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deaths could, however, lead to advances in care, he said. ‘It shines a light on the
range of morbidities this client group is suffering from.’
The new Scottish drug strategy (see news, page 4) also had ‘some good things in
it’, he added. ‘It endorses things like human rights, take-home naloxone, lived-
experience advocacy and it takes a swipe at the UK stance on consumption rooms.’
However, while it was evidence-based that evidence was ‘highly selective’, he argued.
‘There’s stress on the “recovery journey” but, to my mind, at the expense of the NHS.’
While Scotland’s take-home naloxone programme was well-received and
discussed internationally it was still not possible to see a ‘causal effect’ in
preventing drug-related deaths, he said. ‘But it has clearly had an impact in that
super-high risk period of the first few weeks after release from prison, so there is
clear evidence that it can work.’ On the issue of consumption rooms, ‘we really do
have to make some progress on this’, he stressed. ‘The international evidence is
there, and they’re part of a whole spectrum of treatment. You wouldn’t have a
hospital without an A&E or intensive care unit.’
eaths involving ‘festival and party drugs’ were increasing alongside
those involving opiates, director of The Loop, Fiona Measham, told
the conference, with purity levels for ecstasy at their highest ever
level. Her organisation had been carrying out festival testing for the
last three summers, and there was ‘an opportunistic element’ to
festival drug use with people tending to take more drugs than they
normally would. ‘There’s polysubstance use, and a significant group of older people
who only ever take drugs at festivals and may be unaware of the higher purity
levels.’ One in 20 MDMA samples from this summer were actually n-
ethylpentylone, a very long-lasting cathinone, she added, with festival dealers
twice as likely to be selling contaminants and substances of concern. ‘They can sell
anything and get lost in the crowd.
‘We’re not encouraging or condoning drug use, but we give harm reduction
D
advice – 90 per cent of our service users
have never spoken about drug use to a
healthcare professional so we’re reaching
people at the very beginning of their drug-
taking careers. We can monitor trends in
local drug markets and remove high risk
substances from circulation.’
The Loop had also been involved in
setting up testing in consumption rooms
in Copenhagen and Vancouver, and would
soon be operating in Bristol and Durham
city centres. ‘This is something that should
be available to all drug-using
communities.’
The human cost behind the statistics,
however, was brought home powerfully by
author and journalist Poorna Bell, who told
the conference how her husband Rob had
taken his own life in 2015. ‘He struggled
with chronic depression and addiction.
They tore at him to the point where he
couldn’t see anything getting any better.’
She’d known nothing about addiction,
she said. ‘My mind reeled with the horror
that it had been heroin. We have this incorrect hierarchy of substances, and heroin
seemed the worst of the worst. I stayed with him and helped with his recovery but
ironically I felt I couldn’t tell my family and friends, which shows the isolation faced
by people and their loved ones. The resources for someone whose loved one is an
addict are abysmal.’ DDN
‘People talk
about the jewel
in the crown of
the UK
treatment
system being
the very low
HIV prevalence.’
Fentanyl: the opportunity
to prepare is now
One substance associated with worsening drug harms was fentanyl,
delegates heard. ‘Early last year we had a spate of overdoses in one of
our services in the North East,’ said medical director at Change, Grow,
Live, Dr Prun Bijral. ‘We were really concerned and the samples turned
out to contain fentanyl and its analogues.’
Fentanyl was now ‘ubiquitous’ in the US, he said. ‘People ask why
would dealers and criminal gangs want to sell drugs that kill their
customers. The answer is they don’t care.’ On the question of whether
we could see a similar situation here, the UK now accounted for almost a
tenth of all global ‘darknet’ sales of fentanyl, he said. ‘We have to
consider fentanyl in terms of the current situation for people who use
drugs. It’s a really difficult time, with the highest ever rates of drug-
related deaths, and there’s been a small but significant increase in the
number of deaths involving fentanyls. We know their impact.’
The scale of the problem was better understood here than it had been
in the US, however, and the services were in place. Any response would
need to be multi-agency, and optimisation of treatment was also vital.
‘In Teeside, where they had the problems, they’ve established a
preventing drug-related deaths co-ordinator.’ Other essential measures
were sharing police seizure results, and post-mortem testing for fentanyl
as standard practice. Take-home naloxone was also critical, along with
OST. ‘The opportunity to prepare is now.’
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December/January 2019 | drinkanddrugsnews | 17