to talk
When the going gets tough , is it time to get round the table , asks DDN
but have no idea who ’ s using other substances and how many people are using problematically .
‘ We don ’ t think about the chance people have as they walk through the door . We have been conditioned to think about completion rates .’
If addiction services are losing profile and suffering from disinvestment , what should – and could – happen at a political level ? Jonathan Ashworth , shadow health and social care secretary , says that in power , Labour would ‘ give addiction services the profile they need ’. He acknowledges that we ’ re ‘ facing an addiction crisis ’ and that despite high demand , ‘ people receiving treatment have fallen to their lowest levels ’.
‘ Overall it ’ s a bleak picture , with more cuts to come ,’ he told the National Substance Misuse Conference in September , pledging to expand treatment services if he became health secretary . Labour would reverse cuts , spend an extra £ 7.7m on prevention , and address gaps in the workforce , he said . He talked about how the loss of addiction psychiatrists meant that we were unable to provide services for complex dual diagnosis early in the treatment cycle , and wanted to
‘ Drug education in schools is terrible – we need to be honest about the harms and benefits ...’
‘ The UK has the largest number of dark net sales in Europe .’
improve links between mental health and addiction services . Another priority he had learned from talking to the sector was the need to address patchy naloxone provision across the country .
‘ I don ’ t believe we can go on cutting drug and alcohol services – we need to completely change the landscape ,’ he said . ‘ If I become health secretary I will put in a proper strategy for care , support and rehabilitation , backed up by the resources needed .’
The political pledge from the shadows is one thing ; working with the ramifications of complex and illogical drug laws is another . Dr Prun Bijral talks from experience as CGL ’ s medical director and draws a direct line between ‘ the prohibitive situation ’ and more potent forms of drugs finding their way into the mainstream .
‘ Drugs become more potent because there is more profit from stronger drugs ,’ he says . You don ’ t have to look too far to buy these drugs online , he points out – ‘ the UK has the largest number of dark net sales in Europe . We also know the impact of fentanyl and the increase in drug-related deaths from it .’
Katy MacLeod has expertise from her work in training and development at the Scottish Drugs Forum ( SDF ) and also as director of Chill Welfare , a social enterprise created in response to drug-related deaths at music events . She , too , is concerned about ‘ super-strong ’ versions of drugs , and comes across ecstasy tablets on the festival circuit that are ‘ three times the strength they were ’ – a particular issue for people returning to ecstasy at festivals . Many of the people she comes in contact with have undiagnosed mental health issues . She knows of prisoners who aimed to become drug free but who are now on synthetic cannabinoids – just because these drugs are such a regular part of prison life .
‘ If it was any other public health issue we were talking about there would be an outcry ,’ she says , and believes that drug services are hard to reach : ‘ We have to do something about that . If we do what we always did , we ’ ll get what we always got .’
So how do we go about doing things differently ? Many deep-rooted problems stem from lack of investment or outdated legislation . But there is an argument for grabbing the things we can influence by the scruff of the neck . Many believe that education is of primary importance , in every context and to every audience . ‘ Drug education in schools is terrible – we need to be honest about the harms and benefits ,’ says Dr Prun Bijral , while Mike Dixon suggests that ‘ small conversations at home ’ with parents normalising information about drugs , could make a big difference . On a wider scale , those of us working in the sector can audit our language and practice to make sure we are challenging stigma at every opportunity . ‘ Until I worked internationally I didn ’ t realise my language was stigmatising ,’ says Annette Dale-Perera . ‘ International colleagues do not accept the term drug users – it has to be people who use drugs .’
‘ We really need to up the ante and become more dynamic ’ in response to the loss of infrastructure and expertise , suggests Danny Hames , chair of the NHS Substance Misuse Providers Alliance ( NHSSMPA ). ‘ One of the things we could be doing better is finding allies and forming alliances . We need to up the game on how we improve influence in local authorities , where decisions are being made .’
A positive sign is the willingness of police and crime and commissioners ( PCCs ) to join the conversation . A recent meeting of the Drugs , Alcohol and Criminal Justice Cross-Party Parliamentary Group heard from four PCCs keen to declare that ‘ our approach to drugs is failing ’ and find an effective , evidence-based way forward . ( DDN , April , page 6 ). ‘ By joining up with different groups , we can make positive steps in the right direction ,’ said Derbyshire PCC , Hardyal Dhindsa .
Vital to the debate are those who use services , and Hames is among many who see the value of a ‘ strong and equipped service user voice ’. ‘ We need to create a strong service user movement in this country ,’ he says . ‘ If we lock in this powerful movement , we have a chance of fighting cuts .’
With less time and fewer resources , it can be difficult to make time for debate . A comment at the National Substance Misuse conference , from a worker at a homeless service , could serve as a reminder that a little action can go a long way : ‘ We had a grown man cry because we gave him underwear ,’ he said .
This article has been produced with support from an educational grant provided by Camurus , which has not influenced the content in any way . www . drinkanddrugsnews . com October 2018 | drinkanddrugsnews | 11