Drink and Drugs News DDN October 2019 | Page 8

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 www.drinkanddrugsnews.com