In 2016, we witnessed the highest rate in drug related deaths since records began. Every day, five people in the UK die from drugs, which is more than the number of people killed in road traffic accidents.
Why is this occurring? The current system is unable to provide the level of intervention required by people with addiction and other complex needs. There are fewer people in treatment, there are fewer people leaving treatment drug free and there are more drug related deaths than ever before. Coupled with treatment budgets being reduced by 30% since 2013 and set for yet further reduction, then it is inevitably we will witness a further increase in preventable unnecessary deaths.
In January 2017, a review by Public Health England stated that the drug misuse treatment system in England is performing well. Yet, with the dreadful upwards trend over the past five years of drug related deaths and successful treatment completions of heroin users standing at an all time low, this statistic is far from accurate. As a public health care issue, addiction treatment has gone backwards, is failing – and Public Health England as well as commissioners and other similar services should make this issue a priority like other areas of care.
There is some evidence that ageing UK heroin users tend to have complex needs that have not been addressed properly accounting for a larger portion of such deaths.
Other evidence suggests changes in the availability of street heroin, socio-economic changes (including cuts to health and social care, welfare benefits and local authority services) and changes in treatment services and commissioning practices may also have contributed to these increases. Whatever the reason, unless we address the critical factors, the number of dead people will continue to rise.
There is no real prospect of reducing harm or reducing deaths by the UK Government who recently published the 2017 Drug Strategy. The lack of focus on harm reduction, an evidence-based response that protects people and ultimately saves lives, is alarming, especially at a time when drug-related deaths are the highest on record.
We are still obsessed by this idea of recovery, but the fact is more people are dying of drugs whilst the government still believes the same old strategies will somehow eventually work. Policy should not be measured by financial savings, or by quick-fix illusory recovery. The failure of policy should be measured by the dead bodies.
Cuts in drugs and alcohol funding, along with the lack of political leadership and a lack of priority in England, is having a major negative impact on some of the most vulnerable people in our communities. Treatment budgets being reduced by on average 30% across the country since 2013 and look set for yet further reductions.
We are witnessing the end of the best drug and alcohol treatment system in the world. Its decline is being marked by lost opportunities and an increasing death toll as we fail to respond to rapidly increasing numbers of drug related deaths, health needs, and fail to tackle issues such as hepatitis C, HIV and liver disease.
The introduction of the “revised government drug strategy” – with a much greater focus on the politically more palatable ‘recovery agenda’ came about in 2010. A genuine recovery agenda can be effective but it has to be complemented with the harm reduction way of working. This doesn’t mean getting people off the medication that many had been doing so well on and forcing them towards abstinence. Treatment has to go back to being about individual patient care and level of quality not about throughput and homogeneity. Harm reduction efforts will not prevent all deaths. They won’t make all heroin use safe. But they will reduce the amount of harm done by these drugs.
We want everyone to recover from addiction and the overall aim of Iceni is to assist people in becoming drug/alcohol free. This will never change, but we have to accept that for some, this may take many years and many attempts.
We have to keep people safe, until such a time they can ‘recover’ however, the recovery agenda is an ideologically driven “abstinence”. It goes against all the evidence for best practice in drug treatment and is contributing to this shameful rise in deaths. Is it simply a coincidence that since the shift in policy in 2010 from reducing harm that drugs cause to one which promoted abstinence, more people have lost their lives than ever before?
Budgets are important – but this issue will only grow if commissioners only want the cheapest option – not the most healthy one. It is acknowledged that commissioners and local authorities are facing huge challenges in the form of reduced budgets and increasing demand for services. However, there appears to be little evidence that this relentless cycle of tendering is improving the quality and effectiveness of services and outcomes for service users. In fact, it can destabilise services, reducing the morale, quality & number of staff in the sector & producing a highly competitive environment, which is at risk of eroding partnership work not bound by contractual ties.
What can be done to address the dreadful rise in deaths? The answer is not difficult. We should do what happens in other areas of medicine – and follow the evidence of what works. What works for the vast majority of long term heroin users with complex health needs is well supported maintenance prescribing while addressing other health issues and social needs.
We are told that the majority of people who have died were not in treatment – although this claim that the majority would have not been in treatment at least some time is difficult to believe and not backed up. We need a balanced system, based upon evidence that balances reducing harm and drug related deaths alongside approaches that nurture longer term recovery, which is both pragmatic and sensible. Some of our recommendations include:
We know that being in effective treatment protects people against dying of an overdose so we need to improve the reach and retention rates of services.
Take-home Naloxone should be available free of charge, and promoted widely, to those most likely to witness an overdose and to those organisations who come into contact with drug users i.e. housing providers.
Cardiac arrest and hault of bodily functions can be caused by cutting off drugs/alcohol cold turkey after a long term addiction. Wherever there are significant numbers of people injecting in public and people dying then there is a clear need for supervised injecting facilities.