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Re-balancing harm reduction and recovery
Public Health England announces a quality improvement programme to keep heroin users in treatment.

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New OST Programme

Earlier this week (6 February 2018), Public Health England launched a new opioid treatment quality improvement programme.

The programme can be seen both as a vital component in a strategy to tackle the recent and sustained rise in the number of drug-related deaths and as part of the ongoing desire to get harm reduction and recovery approaches in harmony.

There is a consensus across much (but by no means all) of the substance misuse field that recovery should be the ultimate goal for most dependent drug users but that many individuals are unable (or sometimes unwilling) to become drug free at different points in their lives. 

But promoting recovery while still providing harm reduction when it is required or desired is an extremely tricky goal to achieve once it is translated into contracts and targets. This is particularly so in times of austerity with the pressure to get service users through the system to make room for new ones.

The programme

Details of the quality improvement programme are thin on the ground at the moment. While it is reassuring to know that PHE intends to work alongside treatment providers and service user organisations, we know nothing about timescales nor what a “quality improvement programme” will look like — identification and sharing of best practice, expert advice and input available locally?

Here’s the PHE’s press release:

Opioid substitution treatment (OST) plays a fundamental role in supporting people to recover from drug dependence. But sustained recovery is hard to achieve when addiction is combined with a lack of personal and social resources. Long-term recovery often needs high-quality treatment and a range of other support, tailored to each person. Clinical guidance, including the new Drug misuse and dependence: UK guidelines on clinical management, describes quality drug treatment. PHE is helping drug services implement the guidelines and improve treatment where it is not optimal. The OST programme will support services to improve the quality of treatment so that people understand how their treatment works, comply with it and stick with it. That way they should get more from it and increase their chances of recovery. This will include a focus on using psychosocial interventions to support changes in behaviour. There is already a lot of good practice in this country, and the programme will aim to harness and build on that. Among the issues that we plan to address, one is people continuing to use drugs, particularly heroin, while receiving treatment. Drug treatment monitoring data (NDTMS) and PHE’s drugs evidence review both found that people who continue to use illegal substances (especially heroin) while on substitution treatment are less likely to fully benefit from treatment and to reduce the wider harms caused by their drug use. Cutting down, rather than stopping drug use, is still a good result for many people and they still benefit from being in treatment. Pushing people too hard to stop all ‘use on top’ can drive them out of treatment or prevent them seeking help in the first place. The programme will develop resources to support services in getting this right. The programme will also enhance wider recovery support for those in treatment by supporting services to help more in other aspects of their lives beyond drug use, such as employment, living arrangements, family relationships, trauma and abuse. PHE will be making contact with providers and service user organisations shortly to gain their input and involvement.


Whatever the quality improvement programme looks like, it is clear that it is needed. Despite all the criticisms of OST in prison, a recent piece of research I conducted found that many opiate users found it easier to access a script inside than in the community.

The mission of Breaking Free Group is to create the widest possible access to evidence-based psychological interventions. 

To realise this, we have developed a powerful and adaptable digital health platform which targets the underlying psychological and lifestyle factors that drive addictive behaviours.

Breaking Free Online is a clinically-robust computerised treatment and recovery programme for substance misuse. It is enhanced by Staying Free, a powerful relapse prevention toolkit in an Android and iOS smartphone app. It has been commissioned by over 60 Local Authorities and implemented across the spectrum of alcohol and drug services by several leading national service providers.

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