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 September 2010

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New alcohol profiles for England and a national map of alcohol-related harms

Further information from

The key findings from the national alcohol profiles published last month are:

(Figures from a report by the Centre for Public Health, Liverpool John Moores University published in August 2010 - for more information contact 0151 231 4510).

SMMGP comment

The absolutely shocking figures in this report speak loudly about the stark and horrific reality of the true cost of alcohol in England. As a nation our alcohol consumption has been on the rise for decades as has the harms associated with this consumption; the death toll from alcohol in this country now exceeds fifteen and a half thousand people every year and teenagers are drinking twice as much as they did in 1990.

Department of Health figures suggest that over 10 million people drink over recommended limits and a total of 3.5 million of us are dependent on alcohol.

We highlighted these problems, and how we can address them, in our April 2010 edition of Network - a special edition on alcohol.

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Minimum price for unit of alcohol - Scotland in the lead

Scottish Health Secretary Nicola Sturgeon announced on 20 September that the Scottish Government were pursuing a minimum price (45p) for a unit of alcohol, a figure she believed would lead to significant health and social benefits and save the country £721 million over 10 years.

Her announcement was welcomed by health campaigners, but criticised by opposition politicians and drinks bodies.

SMMGP comment

This is great news for Scotland. Therefore it is discouraging, given the previous item, that there was a lack of support from the Royal College of General Practitioners (RCGP) for similar campaigns in England led by Royal College of Physicians and Alcohol Concern amongst others - on the basis of it being too complicated!

Clearly, it can't be right that alcohol is cheaper than some soft drinks. How unfortunate that the RCGP chose not to support this public health campaign in England, which could have dramatically helped the health of the nation as well as individuals.

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Sinning and sinned against: the stigmatisation of problem drug users

UKDPC report by Charlie Lloyd, University of York, Aug 2010

This report provides a summary of research evidence on the stigmatisation of problem drug users (PDU), the impact and why it happens. It uses the EMCDDA definition to make clear what is meant by problem drug users - "injecting drug use or long-duration/regular use of opioids, cocaine and/or amphetamines".

The report makes the following key points in relation to stigmatisation of PDUs:

The report asks what can be done to allay the damage done by stigmatisation - given that stigma is felt so deeply by anyone operating in a social world, and particularly by those who experience extremes of it, or multiple stigmas. It provides some answers too: for example language can be challenged by service user groups, particularly that used by the media; education such as training for health care and pharmacy staff to include a greater awareness of drugs and addiction; contact between the general public and PDUs in the context of for example volunteering could be a positive for removing stigma - PDUs may be viewed as whole individuals who may have multiple interests.

SMMGP comment

The question of stigma is one which has a pervasive impact not only on our clients and patients, but also on those of us who work with problem drug users in primary care as we come up against stigma aimed at our client group. There are many initiatives - for example with the focus on families - where we can make our opinion on this key issue clear.

The brand new RCGP Certificate in Harm Reduction, Health and Wellbeing for Substance Users, developed by SMMGP on behalf of the College, and which will be launched early next year, makes the important point (and in its title!) of viewing substance users as people who are worthy of having their general health and wellbeing looked after, thereby reducing stigmatisation of this group in our society.

Watch out for this timely certificate, which we are pleased to have been asked to develop - and tell all your health care colleagues about it!

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International policy - United Nations Office on Drugs and Crime (UNODC)

Yuri Fedotov - the recently appointed (Russian) Executive Director of UNODC - expressed the view last week in a statement about the unit's work that "Public health and human rights must be central".

He continued by saying "Whether we talk of the victims of human trafficking, communities oppressed by corrupt leaders, unfair criminal justice systems or drug users marginalized by society, we are committed to making a positive difference and Ö drug treatment should also promote the prevention of HIV." He expressed that drug users should receive "humane and effective treatment" instead of being punished.

SMMGP comment

These are encouraging remarks as there were concerns in many quarters at his appointment as Russia has Draconian drug policies. His initial approach however, is heartening and long may that continue.

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International policy - Global State of Harm Reduction 2010

See Global State of Harm Reduction 2010.

An overview of IHRA's second major report in the Global State of Harm Reduction series is available in a leaflet and poster format. It contains a summary of the key findings from the report, including those on the adoption and coverage of key harm reduction interventions and the extent to which harm reduction is funded around the world.

It includes a table listing the countries and territories which currently support harm reduction in their national health or drug policies, as well as those that employ key harm reduction interventions such as prison and community-based needle and syringe exchange and opioid substitution therapy and drug consumption rooms.

Key findings

Harm reduction policies or programmes have been adopted in more than half of the 158 countries and territories where injecting drug use has been reported.

An estimated 15.9 million people inject drugs globally. In 120 countries, there are reports of HIV infection among people who inject drugs. In some countries prevalence among this group reaches 40% or more. Worldwide, an estimated 3 million people who inject drugs are living with HIV. Extremely high proportions of people who inject drugs are also affected by viral hepatitis, tuberculosis, injection site bacterial infections and overdose.

Key harm reduction interventions such as needle and syringe exchange programmes (NSP) and opioid substitution therapy (OST) are available in an increasing number of countries. However, the coverage of services remains limited, particularly in low and middle income countries. Recent estimates indicate that many countries are distributing less than one needle per person who injects drugs per year.

Similarly, in many Central Asian, Latin American and Sub-Saharan African countries, opioid substitution therapy (OST) coverage is low - equating to less than one OST recipient for every 100 people who inject drugs. Of the countries with reported injecting drug use, seventy-six have no needle and syringe exchange services and eighty-eight have no OST provision.

A severe lack of resources, government apathy and distrust of harm reduction, the criminalisation of drug users and harm reduction activities and poor engagement of people most affected by drugs and drug policy in the decision-making fora all act as barriers to harm reduction around the world.

The work of harm reduction networks and wider civil society to advocate for harm reduction approaches, sometimes in very hostile policy and legal environments, is essential to the sustainability and scale up of this life-saving approach.

SMMGP comment

At a time when the basis of good treatment in the UK is being challenged, and our Drug Strategy is being reviewed, we must remember how lucky we are and fight for evidence-based treatment and for the people who use drugs to be able to get the best of care according to what they feel they need - whether it be rehabilitation and abstinence or OST.

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Summary of current consultations related to Drug Policy

Four areas of consultation related to the NHS White Paper - Equity and Excellence - Liberating the NHS - are still open for contributions - until 11 October 2010. They are:

  1. Transparency in Outcomes: A Framework for the NHS
  2. Increasing Local Democratic Legitimacy in Health
  3. Commissioning for Patients
  4. Regulating Healthcare Providers

Of these, number 2 - Increasing Local Democratic Legitimacy in Health - is important in terms of where commissioning of drug and alcohol treatment services might sit, and therefore has the potential for us to influence decision-making about this issue.

It may provide opportunities for suggesting an arrangement for the commissioning of these services, away from where they currently sit locally within safety structures, towards being included in local authority structures as part of a public health and general wellbeing approach within communities.

The e-mail address for responses is

SMMGP comment

Any suggestion towards making drug and alcohol treatment a public health issue rather than having an over-emphasis on safety and criminal justice issues is to be welcomed and encouraged.

If you have any opinion on these matters, please go to consultation link no. 2 and do your bit.

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SMMGP membership consultation on the Drug Strategy

Thank you to our members for the very good response we've had on the "treatment rebalance" section of this consultation. SMMGP's report will be sent to the Home Office by the end of this month and also published on our website (see SMMGP Member Survey Results section).