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Tuesday 25 October 2016 Instagram
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Fewer people need drug addiction treatment

Fewer people need drug addiction treatment

Fewer people need drug addiction treatment

Over 29,000 people have recovered from addiction using drug treatment, figures from Public Health England (PHE) show. 

According to the latest annual adult statistics, specialist services were easy to access for people who need help, with 98% waiting under three weeks to get into treatment. 

In 2012/13, the overall number of people in treatment continued to fall, as did the number of people starting treatment for heroin and crack cocaine, especially in younger people. 

PHE claims these trends show an overall decline in drug use and a move away from the most problematic substances. 

Over 40s are now the largest group starting and receiving treatment. Many older heroin users are “hard to help” into lasting recovery because of entrenched addition problems. 

PHE believes services need to adapt and respond effectively to changing patterns in drug use and the needs of the wider population, such as those who get into problems with new psychoactive substances and prescription medicines. 

Rosanna O’Connor, PHE director of alcohol and drugs said: “Drug misuse is by its nature a highly challenging issue to address and the indications are that the going is getting even tougher for services in meeting the needs of an evolving and increasingly complex treatment population. 

“However, treatment cannot do it all, so it also involves supporting people who often lack personal resources into lasting recovery by helping them to find work, decent accommodation, and a positive social network such as a mutual aid group.  Local authorities are well placed to link together this network of support, working with a range of partners including voluntary and community sector organisations and the NHS.” 


It is difficult to know whether 29,000 people have truly 'recovered' from the problems that brought them into treatment. As a treatment insider, I’ve witnessed the pressure on services to generate performance figures demonstrating high rates of 'Treatment completed (drug free)' that has led to a degree of 'gaming' of the figures to please bureaucrats, whilst treatment providers all compete for contracts that depend on their ‘effectiveness’. This has been exacerbated by the introduction of Payment by Results pilots that have just been seriously criticised within a legal analysis conducted for the NCVO (See: 'Payment by results contracts: a legal analysis of terms and process', October 2013).

In reality, many drug users report feeling coerced off of evidence-based opioid maintenance treatment that has provided them with an elusive degree of enduring stability within lives of ongoing turmoil arising from multiple causes. People in treatment often describe agreeing to reduction regimes they did not want within a context that is the exact opposite of client-centred care i.e. data-centred care planning. Simultaneously, some services have become more punitive in their approach to non-compliance with newly imposed policies and procedures - rarely negotiated with service users - as treatment contracts are tendered and churn.

None of this is to deny the committed and innovative work that takes place within many services, nor the genuine, dramatic changes that many people make during treatment (irrespective of whether they become entirely drug and/or medicine free). But we should be cautious of glib interpretations of treatment data, which are likely to contain more complex truths than this article suggests.

Even with all the pressure on providers to massage outcome data favourably, PHE's own press release says "the proportion of the treatment population completing successfully remained unchanged at 15%." In other words 85% of people's treatment appears to be unsuccessful. Should we regard this as acceptable? Personally, I don’t agree that largely reducing 'success' to whether someone is drug free or not is an intelligent way to measure what drug services aim to do. But surely the headline here should focus on the 85% of people who seem to receive inadequate help? And this at a time when funding is decreasing across the public sector, with the evident implication that this situation will probably get worse, not better.

Public Health England has the unenviably difficult task of responding to these complex, politically unpopular and sometimes intractable problems, in which realistic goals may be far more immediate, such as preventing a street injector from losing a limb due to an abscess or tissue necrosis, ensuring peers have life-saving Naloxone that can revive their friend or lover who overdoses in the public toilet where they inject, or having ready access to the sterile injecting equipment that can prevent chronic, expensive infections such as HIV or Hepatitis C.

Critically, PHE must be a vocal agent for highlighting these fundamental public health issues and resist colluding with a system that prefers to focus on questionable, populist sound bites such as the claim that “Drug treatment in England continued to perform well in 2012 to 2013, helping just over 29,000 people to recover from addiction.” The public health movement in Britain has fulfilled a bold, radical, often angry, globally vital leadership role since the 1800’s. It would be a deep shame if this was subverted and instead became a politician appeasing public relations movement in the 21st Century.

There are a few significant issues with the claims reported in this article.
On a daily basis we receive both calls and emails from people wishing to stay in drug treatment, however their treatment is being withdrawn or made untenable in a number of ways. This does not reflect success in terms of impact on individuals drug use, quite the opposite with many returning to illicit markets. What it does reflect is the drive to achieve targets, not by effective practice and treatment but by identifying those that can be more readily pushed to leave services and achieve national/local targets.

While we know that there are good practitioners out there, there are also a number that cannot effectively work with this group. When I say this group this is of course a generalisation. There are a number of groups of people using a growing range of drugs, however no services are really being provided to them. The article refers primarily to those in receipt of opiate substitution therapy and not to opiate users within society more generally. One cannot conclude that people leaving treatment equates to a reducing number of drug users nationally. That is a logically bizarre claim to make. Our experience suggests that many of those leaving treatment feel forced to do so and are swelling the ranks of those involved in illicit markets.

This kind of sound bite manipulation of people's views is made even easier now that commissioning of these services (along with sexual health services and some health visiting), from any form of regulation. Commissioners are now free too (and do) specify a percentage of the treatment population that are to be removed from treatment within any financial year with significant financial penalties if not achieved.

Take these 'statistics' with a salt mine.
An earlier analysis of statistics, from the NTA when Rosanna O'Connor was there, gives a realistic view:

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