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Drug News |
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Drug News: (archived 4.1.04) This area contains old news and commentary dating back to May 2002. It has been archived to improve navigation on the main News page. To view up-to-date news click the Drug News Button to the right. All information relating to SECTION 8 has been moved to a new section HERE. |
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| DANOS
Training Modules:
The Good, the Bad and The Ugly. The NTA has launched a series of training modules intended to support the implementation of the DANOS core competencies. The modules that have been published to date are a mixed collection of resources: some are excellent while others are considerably weaker on content. One of the hall-marks of the modules released to date is a sense of an unfinished rush-job. Resources and slides are highly variable in content, ranging from the very slim, to the highly technical and detailed. Many of the modules were written in 2002 and this means that some of the content has become dated already. So, for example, the module on substitute prescribing makes no mention of the guidance on Diamorphine prescribing. The section on naltrexone is woefully thin, and there is no reference to complimentary therapies to support substitute prescribing. Similarly, the module on safer injecting was clearly written before the amendment to the paraphernalia legislation so does not reflect the current legal situation. While the module makes it clear that it does not cover the actual process of safer injecting education or identifying appropriate equipment, it is worrying to think that a worker could be deemed "competent" in needle exchange solely by completing this module and without further intensive training. A recurring theme of the modules is an emphasis on the structural framework and a failure to explore practice issues. So repeated reference is made to strategic issues such as the HAS tiers, and the pathways to care. At the same time, factual content - the practical knowledge required - are harder to find and sometimes absent. Some, like the blood-borne virus models are excellent, containing detailed information. Yet even these are incomplete; this module makes no reference to symptoms of Hep C for example. In addition, one would be concerned that trainers with no specialist knowledge of the subject would have difficulty with some of the subject matter. Similarly, the unit on cocaine and crack (misleadingly labelled as being on "working with stimulant users,") written by DanielTaegtmeyer at the Blenheim Projecti is an excellent detailed resource with a healthy mix of theory and practice. It stands in stark contrast to the module on dual diagnosis in which practical information is again absent. Others, like the unit with working with BME clients is wholly strategic and contains no specific factual information at all. The sense that these units have been commissioned and published with little review or revision is reinforced by their appearance. Use of diagrams, images or graphics is minimal, and all handouts are heavily text based. Use and size of fonts is inconsistent, and in some, spelling errors have been left uncorrected. The primary contribution to standardisation has been to place the handouts within a Microsoft standard template. The importance of effective staff training cannot be understated. Hence it is imperative that the training that is being encouraged as part of DANOS is of the highest standard. Based on the modules provided to date, this high standard has been undermined in some of the modules present. This is worrying for the people who will be on the receiving end of these services. A further concern, and one that needs to be explored further, is practical aspects of the training delivery. With the best will in the world, it is not feasible simply to provide a trainer with the pack and the handouts and expect them to be fully competent to deliver some of these specialist modules. And there is a shortage of skilled trainers in the UK, already working at capacity and already delivering well reviewed and evaluated modules. One must suspect that few of these are going to take on delivering DANOS modules to the field. Recruitment of suitably experienced and skilled trainers will be a substantial challenge. In turn, many agencies will find that they will need further training on top of the DANOS modules. So for example, a person attending the Needle Exchange module would still need to attend a safer injecting course; further training would be required over and above the Dual Diagnosis training before a worker was vaguely competent to understand issues in this complex subject. For understaffed and over stretched agencies, training is expensive. Over and above the actual cost of trainers, the cost in terms of staff cover is substantial, or agencies face reductions in client numbers. If serious about taking forward
the staff development agenda, the NTA and allied agencies will need to
invest more substantially in this training. This cannot be undertaken
within existing resources and constraints and cannot be adequately done
with some of these resources. To view the links relating to DANOS, go to: http://www.nta.nhs.uk/ [KFx Training addresses many core competencies of DANOS, though will not be delivering the DANOS modules in their current form.] |
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Reclassification: all smoke and mirrors? The proposal to reclassify cannabis from Class B to Class C comes a step closer with the publication of the ACPO guidance to police on how to process cannabis-related offences. In reality, the proposals from ACPO are a mixed blessing. On the one hand, the number of people put before the courts (approximately 80,000 per year) for cannabis offences will undoubtedly be reduced. Less prosecutions, less criminal records, and less resultant long term consequences: these are welcome and long overdue developments. On the other hand, there are serious and substantial flaws within the way the cannabis reclassification has been handled and these are reflected in the ACPO guidance. Unfortunately, ACPO has not seen fit to place the guidance on their website, and it has yet to appear on the Home Office Website. We are therefore relying on information from the media to understand what is in the guidance. A selection of links is included at the end of the article. The draft legislation currently passing through Parliament makes possession of Class C drugs an arrestable offence. There is nothing in law to shape or restrict under what circumstances this power of arrest should be utilised. This has been left to the guidance prepared by ACPO. In an ideal world, the Home Secretary would have had the courage to simply reclassify cannabis, and possession of it would have ceased to be arrestable offence. Instead, under pressure from senior police officers, Blunkett appears to have acquiesced to a compromise that sees cannabis reclassified but leaves power of arrest wholly at discretion of the police. The guidance produced by ACPO does state that there should be a "presumption against arrest" for possession of cannabis, unless the possession is aggravated by one of a number of factors: · Smoking cannabis in
public: However, these "aggravated" situations are solely guidance and the decision whether or not to arrest is solely at the discretion of the police officer. The net outcome of the ACPO guidance is a regional lottery that means different police forces can choose to adhere to - or disregard the guidance as they see fit. Further, individual officers can choose to arrest or confiscate and caution at their discretion. Such an approach is wholly inconsistent. The risk is that certain groups in society - young people, especially from black and other ethnic groups - will be disproportionately arrested. Others will be happy recipients of a confiscation and a caution. Such an approach leaves too much discretion in the hands of the police. Even though an individual may feel that they have been treated unfairly - that they should have simply received a warning, there is no legal recourse available to them. This is the problem when guidance is used in place of robust legal protection. Juveniles remain especially disadvantaged by the proposed legislative changes, Thanks to confusing messages from the media and from Government, many young people already believe that cannabis has been reclassified and effectively depenalised,. Few are aware that post-reclassification, they will still be arrested and, unlike older users, will not simply receive an informal warning, Instead, depending on previous offending histories, they will end up before Youth Offending Teams or before the courts, and liable to receive criminal records. As with other recent changes to drugs legislation the Government has taken a momentous step - in this case to reclassify cannabis. But as with changes to Section 8 and to paraphernalia legislation the Government has then wavered in their resolve and turned the changes into a poor, misguided compromise that will cause confusion and inconsistency. http://www.obv.org.uk/reports/2003/rpt20030912c.htmlhttp://www.homeoffice.gov.uk/n_story.asp?item_id=603 http://www.mapinc.org/ctcnews/v03/n1378/a02.html http://www.epolitix.com/BOS/epxNews/238FC1C7798E1040A0F463339140C66D000000D8D7C4.htm |
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| Paraphernalia
Legislation (15.9.03)
Welcome changes marred by restrictive drafting: The Government has amended the legislation relating to drugs paraphernalia. The changes increase the range of equipment that can be given out by drugs workers and allied professionals. The legislation ameliorates the situation created by Section 9a of the Misuse of Drugs Act 1971, which made it unlawful to distribute equipment other than hypodermic syringes and needles for the administration of controlled drugs unlawfully held. The changes to the legislation are contained in Statutory Instrument Number 1653, and follow recommendations made by the Police Foundation review and the ACMD. It also follows extensive lobbying by harm reduction groups including The Exchange, UKHRA, Lifeline and others. The changes and their ramifications are considered in detail in the revised KFx publication "Injecting Equipment And Sharps Bins - Legal and Practice Issues (September 2003.)" The key changes are that certain professionals can distribute certain equipment as detailed below: Clearly, there is much to welcome here. The Government has recognized that the legislation impeded effective harm reduction work. Further, it recognizes that it is unacceptable that workers should be obliged to work on the wrong side of the law, even if prosecution is unlikely. The various groups and individuals who have lobbied, provided the evidence base and stuck their necks out to achieve this change deserve praise for facilitating this change. However, as with many other recent changes or developments within the drugs field, the amendments to the paraphernalia legislation have been marred by an overweening desire to maintain 'control' on the part of Government. This tendency has been apparent through the proposals to amend Section 8(d) of the MDA, the reclassification of cannabis, and now the present example. In each case, rather than choose a simple revision or rescinding of the relevant legislation, the Government has chosen a response that on the one hand changes or relaxes the legislation but which simultaneously introduces new restrictions and ambiguities. The revisions to the paraphernalia legislation are a case in point. Rather than removing the existing restrictions entirely, the amendment makes provision for a handful of additional items to be made lawful for distribution by a limited range of professionals. The outcome of this is an inconsistent piece of legislation, which results in the following: · It is lawful for doctors,
vets, pharmacists and others undertaking "lawful" drugs treatment
work to give out specified paraphernalia. However peer supply of this
paraphernalia remains illegal. So on the one hand a drugs worker commits
no offence by giving citric acid to an injector but the injector would
commit an offence if they passed some of that citric on to a partner.
To compound this confusion it is not illegal for a peer to distribute
on needles and syringes to peers, but it is illegal for them to pass on
other paraphernalia such as citric or utensils. The paraphernalia legislation, like much of the Misuse of Drugs Act 1971, has become a hindrance to harm reduction work whilst having a diminishing benefit in terms of law enforcement. Across the country, innumerable shops and market stall sell drug paraphernalia with virtual impunity. The only bodies that are substantially impeded by the legislation are those seeking to undertake harm reduction work. In reality, the paraphernalia legislation has never been an effective piece of legislation and is routinely flouted. But rather than accept this and rescind the legislation, the Government has instead tinkered with it, as it has tried to tinker with Section 8 of the Act, and with cannabis reclassification. The resultant legislation continues to restrict practice, and throws up new ambiguities. It is unclear exactly who it applies to. The Drugs Legislation Enforcement Unit within the Home Office is unclear itself as to who the legislation applies too. They intend that it should extent to all parties engaged in drugs work, even if not directly employed as drugs workers. So it is intended that the legislation should also apply to housing workers, police or others engaged in drug treatment initiatives. However, the DLEU also acknowledge that this is not explicit within the legislation and the exact interpretation of bodies authorized to distribute equipment under the legislation would need to be decided by a court. Similarly, the DLEU were not in a position to determine the scope of the term 'utensils,' and this too would be open for interpretation by a court.. In further worrying comments since the amendment was passed, it has become apparent through discussions on the UKHRA board, that serious concerns are being raised regarding the resources available to ensure adequate distribution of equipment. Some commentators have noted that distribution of equipment is hampered less by law than by fiscal concerns. Unless the relaxation of the law is matched by additional ring-fenced funds to purchase equipment and ensure that it is distributed effectively alongside informed harm-reduction information, then the changes to the law will remain a cosmetic exercise. While the changes to the paraphernalia legislation are to be welcomed, and represent a step on the incremental process of legislative change, this welcome is tempered by unhappiness that the changes remain restrictive, in terms both of the equipment and the groups covered. It enfranchises professionals while excluding users themselves. It allows for some equipment but forbids others. And neither it nor the accompanying guidance places any onus on services or those commissioning them to ensure that this extended provision is made available across the UK. |
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Ian Duncan Smith and Oliver Letwin on drugs 7.7.03 At the start of July, Letwin and IDS launched the Conservative's strategy on drugs, and there was substantial media coverage as a result. While the Tories are hopefully still unelectable, the strategies that they are outlining are the source of great concern. Not least because, if drugs become a political hot potato on the run-up to an election, it seems likely that the ever-flexible David Blunkett could find himself dragged off down an increasingly reactionary drug strategy dead-end. The media reporting on the Tory strategy highlights the extent to which it has not been effectively thought out or priced. Unfortunately, rather more commentators commented on the latter aspects ("how will it be paid for?") than the former ("is it a viable way forward?") Letwin and IDS have clearly
been influenced by the Swedish model, and are seeking to copy this: Rather than just focussing on the issue of Class A drugs, the model used in Sweden is robus against all substances including cannabis. Possession or use of cannabis amongst young people is a trigger offence which means that young people are required to accept treatment. Given that levels of cannabis use in the UK are variously estimated between 16% and 40%, this would mean creating capacity for some 3 million young cannabis users. At various points, Letwin and IDS have said that they want to model policy on both Swedish and Dutch models. These two models are mutually exclusive and demonstrate more about Letwin and IDS's fundamental lack of grasp as to how the systems work. The Netherlands adopt an approach that creates a clear seperation between cannabis and other drugs. No such seperation is made within the Swedish approach. Dutch treatment options are varied but do include high-dose methadone maintenance and experimental use of Diamorphine. Engagement and harm reduction through needle exchange and consumption rooms is also part of the provision, along with a high level of user and activist involvement. The Swedish Government has vigorously opposed such developments and has been lobbied extensively by bodies such as HNN Sweden, who in turn were largely responsible for obstructing moves within the European Parliament and at the UN convention in Vienna to embrace such harm reduction principals. Mr Letwin rejected the idea of prescribing hard drugs on the NHS to help drug users abandon their habit. "If you have maintained addicts you will have a permanent dependent population paid for by hard-working people. That is intolerable," This appears to suggest that Letwin rejects the international evidence that supports the prescribing of Class A drugs such as Diamorphine or Methadone either on a reduction or maintenance basis. It suggests that he is pursuing a forceful detoxification regime followed by a period of enforced rehabiliitation. Finally, the proposals are substantially under-costed, as discussed in the media. But far more worrying than this is the huge shift in thinking that IDS and Letwin's approach would suggest. Many of the gains made over the past fifteen years would be eroded by such as a policy, and while not billed as such, this is still a war on drugs. For media coverage, please see the MEDIA section |
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ISD Scotland unveils new look Drug Misuse web site
The site has a fresh new improved
look and structure making navigation easier and finding relevant information
quicker. The distinctive blue colouring used in the previous DMIS website
has now been encapsulated in a modern design. |
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The Home Office announced that GHB would become a controlled drug with effect from 1st July 2003. A number of other substances were also added to the list of Controlled drugs. The ACMD had recomended that GHB be added to the list of controlled drugs and the Government had consulted on the proposals. The move came in part because of the suggested links between GHB and drug-assisted sexual assaults. Class and Schedule: GHB becomes a Class C, Schedule 4.i drug. This means that possession without prescription will be unlawful, and at present, the maximum penalty for possession will be two years and supply will be five years. However, until the Criminal Justice Bill 2002 completes its passage through parliament, POSSESSION of GHB will NOT be an arrestable offence. Once this bill becomes statute, the penalty for the supply of GHB (and other class C drugs) will increase to 14 years and possession of class c drugs will become an arrestable offence. Strange comparisons: While the addition of GHB to the list of controlled drugs is welcome, it does highlight the inadequacies of the current classification system. Once cannabis is reclassified, it will also be a class C drug. By placing both GHB and cannabis in class C, this suggests some sort of comparabilty in risk/safety between the two substances. This is clearly erroneous, and educators will need to stress that there is no equivalence between the two substances. Links: The Government postings on the reclassification are at: Media reporting at: http://news.bbc.co.uk/1/hi/health/3029854.stm http://observer.guardian.co.uk/uk_news/story/0,6903,987112,00.html and many others.... |
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Blunkett leaves UK drugs policy on disarray (again!). A series of leaks and ad hoc policy decision, fuelled by sloppy reporting in the Sunday papers, have left the UK's drug policy in confusion once again. Having effectively killed off the prospects of extended diamorphine prescribing last week with their restrictive "guidance" document, the Government created further confusion over cannabis and premises legislation. Cannabis Since Blunkett first announced his intention to reclassify cannabis, the process has been mired in confusion and incompetence. The simplest move would have been to move cannabis to Class C, and make possession of it a non-arrestable offence but leaving supply an arrestable offence. But rather than adopting this approach, the Home Secretary, either for personal reasons or under pressure from senior Police Officers, decided it was important that the power of arrest was retained, and so went through a series of half-thought through measures to achieve this. Sine then, a variety of measures have been proposed: there was a proposal to create a three-strikes and your nicked approach to cannabis policing. Given that such an approach would have required a rather substantial data-base, such a plan seems to have been quietly dropped. The second approach was to make cannabis possession an arrestable offence in certain limited settings, described as "aggravated possession." This included the notorious "blowing smoke in a police officers face" and other similar situations. But the bottom line, as incorporated in to the Criminal Justice Act 2002 simply makes unlawful possession of Class C drugs an arrestable offence: 9 Power of
arrest for possession of Class C drugs Effectively, the reclassification of cannabis, in practice, simply means that the maximum penalties for possession have been reduced; it will remain an arrestable offence and the penalties for supply will remain the same as they were for Class B drugs - 14 years. To make matters worse, unable to reach decision about how to implement the revised strategy, it is now being proposed that the reclassification of cannabis be delayed until autumn at the earliest. Young people, already labouring under the misaprehension that cannabis is either now legal or will be from July, are going to be further confused. This mess is entirely of Blunkett's making. It stems from a premature announcement of the decision to reclassify, before the details had been worked out, followed by a craven retreat from the decision as he came under pressure from the police and the media. Use on premises: A series of leaks and reports in the papers caused a flurry of concern that the Home Office wanted to widen the proposed powers incorporated into the Anti-social Behaviour Bill 2003. The legislation proposes creating new powers to close premises where premises are associated with the use or supply of class A drugs and also with nuisance or serious disorder. It was widely reported that the Home Secretary wanted to extend this power to cover Class B and C drugs too. This is something we were concerned would happen when the legislation was first proposed, and it was a relief to see no such amendment was made when the Bill was discussed at committee stage. Again, the driving force behind this seems to have been the Home Secretary, being advised and pressured by unknown sources. Further confusion is being caused by the current state of play regarding the status of Section 8(d) of the MDA; it is not clear either to the field or to the Home Office, whether organisations still have an obligation to prevent the smoking of cannabis on premises that they manage. Under changes to the sentencing for class C drugs offences, organisations who allow cannabis smoking post reclassification (or indeed supply of Valium!) will face a maximum of fourteen years in prison. But first clarification is needed as to whether or not 8(d) is still enforceable at all. Time for Blunkett to get off drugs! Given the importance of drugs policy and strategy, it is essential that drug strategy is taken out of Blunkett's inept hands. Since he has taken over primary control over drugs strategy, it has been wholly subsumed by his crime and anti-social behaviour agenda. Rather than listening to his advisors and those from other departments, he has leant to much of an ear to the police and too little to those who understand the field. It is time for a change in this process and the brief for managing drugs should no longer be left with Mr. Blunkett. For media links on these subjects see MEDIA section. |
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| New
guidance on injectable heroin and injectable methadone treatment for opiate
misusers
The NTA released the long-awaited guidance on the prescribing of injectable diamorphine and methadone on Friday 13th June 2003. Such an inauspicious publication date was matched with an equally inauspicious publication. While recognising that diamorphine and methadone prescribing has a limited role in substitute prescribing, the guidelines bind such restrictions around the prescribing of diamorphine as to make it more difficult, rather than less difficult to achieve than it is at present. So, rather than extending the prescribing of diamorphine, the NTA has effectively done the reverse. Responses from the field have, to date, been muted. Discussions on the UKHRA boards have been vocal and critical of the guidance, asking how "how can the NTA have got it so wrong?" Roger Howard, the soon-to-depart head of Drugscope, provided a quote of stunningly anodyne quality, even by his own standards. Presumably, in anticipation of a move to Crime Concern, he has no wish to upset Blunkett or AInsworth. Anyway, his comment on the guidelines was: "We welcome the NTA guidelines on heroin prescription and hope that they will lead to the situation found in other countries where, when other treatments have failed, there is an increase in users potentially being prescribed heroin." How the report was developed: The Guidance describes itself as a "majority consensus approach" which presumably means that there was some dissent from the expert groups, but this was the consensus of the majority, and the views and concerns of the minority have not gone on record. Our understanding was that, in the final document, the views of the medical consultants, were given higher prominence and the report reflects their views rather than all the experts consulted. The Eight "key principles." The report outlines 8 key principles that underpin prescribing of injectables, as follows: 1. Drug treatment
comprises a range of treatment modalities which should be woven together
to 4. Injectable
maintenance options should be offered in a local area that can offer optimised
oral This is an interesting clause and appears to be an interesting piece of sleight of hand. On the one hand it places a level of obligation on providers to make options other than oral methadone available to people who do not respond to oral methadone. This would appear to suggest that local areas would be expected to make such resources available. However, subsequent clauses provide a number of limitations on this. The requirement to provide "optimised higher dose oral methadone" is an interesting development. It suggests a tacit acknowledgement that methadone is still being prescribed at insufficiently high levels, and without necessary support in place. So before local agencies can explore any other options such as injectables, increases in levels of methadone and additional support will need to be explored. Given that a number of regions still have ridiculously low caps on methadone, increasing this will require substantial movement from local prescribers. 5. Injectable
and oral substitute prescribing must be supported by locally commissioned
and
So despite Blunkett's assertion that an aim was to increase access to diamorphine prescribing, no changes to the archaic licensing system. In the main body of the report, there is a proposal that all injectable opioids would require Home Office licence if being used for the treatment of addiction which could, in turn, have an impact on people currently prescribed injectable methadone. 8. The skills
of the clinician should be matched with good local systems of clinical
governance, The detail and key areas of concern: Supervision: The requirements around supervised consumption are the most odious aspects of the guidance, and the aspect that will reduce stability and make the guidelines unworkable. Provision of supervised consumption - even for a short initial period, will dramatically increase the cost of the intervention. While diamorphine is already a more expensive option compared to methadone, the cost of twenty-plus supervised injections per week, at an average of 10+ worker hours per week, will cost in excess of £150/client/week in terms of supervision, before the cost of converting suitable premises are bourne in mind. Certainly, supervised consumption on pharmacy sites would be difficult: it is hard to envisage many pharmacies would want to undertake this task, and the same is probably true for GP surgeries. Which means that such consumption will need to take place in drug projects. The guidance proposes "there was great potential in providing injectable drug treatment from highly centralised injectable clinics" which is fine in large inner-city areas but means that, in rural areas, such provision is not feasible. While the report notes that supervised consumption will require multiple daily attendances, but perceives this to be a welcome development: The requirement
for daily or multiple daily attendance was also discussed as requiring
a significant But, as policy development work for the Soho Rapid Access Clinic highlighted, this brings with it some complications around storage of CDs on site. Daily doses of drugs have to be delivered to the clinic and CD cabinets installed. Staff authorised under the MD regulations will need to be on site to dispense, and medically trained staff on site for emergencies. Three times a day. For maybe one or two clients who have to travel in three times a day. Although this guidance says that local provision will need to be commissioned, there is no additional money to make such provision available. Again, the NTA will be able to blame the local providers for their failure to provide rather than looking at their own responsibility. Eligibility Criteria: The guidance provides strict limits as to eligibility, as follows: Inclusion criteria for injectable
opioid maintenance
This was to be expected but also means that some clients for whom injectable methadone or heroin may be appropriate will be excluded. For example, amongst homeless drug users in central London, a high proportion had rapidly escalated habits over a short period of time, but had built up substantial injecting habits over less than three years. • The
client should be aged 18 or over. • The
client should be willing to comply with the conditions of injectable opiate
treatment, including: This is a big concern and excludes long-term femoral injectors. Again, looking at Central London homeless populations, the extent of femoral injecting is as high as 80%. This group would be excluded from such treatment, even where it may be an effective intervention. • continuation
of injectable treatment being conditional upon positive healthy response
to treatment (which includes other treatment elements in a package of
planned, co-ordinated care) • diversion
of the prescribed injectable drugs and “double scripting” being
grounds for discontinuation of injectable treatment.
This is a catch 22 and a nasty one at that. In order to get on to a diamorphine prescription, a patient would have to engage with optimised oral methadone for at least six months. Failure to adhere to such a programme (e.g. use on top, missed appointments) is likely to result in being dropped from treatment. But if someone does adhere to the optimised methadone treatment, then it seems likely that the clinician will adjedge the methadone as being effective and, as such, there would be no need to switch to injectable diamorphine. This is the
drugs equivalent of the ducking stool; if you sink and drown, you weren't
a witch; if you float you are and get burned. If the inclusion criteria are met injectable opioid maintenance treatment may then legitimately be considered by the clinician, in consultation with the patient, key carers and the relevant multidisciplinary team. Ommissions: The guidance seems to be a work in progress. It restricts and hampers the work of prescribing injectables without exploring how to overcome these barriers. The document offers no guidance on how supervised consumption can be practically achieved and creates substantial new obligations before injectables can be considered. There is a failure to explore potential other routes of administration, including heroin reefers or other strategies for administration, or proposals for weekend take-home doses. The model of thrice-daily supervision is hugely unworkable, and the exclusion of the most ill, those with impaired liver function and habitual femoral injectors excludes those most at need. Conclusion: After a long period of waiting, there is no sign here of more treatment, better treatment or fairer treatment. This report sides heavily against those who wish to see diamorphine made available on prescription in a practical and accesible way. This is a case of style not substance. The Government will claim credit for more flexible prescribing policy, and will blame practitioners for failing to deliver what they have, in fact, made impossible. Links: To view the complete guidance,
follow this link: Press Release: http://www.nta.nhs.uk/news/020115.htm
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The Home Office unveiled its new "Talk To Frank" campaign in May. The linked campaign includes a telephone helpline service, a website and a new advertising campaign to promote the site. The launch and publicity campaign will cost £3m this year. http://www.number-10.gov.uk/output/Page3766.asp WHO is FRANK? Talk to Frank is put together by a large number of agencies. The PHONE SERVICE: The rebranded "Talk to Frank" service is provided by the Scottish-based Essentia Group. (http://www.essentiagroup.com/). Essentia describe themselves thus: Rewriting the rules of an entire industry, the Essentia Group is the UK's leading contact centre specialising in health and social welfare - a technology-based provider of governmental and commercial organisations’ information and advice services in the area of health and lifestyle management. Essentia do operate a number
of smoking and mental health services and have a track-record in substance
use; presumably therefore, soem staff have a history of working with substances
and new staff are receiving a level of training to achieve this level
of competence. THE ADVERTISING CAMPAIGN: The "Talk to Frank" campaign was designed by Mother working in conjunction with PHD. Mother are big players in Adland, and their roster includes such health-inducing products as Coca-Cola and environmentally sound companies as Unilever. Unfortunately they do not have a website but you can send them feedback on the FRANK campaign by clicking here: mother@mother.ltd.uk. PR for the launch was handled by Fishburn Hedges, a London based PR company who also provided PR for Connexions. The website and email interface was put together by EURO RSCG CIRCLE (aka Circle), a global digital marketing agency. Their website is at http://www.circle.com/contact/index.html Reviewing FRANK So is "Talk to Frank" any good. Reception from the mainstream drugs field was mixed. Roger Howard, was warmly receptive of the site and offered the following uncritical comments to the Guardian: "Frank has been extensively trialed in the community where young people and their parents seem to be receptive to the campaign. "Frank
will hopefully provide better and more accurate information for young
people and their parents to encourage them to talk to each other about
this topic and we look forward to seeing the evaluation on the effectiveness
of this in the future." Much has been made by the Government and the media that the "Talk to Frank" campaign represented a step change away from "Just say no" approaches and a new, more honest and credible approach. In reality however, the National Drugs Helpline had never promoted itself in this way; previous publicity campaigns for the Helpline had concentrated on the line as a source of factual information, such as the long-runnning ads about cocaine and ecstasy that were often on XFM in London. Release welcomed the rebranding too, describing the new "Talk to Frank" approach as "more friendly" than the NDH. There were a number of criticisisms of the NDH; the most important of these was the ridiculously short time window target for callers. Many callers were simply referred on to a local service, and call-handlers assiduously bundled potentially long callers - especially distressed parents - on to other services as quickly as possible. If "Frank" is really providing a better service, it will be interesting to see if there is a greater "depth" to the work, or it restricts itself to simple advice and referal on. The Campaign: The idea of "talk to Frank" was clearly intended to promote the idea of speaking to an informed friend: but the advertising company decided that the informed friend should be someone who sounds like he is white and male. Despite the fact that the campaign was trialled, this seems like a strage choice: why Frank? Why a male? How does this fit in with any sense of cultural diversity? Some organisations have disapproved of the way that the police have been portrayed in the adverts too. Content: KFx has refered a number of errors on the Website to relevant bodies and is satisfied that they are being dealt with at the time of writing. LINKS: Talk To Frank http://www.talktofrank.com/ Guardian Web review: Frank has no cred: http://politics.guardian.co.uk/homeaffairs/story/0,11026,962418,00.html Drug advice campaign is a wasted opportunity, say charities: Guardian:
23.5.03 |
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Guardian runs series of articles offering a detailed critique of drugs strategy: The Guardian ran a series of pieces by Nick Davies looking at current Government strategy and suggesting that it was ineffective due to over-reaching bureaucracy and short-term target setting. The articles are not reproduced below - too long, but links to them are posted below: How
Britain is losing the drugs war: 22/5/03 Routes
to treatment that are little used 22.5.03 An
initiative blunted 22.5.03 National
plan that only fuels the fire 23.5.03 Striking
fall in addicts' crime 23.5.03 Verdict
on treatment 23.5.03 Letters: http://www.guardian.co.uk/letters/story/0,3604,963519,00.html http://www.guardian.co.uk/letters/story/0,3604,963516,00.html http://www.guardian.co.uk/letters/story/0,3604,963517,00.html http://www.guardian.co.uk/letters/story/0,3604,963520,00.html |
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New User Group established in Gwent: David Wright is in the process
of setting up aUser group in Gwent South Wales. |
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The Home Office posts "official" position on Section 8(d) The Home Office has written to people who responded to the consulation to Section 8(d) of the Misuse of Drugs ACt 1971, confirming the current Government position. The letter confirms that the Government does not intend to implement 8(d) at this time, prefering to explore alternative powers under the Anti-social Bhevaiour Bill. The letter says that the postponement of the amended 8(d) will be for a period of 2 years to allow for evaluation, but that the potential to extend 8(d) "will remain on the statute book" pending evaluation. For a text copy of the letter, please click HERE. |
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Blunkett trails release of Government guidelines on Diamorphine prescribing In a widely reported speech to Doctors in Sheffield, David Blunkett announced that guidance on diamorphine prescribing and pilot trials would shortly be established. Further details will in due course be announced via the NTA. Reports of this are in the Media Section of the site. The Home Office statement is at : http://www.homeoffice.gov.uk/n_story.asp?item_id=478
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Drugs: Guidance for Schools (28.4.04) The DfES has published a draft set of guidelines for schools, and is consulting on the document now. The guidance covers aspects of drugs education, management of drugs incidents, and policy. There are some interesting issues within the document and generally achieves a careful balance between effectively working with substance use in a supportive way, and the requirement on schools to ensure a safe environment. There are some especially welcome comments regarding the use of ex-users and drug sniffer dogs in schools. The document can be downloaded from http://www.dfes.gov.uk/consultations2/08/ KFx has produced a document aimed at young people on the subject of drugs in school. The document looks at the rights of young people when being searched, when found in possession of drugs and when sniffer dogs are being used. The document can be found in the RESOURCES section. |
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Blunkett to reschedule Valium? The Independent reported that the Home Secretary is going to order a review of the way that Benzodiazepines are prescribed and handled. The Independent suggested that the review was with a view to reclassifying them as Schedule 2, but such an assertion would appear to be a little premature. At present there does not seem to be a consultation process underway, now any information about such a move on the Home Office website. The overprescribing of benzodiazepines is undoubtedly a problem, and moves to addressing this would certainly be welcome. However, it is not only the scheduling of various drugs that needs to be considered. The Home Office Minister and the Home Secretary have still to act on the issue of the handling and storage of prescribed controlled drugs, a problem that Release brought to the attention of Charles Clarke MP over two years ago. At the time, Clarke acknowledged that, effectively, organisations were working in a legal grey area when storing controlled drugs for clients, and wanted to see this clarified. As yet nothing has happened. As benzodiazepines are very widely prescribed, it will be imperative that the Government reviews conditions and law relating to the storage of all prescribably controlled drugs, to prevent this stupid situation from persisting. See the Media section for the original news article |
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Provisional Results: Smoking Drinking and Drug Use amongst Young People in England in 2002 The Department of Health has released the provisional results of the above study. The main report will be published in 2003. The interim findings indicate that there have not been any substantial shifts in the findings from the preceding comparable studies. The findings indicate that the number of people who had taken a drug in the last year had decreased from 19% to 17%; the proportion who had used in the last month was 11% compared to 12% in 2001. The interim report can be viewed at: http://www.info.doh.gov.uk/doh/IntPress.nsf/page/2003-0130?OpenDocument |
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The UN Commission on Narcotic Drugs me in Vienna between the 8th and the 17th of April, to look at what progress had been made (if any) in achieving the UN's stated aims of:
The meeting was not attended by any ministers from the UK, but the UK was represented by civil servants. UK drugs policy had come in for criticism from some quarters for allegedly "undermining" the UN drugs strategy through such measures as proposals to reclassify cannabis. The meetings in Vienna were also well attended by various lobby groups and NGOs seeking to influence the UN to adopt a variety of positions including the resolutely prohibitionist (e.g. HNN, EURAD), those seeking an objective review of the evidence and a resultant evidence-based strategy (e.g. Transform, Release) and those who sought an end to prohibition. In part, due to the ongoing military invasion of Iraq, the UN review received little media attention. And, despite the huge sums of money spent hosting and lobbying the event, those who sought to reform or redirect the event came away with little to show for their efforts. In the Joint Ministerial Statement released at the end of the session, there was a restated commitment to the goals and targets stated at the twentieth special session of the General Assembly in 1998. There was also some criticism of policy and activity "in favour of the legalisation of illegal narcotic drugs..." Commentary: There are certain parallels between the build-up to the US-led invasion of Iraq and the UN's position on drugs. While one must proceed with caution in developing such analogies, there are grounds for such an analysis. For they represent another example of how American dogma and intransigence lead the agenda. Yet while the US were unable to intimidate or buy sufficient votes from the security council to legitimise their invasion of Iraq, they were admirably successful in forcing through an agenda at the Vienna meeting on drugs. The key difference here is that, while in the case of Iraq, the UK Government was prepared to disregard the wishes of the UN, and act bilaterally with the US, with regards drug policy the UK seems to be willing to be bound by the UN strictures. This would seem to be a marriage of convenience, a way of avoiding grasping the nettle that is a root and branch review of drugs policy and law. There is a willingness to, on the one hand, argue that the UK government is progressive and willing to explore change were it not for the restrictions of the UN. Yet on the other hand there is neither a willingness to push to change those UN conventions (a kow-towing to US policy) and simultaneously a willingness to disregard the UN when convenient (vis the invasion of Iraq). Governments that have wanted to introduce changes have done so despite UN strictures. The UK's decision to allow itself to be fettered by the UN on this but not on Iraw demonstrates that we are not dancing to the UN's tune at all; we listen to the US, and work within a drugs legislative framework driven and maintained by them. For further information about the UN meeting in Vienna, you could look at the following: Ministerial statement: http://www.unodc.org/pdf/document_2003-04-16_1.pdf Reports from individual sessions and round-table discussions: http://www.undcp.org/cndministerial/index.html Media coverage: Just say
no to a drugs policy that doesn't work : Polly
Toynbee: 23.4.03: The Guardian High stakes: Alan Travis:
16.4.03: The Guardian NGO and Lobbyists coverage: Transform Drug Policy Institute: http://www.tdpi.org.uk/press_5.htm Senlis Council: http://www.senliscouncil.net/index.htm |
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Section 8 and "Crack Dens:" What the Home Office did next... Section 8 Amendment: Government adopts new approach? The launch of the Government's white paper "Respect and Responsibility - Taking a Stand Against Anti-Social Behaviour" suggests that the Home Office may be adopting a new approach to addressing the use and supply of drugs on premises, following their ill-conceived amendment to Section 8 of the Misuse of Drugs Act 1971. There is a great deal in the White Paper that has already prompted controversy, including measures to address with begging. However, the measure of most interest - tempered with some concern - is that regarding premises where the use or supply of drugs is taking place. This clause has been trailed in the media as being a measure to clamp down on "crack dens." This was the same rationale for the amendment to Section 8(d) of the Misuse of Drugs Act 1971 by Section 38 of the Police and Criminal Justice Act 2001. The proposal in the White Paper is a very mixed and needs to be approached with cautious optimism. Firstly, and most importantly, it leaves its scope very wide, and is not focused either on premises where crack is the drug in question, nor, more worryingly, on situations where the concern is about supply, rather than use. The paper says: For sometime
local authorities, the police and local communities have been frustrated
by Rather than the current approach, to pursue criminal proceedings under the Misuse of Drugs Act against the occupiers or managers of such premises, the White Paper proposes a more streamlined approach, which would probably require a lower standard of evidence. The proposal is as follows: The new powers will give police the power, after consulting the local authority, to issue notice of impending closure, ratified by a court, which will enable the property to be closed within 48 hours and sealed for a fixed period of up to six months. Drug dealers will be dealt with through the courts and the property will be recovered by the landlord. Effectively, such a piece of
legislation would give the police and local authorities the power to evict
people from a property within 48 hours, without going through normal channels
such as a landlord seeking possession, provided that the police could
demonstrate that the use (or supply) of Class A drugs was taking place
on the premises. Without seeing more detail as to the nature and scope of the proposed legislation, it is probably premature to condemn the proposal out of hand. Ideally, it would be a well-constrained piece of legislation that would require the police and local authority to demonstrate that nuisance was being caused and that such enforcement was the only solution Such a piece of legislation would mean that there would be no need to proceed with the commencement of Section 8(d) of the Misuse of Drugs Act 1971 as amended by section 38 of the Police and Criminal Justice act 2001. We would like to be able to welcome this proposal in the White Paper, and are glad to see that the Home Office has listened to the very real concerns of the field on this subject. It would be churlish to criticise the twenty-two months of uncertainty ad confusion that stemmed from the original vote-grabbing decision to amend the law. However, even though this is still only in the form of a White Paper, there is still substantial cause for concern, and it is far too soon for jubilation. In its loosest form, the proposal would represent a massive extension of police powers, with serious implications for civil liberties. In a constrained form, and as a replacement for Section 8(d) it would be a useful and appropriate measure. In the meantime, the amended Section 8(d) remains on the statute book, awaiting commencement. The risk is that, in a frenzy to address the perceived drug problem, this piece of legislation is also enacted. The Home Office should, without further delay, announce that such a commencement order will not be issued. Section 8(d) should then be repealed without any more prevarication, to allow the development of desperately needed harm reduction and housing provision. In place, a carefully drafted piece of legislation, developed in full consultation with relevant fields, should be introduced in its place. Then, perhaps we can focus on the very necessary work in hand. To read the whole White Paper please click HERE. The Government has announced the 37 areas to be targeted under its crack strategy. The 37 areas identified are:
In the Home Office Press Release, the funding allocation was described as follows: All of the crack priority areas will already have been allocated substantial extra funding for drugs services – for treatment, working with young people, and combatting drug supply. On 21 January the Home Secretary announced that the 30 areas worst hit by drug-related crime would receive extra funding, and this includes the majority of the crack areas. The remaining 17 crack priority areas not in that group, will be allocated an extra £35,000 to help them tackle crack and engage with their communities. |
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Government Launches Prospects: The Government launched its "Prospects" scheme with a low key announcement on the Number 10 website and a verbatim regurgitation of the news on the BBC website. The scheme is intended to address the long--identified gap in services for offenders who missed the CARAT boat by virtue of their shorter senteces but still needed support. Unfortunately, the briefing from Number 10 was long on rhetoric but short on detail: salient points were: "The scheme will be available to offenders who:
After release from prison participants will stay for 12 weeks at the approved premises in the five local communities and undergo a strict but supportive regime. This seems a bit scetchy; it is not clear if it means that people will be tested; at a guess it means that they will be evicted/breached if use is suspected. In addition, housing would of course be threatened thanks to restrictions under Section 8. At the end of this period, they will be provided with a further six months tenancy in longer-term accommodation, and will continue to benefit from a support network run by the supplier. And again, the same problems that dog TST work or Supporting People with Section 8. The pilot will be tested in Exeter, Preston, Merseyside and the wider Bristol area. Contracts to run the projects have been awarded to UK Detention Services (UKDS), Stonham Housing Association and the National Association for the Care and Resettlement of Offenders (NACRO). While Stonham Housing Group and NACRO are familiar names, UKDS was a new one to us; research reveals that they are part of the multinational "Sodexho Alliance" primarily known for supplying food in a multitude of arenas. Sodexho moved in to the provision of "correctional facilities" . Prisoners working in Sodexho-run facilities (UK, Sodexho run Forest Bank) are paid £14 per week, for jobs such as refurbishing sun-beds for local businesses. Sodexhoe's correctional wing earns in 91million euros in revenue per year. The website talks about the detail of their drugs provision, in all its sketchy glory: How are you combating drug use in your facilities? Each
time the government of the country we are operating involves us in this
process, we have a program based on education and detoxification.
One would hope for counsellors and trained staff, especially as they move in to this specialized area of work...Sodexho recently extracted itself from its American correctional facilties, and has adopted a policy of not working in regimes which practice the death penalty or where they would be required to carry weapons. This hasn't stopped growing pressure on Sodexho to pull out of this arena altogether. Sodexho was also the company that had responsibility for running the much criticised "voucher scheme" for asylum seekers in the UK. A trawl on the internet reveals seething disquiet at the role that Sodexho play in the provision of prison services; "According to the most recent Prison Service Annual Report and Accounts (England & Wales, 2000-2001), Sodexho’s "model" prison at Forest Bank has the highest rate of rate of assaults and the sixth highest rate of positive drug tests among all 40 prisons in its class (Male Local Prisons) http://www.hmprisonservice.gov.uk/corporate/dynpage.asp?Page=516. Meanwhile, the company is also making money locking up refugees, including children, in its new Harmondsworth Detention " http://www.notwithourmoney.org/05_sodexho/sodexho.html If their drugs work is anything like their catering.... |
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Government Consults on Changes to the Supply of Controlled Drugs under the PGD System The Government has issued a consultation document that looks at increasing the scope of supplying certain controlled drugs under the Patient Groups Direction (PGD) System. PGD's are directions from a senior doctor and a senior pharmacist that allow the supply of certain CDs by health professionals to (unspecified) presenting patients. The proposed changes would require changes to the Misuse of Drugs Regulations; the key proposals are: suppply of diamorphine for
cardiac pain by nurses in cardiac and A+E settings, The changes would generally allow for the supplly of substances by a range of health practitioners including nurses, midwives, optometrists, pharmacists, chiropodists and other specified groups. Frustratingly, the proposals do not address the long-standing issue relating to the supply and storage of prescribed controlled drugs in non-medical settings, such as hostels. As many readers will be aware, this issue has presented substantial challenges to the management of prescribed drugs in such housing situations. In a written response sent to Release in 2001, Charles Clarke acknowledged that the state of affairs was confusing and said that it was an issue that the Government would be looking in to. It would have made sense to address this issue at the same time as the changes to the PGD system. As this is a public consultation, KFx will be making representations to the Government on this issue; other housing organisations experiencing issues in this area may want to do the same. The Consultation document is at: | |||