SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Clinical & Policy Updates:
SMMGP Policy Update July 2008

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Highlights from the NTA Conference

Highlights from the NTA Conference, Mermaid Theatre, London 11th June 2008.

Paul Hayes (Chief Executive NTA). Congratulated the field for delivering the 10-year drug strategy, saying that twice as many people are now accessing treatment and waiting one tenth of the time to get it. He then issued 5 challenges to the field (these are abbreviated direct quotations). Challenge 2, in particular, paved the way for the afternoon's discussions:

  1. Keep doing what we have been doing.
  2. We need to maintain our confidence in what we do. We know we deliver effective, evidence-based practice We shouldn't be distracted by the siren voices, telling us on the one hand that an "abstinence" based system is the way forward, when we know that is not evidence-based and when we attempted to deliver on that basis in the seventies and eighties, it resulted in unsatisfactory outcomes for service users and for communities. Neither should we assume that once people are in treatment, they need to stay there for a day longer than they absolutely have to. People come into treatment not wanting to stay there, but wanting to come out, having overcome dependency.
  3. A major, major thrust towards improving and consolidating the competence of the workforce and the management, both within services and with commissioners.
  4. To broaden out, to incorporate treatments to prisoners, and to provide drug treatments for the under-18s; so we need to get better at delivering in both of these groups.
  5. To be able to do all this with a flat pooled treatment budget - pooled treatment budget.

Kevin Brennan MP (Under-Secretary of State for Children, Young People & Families)
Emphasised that the new drug strategy makes drug using parents a priority for treatment and that there is now a national indicator measuring progress on reducing substance misuse amongst young people. He noted that young people's drug use is down, class A drug use is stable, young peoples alcohol use is down but heavy drinking is up which was a cause for concern. He discussed the new "children's plan", prompting a review of drug and alcohol education to examine how we communicate these issues best to children and young people. In response to these new priorities there is now a memorandum of understanding between the Department of Children, schools and Families and the NTA. When it comes to treatment he said "think families".

Kamlesh Patel (Chair of the Prison Drug Treatment Review Group)
Gave worrying statistics about present treatment in prison and outlined new government initiatives to improve it, whilst stating that IDTS was key to its delivery. 45% of men and 65% of women arrive in prison drug-dependent - of these 40% report injecting drug use within the 28 days preceding imprisonment. A staggering 80% of people coming into prison with substance misuse problems have never engaged with community treatment services, and someone received into prison who is drug-dependent is twice as likely to commit suicide in the first week of imprisonment, than a non-dependent drug user. Also in the week following release, prisoners are 37 times more likely to die of a drug overdose - with women prisoners 69 times more likely!

He argued that these death rates could be reduced significantly by the provision and continuation of substitution treatment. In addition to a drug treatments service referral, the involvement of GPs needs to be secured before drug users leave prison. Both the Drug Treatment Provider and the GP need to be advised of discharge medications in order to quickly take over prescribing when it's needed.

He outlined a Price Waterhouse Cooper's report, which identified a need for better coordination and provision for prisoners, and an integrated community framework. The field needs to prioritise effective treatment, based on the evidence. In direct response to those issues in the report, Kamlesh has been asked to chair a prison drugs strategy review committee to commission and oversee a work programme to take forward the recommendations. He will report directly to ministers on the work of the group, which will run for the next two years. It is a significant piece of work that will have lasting and far-reaching consequences for drug treatment in prisons and for continuative care for prisoners. The group, which includes experts from across the field including service users, will aim to clarify and prioritise the required outcomes for prison drug treatment.

The group will advise ministers on future drug treatment interventions for people in prison and the development of commissioning structures and funding streams. Their aim is to ensure the establishment of minimum standards of provision for drug treatment in prisons.

Dawn Primarolo MP (Minister of State, Public Health)
Stated that drug treatment is more embedded in the mainstream of the NHS than ever before. The full benefits of the system would take a few years to become apparent as people start to leave the system. Treatment is available and it works is the message we need to get across. When talking about contingency management she said that the challenge is to find ways of using the approach effectively and suggested personalised rewards (e.g. school uniforms for parents in treatment) and was impressed by the large number of applications for pilot sites. She also said that the media had misrepresented the drug strategy in relation to cutting benefits to drug users, when in fact it supports the provision of extensive support to those on benefits.

Professor John Strang (many titles) and John Howard (Reading User Forum)
Introduced the work of the UK Drug Policy Commission (UKDPC) consensus working group on recovery. This representative group convened for 2 days of solid work and managed to come up with an agreed definition. The group, although criticised in some quarters, was representative of all shades of opinion and interest, including 12 step, user advocacy, residential rehabilitation and maintenance prescribing. It was a "damn good group" John Strang said. The consensus statement was the focus of the afternoon's debate. The main statement is below:

The process of recovery is characterised by voluntarily sustained control over substance use which maximises health and well being and participation in the rites, roles and responsibilities of society.

There are also a number of subsidiary statements that can be viewed on the UKDPC web site www.ukdpc.org.uk.

The afternoon debate combined presentations from a range of perspectives and floor contributions. There was a general agreement with the sentiments of the statement. "Anything which seeks to reconcile harm reduction and abstinence should be applauded" is a direct quote that seemed to represent the flavour of the afternoon. Potential hostility to the statement failed to materialise. This is a vibrant debate in the field and you can join in on our Online Forums and/or contribute to the debate in our forthcoming member consultation, which you should receive shortly, if you have opted to be involved. To read or listen to all the transcripts of the conference visit www.nta.nhs.uk.

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Misc

Substance Use Among Older Adults: A neglected area. Report from the European Monitoring Centre for Drugs and Drug Addiction (ECMDDA) (2008)
At last, some action in the area of older people. Illicit drug use is increasing among older people and estimates taken from the US suggest that the number of persons over 50 needing treatment for illicit drug problems may increase by up to 300% between 2001 and 2020. With maintenance treatments becoming more effective at retaining patients in treatment and reducing overdose deaths, the number of older patients will gradually increase. In Europe between 2002 and 2005, the proportion of patients over 40 being treated for an opiate problem more than doubled (8.6% - 17.6%). The report recommends improved assessment of substance use disorders amongst older adults including age specific measurements and also that appropriate and effective treatment should be tailored to their needs. A major new research project has been commissioned in response to this. It will aim to provide guidelines for community-based and residential care for drug users over 35 and will prioritise pinning down the true numbers and ages of drug users aged up to 70 in Frankfurt, Vienna, Warsaw, Edinburgh and Glasgow as well as looking at their living and healthcare problems. Read the report on: www.emcdda.europa.eu.