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out of addiction ‘ because it was not a good place to be ,’ she said . Why should people go into the addictions field ‘ when even the government didn ’ t want to support it ?’ Despite a welcome increase in drug workers , many had not had adequate training and we needed to acknowledge the skills gaps . Psychosocial interventions , mental health support and trauma services were in short supply and giving us no hope of the very necessary ‘ whole system ’ response to people ’ s complex issues .
The review ’ s findings had informed her recommendation for a new government structure – a central unit with a crossgovernment agenda , linked to local combatting drugs partnerships . The proposed structure was that local authorities , councillors , police and PCCs , probation , prisons and YOIs , Jobcentre Plus , treatment providers and the NHS would work in partnership with people affected by drug harm , so that all relevant services were brought to the table . In the current structure it was all too easy for one of the essential partners – such as probation – to think ‘ are we really needed ?’
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‘ The prison system should be an enormous opportunity for therapeutic intervention – it isn ’ t , but it should be , and we ’ re trying to change that .’
PROF DAME CAROL BLACK
Collaboration between mental health and substance misuse services was crucial . ‘ Each blames the other , but they need to make it work ,’ she said . The funding sources – mental health by the NHS and substance misuse by local authorities – made it more difficult , but shared meetings , case reviews and pathways would make it possible for each to understand the other ’ s services . ‘ This is a challenge to us ,’ she said . ‘ People are waiting far too long to get help .’ A joint action plan , currently in progress by OHID and NHS England , acknowledged that mental health and addiction are fundamentally entwined .
She had realised over the course of the review that recovery could take many years . ‘ I never talk about successful completion of treatment – I prefer to say “ you are in control ”,’ she said . ‘ Why do we put the burden on the person ? We , and they , know they might relapse . As Ed Day says , you need to meet the person where they are .’ Our focus had to be on ‘ attractive , high-quality treatment ’.
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DRUG-RELATED DEATHS A later panel discussion on drug-related deaths tapped |
into a network of people around the country who were intent on drilling down to the detail , understanding what was going wrong .
Dr Caroline Copeland , senior lecturer in pharmacology and toxicology at King ’ s College London , was director of a national programme looking at drug-related deaths . She had saved a service user mortality database from being shut down – it had been running since 1997 with information reported voluntarily by coroners .
‘ Our data is of much greater granularity that ONS ,’ she explained . ‘ We get full toxicology reports , so when coroners use ambiguous terms , we can pull out specific information – on polydrug use , for example . Coroners might write “ multi-drug toxicity ” instead of naming different drugs .’ She could also ascertain whether drugs such as fentanyl were prescribed or illicitly obtained .
Her research was helping to build a more informative picture . How was policy affecting drug-related deaths ? How could patient care be improved ? She had involved her PhD students in the research to make sure ‘ some good could come out of this awful set of data ’.
Judith Yates , a retired GP from Birmingham , was still actively involved in visiting the coroner ’ s office to find out the specific cause of drug-related deaths . ‘ The problem is , everything ’ s changing so fast – I ’ m very frightened about what ’ s going to happen next when I go to the coroner ’ s office ,’ she said . She had first heard of nitazenes when three young men died in Birmingham in 2021-22 ; all thought they ’ d bought oxycodone pills online .
Visiting WEDINOS , the drug testing service based in
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Wales , helped her build up a picture of what was happening . The shortage of opium from Afghanistan – result of the Taliban ’ s ban on poppy cultivation – had led to a rapid increase in synthetic opioids , including highly potent nitazenes , being cut with heroin . The risks were obvious , as ‘ the reliable supply of heroin of the last 40 years has been destroyed ’, said Yates .
The situation was getting rapidly worse . ‘ We need more communication , we need to know what ’ s happening . I ’ ve never seen anything like what ’ s happened in the last year ,’ she said . Furthermore , the mixture of drugs was becoming more random – for example , xylazine ( a non-opioid tranquiliser ) being found in heroin , tramadol and codeine – ‘ because people are worried they won ’ t have heroin to sell ’.
OVERDOSE PREVENTION With Scottish drug-related deaths at an all-time high , Peter Krykant , Cranstoun ’ s campaigns lead , highlighted news of the first overdose prevention centre ( OPC ) to open in Scotland in summer 2024 . He had paved the way to a change in the law with his pioneering mobile OPC and was adamant there could be no let-up in the campaign for further centres . ‘ We are sleepwalking into the same crisis as in North America ,’ he warned .
Professor Catriona Matheson of the University of Stirling had chaired the drug death taskforce for two years . She wanted to focus on ‘ what was possible at the emergency end ’ and said that all pharmacies in Scotland now had naloxone kits . Rapid response and assertive outreach were essential – and also our chance for interventions , she said .
Police were carrying naloxone in Scotland but there were still excuses in England , said Copeland . ‘ They say there ’ s no room on the belt , or they need training , or that it ’ s not police that get there first .’
‘ We shouldn ’ t be making people jump through hoops ,’ said Yates . Krykant agreed : ‘ We just want to do what we can before someone dies .’ DDN
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