The eagerly awaited review into drugs by Dame Carol Black has been published. She pulls no punches, highlighting a number of flaws with the way drug treatment and prevention is organised and monitored. Obviously it’s better and cheaper to prevent problems with drugs developing in the first place rather than waiting for them to happen. Dame Carol urges the government to provide the resources needed for effective prevention activity known as “harm reduction”.
Beyond prevention, Dame Carol points to significant failing in the drug treatment sector, from the start of treatment through to termination, no one is spared her critical eye. Describing the commissioning of treatment as messy and complex she calls for improved and integrated service design and delivery. This requires government leadership – as it stands there are six departments involved with drug policy. Her recommendation is that drugs should be viewed as a health issue not a criminal one. That’s a significant reframing if it is accepted, as it would signal that people who have problems with drugs are not deviant but in need of support.
It’s not just the need for national leadership but local management too. In other areas of health, it is often the medical consultant who takes on this pivotal role. This has not been an option for local specialist drug treatment as consultant psychiatrists in addiction are very few and far between now. Viewed as expensive and unnecessary, a decade of funding cuts has depleted this part of the workforce. When budgets are tight it is easy to see how the most expensive parts of the team are sacrificed in order to secure contracts to provide treatment.
Doing without the experience and skills of medical consultants is unimaginable in any other area of healthcare. This more than anything signals the value or rather the lack of value given to this group of patients.
This is a tough time to be calling for additional resources. People who develop problems with drugs in particular don’t receive much in the way of public sympathy – many view the problem as self-inflicted. But Dame Carol makes clear that even if you lack empathy for these individuals, there is a sound economic case for investment in the sector. Resourcing treatment has the potential to provide gains to society more generally, for example reducing crime, while in parallel improving treatment outcomes for those accessing services.
Dame Carol also highlights the current treatment focus on heroin and crack cocaine use, leaving the increasing numbers who have problems with cannabis and cocaine with an inadequate service. The rapid but largely ignored rise in those seeking help for their use of cannabis is something myself and colleagues have been investigating since we first observed this trend in 2014. What makes this tricky is that unlike heroin there is no substitute drug like methadone that can be given to those trying to quit cannabis.
One of the greatest scandals of the last decade is record numbers dying as a result of drug use, something callously explained away by government ministers as something that can be attributed to an “ageing cohort” of drug users. Bear in mind this is a group that currently has a life expectancy not seen since our monarch was Queen Victoria. Again, this would not be viewed as acceptable if the same rate of mortality was evident for those with diabetes or heart disease. Dame Carol rightly suggests that given the high rates of additional health problems people using drugs have, they should be offered timely access to respiratory health services and mental health services, as just two examples of what they would benefit from.
We are not short of reviews on drug policy in the UK and the message they all share is the urgent need for reform. We must hope that this government’s newfound love for science and evidence extends to the thorny issue of drugs.