DDN June 2017 DDN July2017 | Page 14

Dialogue Market forces A strong message from Addaction’s Mortality Matters conference was that treatment services need to put competition to one side and challenge the conditions that are allowing drug-related deaths to rise. DDN reports H ow should we tackle the alarming increase in drug-related deaths head on, asked Addaction’s medical director, Dr Kostas Agath, opening the charity’s one-day conference in Leeds. ‘Drug-related deaths have been increasing year on year for the last three years… we haven’t cracked it,’ he said. The figures – 3,388 drug-related deaths in 2015 in the UK – didn’t give the whole story. He spoke about Martin, who lost his life just recently – and about his mother, struggling to make sense of the gaping hole in her life. ‘Someone, somewhere must begin to ask the right questions. The Martins out there must be someone’s responsibility.’ We could take four steps to reduce drug-related deaths, suggested Alex Stevens, professor of criminology at the University of Kent, setting the scene through his keynote speech. The steps were to care, invest, innovate and integrate with other services. ‘We know these would reduce DRDs. The question is whether we care enough to do something about it.’ There had been a significant increase in opioid- related deaths since 2012 and the government had reacted by banning things (such as psychoactive sub - stances) rather than looking at the contributing factors. We should be looking at the ‘devastating’ consequences of short-term commissioning and worsening socio-economic circumstances for vulnerable groups, he said. ‘The government is 14 | drinkanddrugsnews | June 2017 reducing the income of people who are most vulnerable to drug-related deaths.’ And from talking to legal support charity Release, who provide help and advice, he confirmed that ‘people are being given arbitrary changes to their treatment plans related to what their commissioners would prefer to provide.’ Changes in treatment and a focus on recovery had sidelined harm reduction, and there was pressure on services to achieve ‘drug-free exits’. So what should we be doing? Two of the clearest practical steps were to invest in high quality opioid substitution therapy (OST) at optimal dosage and opti - mal duration, and to provide naloxone to practition ers, ‘Drug-related deaths have been increasing year on year for the last three years… Someone, some - where must begin to ask the right questions.’ Dr KoStaS agath peers and potential bystanders – anyone who comes in contact with a person who could be at risk of overdose. ‘Naloxone should be available and I’m saddened and angry that commissioners haven’t got the message,’ he said. The risks were much higher out of treatment, ‘so we don’t want to be pushing people out of treatment before they’re ready, as this risks them dying,’ he spelled out. We need to innovate, he said, and give proper consideration to heroin-assisted treatment, medically supervised consumption rooms, and new routes for administering naloxone. Better service integration could also make a significant difference. ‘Pulmonary (lung) health tends to be very poor indeed,’ he said. We needed to provide better access to smoking cessation, tobacco harm reduction services, housing, dental health – ‘all the stuff that makes life meaningful’. ‘Service users in drug clinics have a high burden of respiratory disease,’ confirmed Dr Sandra Oelbaum, Addaction’s associate medical director and primary care lead, who gave her experience of improving access to COPD diagnosis and treatment in Liverpool shared care. The links between drug use and breathlessness meant drug users were three times more likely to be admitted to hospital with respiratory conditions, she said, ‘so the impact on health services is very dispro por - tionate’. There was very poor follow-up, with many feeling that they could not access care or go to their GPs. Yet there were simple and effective measures that could engage people in treatment, such as putting spirometry (lung function tests) in drug treatment clinics. Trialing this in Liverpool shared-care clinics had achieved high levels of participation, diagnosis and treatment, with participants comfortable with the idea of having a COPD clinic located in drug treatment. ‘Sometimes we need to go back to principles and make sure we’re doing what we know works,’ said Dr Jan Melichar, consultant psychiatrist and medical director at DHI, South Gloucestershire, who had been asked to talk about ways of maximising treatment to reduce opioid-related deaths. www.drinkanddrugsnews.com