Drug Addiction Services: what is the policy?

We are currently in Belfast experiencing a significant increase in the number of people with drug addictions and I’m informed that similar rises in prevalence are occurring elsewhere.  In addiction things are never simple.  A 24-year-old patient who died back in the spring died of an overdose of opioids – he frequently had a number of fentanyl patches adhered to his body – but he also was a heavy smoker of marijuana and regularly took a range of prescription medicines including Lyrica.

His distraught parents, for a number of months before his death, tried heroically to get help but the system – mental health services and addiction services – could not help because he stated he did not want help.  In his last few months, he lost contact with his partner and their child and was taken back into the family home where life was not good for anyone as his behaviour became more and more erratic.  His local suppliers, as he spiralled downwards, became cruelly aggressive as they sensed a feeding frenzy.

A key pillar of current drug policy is easy access to a treatment programme; access is available yet reports suggest, in spite of strong government commitment and reasonable funding, success eludes the programme if we see success as an addict returning to a “drug-free” life.

In 2010 I looked in detail at the English figures to see how we are faring here. The facts were sobering: in that year £131m extra funding for the National Treatment Agency bringing the total invested from £253 million to a staggering  £384 million and even then the number walking out of treatment “drug-free” has barely changed; 5,759 in 2007, 5,829 in 2010.  Whereas a sanguine politician might argue that offering the service only costs about £2,000 per addict enrolled and that figures show an increase of 70 addicts drug-free on three years before the fact is this represents a decrease, down from 3.5% to 3.0% of those in treatment.   If we qualify “success” as getting an addict “clean” then the service costs £1.85m for each addict returned to normal life; a staggering figure.

The Department of Health defended this claiming that these figures distorted the true picture; it’s unrealistic to expect immediate results they said as successful treatment takes from five and seven years.   DoH is right here; addicts will decide when they want to come off drugs and for many of them they are happy to take their time.

The problem is our drug policy is designed to support individuals in their drug habit rather than getting them off drugs yet no one seems to want to admit this.  The vast majority who experiment with recreational drugs do so for only a short-time or will use on an intermittent basis.  In this way, drug use will not interfere with the day job.  Others sadly will go on to develop a severe problem where normal function takes a back seat to the daily procurement and taking their drugs of choice.

Environment, particularly social deprivation and sexual abuse, will, of course, have a major contributory effect.   People living in toxic environments are more likely to misuse drugs.  In the now famous and much-quoted study we found this; of the 100,000 American soldiers who were classified as “addicted to heroin” in Vietnam only about 7% continued to use heroin on return to the US.    On returning home the adverse environment of combat was removed and there was no need for them to continue their drug use.

So why is are we getting so challenged and upset by the apparent failure of its current drug treatment programmes?  It’s because we are unclear on the policy objectives; it is not to get people off drugs but merely to reduce criminal offending and reduce harm to the user.

The focus has been to get addicts into, and keep them locked into, a drug treatment programme come what may.  The difficulty is the drug treatment programme has been made so attractive to drug users, particularly problem drug users, many now see it as a useful adjunct to their daily illicit drug needs.

Our drug treatment service is about; enrolling, corralling and quarantining addicts.  I am not sure this is wrong as the excellent people who work in these programmes know their limitations.  When we reduce social deprivation and properly protect adults and children from sexual and physical abuse we will then begin to see a reduction.    In the meantime, the objective is to keep the addicts happy so they are less likely to break into the homes of the middle-classes to steal laptops and other must have electrical devices to feed their habit.