RCGP & SMMGP ConfeRenCe
‘The road to recovery – political destination or patient journey?’ was the
theme of this year’s RCGP and SMMGP primary care conference. DDN reports
one of us need reminding about shrinking budgets and
decommissioned services,’ said clinical lead for alcohol and
drug misuse at NHS Nottingham, Dr Stephen Willott. Issues
like the rising cost of buprenorphine were making matters
worse, he said, and ‘while we’re told there’s an extra £20bn
coming for health, my worry is that it won’t come anywhere
near local councils and drug and alcohol services’. Many people, however, were
doing the best they could for a vulnerable group. ‘We need to help people to find
softer landings. Sure, if we had more money we could do more.’
There were some grounds for cautious optimism, however. While the latest
drug-related death figures were still the highest ever there was ‘at least a
flattening of the increase’, he said. ‘We need to make sure that people are seen in a
timely manner, that there are no forced exits before someone is ready, and no
unnecessary hurdles. We need more roads to recovery and we need to be able to
help a wider range of people.’
In terms of drug harms there remained serious questions about why certain
drugs were illegal, said Professor David Nutt of Imperial College. ‘The main reason
why drugs are illegal is because that’s what the media and politicians want.’ One
paradox of working in the field was that drug harms did not correlate with their
control, he argued. ‘By far the worst harm comes from alcohol, and it’s legal. The
Misuse of Drugs Act is supposed to be evidence-based, but it’s not.’
In terms of OST, treatment optimisation was crucial, SMMGP clinical director Dr
Steve Brinksman told delegates. ‘We have to ask ourselves why more people are
dying, and people in OST are at much reduced risk. We need to properly understand
lapses – people will generally blame themselves, but we need to start thinking about
measuring craving as well as withdrawal when we talk about dose optimisation. We
shouldn’t make people who are comfortable and doing well in their lives feel
ashamed that they’re having evidence-based treatment. I’ll support anyone who
wants to work towards abstinence, but I will not force people to come off treatment.’
‘N
Public Health England (PHE) was working on an OST good practice programme, its
alcohol and drug treatment and recovery lead Pete Burkinshaw told the conference.
‘We’re doing this for all the right reasons and, at the moment, it’s a blissfully politics-
free zone. It’s building on what’s gone before but asking what we can do better.
People talk about the jewel in the crown of the UK treatment system being the very
low HIV prevalence, and I agree with that, but there’s also the 60 per cent treatment
penetration. Internationally that’s very good – but it could be better.’ We need to hold
the centre and focus on what’s important in the current operating context, and what
constitutes quality treatment. That’s more important than ever.’
Resources were hugely constrained, he acknowledged, and there were
challenges such as increasing levels of crack use and falling numbers in alcohol
treatment. ‘The system needs to respond to all those things, but the people taking
up most of the capacity are still opiate users.’ The programme’s initial topics would
include prescribing practice, psychological and social interventions and the
segmentation of the treatment population, he said, through the filters of service
user experience and implementation barriers. ‘Let’s look at what are the absolute
must-dos, and take it up from there.’
hen it came to policy and practice, we were ‘at a turning point’,
said professor of addiction medicine at Edinburgh University,
Roy Robertson. ‘We’ve got new drugs, patterns of drug use we
haven’t seen before, demographic change.’ In terms of the high
rates of drug-related deaths, policy was ‘a bit tricky’, he stated.
‘Things like time-limited treatment and trying to get people
off methadone are damaging, and the UK government has no intention of allowing
consumption rooms.’ People who use drugs had also been ‘framed’, he stated –
characterised as reckless, indulgent, violent and responsible for crime.
‘The upshot of that is that we have a marginalised treatment population.
There is neglect, reluctance and a lack of innovation.’ Studies of drug-related
W
Final destination?
16 | drinkanddrugsnews | December/January 2019
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