Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by the National Users’ Network (DP 081)

Executive Summary

The National Users’ Network (NUN) believe that the gains to individual health and reductions in acquisitive crime that have been made through Harm Reduction interventions including Opioid Prescribing must be maintained.

The NUN believe that Recovery from problematic Drug Use is an individual person-centred journey and that all treatment modalities are equally valid and valuable, including both abstinence and Medically Assisted Recovery.

The NUN believe that the national level ring-fenced monies should be maintained. Bearing in mind that these services are already subject to efficiency savings, which in itself may prove unsustainable.

The NUN believe that the removal of a Central Governing body RESPONSIBLE for drug treatment (such as the NTA) may mean that local areas do not prioritise drug treatment within their Public Health Budget.

The NUN believe that Hepatitis C will become an increasing burden on the NHS even if current Harm Reduction measures are maintained. If these measures reduce this cost will increase significantly.

The NUN recognises that the demographic of drug use and users is changing dramatically. Current drug treatment and treatment monitoring were designed for crack and opiate use. This system is not able to offer appropriate help to individuals who develop problems with other stimulants, cannabis or the new “designer” drugs. This may explain the reduction in young people (under 35) presenting to drug treatment.

The NUN believe that (in part) due to the success of current drug treatment methodology we are now seeing an ageing cohort of log-term drug users (primarily opiate). These individuals will be needing support in their old age the same as the rest of the population.

The NUN believe that many of the harms and costs currently associated with drug use may be addressed by examining the idea of a regulated market and looking at the current success of the Portuguese model.

1. The National Users’ Network (NUN) is a community organisation comprising a national network of individuals and groups who believe that drug users should be at the centre of all decisions made about them, whether at an individual or policy level. The membership includes: service users and service user groups, drug users and their organisations, ex-users, recovery groups, carers (family members), professionals and academics. The NUN welcomes anyone, regardless of their personal choices about drug use and treatment, on the condition that they respect the choices of others.

2. The NUN is a user led organisation in pursuance of which principle all board members have experience of drug use current or past in treatment or not.

3. The NUN serves as a community hub by which different organisations, groups, & others share experiences, knowledge, news, advice, alarms and give collective voice to their concerns and the issues that impact on their lives, families and communities: “Nothing about us without us!”

4. The NUN serves as an interface facilitating communication at local, regional, national and international levels, whilst retaining individual autonomy and independence whether as groups, organisations or individuals.

5. The NUN is prepared to (and does) work with many diverse organisations to ensure drug users are involved in all aspects of their own care. These organisations include: the Royal College of General Practitioners, SMMGP , the Addictions Faculty of the Royal College of Psychiatrists, DDN, The Alliance, The UKRF, UKHRA, “Transform”, “Drugscope”, “Release” and NNEF. Internationally, NUN is affiliated to NAMA Recovery (USA), INPUD, the Danish Drug Users Union, AIVL and the Cannabis & Hemp Activist Alliance.

6. Many of our members are involved in the oversight of commissioning of treatment services and the delivery of same at a local, regional and national level. We are similarly committed to and involved in the delivery of peer-led drug education, academic research and advocacy of rights and individuals.

7. The NUN represents the interests of all drug users regardless of their drug of choice, this includes, but is not limited to, those that use Opiates, Stimulants, Alcohol and Dance drugs and those with more complex needs such as poly-drug users and drug users with concurrent physical or mental health problems. The NUN ensures that the collective voices of these diverse groups are heard at all relevant forums.

8. The NUN promotes human rights and responsibilities, harm reduction, informed and empowered treatment, science led, evidence based medical practice and recognition that recovery must be determined by the individual from within rather than imposed from without. (UK Recovery Federation: Statement of principles).

9. The negative media representations of drug users and drug use compounds the many problems they experience , leads to discrimination, prejudice, violence, low self-esteem and other forms of social exclusion ; whilst failing to reflect the many positive examples of drug users past and present who work- often in highly demanding careers, voluntary work, and other activities of benefit to society. Functional, caring, working, drug users and ex users are a success story that dare not be told for fear of adverse consequences members, they and their families may suffer, including loss of employment, violence, vigilante action, loss of housing, benefits, children taken into care and other forms of discrimination.

10. There are many pathways to recovery and we seek to ensure that a diverse range of pathways remain available to all in need during our present economic difficulties. No one size suits all. The NUN notes with concern the UK Recovery Foundation’s reports comment that: “A combination of the removal of the nominal ring fence for drug treatment, a new commissioning environment and competing demands for an ambitious public health agenda create the potential for disinvestment in drug treatment”.

11. The NUN fears this may see a return to the days of the “treatment postcode lottery” at a time when HIV and Hepatitis C are on the rise in the community. Most of us have lost loved ones, friends, and/or live with disease and afflictions acquired before needle exchange and opioid prescribing were uniformly available across the UK.

12. The NTA have ensured that drug treatment across England and Wales has been of a consistent standard and that the Government monies available for drug treatment have been spent on National priorities. The removal of this safety mechanism means that some areas may not prioritise drug treatment and that drug treatment that is available may vary significantly across different areas.

13. The NUN is receiving reports to the effect that some service commissioners and providers are interpreting UK Government policy in varying ways. Leading to fear, anxiety, distress, and concern for what the future may hold for our members. A common concern is that there is an on-going creation of a “hierarchy of recovery” with abstinence at its summit and medically assisted recovery being viewed as an “easy way out”. In effect rewarding drug users by giving them drugs. This is happening even though the current government drug strategy specifically mentioning the benefits of Medically Assisted Recovery and the Clinical Evidence that shows the proven benefits of OST in enabling individuals to achieve many of the outcomes outlined as important in the strategy. This is based on a profound lack of understanding of treatment, of drug use and users, of recovery, and of maintenance treatment in particular.

14. Members of the NUN have expressed concerns that under current conditions commissioners are cutting back on frontline open access (tier 2) work such as Needle and Syringe Provision and Overdose Prevention and other practices associated with Harm Reduction for those who are not engaged in treatment, many of whom are among the most vulnerable members of society. This is being done regardless to the importance attached to preventing Drug Related Deaths in the current Drug Strategy. We feel that Harm Reduction in practice and principle is essential to the successful delivery of drug treatment. In the words of William Nelles founder of the Methadone Alliance: “The job is to keep people alive. Why? Because corpses do not recover, period!!”

15. Members of the NUN have expressed concerns that under current conditions managers of substance misuse services are choosing not to fill posts as they become vacant, or expand on service developments essential to the engagement of current drug users.

16. Members of the NUN have expressed concerns that under current conditions commissioners are also cutting back on Service User and Peer Advocacy Groups. Such groups have been integral to the design, implementation and delivery of improvements to the Drug Treatment System in many local areas.

17. The NUN would like to remind the committee’ that both methadone and buprenorphine maintenance treatment are designated by the World Health Organisation as “essential medicines” due to their impact on reducing incidence and risk of HIV and Hepatitis C. It would, in our view be a source of international shame if such medical treatment was to be denied to NHS patients in need.

18. There has been a significant reduction in the options available for Opioid Substitution Therapy in particular injectable preparations such as diamorphine, although it is mentioned in the current Drug Strategy. We seek to ensure that such options remain available to those in need and who demonstrably benefit from them.

19. The NUN support the UK Recovery Federation’s call for more residential space for those who wish to cease, reduce, modify, or stabilise their drug use and wish to see the establishment of a suitable body and inspectorships, with patient involvement, ensuring that all residential rehabilitation facilities both public and private sector are offering services of an appropriate standard ensuring the safety and wellbeing of patients, many of whom may be highly vulnerable.

20. Of concern is the increasing demographic of older users. (“Our invisible addicts” Royal College of Psychiatrists, 2011. (http://www.rcpsych.ac.uk/files/pdfversion/CR165.pdf and http://www.rcpsych.ac.uk/press/pressreleases2011/ourinvisibleaddicts.aspx). Aside from the problems associated with the ageing process, there are also additional problems which may be a legacy of past drug use, including lack of pension contributions, poverty, social isolation and housing. Many will not be welcome in existing care homes and facilities even if they can afford them. This demographic, itself a testament to the success of harm reduction based practice and opioid maintenance is projected to continue to grow in the medium to long term. http://www.guardian.co.uk/society/2011/jan/26/older-drug-users-habits-die-hard “It is essential for treatment services to respond to everyone as an individual …. Physical and mental health needs are essential considerations for all drug users coming into treatment, but particularly for ageing drug users...” Paul Hayes, CEO, NTA.

21. Current Drug Treatment, as monitored in the National Drug Treatment Measurement System (NDTMS https://www.ndtms.net/) for Drug Trends and enforcement are weighted towards treating opiates and crack cocaine use. For this reason we are concerned that current assumptions concerning the success of drug policy and concomitant treatment as measured by the proxy indicator of the decline in the number of younger people (under 35s) presenting for treatment may well prove ill founded. Crack cocaine and heroin use has undergone a radical change in its perception by the young. No longer is its use seen as fashionable and chic, rather it would appear that those presenting or seeking treatment for drug and alcohol related problems exemplify an image seen as undesirable by the young. Consequently reports from drug treatment workers indicate younger users prefer to use cocaine powder—either in a purer form at premium cost or in the form of “bash”, a generic highly adulterated cocaine powder that may be cut with a variety of other dangerous and/or unidentified substances presenting unknown risks. There is an increased use amongst young people of synthesised drugs (commonly identified as “legal highs”) with unknown short or long term effects. Cannabis use is the norm rather than the exception amongst a significant minority of young people, but the social context and culture of substance use is undoubtedly changing. Alcohol use is on the rise in this group, as it is across the board.

22. There is an increasing use of diverted prescription drugs and “over the counter” medications both for self-medication and for use as bulking agents in other drugs. This is of concern as the effects of long term exposure to Paracetamol at variable, potentially dangerous or lethal levels which could well lead to hepatic or gastro-intestinal health issues in both short and longer term, increasing the burden on the NHS.

23. The NUN would like to see wider licensing of cannabis preparations and herbal cannabis for medical use, noting its established benefits for MS suffers and research indicating that it helps with other chronic conditions, confirming anecdotal reports received as to its therapeutic benefits, and noting a global trend in legalisation for therapeutic use. In addition, the NUN’s members would also welcome the development of legal regulation allowing for eventual cannabis use for adults noting that it is far less harmful and anti-social than currently legal drugs such as Alcohol and Tobacco.

24. Drugs can and do cause harm. Some to greater degree than others, but we wish to submit evidence that such harm is frequently compounded by existing policy, prohibition, and criminalisation, and suggest that such evidence merits further investigation.

25. We suggest that custodial sentences for most drug users are harmful to society, the individual and their families and that serious consideration be given to the abolition of prohibition and the introduction of regulation in accordance with a planned strategy for an exit from the “war on drugs” which is in reality a war on all who use them.

26. The NUN notes the success of the Portuguese model as attested to in the Greenwold report for the respected Cato Institute and reflect our members’ view that this is an option the UK Government would be well advised to consider: http://www.cato.org/store/reports/drug-decriminalization-portugal-lessons-creating-fair-successful-drug-policies

27. The NUN would like to note that many people who use drugs do not do so problematically. We note Stanton Peele’s work on “Natural recovery”. Writing to SMART Recovery counsellors, Stanton reminds them that recovery is a natural process, one assisted by counsellors (http://peele.net/lib/change.html) which shows that many people use drugs non-problematically and reduce or cease drug use around the median age of 35 without recourse to treatment or other help.

28. The minority of drug users who develop problems often suffer from mental or physical health problems for which drug use is a form of “self-medication” We note that a majority (around 60%, http://psychcentral.com/disorders/bipolarresearch.htm and http://archives.drugabuse.gov/NIDA_Notes/NNVol14N4/DirRepVol14N4.html) of people diagnosed with a mental health condition choose to “self-medicate” with illicit or illegal drugs. It seems cruel and unusual punishment to criminalise and further compound the problems and conditions of those who are “self-medicating” for untreated or undiagnosed medical conditions, rather than invest in early and effective interventions by social and health care services.

29. We also recognise that drugs are used for pleasure and other reasons. Prof R K Seigal in his book “Intoxification” describes this search for pleasure and altered states of being, mind and body, as the fourth primordial drive akin and no less important to us than the need to eat, sleep and procreate. Coming from a relatively staid academic this is a very candid observation based on evidence.

January 2012

Prepared 8th December 2012