Issues for drug and alcohol policy

in the UK

Andrew Brown

Director of Policy Influence and Engagement

Trends in illicit drug use (excluding mephedrone) in the last year among

adults, by age group, 1996 to 2013 to 2014, Crime Survey for England and

Wales

Around 1 in 11 (8.8%)

adults aged 16 to 59

had taken an illicit

drug (excluding

mephedrone) in the

last year, which

equated to around

2.7 million people.

Nearly 1 in 100 people between the ages of 15-64 in Great Britain are

estimated to be high risk drug users - injecting, long term or regular use.

Age-standardised mortality rates for deaths related to drug poisoning and

drug misuse, by sex, deaths registered in 1993–2013

In 2013, there were 1,957

drug misuse deaths, an

increase of 20% from 1,636

deaths in 2012 following a

decrease over the last two

years.

The proportion of female drug

poisoning deaths that were

related to drug misuse was

highest in 2013 at 56%.

Age-standardised alcohol-related death rates in the UK, per 100,000 of

population

Supply issues

● The rise of the ‘dark net’ and use of the

internet as the way that people can access

legal, illegal drugs, and knock off medicines

● Organised crime and the issues of modern

day slavery, where drugs (including alcohol)

are a significant factor in the sexual

exploitation of children and women, and are

also a major part of the issue of in-country

drug production (the Vietnamese gangs

involved in cannabis factories)

New Psychoactive Substances

● The expert panel review and the government’s

response will lead to new legislation to ban the

sale and import of psychoactive substances (NB

no possession offences)

● New guidance to prison governors about

prisoners found with NPS will have their

sentences extended.

● An increasing focus on vulnerable people

(homeless people, young drug users, some

injecting drug users) in the responses to NPS,

moving away from the idea that these are drugs

that recreational users are attracted to.

There were about 250

recorded incidents of NPS

being thrown into prison in

2014 compared with 36 in

2013

Alcohol

● Integration between drug and alcohol

services, which might create better

services, or might just exclude high

risk drug takers

● Public Health England are focusing

on alcohol harms

● Local areas with the highest needs

seem to be most likely to be reducing

funding for alcohol services

Crime and punishment

● The evidence that drugs (including

alcohol) are a driver of crime.

o 53% of violent incidents involving

adults were alcohol-related

● The tailing off of the heroin epidemic

has accounted for about 1/3 of the fall

in property crime in recent years.

● Can policy makers interest the police in

helping to ensure that Directors of

Public Health are investing in drug and

alcohol treatment.

Investment in treatment

● A review of commissioning last year and

DrugScope’s State of the Sector report has

shown that resources for treatment services have

reduced in the last two years.

● The response has been to introduce a Health

Premium (£5 m) on the successful completion of

treatment, and to add a condition to the Public

Health grant which requires local authorities to

“have regard to the need to improve the take up

of, and outcomes from, their drug and alcohol

misuse treatment services”.

Treatment and Recovery

● How important is medication in the treatment of drug and alcohol

problems, and what dose and length of time is best for patients to be

proscribed (particularly for opioid substitution therapy)?

● A review of the clinical guidelines for treatment (which will reinforce the

clinical view that OST is an important part of the armoury)

● How should treatment systems respond to ‘use on top’ (where people in

receipt of methadone (or similar) are still using street drugs)?

● For those in recovery what is the offer? There’s a policy focus on

employability and employment opportunities.

● Is it acceptable to sanction drug and alcohol users who are in receipt of

welfare benefits who refuse drug or alcohol treatment?

Drug related deaths

● The unexpected (and large) rise in drug related

deaths last year is something that worries policy

makers and drug treatment services.

● The government have committed to making

Naloxone (the medicine that reverses opioid

overdose) more widely available in the

community.

● A stronger focus on the wider health issues for

an aging drug using population – for example in

identifying and treating people with hepatitis C.

Multiple needs

● The Making Every Adult Matters (MEAM) coalition

● Updated guidance on dual diagnosis (mental health and substance use as

co-existing conditions)

● National Institute on health and Clinical Excellence (NICE) guidance

Law reform

● Can policy makers continue to ignore the chorus of liberal and libertarian

calls for creating a regulated market?

● What difference will international experience with different regimes make?

● Will the government return to considerations of a Minimum Unit Pricing for

alcohol particularly if/when it is introduced in Scotland.

● Will different parts of the UK want different drug and alcohol policy and

law?

The elephant(s) in the room

● The precarious position of

publicly delivered or

commissioned services

and the local state – for

example that there will be

system and service

failures in adult and

children’s social care in

particular.