It’s time to stand and fight

1 Jul

Disinvestment in drug and alcohol treatment is putting lives at risk.

Blenheim has four strategic aims: number two is to actively and effectively campaign on behalf of people stigmatized by alcohol & drug use. So here goes…

Cuts in drugs and alcohol funding, along with the lack of political leadership, along with a lack of priority in England is having a major negative impact on some of the most vulnerable people in our communities. The moving of drugs funding into Public Health England (PHE), where illicit drug use is not a strategic priority, has given a green light to local authorities to disinvest in substance misuse services.

There has never been a more urgent need to have clear English government leadership spelling out the responsibilities of local authorities along with the levers to ensure they deliver. What we have is localism, a post code lottery, a government washing their hands of responsibility like Pontius Pilate and senior political figures actively conspiring to undermine evidenced based practice. Indeed it is not clear whether under the current Government in England will even have drug and alcohol policies.

We are witnessing the end of the best drug and alcohol treatment system in the world and the time to act to defend it is now. Its decline is being marked by lost opportunities and an increasing death toll as we fail to respond to rapidly increasing numbers of drug related deaths, health needs, and fail to tackle issues such as hepatitis C, HIV and liver disease. We are also failing to resource “harm reduction”, a phrase banished from the Government lexicon like a dirty word.

Over the next 3 years, spending on drug and alcohol services is predicted by some officials to fall between 25% and 50%.

Prior to Drugscope falling victim to Government cuts it’s recently published State of the Sector Report revealed;

  • Evidence of deep and widespread disinvestment and planned disinvestment in drug and alcohol services. (Over 70 services indicating cuts in funding with an average net reduction of 16.5%)
  • A third of local authorities indicating decisions to reduce funding in 2014/15 and 2015/16
  • The massive scale of re-commissioning and tender renegotiation leading to the widespread disruption of services. (54% of services since Sept 13 with another 49% indicating re-commissioning between Sept 14 – Sept 15)
  • Cuts in frontline drug and alcohol staff across the country and increasing caseloads
  • Worsening access to mental health services
  • Worsening provision of outreach services
  • Worsening access to housing and resettlement provision
  • Worsening access to employment support
  • Lack of provision for older clients
  • Negative impact of prison staffing cuts on access to treatment
  • Little confidence in Police and Crime plans and Joint Strategic needs Assessments/Joint Health and Wellbeing strategies reflected local needs
  • Reduction’s in harm reduction services at a time of increases in drug related deaths
  • Commissioning processes that discriminate against excellent small and medium-sized organisations delivering excellent local services

There has been a change in the focus away from the needs of vulnerable heavily addicted people with often multiple economic, social and health problems onto the needs of the wider population. The not insignificant needs of this far larger population will mean fewer resources to support those heavily dependent on drugs and alcohol with multiple and complex needs.

The provision of services to people with significant and multiple needs is being disrupted by frequent re-commissioning and system redesign. It has a hugely detrimental impact on the ability of organisations to care for people accessing services. It has had a significant negative affect on staff morale and the ability of organisations to invest their resources into the provision of services which are increasingly diverted to funding tendering capacity. Sadly at Blenheim, and I suspect other providers, staff work through the night not to help those in need but to win the right to deliver services with significant reductions in funding, challenging targets and poorly thought out PbR requirements. The costs and transfer of liabilities to the voluntary sector are driving all but the largest providers out of existence.

There is an increasing failure to address housing, complex needs, mental health and employment. There is a shocking lack of access to the employment market for people with a history of drug and alcohol misuse particularly where this is associated with criminal convictions. Specialist services addressing employment for this group were decimated in the Government commissioning of the Works Programme. Changes to welfare benefits have impacted detrimentally on housing stability and the level of homelessness experienced by those who are drug and/or alcohol dependent is rapidly increasing. The decommissioning of many NHS providers is resulting in a decline in many areas in access to specialist mental health service provision.

People with drugs and alcohol problems suffer prejudice and discrimination particularly if they commit the crime of being poor. Sadly this right to discriminate is enshrined in UK equality legislation. Yet again we see policies being suggested which focus on drug and alcohol users as being the undeserving benefit claimant if they are not in treatment. A requirement on local authorities to provide employment paying the living wage would be more constructive. It’s often not that people with drugs and alcohol problems are reluctant to work but that employers are reluctant to provide employment. We need a system of regulation that supports those experiencing problems with alcohol and drugs rather than criminalizing and stigmatizing people for being ill and vulnerable.

People who inject drugs are the group most affected by hepatitis C in the UK: around 90% of the hepatitis C infections diagnosed in the UK will have been acquired through injecting drug use. Across the UK 13,758 hepatitis C infections were diagnosed during 2013.

Around 2 in 5 people who inject psychoactive drugs such as heroin, crack and amphetamines are now living with hepatitis C, but half of these infections remain undiagnosed. PHE state “Interventions to diagnose infections earlier, reduce transmission and treat those infected need to be continued and expanded, with the goal of reducing the prevalence of hepatitis C.”

Often, hepatitis C infection remains asymptomatic and is only diagnosed after liver damage has occurred. Left untreated hepatitis C infection can result in severe liver damage, liver cancer, liver failure and death.

This year we will leave 97% of people with hepatitis C untreated. Imagine the outrage if this was breast cancer or lung cancer, particularly if the death rate was climbing year on year as it is with hepatitis C.  Now imagine if you could completely cure everyone with breast cancer or lung cancer but decided to only treat 3% a year. Outrage! This is precisely what happens to those with hepatitis C.  There is a real risk now that even this appallingly low figure will become unachievable as a result of changes in funding.

Lets move on to Naloxone: the failure of Government to roll out Naloxone in England along with a lack of emphasis on harm reduction and disinvestment in drugs services are likely factors in a 32% increase in heroin/morphine related deaths.

The ONS figures (2013) for drug related deaths show that there were 765 deaths involving heroin/morphine; a sharp rise of 32% from 579 deaths in 2012. Many of these fatalities could possibly have been prevented by the use of Naloxone as an intervention.

Naloxone is a medicine that is a safe, effective and with no dependence-forming potential. Its only action is to reverse the effects of opioid overdoses. Naloxone provision reduces rates of drug-related death particularly when combined with training in all aspects of overdose response.

The Advisory Council on the Misuse of Drugs (ACMD) undertook a review of Naloxone availability in the UK in May 2012, its report to the Government strongly recommended that Naloxone should be made more widely available, to prevent future drug-related deaths.

Scotland and Wales have national programmes to make Naloxone widely available but there has been no similar programme in England. This has led to a failure across England to supply Naloxone in over of 50% of local authorities.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of Naloxone would reduce these deaths overnight. Perhaps we should conclude that English opiate users lives are worth less than the Welsh and Scottish ones.

There is a growing palpable sense “old school activism” in the sector. There’s no time, no money, no staff, no resource but up and down the country people, organisations and service user groups are rising to the challenge. There is a palpable sense of determination; the power of networking is gearing up, sharing ideas, inspiration and the need to stand strong in the face of cutbacks.

Unless Service User Groups and a powerful alliance of GP’s, NHS and third sector providers and charities are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of local authority cuts, I fear that the worlds best treatment system is about to be decimated in 2015/16. I fear for the people we help and I pray that I am wrong. It’s time to stand and fight.

Tories – England needs you to show strong, inclusive leadership

14 May

England has the best drug treatment system in the world; it exists because of the vision of far sighted people from all political parties and the dedication of amazing staff, organisations, charities and public officials over the last 50 years.

Cuts in drugs and alcohol funding, along with the lack of political leadership and the lack of priority in England may in the coming years have a major negative impact on some of the most vulnerable people in our communities.

The moving of drugs funding into Public Health England, where illicit drug use is not a strategic priority, has given a green light to some local authorities to make heart breaking cuts in services, Birmingham being one example.

There has never been a more urgent need to have clear English government leadership matching that of Scotland. Spelling out the responsibilities of local authorities along with the levers to ensure they deliver. I would like the next government to take clear action to protect the best drug and alcohol treatment system in the world. Provide better opportunities for those in recovery and significantly reduce the death toll by committing to harm reduction, responding more robustly to rapidly increasing numbers of drug and alcohol related death and serious illness. I also would like to see a greater emphasis on responding to other health needs of those with drug and alcohol problems.

Any government with an ounce of decency would follow the Portuguese example and move rapidly to bring hepatitis C treatment up to the standards of HIV treatment. If hepatitis C treatment was running trains only 3 in every 100 would get to work and many would die on the platform.

I would like to see the incoming government do the following things with drug and alcohol treatment policy and funding;

  • Identify and appoint a single Senior Government Minister to be responsible for drug and alcohol policy, accountable to Parliament
  • Commit to evidenced-based practice
  • Ensure everyone in recovery from drug and alcohol problems has opportunities to rebuild their lives
  • Develop a national harm-reduction strategy to reduce drug and alcohol related deaths and ill health
  • Widen of the access to residential treatment focusing on need rather than the failure of everything else
  • A minimum unit price for alcoholic drinks is introduced along with health warnings on labels and prominent display of calorie’s
  • Create a national commissioning Ombudsman, to ensure transparency and accountability for local commissioning decisions
  • Widen the remit of the Care Quality Commission (CQC) to include all local authority-commissioned drug and alcohol services
  • Ensure the competence and appropriate accreditation of the drugs and alcohol sector workforce, in line with other areas of health and social welfare, by investing in an independent association
  • Follow the guidance provided by the Advisory Council on the Misuse of Drugs (ACMD)
  • Reinvigorate independent research on drugs and alcohol to fill the gap left by the UK Drug Policy Commission (UKDPC)
  • Ensure comprehensive access to the life-saving drug Naloxone, across the whole of the United Kingdom, in line with World Health Organization (WHO), ACMD and public health guidelines and advice.
  • Ensure the availability of services and National Institute for Health and Care Excellence (NICE) -approved treatments for all patients diagnosed with hepatitis C, in line with international guidelines
  • Everyone in recovery from drug and alcohol problems has opportunities to rebuild their lives,
  • Ensure access to safe and secure housing, employment and meaningful activity and support for health and mental health
  • Investment is provided for a national programme to tackle the stigma and discrimination experienced by people in recovery from drug and alcohol problems
  • ensures expenditure on drugs and alcohol treatment is maintained at a time of severe budgetary pressure on local authorities

Guest Blog – Working for Blenheim by Noor Salik

27 Mar

I first heard of my six-month posting to Blenheim in a tiny internet café in Sicily.  I was on holiday and taking a break from the heat by checking emails. A message from the fast stream civil service resourcing team informed me that my next posting would be a secondment to the voluntary sector.  My mood, already happy from days of sea, sun and pasta, was cheered enormously by the prospect of joining Blenheim.

My good feelings were confirmed once I’d arrived.  Blenheim’s central office staff were enormously welcoming.  Cathy, my line manager for the posting, organised a brilliant induction and I got to meet the Chief Executive and other senior staff immediately.  I was part of the Business Development Unit at Blenheim, an important part of the organisation dedicated to ensuring that it is able to submit high quality bids to provide drug and alcohol services. I was astonished by the sheer amount of information required to fill in a tender (and all within such short deadlines)!  I never thought I’d develop so much knowledge about how to undertake First Aid at Work assessments nor about drug and alcohol training courses.

It was fascinating to see the tender process from end to end – from attending a buyer’s event and then helping the team make decisions on which services to bid for and to then moving from the Pre-Qualification questionnaire (PQQ) stage to the final tender.  For a small charity such as Blenheim, I was impressed by the ambition and professionalism with which tenders were undertaken – on occasions Blenheim led bids for multi-million pound contracts with NHS and other voluntary sector partners. I was happy that I was able to help a team that had won six of its last seven tender applications.

As part of my time with Blenheim, I also got to visit a couple of Blenheim’s frontline services.  I won’t forget going to the police station, including visiting cells, to see how Blenheim works in partnership with police and other agencies as part of its Drug Intervention Programme. I also attended Blenheim’s KC North Hub service and was impressed with the staff’s commitment to their service users (for example adjusting opening times to accommodate service users who wished to keep visits discrete).

Part of the scheme I am on encourages us to think about how things could be done differently.  I would definitely look at procurement processes for public sector contracts.  I did find it remarkable that external organisations were given little time to develop proposals for services lasting several years.  This is an area the Government has recognised and my previous job posting at the Cabinet Office had been looking at how the public sector could procure more effectively and efficiently.

I’ve had a fantastic time at Blenheim.  I will miss the camaraderie of the team led, admirably by Cathy, and the dedication and commitment of individuals working with some of society’s most vulnerable individuals.  I wish the organisation all the best as it expands in future!

Noor Salik, Civil Service secondee on the Charity Next scheme.

Is everything going well with the reform of the Probation Service?

24 Feb

Not if you read a recent exchange this month (Feb 2015) on the floor of the House of Lords.

Following what must have been a lacklustre response from the Minister Lord Ramsbotham said “When I was Chief Inspector of Prisons, I used to tell Ministers that they could accept either observed facts from me or unobserved fudge from officials, but that improvements could follow only on facts. Since the Secretary of State denied parliamentary approval of the rushed Transforming Rehabilitation timetable, it has slipped. Among many other problems, community rehabilitation companies have been given only a bare five weeks to mobilise when they say that they need six months, and community probation service officers, for example, are having to perform tasks with high-risk offenders for which they are not qualified. Clearly, all is not well. Will the Minister please tell the House when the Government will give the public the facts rather than fudge about the delivery of probation services?”

Lord Beecham then put the boot in further “In the course of court hearings over a challenge to the legality of the Government’s proceeding with the contracts for the 21 community rehabilitation companies, a number of concerns were raised. These related to problems with IT, the management of sensitive victim information, lost records of offender contacts, staff shortages, delays in pre-sentence and standard reports, and more besides.”

​What have the 21 community rehabilitation companies have to say? Well very little as apparently rumour has it  they have all been instructed to act like the 3 wise monkey’s, hear no evil, speak no evil, see no evil, until after the general election in May or face dire consequences.

In the meantime what we really need to do is set up a service to advise, assist and befriend offenders, rather than create shareholder value.

My apologies to the Government but I edited out “unobserved fudge” it is after all my blog.

“Do not let me die”

11 Feb

At the beginning of last year (2014) I committed Blenheim to campaign on behalf of people with drug and alcohol problems, more specifically for the organisation to campaign around the issues of declining investment in services and the failure to treat those with hepatitis C. By the middle of 2014 I had added the failure to provide access to the life saving drug Naloxone and the need to review drugs legislation to bring it into the 21st century. Interestingly a view shared by a majority of ex Government Ministers responsible for drugs and a significant proportion of ex Chief Constables. Well done Nick Barton the Chief Constable in Durham and Norman Baker MP for daring to say so whilst still in office.

At a time of public sector cuts and funding for drugs and alcohol services delegated to Local Authorities along with a lack of clarity about what they are legally required to provide, there has never been a more urgent need to have clear English government lead spelling out the responsibilities of Local Authorities along with the levers to ensure they deliver. What we have is Localism, a post code lottery and a Government acting like Pontius Pilate. Over the next 3 years spending on drug and alcohol services is predicted, on average, to fall between 25% and 50%.

I and other dedicated determined people have meet with Ministers, MP’s, officials, signed letters of outrage, letters consensus, got questions asked in the House of Lords and the House of Commons and received promises of change and assurances of a Government commitment to action. Thank you to those committed MP’s, Lord’s and Baroness’s who have supported our cause.

Such promises vanish quickly into interdepartmental committees, policy forums and committee sign off, and if all else fails denial of responsibility or power and the words “the funding and responsibility has been devolved we no longer have control and few levers”.

Over the last year there has been a lot of talk, lots of meetings, and little action or change on the ground. There has been little improvement in access to hepatitis C treatment. We still fail to treat 97% of people with this life threatening illness. Imagine the outrage if this was breast cancer or lung cancer, particularly if the death rate was climbing year on year as it is with hepatitis C.  Now imagine if you could completely cure everyone with breast cancer or lung cancer but decided to only cure 3% a year. Outrage! This is precisely what happens to those with hepatitis C.  There is a real risk now that even this appallingly low figure will become unachievable as a result of changes in funding.

Lets move on to Naloxone, I am going to plagiarise an article by Chris Ford and Sebastian Saville, otherwise known as creative swiping (sorry).

What do we do with a medicine that prevents certain death for people with a particular condition—and is safe, cheap, and easy to administer?

  1. Immediately make it accessible to those who can administer it when such a life-or-death situation arises.
  2. Make it available to no one except doctors and emergency room workers.
  3. Endlessly debate the particulars of how and when it should be widely introduced.

If you picked number one that would seem to be a reasonable choice. Unfortunately, it would also be incorrect. With few exceptions, answers two or three apply in the vast majority of the world when it comes to the medicine naloxone.

I was outraged when I heard of a 3 year delay in responding to the ACMD recommendations to make Naloxone more available to families, peers and friends. Blenheim hosted a summit and a wide coalition of agencies and service users formed the Naloxone Action Group (NAG) England. We quickly found a wider scandal of widespread failure across England to supply Naloxone to anyone in over of 50% of Local Authorities.  This is shameful and NAG England will seek to hold authorities accountable.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of Naloxone would reduce these deaths overnight.

We await important guidance from PHE on Naloxone, due this month, which local authorities are unfortunately free to ignore unless we give those who are failing to implement a reason to change and somehow hold them to account.

Now this could get depressing and I could go all Shakespeare on you and the following Macbeth quote springs to mind.

“To-morrow, and to-morrow, and to-morrow,

Creeps in this petty pace from day to day

To the last syllable of recorded time,

And all our yesterdays have lighted fools

The way to dusty death.

Out, out, brief candle!

Life’s but a walking shadow, a poor player

That struts and frets his hour upon the stage

And then is heard no more: it is a tale

Told by an idiot, full of sound and fury,

Signifying nothing.”

But last week something amazing happened in Portugal!

“Do not let me die, I want to live” shouted Jose Carlos Saldanha a patient awaiting treatment for hepatitis C, to the Minister of Health during a hearing taking place at a Parliamentary Committee on Health before being escorted from the room.

José Carlos Saldanha was attending several hours of debate on access to treatment for hepatitis C.  He was accompanied by the children of two other patients with hepatitis C one of whom had recently died. Speaking to journalists outside José Carlos Saldanha said that “only in this country, do you see this little shame and that the minister is a “killer” (unfortunately Jose is wrong the same is true in England).

Interviewed on TV the following day José Carlos Saldanha revealed that his treatment had been agreed a year ago and spoke of a “war” that has waged as he struggled to gain access to treatment.

“I am not an imaginary patient, I’m real. The war has been great and my air time is very short. […] There is a cure and I do not understand what they are waiting for.”

This issue has now been a leading political story in Portugal for the last week with the politian’s under fire not only for the failure to supply treatment but for the way in which they initially treated Mr Saldanha and the two people with him.

A week later and Mr Saldanha has started hepatitis C treatment and Portugal is well on the way to putting in place a national programme of treatment for those with hepatitis C.

The extortionate prices of new hepatitis C treatments are also under attack as Medecins du Monde an NGO are challenging the patent on Sofosbuvir with the possibility of dramatic reductions in cost.

Later this month is the DDN Service User Conference, perhaps the time for talking is over, perhaps the time for war is here, and perhaps the time to demand the right to treatment is now. The time to demand “Do not let me die” has arrived.

“We make a living by what we get, but we make a life by what we give.”

29 Dec

As the clock ticks towards the end of 2014 and our 50th year I look back on what has been an amazing year for Blenheim. A new sense of direction, new state of the art central training and management facility, huge investment in upgrading buildings and infrastructure across the organisation and a shift to put the charitable purpose and our beneficiaries even more at the heart of what we do. It has also been the year when we have focused on investing in our capacity to be a business focused highly competitive organisation with the capacity to take on multi-national organisations and win.  Not withstanding this we are determined to work in partnership and support the increasingly threatened smaller providers in our sector.

In a changing landscape for charities Blenheim chooses to say focused on the needs of those with drug and alcohol problems, we choose to focus on the skills of our staff and delivering high quality services, and most of all we choose to stand up for and campaign on behalf of our beneficiaries who are mothers, brothers, sisters and grandparents, work colleagues and friends not just people to be defined and stigmatized by their drug and alcohol use.

Blenheim’s has a proud history based on the work and dedication of its staff and volunteers both past and present. Blenheim has made such a difference to so many lives down the generations. A book “London Calling” documents this history via the memories of current and former service users, staff, volunteers, trustees, and leaders in the drug and alcohol sector.

Throughout 2014 we have actively challenged the stigmatisation of people with drug and alcohol problems by enabling them to tell their moving and humbling stories of recovery, and argue in the corridors of power for a system of regulation that supports those experiencing problems with alcohol and drugs rather than criminalises people for being ill and vulnerable.  In 2015 we will publish a book of 50 recovery stories which shows the impact not just of Blenheim but of the drugs and alcohol sector in the voices of our beneficiaries.

I am appalled at the shameful fact that 97% people with hepatitis C go untreated and that despite a 32% rise in heroin and opiate deaths Naloxone availability (which may have averted some of these) in the England is highly variable with little sense of Government urgency.  Blenheim challenges this clear inequality of care for the people we work with, it is wrong and we will take action. Currently I am chairing the Naloxone Action Group England and Blenheim is a member of both the Hepatitis C Coalition and the London Working Party on Hepatitis C.

As we move forward into 2015 I am determined that Blenheim remains focused on the individual and their holistic needs. The need for friendship, love, employment, somewhere to live, something to eat, support with often deeply troubled lives, and help with a range of physical and mental health problems.

However unless Drugscope along with a powerful alliance of providers are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of Local Authority cuts I fear that the worlds best treatment system is about to be decimated in April 2015. I fear for the people we help. I fear that commercial self interest will mean as a sector we will walk quietly off the cliff. I am determined that Blenheim will go shouting whilst learning to rock climb or even better fly.

As we enter the next 50 years I am determined Blenheim will continue to dedicate itself to improving the quality of life of people the organisation supports. Everyone deserves a better future.

Hepatitis C infection is a major health issue nationally and should be a PHE priority

12 Nov

People who inject drugs are the group most affected by hepatitis C in the UK: around 90% of the hepatitis C infections diagnosed in the UK will have been acquired through injecting drug use. Across the UK 13,758 hepatitis C infections were diagnosed during 2013.

Around half of the people living with hepatitis C infections don’t know it, according to a new publication from Public Health England (PHE) ‘Shooting up: infections among people who inject drugs in the UK 2013’ published on the 5th November 2014.

In total, 13,758 hepatitis C infections were diagnosed in 2013 in the UK, with around 90% acquired through injecting drug use. Around 2 in 5 people who inject psychoactive drugs such as heroin, crack and amphetamines are now living with hepatitis C, but half of these infections remain undiagnosed. This is why Blenheim in partnership with a wide range of organisations under the banner of the Hepatitis C Coalition is doing everything we can at a national, local and operational level to ensure more people at risk now or in the past get tested. I agree 100% with PHE when they state “Interventions to diagnose infections earlier, reduce transmission and treat those infected need to be continued and expanded, with the goal of reducing the prevalence of hepatitis C.” Current service provision needs rapid expansion.

If caught early hepatitis C can be successfully treated with antiviral medications. Often, hepatitis C infection remains asymptomatic and is only diagnosed after liver damage has occurred. Left untreated hepatitis C infection can result in severe liver damage, liver cancer, liver failure, and even death. This is why Blenheim is appalled that only a shameful 3 out of every 100 people with hepatitis C are treated each year. Treatment can completely cure most people at a fraction of the life time cost of treating HIV.

In 2013 there were 7,290 cases of tuberculosis reported in England, which is a rate of 13.5 cases per 100,000 population and TB is now one of PHE’s 7 priorities. My unscientific back of a fag packet approach suggests a rate for 21 cases per 100,000 population being diagnosed annually with hepatitis C. (Yes I adjusted for hepatitis C being UK and TB being England in relevant PHE figures).

If this is the case PHE need to prioritise hepatitis C treatment and the treatment of injecting drug users. Indeed their own experts agree.

Dr Vivian Hope, a PHE expert in infections among people who inject drugs, said: “with around half of those people living with hepatitis C still unaware of their infection, we need to do more to increase diagnosis rates. Ultimately, this will help reduce the current high level of infection we’re still seeing among people who inject drugs”.

Dr Fortune Ncube, Consultant Epidemiologist and lead for PHE on Injecting Drug Use said: to reduce transmission and decrease rates of hepatitis C infection it is imperative that we maintain adequate provision of effective interventions such as needle and syringe programmes, opiate substitution and other drug treatment.

With many services for drug and alcohol dependent people being cut back significantly across the country we are in danger of a continuing increase in the numbers infected with hepatitis C and even more people not getting the treatment they so urgently need.

More naloxone programmes urgently needed

10 Nov

Blenheim and IDHDP were appalled by the alarming 32% increase in opiate-overdose deaths in 2013 in England, so they called a Naloxone Action Summit to see what could be changed to reduce this number of unnecessary deaths.

Globally thousands of lives could be saved by simply increasing opiate users’ access to naloxone. England experienced an alarming 32% increase in opiate-overdose deaths in 2013, totalling 765 in 2013. Blenheim and IDHDP were so appalled by these figures they called a Naloxone Action Summit to see what could be changed to reduce this number of unnecessary deaths. The Summit took place on Monday 27th October and the room was packed with people who wanted to see change happen quickly.

Participants were asked a series of questions before the event and what was clear was there was marked variation of naloxone availability, ranging from nothing to wide available to all. The main barriers to availability appeared to be lethargy, lack of understanding and knowledge, competing priorities, finance and confusion, particularly what you can and can’t do currently. Nationally, the lack of clear guidance or instructions from the centre, confusion about the MHRA consultation, the October 2015 date and funding issues. The main drivers were usually champions in the area with a real desire to reduce these deaths.

The summit got off to a positive start with Professor John Strang of the National Addiction Centre setting the scene and giving a history of naloxone. The evidence has long been available but it took until 1998 for Jersey to provide naloxone to opiate users, but then we had to wait until 2010 to see Scotland launch the first national programme. He then went on to encourage us to do the things we could, like prescribe to all entering  opiate substitute treatment (OST). Professor Strang also stressed the necessity of considering families as a key work-force and highlighted the great importance of normalising use of naloxone. “Why should Naloxone use be any different from the use of insulin, glucagon, the EpiPen or defibrillators?”.

John Jolly reminded us of the ACMD recommendations made in May 2012, which after a review of naloxone said that it should be more widely available in the UK, there should be less restrictions to access and more training is needed. It would appear that saying more training is needed has been used to delay the immediate implementation until after the next election – particularly as training has been going on for sometime now and continues to do so.

Good practice saves lives

Rhian Hills from Wales and Kirsten Horsburgh from Scotland explained how both countries are moving forward with naloxone use. In Wales, as in all places, large numbers of opiate users have witnessed overdoses so clearly a programme was needed. Hills highlighted how since naloxone access programmes were launched in 2010, the overdose deaths decreased 53%.

Kirsten Horsburgh agreed; “the most likely person to witness an overdose is another drug user. So, if the person who uses drugs is carrying naloxone, deaths can be prevented”. Scotland funds the cost of naloxone kits and prioritizes the supply to people who use drugs. They also try to ensure people starting OST have a supply and normalise naloxone provision in services. The training on how to use it is brief (10 minutes is enough!) and they involve peer trainers.

One of the few places in England that has a well established scheme is Birmingham and Dr Judith Yates gave “top tips” on how to get it going e.g. getting on and doing it, prescribing it to all people starting OST, holding naloxone meetings every month, providing training in the management of overdose and in the use of naloxone to all potential first responders (such as hostel workers, families and friends) and making every contact count. “The naloxone experience in Birmingham was not driven and pushed by commissioners, but by doctors, nurses and pharmacists!”, Dr Yates stated enthusiastically.

Kevin Jaffray explained the role of user activism and how they are vital to the process; Elsa Browne discussed the role of training and Kirstie Douse, Head of Legal Services of Release, explained how to use thelegal challenges, such as a judicial review, to improve naloxone access.

Both, during the presentations and after, there were lively discussions, focusing on what can be done now and not getting distracted by what you can’t do. We can prioritise people starting, or on OST, leaving rehab or detox and many other situations where the person could become a patient and have it prescribed to them. Also provision through A+E and prescribing it to all opiate users that access health care for other things. Discussion included how it fitted perfectly into the recovery agenda, how to use PGDs (patient group directives) and PSDs (patient specific directives), how to make training sharp and to the point and involve peer trainers. Very important is to normalise its use in services – “It makes no sense prescribing methadone as a harm reduction measure and not  also prescribing naloxone!” PHE stated that they are planning  to provide guidance to be issued before the end of the year, on what can and should be done  immediately, without waiting for  October 2015.I It was agreed to work with them on that, while also producing a separate clear statements with guidance and advice from the expert members of this group.  This will be helped by the WHO guidance on overdose prevention published on 4th November that completely endorses naloxone.

There is work to be done so a smaller group was formed to take the work forward called Naloxone Action Group – England (NAG – England!). John Jolly CEO of Blenheim was elected as chair. Summing up before leaving one delegate from Penrose put it so well: “It’s a no brainer, training is easy, we need to push the agenda and sort it out!”.

You can see the presentations and more resources on the IDHDP website.

Guest Blog – Complete IT Recovery Ride

8 Sep

17 team members from I.T. support company Complete I.T. and their 2014 Charity of the Year partners, drugs and alcohol charity Blenheim CDP completed the 29 mile bike ride from Richmond to Windsor, raising £2k in the process. The money raised will go to Blenheim’s family services to help them buy toys and materials for their crèches and support the work that they do to improves families lives that are affected by drugs or alcohol.

Complete I.T. client Blenheim is currently celebrating its 50th Anniversary of supporting drug and alcohol users and their families across London.

A big well done to all of those who took part yesterday and a special thanks to technical consultant Mark Whittlesea for organising the day for us.

DSC_0120 Blenheim Bike Ride Small Thumbs Up!

People are dying because of a lack of harm reduction and access to naloxone

4 Sep

Lack of focus on harm reduction and shameful failure to roll out naloxone in England is leading to needless deaths. I feel deeply sad and ashamed to be part of a system that is letting this happen.

I believe the failure of Government to roll out naloxone in England and a lack of focus on and dis-investment in harm reduction and drugs services is a factor in the 32% increase in heroin/morphine related deaths. Many people I suspect are now being encouraged to leave treatment before they are ready.

There were 765 deaths involving heroin/morphine in 2013; a sharp rise of 32% from 579 deaths in 2012. Many of these fatalities could have been prevented by the use of naloxone as an intervention.

Naloxone is a medicine that is a safe, effective, with no dependence-forming potential. Its only action is to reverse the effects of opioid overdoses, and it is already used by emergency services personnel in the UK for this purpose. Naloxone provision reduces rates of drug-related death particularly when combined with training in all aspects of overdose response 

The Advisory Council on the Misuse of Drugs (ACMD) undertook a review of naloxone availability in the UK and in May 2012, its report to the Government strongly recommended that naloxone should be made more widely available, to prevent future drug-related deaths.

In Scotland and Wales, successful pilots resulted in national programmes to make naloxone widely available but there has been no similar national programme in England. Scotland has allowed naloxone to be provided to services without prescription, for use in an emergency. This enables Scottish drug treatment and homeless hostel staff to have naloxone ready for use. We urgently need the law in the UK changed to allow this.

Naloxone is available on prescription in England to people at risk of opioid overdose. However, maximum impact on drug-related death rates will only be achieved if naloxone is given to people with the greatest opportunity to use it, and to those who can best engage with heroin users.

The ACMD in May 2012 made 3 recommendations for government to take to maximise naloxone’s role in reducing drug-related deaths.

  1. Naloxone should be made more widely available, to tackle the high numbers of fatal opioid overdoses in the UK.
  1. Government should ease the restrictions on who can be supplied with naloxone
  1. Government should investigate how people supplied with naloxone can be suitably trained to administer it in an emergency and respond to overdoses

Over two years later in July 2014 Jane Ellison Parliamentary Under Secretary of State for Public Health wrote to confirm that Government would act on the recommendations by October 2015 in England. Not only does this shamefully push the issue into the post election long grass it also makes no suggestion of a national programme similar to Scotland or Wales. Perhaps we should conclude that English heroin users lives are worth less than the Welsh and Scottish ones. Think I’m cynical; sources in Public Health England tell me a roll of naloxone is not on their agenda and they have no current plans.

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Germaine de Larch | Writer, Artist using photography as a medium, Art-Activist. Genderqueer, recovering addict and depressive learning to live life large, one day at a time. germainedelarch.co.za | germainedelarch.tumblr.com

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