Clinical & Policy Updates:
SMMGP Policy Update December 2014
|Download the PDF version of this Update here! (PDF*, 76K)|
Available at www.nta.nhs.uk (PDF).
The national drug statistics and trends are analysed in the report published in November 2014 - Drug treatment in England 2013-14. The annual report on drug stats revealed a slowing in the rate of people successfully overcoming addiction. From these figures, PHE suggest that the challenges that local authorities and the NHS need to pay attention to are:
- an ageing population in treatment, who have experienced years of drug related harm and who need intensive multi-agency support (e.g. employment and housing services);
- last year's increase in drug related deaths across virtually all substances; and
- new psychoactive substances or so-called "legal highs".
The total number of people in treatment from 2013-14 was 193,198. A total of 29,150 adults left treatment ("recovered from their addiction") in 2013-14, around the same number as the previous year. The number of adults starting treatment for heroin or crack cocaine increased slightly 45,739 in 2012-13, to 46,001 in 2013-14. Waiting times remain low (majority being admitted within 3 weeks). Other points of interest are:
- Among the 18 to 24 age group, numbers fell from 3,907 to 3,438 while in the 40+ age group numbers increased from 13,233 to 14,663.
- Cannabis and cocaine - the number of people starting treatment for cannabis increased from 11,280 in 2012-13 to 11,821 in 2013-14; for powder cocaine, new cases increased from 7,372 to 7,782.
- Around the same number of people successfully completed their treatment programme in 2013-14 (29,150) as in 2012-13.
- Most people (81%) were in treatment for heroin or crack cocaine, while cannabis was the primary drug for 9% and powder cocaine for 5%.
Despite (according to the PHE comments on this year's drug stats report) the overall positive trends of recent years - the 2013 report shows a plateau in the rate of the number of people leaving treatment having successfully completed. In the cautious PHE-speak that we are becoming accustomed to, in response it is further "suggested that local authorities and NHS may want to adapt their services..." Come back, NTA, all is forgiven.
Available at www.nta.nhs.uk (PDF).
A report published by Public Health England during December 2014 shows a 5% increase in the number of people in treatment for alcohol use disorders and 6% more overcoming their dependency than last year. 93% of people were waiting less than three weeks to start treatment. Of the 9 million adults who drink at levels that pose some risk to their health 1.6 million adults show some signs of dependence.
The alcohol statistics show that the numbers of people in treatment are increasing and there is a slight upturn in the numbers of those overcoming their dependency on alcohol.
To support the primary care workforce, SMMGP has developed an Advanced Certificate in the Management of Alcohol Use Disorders aimed at GPs and other practitioners who wish to progress their skills to "Practitioner with Special Interest" level and the first cohort of 28 participants commenced work on the course in late December. We are currently still accepting enrolments, provided the course work can be completed by the end of this year. For more information about this exciting and much needed new course, see our website.
Available at www.nta.nhs.uk (PDF).
In early 2014 PHE surveyed residential rehabilitation (rehab) providers and substance misuse commissioners to get a snapshot of the current state of the rehab sector. The survey was held in response to concerns within the sector that changes to commissioning for drug and alcohol treatment was having an adverse impact.
The report from the above survey has now been published and the majority of commissioners said that they intended to keep investing in residential rehab services, and local funding for rehab was reported to have remained much the same after April 2013. Over three quarters of residential providers said they have either increased or maintained occupancy in the past five years.
The survey also raised questions about the extent to which this largely positive picture may continue. Most commissioners reported that social care budgets continued to be the primary funding stream for residential rehab and, although many had maintained levels of funding, a degree of uncertainty had emerged about longer term sustainability at a time of reducing local authority budgets. Many providers said they were apprehensive about the future and how they deliver services was being adversely affected in some cases. In light of this, PHE will carry out a follow-up survey in early 2015 to see whether the situation has changed.
It seems that the residential rehab sector has held up very well considering that outcomes are not always as good as the 60% managing to "overcome dependence" in the "best performers" rehabs as quoted by PHE in the report and the financial pressures that have been exerted on the system.
"The Role of Residential Rehab in an Integrated Treatment System" published by the NTA in 2012, is a good companion read to this report and we reported on it in the Jul-August 2012 Policy Update. Concerns have been raised about value for money as residential rehab is relatively expensive consuming 10% of the central budget for 2% of the people on treatment - but they remain an essential service for the right person at the right time. For historical NTA publications, see the NTA legacy website.
Home Office report, October 2014
From the Home Office, a report was published in October 2014 on an expert panel review of new (or novel) psychoactive substances, including synthetic cannabinoids.
The Government response to the report by the expert panel includes the commitment to work with PHE and improve information recording and sharing on drug- and NPS-related health and social harms through local and national professional/practitioner networks; to better support these networks by sharing information gathered through the Drugs Early Warning System (DEWS) more widely where appropriate; and to disseminate effective practice in drug treatment and intervention. Read the response in full (PDF).
PHE, December 2014. Available at www.nta.nhs.uk (PDF).
Public Health England has responded to the challenges presented by the rise in use of NPS by producing a toolkit aimed at commissioners.
The toolkit acknowledges that there is no complete picture of NPS prevalence, but it is known from various surveys that use of these drugs is lower than more established drugs such as cannabis, powder cocaine, and alcohol.
However, reports do suggest that NPS use is higher in some subgroups, such as clubbers and men who have sex with men, and is more prevalent in rural areas.
The aim of the toolkit is to assist local authorities to respond to NPS use and problems in their areas. It sets out the ever-changing legislative landscape against which NPS (or "club drugs", "designer drugs" or "legal highs") are available and provides a section on how to respond to acute NPS problems (interventions and treatment) and concludes each section with a series of key questions for commissioners.
NPS is a topic frequently suggested for future SMMGP CPD training days. Steve Brinksman is on the expert group of Project NEPTUNE (Novel Psychoactive Treatment UK Network). The project is working to harness the emerging knowledge and expertise of treatment for NPS use in the UK and to produce the first set of clinical guidelines for detection, assessment and management of NPS users; and will publish its work later this year. Read more about Project NEPTUNE here.
Last year - partly in response to a request from SMMGP after repeated enquiries about misuse of the above medications on our forums - an expert group headed up by pain consultant Dr Cathy Stannard was established with a brief to provide guidance for healthcare providers and clinicians on the risks of misuse related to pregabalin and gabapentin.
The expert group's advice for prescribers on the risk of misuse of pregabalin and gabapentin was published in December 2014, and calls for a balanced and rational use of these medicines. The advice will be of use to local healthcare providers and clinicians.
The document is available (in pdf format) in the Guidance Documents section on our website.
"From small acorns..." The consistent requests on our forums and at every single one of our "Addiction to Medicine" training days for help and guidance around the misuse of "gaba" and "prega" drugs had all but become deafening. We are pleased that we were able to convey these concerns from primary care to the powers-that-be and contribute to the expert group that was convened (at least partly in response to our nagging repeated requests that something be done to help prescribers).
In a nutshell, the power of SMMGP lies in being a conduit of the needs and concerns of primary care practitioners working in the drugs and alcohol field, via our close strategic ties with Public Health England and other partners. Keep posting on our forums, and provide a barometer of what is going on.
Dr Cathy Stannard presented at our annual conference in October, her presentation "Pain Management in People with Alcohol and Drug Problems" is available on our website (as are others from the day).
SMMGP is part of the Naloxone Action Group (NAG) established in October 2014. The lack of national guidance or a naloxone programme in England has led to a postcode lottery in terms of the provision of naloxone. From information provided to NAG, over 60 local authorities are seen to have programmes that enable access to naloxone, but over 60 others indicate that that they no current plans to allow naloxone nor is it a priority. The Naloxone Action Group is developing key actions with a view to increase the availability of naloxone to the people that need it most.
Available at www.ihra.net (PDF).
A report by the International Harm Reduction Association, endorsed by other groups, finds that there is a global crisis in funding for harm reduction in drug treatment.
This report follows the story of HIV-related harm reduction funding over time and illustrates why an AIDS-free generation will not be possible if the present rate and pace of investment (or lack thereof) continues. It highlights the changing donor landscape and the particular problem for harm reduction funding in middle income countries with decreasing international donor support.
While the challenges are considerable, the report lists concrete actions that donors, governments and harm reduction advocates can take to build a fully funded, sustainable harm reduction response.
Strategic investment in HIV programmes targeting key populations is required, regardless of country income status.
Bilateral investments must be re-prioritised, and existing resources in drug policy should be rebalanced in favour of health and harm reduction.
The IHRA report provides a fascinating insight into the state of funding for harm reduction against the backdrop of the global fight against AIDS.
Closer to home, investment in drug treatment should be investment in harm reduction from one end of the spectrum to the other, period. Whoever would have thought that in the UK - long a bastion of world class treatment for problematic drug use in terms of providing good, solid harm reduction - it will mainly exist as a ghost of Drug Strategy past.
It is disheartening - to say the least - that some commissioners do not appear to pay heed to this really basic fact about allocation of funds in their localities: harm reduction saves lives. It remains the responsibility of all who work in the system and who are involved in drug treatment to continue to advocate for best practice in harm reduction which begins with meeting and treating people wherever they may be. So many important issues are currently at risk: provision of naloxone, treatment for Hep C are two of the most pressing ones.
John Jolly, CEO of Blenheim puts his concerns this strongly in his December blog: "Unless... a powerful alliance of providers are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of Local Authority cuts, I fear that the world's best treatment system is about to be decimated in April 2015. I fear for the people we help. I fear that commercial self interest will mean as a sector we will walk quietly off the cliff".