Power of TEN
The opening session of the tenth DDN service user conference mixed stark reflections on drug-related deaths and budget cuts with powerful exhortations to make sure the service user voice was properly heard
Looking back over the last ten years , there ’ s been so many cuts that I don ’ t know what ’ s left to cut ,’ Chris Robin of Janus Solutions told delegates as he introduced the opening session of One Life . Service users , however , had come a long way in those ten years . ‘ They know want they want , and they have a voice ,’ he said .
There had been far more money in the system a decade ago , he told the conference . ‘ But I ’ m not sure we made
‘ There ’ s been so many cuts that I don ’ t know what ’ s left to cut .’
the most of the money we had , and maybe we ’ re paying the price now .’ Services had been forced into ‘ unhealthy competition ’ with each other , which inevitably meant that clients were losing out , while drug workers had huge caseloads and were effectively becoming mental health counsellors , housing officers and more in addition to their core work . ‘ Where do they get the time to actually talk about the client ’ s drug use ?’ What ’ s more , the workers themselves were also feeling extremely insecure about their future , he stressed .
‘ We ’ re seeing so many services being re-commissioned – there ’ s a real need for stability ,’ he stated . ‘ And again , the honest question we have to ask ourselves is , “ when the money was available , did we do the right thing ?”’ The financial climate had forced services to be more creative and innovative , however , and to tailor their designs to the needs of their clients . ‘ It ’ s no longer possible to get away with just offering generic services . We talk about the evidence base , but we have to open the door and create space for new kinds of evidence .
‘ There ’ s nothing negative about service user involvement , but we can ’ t allow a situation where service users are running the projects while the profess - ion als sit back and let them get on with it ,’ he continued . ‘ We ’ ve got to give workers the power to be more authentic , and to relate back to what they see .’
One of the most disturbing developments in the decade since the first DDN service user conference has been the increase in drug-related fatalities in the last few years , delegates heard . ‘ At the ACMD [ Advisory Council on the Misuse of Drugs ] we ’ re really , really worried about the trends we ’ re seeing in drugrelated deaths ,’ chair of its recovery committee , Annette Dale-Perera , told the conference . ‘ We advise the govern ment . They don ’ t listen to us most of the time , but we still tell them things .’
The ACMD had carried out work on opioid-related deaths because it was able to say things that Public Health England ( PHE ) couldn ’ t , she told delegates . ‘ However , the data is not very good – it ’ s based on coroner reports and it ’ s not a consistent system . The data coming out of Wales is much better than what ’ s published in England and Scotland .’
There had been 1,842 opioid-related deaths in England alone in 2015 , she told the conference . ‘ That ’ s massive .’ Previously , the numbers had been increasing until 2001 , the point at which more money started to come into the system and deaths had started to come down – ‘ a direct correlation ’, she said . The ‘ heroin drought ’ of 2009 to 2011 had also meant fewer fatalities , but the death toll had been increasing since then , she warned .
‘ Deaths in the under-30s have been going down – that ’ s good , that ’ s a success story – but deaths among the over-40s have been going up exponentially . Far , far more men are dying , but the numbers are creeping up among women as well .’ The vast majority of those dying were either not in treatment at the time , or had never been in treatment , she stressed . ‘ Treatment is protective .’
Some of the deaths were undoubtedly being driven by supply – ‘ deaths go down when the heroin supply goes down ’ – and , worryingly , Afghanistan had seen ‘ bumper ’ opium crops recently ( DDN , November 2016 , page 4 ). However , many of the fatalities were the result of the impact of longterm heroin use and its associations with chronic health conditions , poor diet , smoking and heavy drinking .
Someone who had been smoking for 25 to 30 years would have a substantially reduced lung capacity , she said , which inevitably meant they were more likely to stop breathing in an overdose situation . ‘ Their livers are likely to be compromised as well , so it ’ s the
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