression, which was, significantly, the work of the Centre for Economic Performance at LSE). We have some good data and research to work with, and some good tools to help us to use it to best effect, including those launched by PHE last week.

Secondly, Gerard Lemos once said to me that ‘the impact of any research study is inversely proportionate to sample size’. By implication, the most influential ‘research’ has a sample of one. The observation was tongue in cheek, but it highlights the importance of human stories in winning hearts and minds. We’ve all been at conferences where the personal testimony of service users has cut through a long day of policy analysis, graphs and statistics. Similarly, getting local officials and representatives along to a service brings home that it is not just an address, a set of interventions, outcome data and a balance sheet, but a building with skilled and dedicated people in it working to make a difference, and a community resource in its own right.

Thirdly, we are one of many sectors facing similar challenges in the current financial environment. The people that we are seeking to influence have headaches of their own: seeking to balance competing demands and priorities, balance the books and manage funding cuts … all with local accountability and scrutiny, and statutory obligations to worry about too. It is important to engage constructively in this environment, look for opportunities for partnership and offer solutions where possible, while giving clear messages about the risks and threats. 

DrugScope has taken a particular interest in developing partnerships with other sectors in a way that has the potential both to cut costs and improve outcomes for service users and their communities. We are doing this, for example, in our work with Clinks, Homeless Link and Mind as part of the Making Every Adult Matter coalition on multiple needs. We are currently working closely with colleagues in mental health, building on the work we did with the Centre for Mental Health on the potential to commission for recovery across substance misuse and mental health. Our sector is also showing how to effectively mobilise the natural resources that are available in local communities – including, of course, the assets and resources of service users, people in recovery and the networks and communities they have created. This is an area where DrugScope has worked closely with the Royal Society of Arts to support their work on user-centred recovery and connected communities.

Looking for solutions in a tight financial environment can spur innovation, but it also creates significant risks. For example, the assets of service users and the dynamism of community networks and initiatives have a critical role to play. It is important, however, to ensure that this contribution is appropriately supported (for example, with funding for development and ensuring that there is support for those taking on roles as ‘recovery champions’ and ‘peer mentors’, an issue my colleague Harry Shapiro took up in the Druglink article ‘Walking the line’). In addition, this augments and cannot replace the contribution of specialist staff with other skills and qualifications. The wider danger is that the pressure of the times fuel an unintended ‘race to the bottom’ and cost cutting compromises quality.

To conclude on a positive note, while ‘stigma’ is an issue and a challenge, the public may be more sympathetic than is often assumed. A DrugScope/ICM poll conducted in 2009 found that nine in ten people agreed that ‘people who have become addicted to drugs need help and support to get their lives back on track’ and over three quarters said that investment in treatment was ‘a sensible use of government money’. One in five had direct or indirect experience of drug addiction (and this figure would be significantly increased if alcohol had been included).

None of this is to underestimate the challenges – a phrase of the Italian socialist Antonio Gramsci seems apt: ‘pessimism of the intellect, optimism of the will’.

I hope you find Making the Case a valuable resource in supporting you to influence local people, opinion formers and decision makers. You can also support us to ‘make the case’ by completing our State of the Sector 2014 survey if you are a service manager, and by joining us as a member if you are not with us already.

Review of Drug and Alcohol Commissioning

Posted by Marcus Roberts, Chief Executive and Andrew Brown, Director of Policy Influence and Engagement.

What is the distinction between ‘disinvesting’ and ‘simply disinvesting’?

The question arises as an official review of drug and alcohol commissioning intentions, published by Public Health England (PHE) and the Association of Directors of Public Health (ADPH) concludes that ‘there is little intention to simply disinvest in services’, and ‘if anything, there seems to be an element of trying to protect levels of investment while improving services’. The review was based on structured interviews between PHE Centres and Directors of Public Health, with input from DrugScope based on our State of the Sector 2013 (SOS 2013) survey.

Does the review suggest that there will be disinvestment in the sense that less money is or will be available for treatment services than before?

Pills & Powders, Pleasure or Pain

Posted by Andrew Brown, Director of Policy Influence and Engagement.

On the 24th September the London Drug and Alcohol Policy Forum held a seminar focusing on new and emerging drugs, the current understanding of what is out there, how some users appear to be acquiring them, the sorts of harms they are experiencing and how services might respond.

The following are the notes I made of the contributions of the three panelists: John Ramsey, Adam Winstock and Owen Bowden Jones.

Benefit cards proposal raises concerns and questions while offering few answers

At the Conservative Party Conference this week, Iain Duncan Smith, the Secretary of State for Work and Pensions, pledged to introduce pre-paid benefit ‘smart cards’ for social security claimants affected by ‘drug or alcohol addiction, even problem debt, or more’. The immediate activity will focus on extending and evaluating a relatively small-scale scheme currently operating in North Tyneside. While the emphasis in Duncan Smith’s speech was on parents and family, the scope of the current activity is more broadly around people perceived to have difficulty budgeting.

Several charities, usually in partnership with firms from the financial sector, are developing specialised accounts products to accompany the introduction of Universal Credit. These often involve ‘jam jar’ facilities that ring-fence pots of money for specific bills like rent and many involve voluntarily giving up a degree of financial autonomy, such as agreeing to a waiting period before being able to withdraw large sums of money. These specialised accounts are, or will be, entirely voluntary to take up and are fee-charging. A voluntary benefit card scheme could be seen as analogous to this and, in this sense, as offering what some individuals may want.

However, while the idea of a wider roll-out of benefit smart cards may be at least superficially attractive, the proposal raises a number of concerns.

Anyone with an interest in drug and alcohol misuse, treatment and recovery knows that one of the biggest barriers an individual can face is that of stigma. It can have a detrimental impact socially, economically and is often not just restricted to the individual themselves, but often extends to their family. There is persuasive evidence from places where similar cards have been introduced that presenting a recognised card, particularly at a local shop, possibly in front of friends and neighbours, increases stigma. The Government’s 2010 Drug Strategy places recovery capital and reintegration top and centre: introducing a measure that would instantly make someone stand out as being affected by addiction, problem debt ‘or even more’ seems unlikely to yield dividends in that regard.

Again looking at areas where similar schemes operate, the evidence for their efficacy is unclear. Studies looking at income management schemes in Australia, for example, have highlighted both the unclear evidence and the problem of attribution – that is, that in some cases it’s unclear whether a significant positive change has occurred, and that where a change has, it is difficult to attribute it to one cause among a suite of other interventions aimed at the same cohort. Work around similar schemes in the United States (e.g. the Supplemental Nutrition Assistance Program, often referred to as food stamps) have highlighted concerns around stigma and the frequent inability to purchase necessary but unapproved items.

In addition to concerns of increased stigmatisation and unclear evidence of efficacy, any proposal to roll benefit cards out more widely would need to address a number of questions. These include how to avoid unintended consequences. Any measure that would serve as a disincentive to access treatment for drug and/or alcohol use, or to disclose use or misuse as a barrier to employment at Jobcentre Plus would be highly unwelcome – and we already know that for sensitive subjects such as substance use and homelessness the disincentives (whether actual or perceived) are already so substantial that comparatively few people do disclose, or at least not immediately.

While this measure has so far been talked about as a means of protecting children and families from parents or carers who routinely make suboptimal decisions, there is the question of who would decide whether or not an individual would be eligible for (or potentially compelled to take part in) the scheme, and whether Jobcentre Plus staff (or staff in, say, a local authority) are equipped and trained to come to this decision, which could approach or at least rely on a clinical diagnosis in the case of substance misuse. Separate criteria would presumably be needed for problem debt, and the ‘more’ referred to in Duncan Smith’s speech. 

While clearly some people (whether in receipt of welfare benefits or not) do struggle to budget and measures such as the Local Support Services Framework may turn out to be helpful in supporting people to meet the challenges of Universal Credit in particular, there seems to be a risk with benefit cards of moving from support to paternalism, against the direction of travel of reforms by this and previous governments which have tended to prioritise increasing autonomy and responsibility while focusing support on those most in need. Moving away from groups with particular needs to the wider claimant cohort, there is little evidence to suggest such measures are necessary.

Any government implementing this sort of scheme also has practical issues to consider. Such a scheme may come with a substantial cost, financially and in other resources, if rolled out nationwide. The implementation of the Azure card for asylum seekers was beset by problems on introduction and, some campaigners and stakeholders claim, the failings of the scheme are actually inherent to it rather than related solely to problems of implementation. Some of this may carry across to a wider benefit card scheme. For example, if a scheme is limited to a restricted pool of retailers, it may end up penalising those in remote or dispersed communities or some people with mobility problems. This is before one considers the potential for fraud and abuse.

Given that a genuinely voluntary smart card scheme could be seen as being broadly comparable to the commercial or social enterprise products being developed, what could government consider as an alternative? Positive steps to address the deep disadvantages that lie at the heart of poverty and social exclusion – a commitment given by the government in the Social Justice Strategy – might be a constructive way of doing this. For example, investing in health education, family support, support for young carers and so on might all bring rewards, as would improving the support people receive to help them into employment, thereby providing an exit strategy for people with histories of drug and alcohol use.

Smoking, Drinking and Drug Use among Young People in England 2014

I'm a member of the advisory group for the Smoking Drinking and Drug Use survey, which publishes the figures on English school pupils' substance use on an annual basis; so it is great to see this short animation telling the story of the way that the data helps policy makers and others understand what's been happening over the years.



Being able to dig into the data that comes with the report is critical to improving our understanding of the earliest use of substances, both in terms of trends and in respect of some of the more subtle correlations that the survey allows us to examine.

Because the same questions are asked year after year the survey really helps give a detailed understanding of young people's behaviours. For example, it has been fascinating to watch the changes in the amount of street drinking that this age group takes part in - which has declined while (among those who do drink) the proportion that say they drink at parties has increased.

One of the roles we have on the advisory group is to try and help the designers to adapt the questions; adding new ones as new issues emerge, and taking out redundant ones where we can.  The questionnaire this year will include some new questions about e-cigarette use, something on energy drinks and we've tried to include questions that will help tease out whether pupils are using novel psychoactive substances (NPS sometimes called 'legal' highs).

There are some tricky issues in all of this, for example we know from talking to different services that NPS use can vary substantially between areas and the subtlety of these local differences may be lost in a national survey.  We also know that the names for NPS may or may not be recognised by young people - brand names and street names vary.  Helpfully the survey designers do test the questions directly with young people before the survey goes out to into the field, so we can try to ensure that we don't make too many mistakes.

10 things about alcohol and other drugs you may have missed

These slides are a way of capturing some of the interesting information about alcohol and other drugs that I come across in my reading.

As you'll see the ones below include data on drug related deaths in England and Wales, local government spending on substance misuse services, mental and behavioural problems for adult prisoners, prisoners testing positive for drugs, the use of custodial sentences for drugs offences in England and Wales

It should be clear where I've sourced the information from (but if not and you'd like to know then do get in touch)

It is also worth saying that if there are any errors in the presentation they are almost certainly mine rather than the original authors.



Earlier slide packs are available here.

The Unusual Suspects

Photo by Flickr user Rick Payette

Last week I took part in a session at the Unusual Suspects Festival, an event which brought together individuals and organisations that are delivering social change with the aim of exploring how collaboration and social innovation can work in sync to help address some of society’s most pressing challenges.  A group of us from the Making Every Adult Matter (MEAM) coalition looked at the issues of collaboration that have been thrown up by working together on multiple and complex needs. 

MEAM is a coalition of the membership bodies for service organisations across homelessness (Homeless Link), drugs (DrugScope), mental health (Mind), and criminal justice (Clinks) which came together in 2009 to improve practice and policy for those with multiple and complex needs and who struggle to stay engaged with services.

Without running through all of the contributions that were made at our session – I’ve collected together the Tweets that I and others sent out if you’re interested and the slides we presented are below – there were a number of themes that came up across the presentations.

Collaboration is messy and trust is key

We talked about how frustrating collaboration can be and that sometimes it may feel that it would be easier if we did things by ourselves; but that doing so would mean that we’re less likely to achieve all that we could.  We explored how within MEAM we have learnt to accept that collaboration can be a messy business, but that this mirrors the complexities of the issues we’re trying to address, and leads to better outcomes.

It is through developing trust in each other and a deeper understanding of each other’s expertise that we have achieved outcomes that are truly shared.  And remembering and exploring the focus of the MEAM coalition has been an important loadstone for the work we’ve done together.

Being able to have open conversations, both with partners and with our funders, has also been critical to deepening the relationships. We know that sometimes MEAM will be at the front of some of the partner’s work and at other times it may not be a priority, but that this doesn’t mean that we’re not equal partners.  We know that sometimes we aren’t as visible on issues as we would be if we were to speak as individual organisations, but we believe that we are stronger by standing together.

We also know that trust is important in the direct work that the MEAM coalition has facilitated. Those working to support individuals with multiple needs in local areas explained how building towards mutually agreed outcomes and at a pace set by individual beneficiaries seems to have borne more fruit than working in silos. We heard about one case where small steps towards a trusting relationship with a client started with buying a bike lock and ended with the client engaging with drug treatment and taking steps towards recovery.

Resources are at the heart of getting it right

Across MEAM there has never been a desire to build the coalition as a separate organisation, and that has determined how resources have been allocated.

Most of the posts that are focused on delivering our shared MEAM agenda are ‘embedded’ in the organisations that make up the coalition – so my colleague Sam, who is managing the Voices from the Frontline project, sits at the desk next to me, but works with a team that sits in Homeless Link, Clinks and Mind.

But we also reflected that having a small ‘core’ MEAM team that focusses solely on how to progress the coalition’s aims has been at the heart of the progress we’ve made.

Similarly, in the direct work that localities have undertaken using the MEAM Approach, bringing shared resources to bear on the issues that service users have identified as their priority has been crucial.

Give it away

At a period of time where many organisations (including DrugScope) are thinking about how we create new forms of income MEAM is taking a slightly different tack.

MEAM has chosen to ‘give away’ the approach that we’ve developed to working with people with multiple and complex needs – providing information and advice via the MEAM Approach website.

It isn’t that MEAM partners don’t want to be paid for what we do but our view has been that it is more important to share with others how we’ve worked and to see if that leads to new contacts and subsequently new opportunities that are mutually beneficial to us and to people with multiple needs.

Anyone can see the detail of how we’ve worked and this has helped (we think) develop a sense that with patience and a person-centred approach, things do turn round for the people we’ve been trying to support.

So where next?

We concluded by reflecting that we need to make sure that we’re listening to and reflecting on the stories and priorities of the people who find themselves with multiple needs.  Thinking we know all of those stories and that we’ve nothing left to learn would be a terrible mistake.

My sense of the discussion we had at the festival was that the partners involved in MEAM retain a strong commitment to the aims that brought us together in the first place.  We see both the continuing failures in society to reduce the most extreme harms that this group suffer and the potential to make a step-change, should our and others’ efforts in this area bear fruit.

Sharp rise in drug deaths is a cause for concern

Last year the Office for National Statistics consulted on making savings by stopping the analysis they do on drug related deaths.  Fortunately that consultation concluded that this was a “high impact output with widespread support” and as a result we have this year’s report, which shows that the recent trend of falling numbers of people dying as a result of drug use was sharply reversed in 2013.

Deaths that were attributed to illegal drug use rose by 20% in 2013 to 1,957 contributing to the overall number of drug deaths (both legal and illegal) which at 2,995 are the highest levels since 2001.

Over half of all drug related deaths involved an opiate, and for men in their 30s this rose to two in three (68%).  The most commonly recorded opiates were heroin and/or morphine which were seen in 765 deaths a 32% increase from 2012.  They also record 429 deaths where methadone was detected.

The ONS suggest that the end of the ‘heroin drought’ which has seen rising purity of street heroin may explain the increase in the number of deaths associated with the drug.

But there are a number of other drugs where 2013 is the year with the highest number of deaths since records were started.  These include:

• Amphetamines including ecstasy (120), 
• New Psychoactive Substances (60), 
• benzodiazepines (342), and 
• tramadol (220)

Also worth noting is that while alcohol deaths are recorded separately, in 30% of the cases in this report there was a mention of alcohol or long term conditions associated with alcohol abuse, in addition to drugs, in the coroners’ reports.

Men in their 30s, followed by those in their 40s, had the highest mortality rates as a result of drug use. And the ONS point out that:

The male mortality rates in these two age groups were significantly higher than the rates in all other age groups, and much higher than females of any age.

However, in a background note, they do point out that nearly 1 in 7 deaths among people in their 20s and 30s were drug related.

Marcus Roberts, DrugScope’s Chief Executive, in our response to these figures says:

DrugScope has grave concerns over the significant increase in the number of drug-related deaths registered in England and Wales last year.  The figures mark a reversal of the recent downward trend and appear to show the sharpest increase since the early 1990s.  Of course, this is about more than just numbers; each death represents a tragedy for the individual concerned, their family and friends.

In 2012, the Advisory Council on the Misuse of Drugs (ACMD) reported to the Home Secretary that naloxone saves lives and ‘fits with other measures to promote recovery’, concluding that the drug should be made more widely available.  While the government (in 2014)  accepted this recommendation, the current date for implementation is still a year away, in October 2015.

In our media release, we call on the Home Office and Department of Health to reconsider that timetable, “so that this life-saving medication can be used sooner, to prevent more people from dying.”