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-October 2012

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Adobe Acrobat DocumentDownload the PDF version of this Update here! (PDF*, 362K)

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Delivering quality care for drug and alcohol users: the roles and competencies of doctors

See Guidance Documents section.

New guidance published during September by the Royal College of General Practitioners and the Royal College of Psychiatrists highlights the need for services to employ teams with the right mix of skills and clinical expertise to support the recovery of people with drug and alcohol problems.

The document provides a clear analysis of the medical competencies involved in working with drug and alcohol users. The guide acknowledges the crucial importance of adequate supervision and clinical governance in providing safe and effective care to service users. It will help commissioners, employers and others to meet their legal and regulatory requirements and provide a high quality service to all those seeking recovery, including those with more complex needs. The guide will also help doctors working in the sector to ensure that they are meeting General Medical Council requirements on revalidation. Doctors supporting drug or alcohol users come from a variety of medical backgrounds (mainly General Practice and Psychiatry) and have varying degrees of specialist competency. The guide identifies three levels of competency that apply across all doctors:

The guide maps levels of competency and how they relate to service user needs, and to available training and qualifications. It also draws out broader implications for commissioning drug and alcohol services and it is timely in the transition towards new commissioning arrangements for drug and alcohol services next year.

Commentary

SMMGP welcomes the updated guidance which continues to support the concept of a GP attaining specialist status via ongoing continuing professional development and experience. The document provides useful guidance on the CPD and competencies required for doctors practicing at every level of treatment. SMMGP is currently providing CPD and support on a consultancy basis to GPs working in shared care schemes, which fulfils the requirements laid out in the guidance. For more information contact Elsa Browne at elsa.browne@nta-nhs.org.uk.

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Annual NDTMS report: Drug treatment 2012: progress made, challenges ahead

See www.nta.nhs.uk web site.

According to the NTA's annual analysis of the NDTMS figures published last week, record numbers of people are recovering from addiction, with 29,855 successful completions during 2011-12, which is almost three times that of 7 years ago when it was early days for drug stats. Casting a long look back, the overview of the data for the past 7 years also reveals that nearly one third of users successfully completed during this time and did not return. These figures compare favourably to international recovery rates.

Also from the figures, the number of young adults seeking treatment for the problematic use of heroin or crack is at its lowest recorded level and the only group to increase their numbers in treatment is the 40 plus age group with 16,187 people in that age group starting treatment in 2011-12. Heroin dependency also remains the biggest problem and of the 197,110 adults in treatment, 96,343 were receiving help for problematic heroin use and a further 63,100 for heroin and crack, accounting for 81% of the treatment population (as compared to 8% for cannabis and 5% for powder cocaine).

Commentary

This is the last time that the NTA will publish their annual NDTMS stats before they are absorbed into PHE in 2013. The report was widely picked up in the national press with the main thrust of the reporting being about "the end of the heroin epidemic"; the increase in numbers of people starting treatment in the over 40 age group; and that fewer young people are seeking treatment for heroin dependency. It is our opinion that primary care is best placed to treat the cohort of over 40s who are still in treatment - alongside every other member of that age group on the average GP patient list - where concomitant health issues are readily addressed.

At the press conference to launch the report, Paul Hayes said that it was encouraging that the pool of people in treatment for heroin and crack use is shrinking, and made particular mention of the sharp drop in the number of young adults needing treatment. He added that there are risks and challenges ahead: that "treatment needs to accelerate its recovery focus" if more of the ageing heroin population are to successfully complete treatment and get their lives back on track.

But he did also make some very clear statements about the benefits of a harm reduction approach, including voicing the caveat of the rise in HIV infections in Greece since the economic squeeze resulted in e.g. needle exchange programmes being closed. Altogether, the report and the accompanying documents make a powerful case for the benefits of investing in drug treatment, and bring into sharp relief the risks of losing the gains that have been made over the past 10 years which are all too real, not only due to the threat of disinvestments as drug treatment vies with other priorities in local areas, but also if there is misinterpretation of the recovery agenda to mean the enforced reduction of methadone scripts.

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Alcohol, the NTA and Public Health England

The 2010 Drug Strategy gave the NTA interim responsibility for a role in helping to improve the provision of services for severe alcohol dependence. A key priority for the organisation's alcohol team until the end of March 2013 is to support the emerging local commissioning infrastructure and to ensure that existing alcohol treatment capacity is maintained through the transitional period. Other priorities are ensuring that commissioning is in line with NICE guidance; improving compliance around reporting to the National Alcohol Monitoring System (NATMS); and supporting improvements in IBA and the development of ALNs. The latter two priorities go beyond concentrating on severe dependency in preparation for a focus on prevention as well as treatment once PHE is operational.

Commentary

The NTA have appointed Alcohol Programme managers to advise their regional teams on collaboration with other key regional stakeholders, including those who are currently leading on other areas of the alcohol agenda. As alcohol treatment takes its rightful place alongside drugs in the realm of substance misuse treatment, we are grateful to Drugscope for their comprehensive briefing to bring us all up to speed.

See http://tinyurl.com/Alc-Summary.

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Transition of contracts to Public Health, such as LES arrangements

At the end of March 2013 existing LES contracts will transfer to local authorities (if they extend beyond that date) and the continuing arrangements will become LA contracts. Clinical Commissioning Groups are responsible for local investment decisions for the NHS, including joint commissioning with local authorities. Each GP practice will be an individual provider agency.

Commentary

SMMGP is receiving numerous requests for clarification and information regarding the arrangements for LES contracts after March 2013. At the time of writing we await an update from the NTA about specifics for drug and alcohol LESs and we will put the relevant information on our website as soon as possible. In the meanwhile, please send an email to Elsa Browne, SMMGP Project Manager on elsa.browne@nta-nhs.org.uk with your questions, if you have any. This will help shape responses to "frequently asked questions". There is now a PHE website with information being added all the time

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Global State of Harm Reduction (report)

See www.ihra.net/global-state-of-harm-reduction-2012.

The Global State of Harm Reduction report 2012, which is the biennial report by Harm Reduction International which maps responses to drug-related HIV and hepatitis C epidemics around the world, presents the major developments in harm reduction policy adoption and programme implementation that have occurred since 2010, enabling some assessment of global progress. It also explores several key issues for developing an integrated harm reduction response, such as building effective harm reduction services for women who inject drugs, access to harm reduction services by young people, drug use among men who have sex with men, global progress toward drug decriminalisation and sustainability of services in challenging environments. This report, and other global state of harm reduction resources, are designed to provide reference tools for a wide range of audiences, such as international donor organisations, multilateral and bilateral agencies, civil society and non-governmental organisations, including organisations of people who use drugs, as well as researchers and the media.

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The War on Drugs and HIV/AIDS: How the Criminalisation of Drug Use Fuels the Global Pandemic

This report, which was released in advance of the International AIDS conference at the end of July in Washington, condemns the drug war as a failure and recommends immediate, major reforms of the global drug prohibition regime, in order to halt the spread of HIV and other drug war harms.

See www.globalcommissionondrugs.org/reports/.

Commentary

With so much going on around drugs policy here at home, it is important not to lose sight of international drug policy and the impact it has globally. Research has consistently shown that repressive drug enforcement drive drug users "underground" and away from public health services where HIV risk becomes elevated. There are an estimated 33 million people worldwide who live with HIV and injecting drug use accounts for a third of new HIV infections outside of sub-Saharan Africa. This report by the Global Commission on Drug Policy depicts how the fight against HIV is being won in countries where addiction is treated as a health issue and where harm reduction is a cornerstone of the approach to treatment. The rise of new HIV infections amongst people who inject drugs in European countries such Greece (European Monitoring Centre for Drugs and Addiction 2011 report), is a stark reminder that HIV prevalence is linked to economic austerity as well as drug policy. For up to date information on global drug policy and its effects in various countries, see the IDHDP web site.

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Drugs Meter and Drinks Meter

"It's not about other people, it's about you!"

We support this innovative tool - including a free Smartphone app - that measures individual drug use against that of others across the globe. It is available on www.drugsmeter.com and a "sister" one for drinking is on www.drinksmeter.com

Drugsmeter asks simple questions about substance use and provides immediate personalised feedback, along with the chance to check answers. The information pack on the SMMGP website includes a handy display poster with QR code as well as a guide for alcohol and drug services on how to use and promote this free and confidential tool to encourage self-reporting. For more info, see the Other Resources section.