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‘ We have to look at the competence of our own clinical practices .’
PROFESSOR SIR
JOHN STRANG
was a significant challenge around training need . ‘ We need to look at how to support and improve the development of the general workforce , so that somebody entering treatment is being seen by someone with a good , broad knowledge of the treatment field and how to integrate medical and social interventions ,’ along with developing a cadre of specialists for the future .
From a research point of view , what was needed was a serious commitment to a much more practice and policy-orientated research agenda , he said . ‘ If you look at the National Institute on Drug Abuse in the US , we don ’ t have anything comparable – which means we don ’ t have that critical science perspective .’
While the strategy committed to building a world-leading evidence base there was no mention of consumption rooms , said Release executive director Niamh Eastwood , despite evidence of their effectiveness and ability to provide access to treatment and other support . The strategy was a ‘ tale of two competing directions ’, with ‘ once again an over-focus on criminal justice responses ’ – something that undermined the ambition to get people into treatment . ‘ When we treat people first and foremost as
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‘ It ’ s surprising to find myself on a platform saying the politicians have delivered .’
ROSANNA O ’ CONNOR
criminals , it ’ s very hard to address their health needs .’
THE EVIDENCE BASE ‘ We ’ re traditionally seen as the enforcers ,’ deputy chief constable of Lincolnshire Police , Jason Harwin , told the seminar . ‘ And let ’ s be very clear , we have significant numbers of serious organised criminals who are exploiting young and vulnerable people , who we have to continue to enforce the law against . But we do need to make sure we ’ re diverting individuals to effective , evidencebased treatment services that we know reduces their vulnerability and their likelihood to continue to commit offences .’
‘ From my own experience of addiction I ’ ve lived a definition of madness , which is doing the same thing over and over again and expecting a different result ,’ said the Scottish Recovery Consortium ’ s lived experience officer , Michaela Jones . ‘ The only solution in these circumstances is to stop and recognise the need for radical and sustained change – in this case it ’ s to accept that the resilience and flexibility of the drugs market make it almost impervious to enforcement activity .’ There had in fact been extensive , informal decriminalisation , said Strang .
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‘ It ’ s not been driven by laws , it ’ s driven by changing attitudes within different police forces and within society , and that ’ s a much more important level at which to engage .’
DEPRIVATION In terms of preventing dependency , Release had consistently argued for re-allocating some of the ‘ endless resources ’ for law enforcement into traumainformed counselling in schools from an early age , said Eastwood . ‘ We know adverse childhood experiences are one of the biggest drivers for drug dependency . That could have a massive impact – addiction isn ’ t all about the drugs , it ’ s very much a response to abuse , neglect , deprivation .’
MARKET FORCES Legal and illegal drug markets went ‘ back and forth ’, said Dr Keith Humphreys , professor of psychiatry at Stanford University , advisor to the Carol Black review and former drug policy advisor to President Obama . ‘ It was legal companies that flooded our healthcare system with a 400 per cent increase in per capita prescribing , and many , many people got addicted to those drugs . Heroin traffickers then realised “ there ’ s gold in them thar hills ”, started to expand to different cities and began getting as customers people who were addicted to legal drugs like oxycontin .
‘ If you believe that full legalisation , as is commonly said , will only bring good things then you have to be candid about what we ’ ve learned about the legal drugs we have ’, he continued , as tobacco and alcohol killed far more than all illegal drugs combined . ‘ If you ’ re going to argue – as many bright people have – that we should have corporations like the tobacco industry sell methamphetamine and cocaine , you should explain why those drugs wouldn ’ t then be up there at the top of that list .’
REDUCING DEMAND In terms of reducing demand , while it was possible to use the media to encourage people to access services or give them
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factual information , advertising campaigns to discourage drug use simply didn ’ t work , he said . ‘ Demand responds to supply , as is well demonstrated across all kinds of industries . Within the prescription system , where we at least putatively have a huge amount of control , if we don ’ t exercise that wisely we ’ ll get a lot more demand as we ’ ll make many more people dependent on – in the US and Canada – opioids , but also benzodiazepines , stimulant medication and so on .’
Ultimately , putting the person at the centre of services was vital , stressed Black . ‘ We would do that with any other condition , and this really is a chronic disease with remissions and relapses . The real issue for me now is how do we keep this energy up , and enable it to go forward , keeping the government ’ s foot on the peddle and making sure it really is a whole-systems approach . We really have the opportunity to improve a quite dire situation when it comes to treatment and recovery . There ’ s a willingness to think about doing things differently . But everyone also recognises the hill that needs to be climbed .’
LANDMARK OPPORTUNITY ‘ This is a landmark opportunity for a system transformation that will help us save lives and improve outcomes for individuals and the communities in which they live ,’ said Rosanna O ’ Connor , director of addictions and inclusion at the Office for Health Improvement and Disparities ( OHID ). ‘ It ’ s a very significant moment .’ It was also important to put aside concerns about the criminal justice focus , she said . ‘ It ’ s through the criminal justice lens that we ’ ve landed ourselves such significant investment in treatment and recovery .
‘ It ’ s surprising to find myself on a platform saying the politicians have delivered , and it ’ s now in our hands as a sector . We have to collaborate to deliver , and really up our game across the whole system if we ’ re to have any chance of having this investment sustained . We can do it , but we have to do it together .’ DDN
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MARCH 2022 • DRINK AND DRUGS NEWS • 9 |