December 6, 2021

expert reaction to UK government’s proposed new drugs strategy

The government has launched a new 10-year drugs strategy for England and Wales.

Prof Liz Hughes, Professor of Nursing, Edinburgh Napier University, said:

“As an addictions nurse and a health services researcher specialising in improving services for people with drug and alcohol addictions and co-occurring mental health, I am pleased that the government is acknowledging the multifaceted issues of drug and alcohol problems on individuals, families and society. It is very important to emphasise that, to deliver on the ambitions of the strategy, considerable energy must be placed on replenishing the skilled and qualified workforce that is required to deliver evidence-based effective treatment and harm reduction. My particular interest is in people who need help from mental health and drug and alcohol teams as well as other agencies, and the call for more integration is welcomed. A recent mapping of co-morbidity services in the UK (as part of an ongoing RECO study funded by the NIHR) found very patchy and limited examples of care pathways and joint working arrangements.

“Integrated care can only occur with joint commissioning, local joint ownership, and a skilled workforce to deliver safe, effective and compassionate care. Many people who attend drug and alcohol services have mental health problems including trauma. Those who use drugs and alcohol with PTSD often struggle to access NHS trauma services because they are excluded because of their drug/alcohol use. The drug and alcohol services have been depleted of addictions psychiatry, psychology and mental health nursing, and these could assess and provide brief interventions or work with local NHS providers to offer joined up care for those with trauma and mental health.

“There needs to be a clear connection between what’s offered in prison healthcare with what is offered in the community, and a seamless transition from prison to community (which is a critical period for relapse and overdose).”

Prof Celia Morgan, Professor of Psychopharmacology, University of Exeter, said:

“The further investment in treatment is an important move, but the science suggests that the focus on criminalisation in this policy may have paradoxical effects. It is not clear why drug policies are not being updated to reflect more health-oriented approach to substance use.

“Changes proposed here such as further stripping away drug users’ human rights, by taking passports and drivers’ licenses, will only increase the harms of drugs and the drugs industry. Criminalising drug use reduces the ability of people prosecuted for drugs offences to find other types of legal employment.

“The proposed changes, intended to be hard on crime gangs, may actually increase drug-related crime by shutting down other opportunities for income for people involved. Evidence has shown that drug-related harm disproportionately effects those living in poverty. The criminalisation proposed here will compound the negative effects of poverty, widening the gap.”

Prof David Nutt, Edmond J Safra Chair and Head of the Centre for Neuropsychopharmacology, Imperial College London, and Chief Scientific Officer, Drug Science, said:

“Drug Science welcomes the fact that the government has agreed to accept many aspects of the Carol Black review on addiction treatment services.

“The major positive outcome appears to be a focus on the use of treatments rather than punishments to reduce drug use and harms. This suggests the government has at last caught up with the scientific community in understanding that addiction is a medical rather than a criminal issue and that criminalising drug users [as opposed to drug dealers] only perpetuates a cycle of use that drives more into drug dealing and hence more drug users.

“As well as being humane, this change of attitude makes sense for several reasons. These include the fact that the massive increase in prison numbers over the past 40 years for drug offences hasn’t reduced use. The rising death toll, especially from opioids, in the past five years, which now has reached an all-time high, reflects a failure of treatment availability.

“However, the proclaimed focus on recovery is worrying if that continues to translate into abstinence-only approaches. The recent calls by senior Tories to stop methadone use in prisons suggests that some still believe this dangerous idea that abstinence is the only acceptable outcome for addiction. Of course, if it can be achieved abstinence is to be welcomed, and almost all opioid and alcohol addicts repeatedly try for this. But for most this is not immediately possible, and it comes with a greatly increased risk of death from accidental overdose when they relapse. So other policies must be pursued in parallel. The three most important of these are:

1. “Major investment into research for new treatments to promote abstinence. Currently there are no licensed treatments for opioid addiction other than substitute therapy with methadone and buprenorphine, two safer opioids that protect from the worst harms of IV opioid use but at the price of maintaining dependence. Proven non-dependence-producing abstinence-promoting treatments for alcohol addiction exist (e.g. acamprosate, nalmefene) and modern neuroscience suggests similar approaches to opioid and cocaine addiction are possible. This research should be made a priority for the MRC whose addiction research portfolio is currently very empty.
2. “The development and then provision of new approaches to treatment, especially the use of drugs that break down the brain circuits that perpetuate drug and alcohol seeking behaviour and cravings. When coupled with standard abstinence-based talking therapy, they can offer greatly enhanced likelihood of abstinence. This is an area of major innovation with exciting new findings for just one or two treatments providing enduring outcomes. Examples include psilocybin in the treatment of tobacco and alcohol addiction, and MDMA or ketamine in alcoholism. Trials in opioid and cocaine addiction are now a priority, and given the UK leads the world in this research, psychedelic addiction treatment studies should be commissioned here ASAP. Also, as the controlled status of these drugs makes research unnecessarily complicated and difficult, these should be rectified as recommended by Drug Science and the CCPG.
3. “Encouraging pilot programmes for safe injecting rooms (drug consumption rooms). These are proven to save lives, but their other attributes are often not appreciated. They can be used to promote entry into addiction treatments and facilitate other health interventions, plus facilitate social integration and moves towards employment. They also get needles and other drug paraphernalia off the streets, so improving neighbourhood quality and protecting children from accidental harms. Scotland is beginning to see the benefits of the safe injecting vehicle that Peter Krykant has set up in Glasgow, so there is no reason for England and Wales to hold back.”

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1038722/From_harm_to_hope_PDF_FINAL.pdf

Declared interests

None received.