Drink and Drugs News DDN December 2018 | Page 16

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 www.drinkanddrugsnews.com