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-August 2013

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Adobe Acrobat DocumentDownload the PDF version of this Update here! (PDF*, 74K)

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National prevalence statistics 2012/13

Two sets of national statistics showing prevalence of drug use among adults and school children in the population were published during July 2013. The main relevance of highlighting substance misuse trends is in indicating possible nature of future treatment demand. However, as household surveys, the prevalence figures do not capture data from key groups e.g. students or homeless people.

"Drug Misuse: Findings from the 2012/13 Crime Survey for England and Wales" (Home Office) (age 16-59)

www.gov.uk

Highlights from the survey show that:

"Smoking, drinking and drug use among young people (aged 11-15) in 2012" (Health and Social Care Information Centre)

www.hscic.gov.uk

Overall, the survey shows that:

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Deaths related to drug poisoning in England and Wales 2012

Drug related deaths statistics for 2012 were published in late August followed by a wave of media and press reporting which focussed on the fact that deaths from novel psychoactive substances such as PMA "had soared".

http://tinyurl.com/2012DRD

Key findings include:

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Drug-related deaths in Scotland in 2012

The statistics of drug-related deaths in 2012 in Scotland, broken down by age, sex, selected drugs reported, underlying cause of death and NHS Board and Council areas is also available this month.

http://tinyurl.com/Scot12

Commentary

Whist it is good news that the trend is towards an overall reduction in drug related deaths, there remains 50 drug related poisonings a week, 11 of these from heroin/morphine. These figures support the continuing spread of the provision of naloxone, together with sound harm reduction advice, to people in drug treatment. We echo concerns from others in the field about the increase in deaths from tramadol and novel psychoactive substances.

The guest blog post on our website by David Henderson, Head of Substance Misuse Services, South Tyneside NHS Foundation Trust, is a heartening example of how Gateshead tackled the problem of drug related deaths in their local community in a practical and meaningful way. Congratulations to the team on their award.

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Independent Expert Review on Opioid Replacement Therapies (ORT) - (Scotland)

The independent expert group report on Opioid Replacement Therapies (ORT) was published on the Scottish Government's website during August 2013:

It concluded that ORT, in particular methadone, is supported by a strong evidence base, that local services are largely providing it in accordance with national guidance and its use should continue in Scotland. However, it also concluded that ORT must be one of a full range of treatment options across the country ranging from community to residential rehabilitation, and services should become more aspirational in relation to supporting individuals' recovery. Other key recommendations are:

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New tools available for drug and alcohol workers (PHE) and commissioners (JCP-MH)

The PHE alcohol and drugs team is developing a number of tools and resources to support improvement of effective local responses to alcohol and drugs-related ill-health.

Routes to Recovery - mapping manual

http://www.nta.nhs.uk/uploads/phemappingmanual.pdf (PDF)

Public Health England has published a new mapping manual for drugs workers called "Routes to Recovery via the community".

This manual is "a user-friendly, client-focused tool, designed for busy community service based key workers, responsible for large case loads of people". It includes elements of effective interventions, such as Motivational Interviewing and cognitive behavioural approaches. Node-Link Mapping is used as a unifying element, presenting clinical tools in a simple to use map format. It is designed to be a practical tool to support effective recovery focussed interventions for people who use drugs problematically.

Printed copies of the manual have been distributed to providers and other partners in the treatment sector by PHE's Centre teams or the PDF can be downloaded from the NTA's "legacy" website.

Improving local responses to alcohol ill health

The Alcohol stocktake self-assessment tool is available now and provides a structure for local areas to take a systematic review of their system for responding to alcohol-related harm in the adult population. It explores the integration of activity by all local partners across all levels of prevention and covers the interventions that evidence indicates are most effective.

The tool provides an opportunity to benchmark against evidence-based practice, facilitating the identification of effective practice, any gaps in provision and highlighting possible improvements.

Guidance for Commissioners of Drug and Alcohol Services

"Guidance for Commissioners of Drug and Alcohol Services" is produced by the Joint Commissioning Panel for Mental Health (JCP-MH) and is a collaboration co-chaired by RCGP and RCPsychs and brings together leading organisations and individuals with an interest in commissioning for mental health. It is part of the implementation arm of the government health strategy "No Health Without Mental Health".

http://www.jcpmh.info/good-services/drug-and-alcohol-services/

Key messages for commissioners from the guidance are:

  1. Investment in drug and alcohol services gets results. Treatment as part of a co-ordinated public health approach is proven to be cost effective and disinvestment brings with is a risk of reversing gains made in recent years.
  2. A strong evidence base exists for the range of interventions that are effective in substance misuse, and commissioning should be based on this evidence using NICE Quality Standards.
  3. The treatment system should be equipped to respond to the full range of complexity of need.
  4. A skilled workforce, with appropriate supervision and working to their competencies, is key to delivering good outcomes.
  5. Collaboration and partnership gets results - NHS and voluntary sector have a contribution to make.
  6. Commissioning of drug and alcohol services should be based upon accurate and up to date information about local needs.
  7. Commissioners should ensure that local services have clear leadership (clinical and managerial).
  8. Commissioning of drug and alcohol services should be outcome based and make use of data.
  9. Services should place recovery at the centre of their approach, central to strategic decision making.
  10. Treatment is not simply about patients and should address the needs of families and carers and wider social networks.

Commentary

Within the new commissioning landscape with its emphasis on localism there is an increasing need for practitioners to understand and become involved in the commissioning process. Any guidance and tools we can utilise to do so will help this process.