Drink and Drugs News DDN Feb2018 - Page 11

It is important for commissioners to consider how innovation can play a role in continuing to improve care, while balancing budgets... understanding the balance between innovation and organisational change is key in this instance. Exponential growth of the problem Treatment approaches emerged in the 1970s. Prescribed methadone doses were often challenged and inpatient treatment duration limited in response to increased demand and financial pressures. Subsequent explosive growth of problem drug use in the 1980s and 1990s led to a resurgence in ‘maintenance prescribing’ and introduction of on-site dispensing facilities with supervised consumption. Treatment availability and coverage were lower than they are today, locally governed, commonly led by NHS specialists and funded to provide services in a relatively limited capacity. Expansion in treatment The National Treatment Agency was established in the 2000s with the aim of addressing the increasing problem of heroin use by improving treatment availability and reducing waiting times. More resources and organisational change gave rise to a competitive provider market, while new models of care were designed with an emphasis on performance management. Innovative thinking led to a step change in successful outcomes for people with problematic opioid use. Evolution: a shift in focus Recently the incidence of new heroin use has reduced. The existing cohort of approximately 150,000 people remains engaged with treatment services, with potentially greater needs related to comorbidity. The treatment system and method has evolved: policy has promoted focus on recovery-oriented and abstinence-based approaches, and concurrent mental health disorders have received greater attention. In parallel a step-down in resources has occurred in many locations, placing stronger focus on the need to achieve efficiency and cost-effectiveness in providing services. Mark Gilman, managing director, Discovering Health www.drinkanddrugsnews.com Paul Musgrave, senior manager, public health and communities, Cumbria County Council More on commissioning at www.drinkanddrugsnews.com Challenges today While funding for treating opioid-related disorders is decreasing in many areas, there has not been an equivalent change in working practices to compensate. At the same time, drug-related deaths have been increasing in all four nations, linked to the ageing population and also unexplained factors. In many cases, services are essentially delivering less of the same, which is keeping the system ‘ticking over’. Looking to the future, it is relevant to consider if services are achieving the impact the population needs and deserves. And in parallel, how can we focus on innovation to maintain continuing improvement in outcomes? There are a number of areas of innovation: use of digital technologies to provide psychological interventions, different forms of opioid agonist medications, and options to better address comorbidities such as hepatitis C virus (HCV) infection. It is important for commissioners to consider how innovation can play a role in continuing to improve care, while balancing budgets. There is already evidence of a new group of injectable opioid agonist therapies from various pharmaceutical companies which, if approved for prescription in UK, may allow treatment to be delivered with injections weekly or monthly. Current spending with community pharmacies on medications, supervised consumption and dispensing is substantial. There may be opportunity to restructure services to allow direct supply of medications or on-site storage at clinics, allowing resources to be redirected. Understanding the balance between innovation and organisational change is key in this instance. Evolving treatment options pose questions about the different ways in which therapy is tailored to the needs of the individual. In some cases, medications for opioid dependency are used chaotically as part of a wider cocktail of drugs; f