Clinical & Policy Updates:
SMMGP Policy Update November-December 2012
SMMGP Policy Update November-December 2012
|Download the PDF version of this Update here! (PDF*, 486K)|
The NICE quality standard for drug use disorders sets out what high-quality care in the NHS in England should include, so that the best care can be offered to people with drug use disorders using NHS services in England.
The quality standard for drug use disorders requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole drug use disorder care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to adults with drug use disorders.
Under the Health and Social Care Act 2012, the commissioning of substance misuse treatment services will be transferred to local authorities in April 2013.
NICE will produce a local government briefing in the first quarter of 2013/14, drawing together resources for local authorities on drug services, including this quality standard and related NICE guidance.
SMMGP clinical lead Steve Brinksman, and Kevin Ratcliffe, Consultant Pharmacist and SMMGP forum moderator, were included on the expert group for the development of the Quality Standards for Drug Misuse Disorders. The document makes a welcome addition to the NICE suite of guidelines that underpin quality care for people who use drugs and alcohol.
The NTA has released statistics that shows that the number of young people requiring specialist support for alcohol problems has dropped, with the figures showing that the overall number of young people using services dropped to 20,688 in 2011/12, from a peak of 24,053 in 2008/9.
A closer look at the figures reveals that:
- 92% of under 18s who received support had problems with cannabis and alcohol (overall the cannabis figures rose from 12,784 in 2010/11 to 13,200 and the alcohol figures dropped from 7,054 last year, to 5,884 this year).
- The number of young people requiring support for problems with Class A drugs including heroin, cocaine or ecstasy has dropped to 631 in 2011/12, from 770 in 2010/11 (and a peak of 1,979 in 2006/07).
NTA interpretation of these figures is that they indicate that more young people are turning away from "the most problematic drugs". It is also acknowledged, however, that the advent of new substances and ongoing risks of using cannabis and alcohol presents a challenge. Other challenges are the threat of disinvestment to young people's services; and new drug trends. Effective routes of referral for young people are vital.
The NTA have published a report for the first time on Club Drugs, taken from the data they collect via NDTMS, from their recent 6 year reflective report. The latter report (see previous Policy Update for summary) entitled "Progress made, Challenges ahead" showed that whilst overall drug use has declined in England, analysis of the NDTMS figures also revealed an increase in numbers of people seeking treatment for "club drugs" such as ketamine and mephedrone. The numbers remain small compared to addiction to heroin and crack, but services need to respond to emerging treatment needs. Experts who contributed to the report describe some of the health harms such as psychosis, bladder pain and damage related to ketamine use.
A closer look at the numbers shows that:
- 6486 people sought treatment for a club drug during 2011, up from the 2005/06 figure (however this accounts for only 2% of adults and 10% of young people in treatment).
- Ecstasy is the most commonly treated drug, although the numbers of new adults entering treatment for ecstasy has halved.
- Mephedrone and ketamine presentations are growing year on year since 2005/06.
Club drug users typically have a good chance of responding well to treatment, which involves the techniques used to treat stimulants, such as counselling. In some cases detoxification is needed.
See also the results of the Drugscope Survey - growing problems with mephedrone.
The presentation by Christopher Hilton on "The Rise and Rise of Club Drugs" at the SMMGP conference in October attracted a lot interest as we all strive to get a handle on this growing problem. His presentation, along with others from the conference, is available on our website.
Regular contributors to our discussion forums report increased instances of mephedrone being injected by groups who would not previously have injected (non-opioid users); and the question of existing NSPs having to adapt to dealing with a different drug population arises. There are also increasing reports of it being the "cheap alternative to heroin" for people who inject drugs, in the revival of a discussion from 2009 re "M-CAT" also on our forums.
People who progress from recreational use to problematic use are as likely to be seen in primary care as in one of the dedicated club drug services.
The Drugsmeter and Drinksmeter tools are useful to encourage self-reporting - download and print the handy poster for your service from www.drugsmeter.com
The report on the state of the drugs problem in Europe presents the EMCDDA's yearly overview of the drug phenomenon. The report details an overall fall in the use of heroin across Europe, together with an increasingly complex stimulant market.
This is an essential reference book for policymakers, specialists and practitioners in the drugs field or indeed anyone seeking the latest findings on drugs in Europe. It includes an overview by country.
See also the EMCDDA published harm reduction overview for 30 countries (mostly EU member states).
See www.sgul.ac.uk (PDF).
This is an annual report on Drug-related deaths (np-SAD report) as recorded by Coroners in England, Wales, Northern Ireland, Guernsey, Jersey and the Isle of Man; Police forces in Scotland; & the Northern Ireland Statistics and Research Agency Indicator of the extent and nature of drug misuse. The findings show an increase in deaths in 2009 reportedly directly to np-SAD by coroners from England, Wales, Northern Ireland and the Islands, when compared to the numbers in the previous year's report. This year's report provides a more detailed analysis for "drug misuse" deaths for England, looking in particular at differences between age groups, mortality of drug users over 40, and poly-substance use as implication in death. The report also provides a number of indications of changes in patterns of drug use and emerging issues and makes a contribution to prevention of drug deaths.
- There were 1,883 notifications of drug-related deaths occurring in 2010 in the UK and Islands. This represents a decrease of 299 (13.7%) over the same reporting period in 2009.
- The principal demographic characteristics of those dying have remained consistent with previous reports. The majority of cases were males (74%), under the age of 45 years (70%), and White (96%). Most deaths (77%) occurred at a private residential address.
- Heroin/morphine continues to be the principal substance implicated in death in the UK and Islands. However, the proportion of deaths involving this substance fell from 53% to 41%. Methadone deaths rose by 4%.
Whilst the reduction in drug related deaths is encouraging we need to continue to be vigilant regarding harm reduction messages with people using opioids, The widespread adoption of naloxone schemes may help to reduce drug related deaths even further.
The Health Protection Agency (HPA) has published the annual "Shooting Up" report on its website.
The "Shooting Up" report focuses on Hepatitis B infection among people who inject drugs.
Key messages from the report are:
- Hepatitis B infection among people who inject drugs has declined over the last decade. One in six people who inject drugs had ever been infected with the hepatitis B virus in 2011.
- This decline most probably reflects the marked increase in the uptake of the hepatitis B vaccine among people who inject drugs. Targeting vaccination to this group needs to be maintained if the current low level of new infections is to be sustained.
The report also contains a brief update on other infections such as hepatitis C, HIV and bacterial infections including anthrax. It includes information on risk behaviours such as needle and syringe sharing.
The Health Protection Agency (HPA) also published its local area estimates in November of the hepatitis C prevalence among people who inject drugs.
This is available on their website and the estimates are intended as a guide for those who commission services for people who use drugs. NDTMS data was used to develop these estimates.
- This report provides local and regional data on the estimated prevalence of hepatitis C among injectors;
- Local hepatitis C prevalence varies widely across England, ranging from 17% to 82%;
- The national average figure for hepatitis C prevalence among injectors in England is 45%.
The prevalence of BBV transmission is of ongoing concern amongst people who inject drugs. Whilst there have been significant reductions in hepatitis B, we still have a long way to go to prevent, diagnose and treat hepatitis C and other harms related to injecting drug use. As part of the suite of training resources available to GPs the RCGP has a Part 1 and a Part 2 course in viral hepatitis, for more information see the RCGP Training Section on our website.
As the UK Drug Policy Commission (UKDPC) comes to the end of its term, they have published the above report calling for a fresh approach to drugs and drug policy. The aim of the UKDPC has been to show how independent scrutiny of evidence can produce both better results and more effective use of resources in drug policy and practice.
Existing drug policies have struggled to limit the damage drug use can cause, and now new challenges are emerging. The rapid development of new drugs is changing drug markets too quickly for the traditional methods we use to control drugs to be effective. The economic crisis may be impacting on the nature of drug use and drug problems and, with fewer resources, the capacity of services to respond will be limited further. Added to that, the speed and scale at which services are being devolved to a local level may create increasing and unpredictable variations in the kind of services offered in different parts of the UK.
In this report, UKDPC proposes a radical rethink of how we structure our response to drug problems, including a review of the legislation regarding drugs. It provides an analysis of the evidence for how policies and interventions could be improved, with recommendations for policymakers and practitioners to address the new and established challenges associated with drug use.
With this report, UKDPC aims to foster a fresh approach to drug policy: one in which evidence takes priority, creating light rather than heat in the debate on drugs, so that we can create an environment that works to reduce dependence on drugs, safeguards communities and delivers value for money.
International policy news and events from IDHDP - International Doctors for Healthy Drug Policies
Read the IDHDP newsletter (PDF) on their website.