The launch of the 2017 Drug Strategy
Today sees the launch of the long awaited 2017 Drug Strategy. It has been long awaited by many; with questions being asked in the House of Commons and therefore is extremely welcome, if only as a sign that Government hasn't lost sight of this crucial matter. Having read the new strategy, it is clear that it is more evolution than revolution with the same top level aims of reducing the use of drugs and increasing the rates of recovery. This evolution is reflected by the first three key themes of the strategy’s approach: “reducing demand”; “restricting supply”; and “building recovery” being the name of the 2010 Drug Strategy. The fourth and final theme of “global action” is a new addition, expanding on the goal of restricting supply, making clear the ambition for the UK to continue to be active around international enforcement and promoting best practice in the global context.
The evolution seems to be positive in some respects. For example, the specificity of certain areas makes it feel more strategic as an approach. The strategy outlines emerging threats and high priority vulnerable groups. Areas of specific interest to Revolving Doors Agency include vulnerable young people, offenders and homelessness. With regard to children, young persons and schools, we welcome the commitment to promote evidence based programmes, especially in an area where many programmes are not evidenced. With regard to people in contact with the criminal justice system, we are pleased to see the prominence given to the continuation of the roll-out of Liaison and Diversion – in line with the recommendations of the Bradley Report (2009). The commitment to work with membership organisation Homeless Link to address the misuse of new psychoactive substances (NPSs) among the homeless community recognises the association between drugs and homelessness, and the significant impacts of NPS use that so many of our partner agencies have told us about.
Drug misuse in prisons, and particularly the use of NPS, is clearly a cause of considerable concern, with seizures, incidents and deaths related to substance misuse all increasing (see the Prison and Probation Ombudsman report on fatalities in prison; and the MoJ’s report on changing patterns of substance misuse in adult prisons). This is reflected in the strategy, which makes a firm commitment to tackling substance misuse in prisons and highlights the proposals in the Prison Safety and Reform White Paper. However, while prisons continue to be understaffed and under resourced, while arguably being overused, we will need to see what sort of traction and impact these reforms will have.
The Drug Strategy makes reference – appropriately – to the shocking increase in drug related deaths, which now account for more deaths than road traffic accidents. However, there is little on offer in the strategy other than exhortations to maintain and improve treatment, to adhere rigorously to evidence-based practice, and to ensure the availability of naloxone, a medicine that can save lives in the case of heroin overdose. Government commits to responding separately to the Advisory Council on the Misuse of Drugs’ recommendations on reducing drug related deaths, although given that these were published in December 2016, it seems unfortunate that this couldn’t have been included in the strategy itself. While these recommendations don’t go as far as some would like, such as calling for decriminalisation in order to lower barriers to accessing support, they do recommend that Government, and local commissioners in areas of high concentrations of injecting drug use, consider the provision of medically supervised consumption facilities.
We are pleased to see emphasis placed on the importance of user involvement not just in delivery but also in design and commissioning at system level, something we have long advocated. Substance misuse treatment and recovery systems and services take user involvement seriously. Indeed, many organisations are entirely led and managed by people with lived experience of substance misuse and recovery. PHE published a guide to user involvement last year which should prove helpful to areas aiming to expand their current activity. Service user involvement is core to the work of Revolving Doors and we have published various guides to service user involvement, including a guide to service user involvement and co-production.
It is unsurprising to see the inclusion of ‘measuring outcomes’ under the theme of building recovery. This Drug Strategy goes a step beyond the 2010 Drug Strategy by emphasising the importance of understanding and addressing the wider personal, health and social costs and harms associated with drug use. Proposing joint outcomes measures should enable a better understanding of outcomes at local levels and emphasises the importance of cooperation and partnership at service and commissioner levels. The need for a joint approach and the centrality of housing and employment is something that is recognised by most substance misuse services. This is also reflected in both the Homelessness Reduction Act (which emphasises the role of public services in reducing homelessness) and Dame Carol Black’s review into employment outcomes of drug or alcohol addiction, and obesity, which highlights the role employment can play in recovery.
A point of concern is that all the ambitions for treatment and associated services – which in their own terms appear perfectly reasonable – are taking place against a backdrop of decreasing support for local substance misuse services. According to recent analysis by The King’s Fund tackling drug misuse in adults will face a 5.5% cut, with larger cuts to alcohol services, and larger still for specialist services for children and young people. This is on top of reductions in many areas over the last few years. Consequently, the detailed and in many places ambitious approach the new Drug Strategy has taken, the challenge of implementing the strategy should not be underestimated. Given the diminishing funds available not just to treatment services to but also to, for example, many housing and homelessness services, careful planning will be needed in order to ensure that “a coordinated approach across many agencies” does indeed occur.