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It’s official: Heroin treatment under threat
The ACMD found that the current quality of drug treatment in England varies significantly and is being compromised by frequent re-procurement and shrinking resources.

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The Advisory Council for the Misuse of Drugs. the government’s official advisers, just (23 October 2015) published the second instalment of their report on treatment for heroin users.

The first part of the report was published in November 2014 and found that imposing a time limit on treatment would result in the majority of addicts relapsing into heroin use with serious unintended consequences, including increased drug driven crime; heroin overdose; deaths and the spread of some blood borne viruses.

This part, formally entitled:

How can opioid  substitution therapy (and drug treatment and recovery systems) be optimised to maximise recovery outcomes for service users?

is very critical of the current state of drug treatment/recovery.



The report comes to the following main conclusions:

1: Outcomes are difficult to achieve but all can achieve some

Overcoming heroin dependence is difficult; optimism is important but within realistic expectations. Some people will become free of dependency, while others will need ongoing medication; the ACMD says its important not to discriminate against this latter group because this will limit the recovery outcomes they can achieve.

2: High quality opioid substitution therapy is cost-effective

The ACMD uses strong language in its defence of treatment: “There is strong evidence that high quality drug treatment for heroin users is cost-effective and the impact of locally commissioned services are as, or more, important to service user outcomes as the service users themselves.”

3: Local recovery-orientated drug treatment systems are required

The ACMD regarded this issue as requiring more exploration because local systems differed significantly; the report lists four different common”cultures”:

  • some systems appear to be ‘risk averse to attempting abstinence’ for fear of relapse and harm to service users;
  • others operate ‘slow reductions’ which risk being poor quality, low dose opioid substitution therapy;
  • some encourage abstinence attempts once a service user has built sufficient assets; and,
  • others may encourage abstinence attempts ‘too early’ resulting in relapse.

4: Does the system have low expectations of heroin users in OST?
ACMD heard evidence that ‘hope and optimism’ for recovery outcomes has improved and at least three-quarters of services users surveyed reported service expectations of recovery and abstinence. However, this appears to be variable among staff and services and complicated by different ideas about ‘what works’ or what is ‘best for service users’.

5: How good is opioid substitution therapy?
The ACMD is extremely critical of current provision. It expresses serious concerns about whether service users get enough of a ‘therapeutic dose’ of quality clinical and psycho-social interventions, particularly in the context of shrinking local resources.
There is concern that some services do not appear to be providing adequate doses of opioid substitution medication, or enough monitoring of ‘use on top’ (see 6 below) by drug tests, or enough use of supervised consumption.
The ACMD was very concerned that the interventions with the strongest evidence-base: contingency management, behavioural couples’ therapy and family therapy do not appear to have been widely implemented.
Access to mutual aid (peer support) appears to be more widespread and growing, but there was mixed evidence on how much different treatment providers facilitated the development of mutual aid services and encouraged service users to make use of them.

6: Use on top

Research has consistently shown than many heroin users getting methadone or other substitute medications continue to use heroin “on top”, particularly when they first get a prescription. Those who stop using heroin within six months of starting treatment are much more likely to have positive outcomes. There are national guidelines in place to try to minimise continuing use of heroin. The guidelines recommend regular random drug testing; but the ACMD was concerned to hear that the use of drug testing is becoming less frequent due to cuts in resources.

7: Difficulties in accessing other services

Dependent drug users normally have a host of problems and require a co-ordinated response from a range of services. The ACMD is particularly concerned that access to treatment for both mental health problems and hepatitis C appears to be variable. This is of great concern as ongoing physical and mental health problems are obviously a barrier to achieving recovery outcomes.  The ACMD would also like to see more resources invested into helping recovering drug users find work and says that tackling stigma among employers is a key issue.

recovery domains

8: Why is drug treatment so variable?

One of the key reasons highlighted by the ACMD is the constant re-commissioning of local services, which together with cuts in resources, appears to be damaging many treatment systems.




The ACMD found that the current quality of drug treatment in England varies significantly and is being compromised by frequent re-procurement and shrinking resources.

The report calls for investment in drug treatment to be protected and a national quality improvement programme to be implemented. It also recommends that ‘churn’ in local systems should be reduced and that more should be done to stop discrimination against people in recovery from heroin addiction.

Annette Dale-Perera, co-chair of the ACMD’s Recovery Committee, said:

Government has done well to achieve widespread recovery-orientated drug treatment for heroin users. Treatment protects against drug related death, ill health, chaos caused by addiction, and crime and can help people turn their lives around. We need to act to improve and not lose this valuable asset to society.

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6 Responses

  1. I think this is one of the most honest study’s they have produced.
    The issue of continued commissioning is spot on, (we lost funding when a new service took over). 5yrs would be better.
    Local recovery communities need to be better supported.
    More connection with MH & other support services.
    Not to sure about a National Quality Improvement Program, I think this would be better done on a county by country basis.
    All in all an honest assessment of the treatment system.

  2. I was on methadone for over 10yrs and as a result when i finally did come off methadone and stopped using that methadone because i had not used illicit drugs for a long time and wanted to be “Drug free” and the next couple of years of my life when i did stop the methadone were the hardest I have ever lived, my mood became so low, it was horrendous as a person who has always been upbeat through out my life and even as an addict and methadone user i couldn’t believe how depressed I was feeling, my family said it was awful watching me, I lost the will to live literally and after doing almost 2yrs clean of drugs and methadone i went back to my doctor and asked to be prescribed methadone again or I would of ended up having to go buy street heroin, you see i did not want methadone to give me any kind of buzz or high I wanted it just to be able to get out of bed in the mornings to be well again, to be bothered getting dressed to just function and not from waking just wanting bedtime to come round as quick as it could, I was sleeping throughout the day and I can’t ever recall feeling that low in my lifetime before or since, my doctor did prescribe me methadone back in the end and within 24 hours the change was dramatic i came back to life, I am still on that methadone now almost a 8 years on although only 25mls daily 1ml/1mg and I haven’t lived the life of an addict for almost a decade now, but it made me realise that the methadone is a far worse fight to break away from than the heroin ever was, to do cold turkey off heroin can last 5 days usually 3 or 4 days and it’s over with but methadone is in your system for much longer usualy weeks and in some cases a couple of months ….. it does not get into your bones like some people seem to think it does but that’s an old wives tale but when they give it us to stop us withdrawing we are just that happy to have something to stop a cold turkey coming on that we just neck it as soon as we get it and then every 24hrs there after but no one said to me anything about it being a mood suppressant, not one thing and this is where it beat me after at least 10 years taking it I do wonder if my body has got that used to it that i might always need it just to function, I have decided to try and come off it again, last time I stopped it dead at 20mls daily and after my doctor agreed to give me painkillers and some sleeping tablets to last me a couple of weeks i stopped going for my script and I got over the cold turkey off that 20 mls quite easily, I was a bit rough for a week or two and i did feel pretty shitty but i could handle it until my low mood kicked in and even then i went on for a long time thinking “It will pass” and “it can’t go on forever you are going to wake up one morning and it will be gone” and I so wanted to do this it was everything i had spent that last few yeas heading towards my life was in a really good place and so for what happened to me i was so upset, i’d tried my absolute hardest and still i had not beat it, however I am going to stop my methadone again but this time I will come down t 2mls every fortnight and even a month if I have to, it could take me the next year or even the next 2yrs before i am finally free of it but i am aiming to be free of it, you see to of turned my whole life round to get to this point and it still has a hold of me is soul destroying especially when you know you have give it your all, treatment is definitely needed for addicts without a shadow of a doubt but giving an addict something else that just covers up the cold turkey and which they are going to have to fight further down the line on top of their drug addiction is not the answer infact I think it is stupid, I know alot of subutex seems to be the norm these days or naltrexone…it’s time the government took this drugs issue seriously and instead of trying this that or the other half asses trials on people who have hardly any other options and wasting money which they should invest in something that will work and they need to be asking the patients what they want because that really matters, of course some will ask for methadone but they don’t really know what else is available except the couple of things mentioned here, all I know is addicts do not need other fights on top of their addictins to drugs…they don’t need the powers that be to keep giving out other addictions altogether……..They need the powers that be to be on their side to have some empathy and to ralise that drug addicts don’t love the lives they lead, anything but they lead the most wretched poor down and out lives you can ever imagne and people are dying over this issue all the time, after all this time that drug sevices have been available why as there been hardly any chage to the treatments offered out? Drug addicts don’t need a drug service that will also use them as scape goats because society already does that, if anything gos missing or someone gets robbed or someone else burgled you can usually guarantee someone will say “It’ll be a dirty smack head mate”………when in alot of cases it is nothing to do with drug addicts……. when the powers that be start to put more positive stuff out there in the public arena you never know the public might get a bit more positive abut them receiving help, over the years I heard many people tell me to “Get off drugs and change your life, everyone deserves a second chance” but the reality is that whilst people like to be heard saying these things the reality is it is so hard to get help to move on with your life when your a drug addict….yes some places do help rehabs, drug centres and such but there are far more drug addicts getting no help and being society’s scapegoats than there are drug addicts being welcomed with open arms by society and helping them to build a new life……………………..sad but true

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