opinion
The implications of this political turmoil are
dangerous for service users says Nick Goldstein
We need to talk about
H
a! Brexit!! I can imagine eyes rolling out there, but bear with me
– I promise to avoid commenting on Brexit itself or the ideology
and tribal politics that propel it.
This article will just be a gentle ramble through some of the
plausible short- and long-term implications of Brexit on
substance misuse.
I’m afraid there will much supposition, conjecture and flat-out guess work
because when it comes to Brexit there are very few definites and a mountain of
intangibles. This is certainly the cause of much political uncertainty, but the
coup de grace is an uninterested silence from the state, political parties, NGOs,
charities and, more forgivably, from drug users themselves. More on this silence
and its meaning later.
There are significant implications for substance misuse and substance
misuse treatment that come from the wide variety of Brexits still possible.
These range from our potentially leaving Europol with its knock-on effect on
policing influencing how much and even what drugs are available, to our
potentially leaving the EMCDDA – an agency that provides key data used by
policy makers, which would obviously have a knock-on effect on any future
politico-legal change.
Of rather more concern would be the loss of the European Convention on
Human Rights and access to the European Court of Human Rights in Strasbourg.
These rights (ironically put together mainly by David Maxwell Fyfe at Churchill's
behest and based on English law) are limited but offer invaluable protection to
many vulnerable groups – including drug users.
One example of their worth is that they were used successfully as the legal
basis of a case brought by prisoners to ensure maintenance treatment in the
prison estate. I can’t prove it, but I have a feeling that it was fear of Strasbourg
that curtailed many of the coalition government’s more extreme plans for
substance misuse treatment, including time-limiting it – something that might
become of interest to some in government again after Brexit.
In the longer term it would take a brave human to bet against the economic
and social cost of a Brexit which could be a negative influence for 50 years,
increasing both numbers of drug users and those seeking treatment.
8 | drinkanddrugsnews | October 2019
A
‘Brexit has made
it clear that the
state’s primary
aim is to protect
wider society
from substance
misusers not
help substance
misusers
themselves.’
treatment system that has
struggled with the removal of
ring-fenced budgets and is now
funded as part of public health
through local authorities can
only suffer as the economy
struggles and business rates fall. So, there will
potentially be more service users and less
money for services – a turbo charging of the
double whammy that has hit treatment
services since 2010 and has resulted in an orgy
of ‘salami slicing’.
A further worry is that there isn’t much
salami left to slice, and a brave new, post-Brexit
world could provide the impetus for a
significant change in the structure of
treatment. And while change is subjective, it
would take a very brave man to see Brexit as an
opportunity for positive change.
Most of these outcomes lie in the future,
but drug shortages and supply chain problems
are of more immediate concern. Considering
the complex supply system of modern drug
production, it’s distinctly possible that there will be temporary problems with the
availability of some drugs. Of even more concern is the government’s response to
this possibility, which amounts to quietly passing the power to pharmacists to alter
both the amount of drug and even the drug itself, via an amendment to the
Human Medicines Regulations.
Granted, ministers have to specifically give pharmacists this power on a drug by
drug basis, despite a lack of medical training or a full assessment of the patient’s
needs. Absolutely nothing in my experience suggests the unique maintenance
prescribing that predominates substance misuse treatment would receive any
consideration. The amendment, which takes power away from doctors and gives it
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