The seven year itch

After seven years, England finally (published on 13 July 2017) has a new Drug Strategy  simply, if somewhat strangely entitled “2017 Drug Strategy”. Although some parts of the strategy apply to other parts of Great Britain, the healthcare, education, housing and social care strategies apply only to England and the criminal justice ones only to England and Wales.

The strategy is similar to many of its predecessors and announces no new radical change of direction despite an international growth in opposition to the war in drugs over the last decade with a growing number of countries who have either legalised or are planning to legalise at least cannabis use in some form or other.

Despite calls for drugs to be treated primarily as a health issue, the Home Office retains ownership of the drug strategy and will chair a newmulti-departmental Drug Strategy Board. The strategy says that a new national Recovery Champion will be introduced (which I guess, is the 2017 term for Drug Czar) who will sit on the board with a remit to:

• provide a national leadership role around key aspects of the recovery agenda that support sustained recovery, in partnership with PHE;
• support collaboration between local authorities, public employment services and the Health and Work Programme, housing, criminal justice agencies, and other partners;
• seek to address the stigma faced by people with drug or alcohol dependency issues; and
• act as a ministerial envoy visiting different communities, providers and local recovery champions.

Structure

The strategy is structured into four sections:

1: Reducing Demand

We will take action to prevent the onset of drug use, and its escalation at all ages, through universal action combined with more targeted action for the most vulnerable. This includes placing a greater emphasis on building resilience and confidence among our young people to prevent the range of risks they face (e.g. drug and alcohol misuse, crime, exploitation, unhealthy  relationships).

2: Restricting supply

We will take a smarter approach to restricting the supply of drugs: adapting our approach to reflect changes in criminal activity; using innovative data and technology; taking coordinated partnership action to tackle drugs alongside other criminal activity.

3: Building recovery

We will raise our ambition for full recovery by improving both treatment quality and outcomes for different user groups; ensuring the right interventions are given to people according to their needs; and facilitating the delivery of an enhanced joined-up approach to commissioning and the wide range of services that are essential to supporting every individual to live a life free from drugs.

4: Global Action

We will take a leading role in driving international action, spearheading new initiatives e.g. on new psychoactive substances,  sharing best practice and promoting an evidence-based approach to preventing drug harms.

Key features

Harm reduction

The strategy continues with an emphasis on recovery, which was the defining feature of the last strategy, but acknowledges the recent rise in drug-related deaths, particularly among long term opiate users with associated health problems and complex needs. The focus in the new strategy is on “individually tailored treatment” which is an acknowledgement that not everyone wants or is ready for recovery and that harm reduction remains an important approach for many.

Employment and meaningful activity integrated into recovery

Acting on Dame Carol Black’s report to support recovering drug users into constructive activities and employment.

NPS

The strategy includes a section setting out a targeted approach to tackle new psychoactive substances (NPS) which involves both a PHE-led early detection system and establishing a NPS clinical network of leading clinicians and experts to identify patterns and harms, and agree
appropriate clinical responses to NPS problems.

Chemsex

Targeting interventions at (mainly) men who have chemsex is also highlighted with PHE to publish guidance on best practice including “targeted interventions and close collaboration between sexual health services and other relevant services including community groups.”

Image and performance enhancing drugs

IPEDs are also highlighted as an issue requiring attention although the response is less clear, acknowledging that next steps are more about understanding who uses IPEDs and why in order to formulate an effective response.

Court-ordered treatment

As already announced by the previous Justice Secretary Liz Truss, the government intends to increase the use of treatment as part of a community sentence.

Drug use in prison

The main action points for tackling drug use in prison include:

• Governors to work in partnership with health commissioners to co-commission integrated and patient-focused drug treatment programmes.
• New substance misuse outcome measures against which governors will be measured.
• 300 drug dogs to detect NPS.
• A more extensive drug testing programme (in my opinion, a likely waste of resources which would be better invested in treatment).
• Improving continuity of care with community services

Conclusion

The strategy also promises more robust evaluation, including better segmentation of recovery rates in order to assess whether new initiatives are successful. The document does not, unsurprisingly, address the likely impact of the reduction of funding for both drug treatment and health promotion in the last seven years since the previous drug strategy.

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