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Welcome to July's Policy Briefing. Please let us know if you have any feedback about the content or format of the briefing.
This month's edition has a focus on: New Psychoactive Substances and the Psychoactive Substances Act 2016.
Adfam's Policy Briefings are supported by:
 
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The changes that have happened in our sector, and related ones across the range of health and social care, have impacted on all elements of ‘the system’ – those struggling with drug and alcohol issues, their families and communities plus those working in, managing, funding and commissioning services. The days of the dedicated, named substance misuse commissioner seem to be coming to a close – what many of us call ‘commissioners’ as a useful shorthand are now more likely to be called ‘public health specialists or managers’ and be working across the gamut of public health interventions and services.
As some of you may now Adfam is delivering throughout 2016 and 17 the work of the Recovery Partnership – an integral part of which focuses on those commissioning drug and alcohol services. We are running a free, Chatham House event in Manchester in September for anyone with a responsibility for commissioning these vital services. The day will feature presentations from people in the field, updates and peer support for all attendees and a confidential space for people to raise concerns as well as identify challenges and successes. There will be a second event in London in the new year. Please get in touch if you’d like to attend.
Collective Voice – the alliance of most of the leading third sector treatment providers – will also be running events for commissioners in the coming months. In their own words ‘In our view the sector cannot afford to wait until the drug strategy is published before it collectively considers how to respond to the challenges the emerging political landscape represents’. If you’d like to be part of that conversation keep an eye on their news page or drop them a line.
Lastly, Russell Webster has finished work on his payment by results (PbR) tool, which can be found online here, with a one minute explanatory video also available.
In short the purpose of the interactive tool is to help commissioners, investors and providers consider whether it might be appropriate to use PbR for a particular service. The tool asks key questions on both the rationale for using PbR and key elements of the contract such as defining and validating outcomes and guarding against common PbR problems such as “creaming and parking” and unintended consequences.
The tool provides immediate feedback, followed up by summaries of key research. It is evidence-based and completely free to use.
Oliver Standing
Director of Policy and Communications
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MP Mary Glindon asked the Secretary of State for Health how the Department ensures that the delivery of drug and alcohol treatment by local authorities conforms to the NHS constitution. Jane Ellison MP, the Parliamentary Under-Secretary of State for Health, replied that Section 2 of the Health Act 2009, as amended by the Health and Social Care Act 2012, requires local authorities to have regard to the National Health Service. The Department also distributes funding to local authorities through the Public Health Grant. The grant includes a requirement for each local authority to have regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services. Local authorities are also required to report annual expenditure on drug and alcohol services.
MP Byron Davies asked the Secretary of Health what assessment he has made of the potential effect of the Chief Medical Officer’s revised guidelines on alcohol consumption on consumer behaviour. Jane Ellison, the Parliamentary Under-Secretary of State for Health, replied that the National Institute for Health Research has awarded funding to the University of Sheffield Alcohol Research Group to evaluate the new drinking guidelines.
MP Paul Flynn asked the Secretary of State for Transport what evidence his Department holds on the effect of the number of roadside drug testing on the number of traffic accidents, and what assessment he has made of improvement in road safety since the introduction of roadside testing. Andrew Jones MP, Parliamentary Under-Secretary for the Department of Transport, replied that the Department will publish a final report in 2017 to evaluate the effect and impact on road safety of the new section 5A offence, which will include the use of roadside testing. In addition, the effectiveness of the recent THINK! 2016 drug drive spring campaign, which refers to the use of roadside drug testing, will also be evaluated and a report will be published in the summer 2016.
Lord Chadlington asked Her Majesty’s Government what steps they have taken to engage with individuals who are aware of having an alcohol problem but have not, because they are too ashamed or frightened, sought help. Lord Prior of Brampton replied that local authorities and their health and wellbeing board partners have responsibility for planning the full range of alcohol services, from early intervention and prevention through to commissioning alcohol treatment services to meet need in their area, and ensuring services are accessible to everyone. Furthermore, in line with the National Institute for Health and Care Excellence (NICE) public health guidance, Public Health England (PHE) encourages health and social care professionals to carry out Identification and Brief Advice through general practitioners and programs such as NHS Health Checks and Making Every Contact Count.
MP Tom Blenkinsop asked the Secretary of State for Health what recent assessment he has made of the level of alcohol dependency in the criminal justice system. Ben Gummer MP, Parliamentary Under-Secretary for the Department of Health, replied that research shows that around three-quarters of people in contact with the criminal justice system in the United Kingdom have a problem with alcohol, and over a third are dependent on alcohol. This includes those in police custody, probation settings and the prison system.
Public Health England has advised that in 2014/15 there were 79,952 new presentations to alcohol treatment in the community, and 7,688 (10%) of these were referred to treatment via the criminal justice system (including arrest referral services, prisons and probation).
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New Policy Direction for the Big Lotter Fund – Big Lottery Fund
The Big Lottery Fund is seeking views on the proposed new policy direction for the allocation of Big Lottery funds in England, the Isle of Man and UK-wide programmes. The Big Lottery is keen to collect views on new directions that the Big Lottery Fund should be covering, and on the Fund’s international work. This is a 12-week consultation, running from 20 May until Friday 12 August.
Fundraisers- tell us how the fundraising crisis affected you –The Guardian
The Guardian Voluntary Sector Network is looking for charity fundraisers to share their views on how regulation changes in fundraising affects their morale, and whether it poses any challenges at work and for the future. It is a short 10-minute survey open to all charity fundraisers.
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Drug Education Yet to Match Great (Preventive) Expectations – Drug and Alcohol Findings
This article considers the impact of school-based drug education on preventing unhealthy or illegal drug use. It argues that whilst the promise of prevention is clear, fulfillment is less so. The Blueprint programme, a multi-million pound trial implemented in 23 schools in England in 2004 and 2005,was found to be the most disappointing of all studies considered. The programme utilized advanced interactive teaching methods, reinforced by parental and community-wide components. By the end of the trial, there was no indication that the programme had retarded the growth in substance use more effectively than usual lessons in non-Blueprint schools. Such findings raise the possibility of focusing on harm reduction rather than preventing or delaying substance use. Recent findings from Northern Ireland, where the ‘SHAHRP’ alcohol harm reduction curriculum has been adapted for secondary schools, show that the programme curbed the growth in alcohol-related problems during teenage years, pupils drank less and the effects were most apparent when lessons were taught by voluntary-sector drug and alcohol educators rather than schools’ own teachers.
Hidden Harm: Treating Alcohol’s Impact on Children and Families – Foundation for Alcohol Research and Education
This campaign highlights the extent of alcohol-related family and domestic violence in Australia, and its effects on children, families and communities. It calls for action in five specific areas to be taken at the community, family and individual level, and argues for the need for political leadership to facilitate change. FARE calls for action to prevent alcohol-related family violence through encouraging cooperation and providing training and funding to alcohol and other drug services to implement family-centered practice. It seeks to protect children from alcohol advertising and sponsorship through instigating a government-led review of alcohol advertising regulation across all forms of media, and urges government to fund and develop a second National Fetal Alcohol Disorders Strategy from 2017-2018. FARE encourages a nationwide public education campaign on alcohol harms and harm reduction, and advocates for the reform of alcohol tax and the development of a funding-base for preventing alcohol harms.
Spice: The Bird Killer – What Prisoners Think About the Use of Spice and Other Legal Highs in Prison – User Voice
This report examined prisoners’ views on the nature and extent of spice use and problems inside prison. Spice, formally known as synthetic cannabinoid receptor agonists (SCRAs), is a type of new psychoactive substance (NPS) that is prohibited under the Psychoactive Substances Act 2016. Since 2011, there has been growing evidence that Spice has become a serious problem in British prisons. According to research, the amount of Spice seizures in prisons in England and Wales rocketed from 15 in 2010 to 737 in 2014, and NPS-related deaths in prison reached 39 at the start of May 2016. The majority of survey participants estimated that between half and nearly all of their fellow prisoners had used Spice in prison, reportedly fueled by the desire for ‘mind-numbing’ experience, as well as the huge amount of money that can be made from selling spice inside prison. The report concludes that prisoners are not using NPS to break the rules,but to self-medicate and attempt to cope with a range of psychosocial problems, such as depression and anxiety. Most NPS users within prisons are not seeking help because of the fear of stigmatisation or not knowing what help is available.
Alcohol Use across Retirement: A Qualitative Study of Drinking in Later Life – Glasgow Centre for Population Health
This report presents the results of a qualitative exploration of older people’s drinking and the factors influencing their use of alcohol. It found that retirement is one of many events in a person’s life which can bring a change of routine, including around alcohol. The increased opportunity to drink provides an opportunity for the volume of alcohol consumed to increase. However, it also notes that alcohol need not be viewed simply as a hurdle to health and wellbeing, since moderate drinking can contribute to engagement with ‘active’ and ‘healthy’ ageing. The report states that services should ensure that older people’s drinking is not missed, and that the needs of older people, particularly around ensuring social connections and interaction, are no different from adults more generally.
European Drug Report 2016 – EMCDDA
The report by EMCDDA offers an up-to-date and top-level overview of drug use, problems and markets across Europe. It highlights the increasing complexity of current drug problems with stimulants, NPS and misused medicines, and finds that problematic cannabis use is on the rise. It points out that past problems have not been alleviated, since Europe’s opioids problem remains a central issue in the analysis. There are regional differences in stimulant consumption patterns across Europe: cocaine use appears higher in western and southern European countries, while amphetamines are more prominent in northern and eastern Europe. It estimates that cannabis accounts for the largest share in value of Europe’s illicit drug market, is becoming a major income generator for organized crime and accounts for nearly three-quarters of all drug-related offences. Another challenge identified was the rise of NPS: 60% of reported seizures in 2014 were synthetic cannabinoids. A follow-up article in the Guardian based on the report and interviews with drugs counsellors can be viewed here.
Event Report: Supporting Positive Relationships between Prisoners and their Families – CLINKS
This event report is based on a roundtable meeting on the maintenance of family ties during imprisonment, organized by the Ministry of Justice. It compiles evidence to assist and inform the prison reform and transformation programmes, and acknowledges that families experience a ‘hiddensentence’ when a family member is imprisoned. It points out that installation of telephones in prisoners’ cells have yielded benefits such as improvements in prison security and reduction in attempts to smuggle mobile phones into the establishment. The number of prisoners failing random mandatory drug tests also fell following the introduction of the scheme. The report draws attention to the universal challenges of the system, including inconsistency regarding the needs of women, people of different faiths, national and linguistic backgrounds, drug users and IPP (imprisoned for public protection) prisoners. The Strengthening Families, Strengthening Communities (SFSC), was also discussed: it emphasises family value, promotes protective factors associated with good parenting and often supports parents at risk of being marginalised, including those with experience of drugs, alcohol or violence.
Statistics on Alcohol – Health and Social Care Information Centre
This statistical report presents a range of information – new and old –on alcohol use by adults and children, drawn together from a variety of sources in England states that alcohol misuse can be directly responsible for deaths resulting from certain diseases, such as cirrhosis of the liver, and in some cases may be associated with other causes of death, such as strokes. The report also looks at drinking behaviours amongst adults and children and the different consequences of drinking for the two groups. As well as this, the report includes data on alcohol related hospital admissions, alcohol related prescriptions and expenditure and affordability of alcohol.This publication has been reformatted following feedback gathered from a user consultation.
Widening the availability of naloxone – PHE et. al.
The updated guidance explains the regulations that widen the availability of naloxone, which came into force on 1st October 2015. Naloxone reverses the effects of opioid overdose. A range of drug treatment services can now order naloxone and make it available to others without a prescription. This report also outlines the cost effectiveness and risks of widening the availability of naloxone.
The Life Chances Fund – The Cabinet Office
The Life Chances Fund was launched by the Cabinet Office on 4th July 2016, and aims to tackle entrenched social issues and improving people’s life chances by looking at local solutions to local problems. It is structured around six key themes, including drug and alcohol dependency. The Fund reflects a growing recognition that resolving complex social issues, such supporting people who are experiencing multiple needs, requires a cross-governmental approach. £30 million of the funding is allocated specifically for proposals to address drug and alcohol dependency recognising the close links between substance misuse and other outcomes, including stable accommodation, reduced offending and improved mental health.
Hundreds of babies born drug-dependent – BBC News
According to a BBC investigation almost one in 500 babies born in hospitals in England are dependent on substances their mother took while pregnant. The highest percentage of drug dependent babies were born in Bedford Hospital, with 1.39% of new-borns being drug dependent. In contrast, Leicester General had one of the lowest rates, with one in every 5,000 babies born addicted to a harmful substance. This shows that there is wide geographical variation in the number of babies born dependent on harmful substances. In addition, those working to treat mothers and babies with a drug addiction reported that the majority of parents they deal with come from a disadvantaged background, with most cases involving misuse of drugs like heroin, cocaine or alcohol. However, the English data shows that over the past four years there has been general decline in the number of new-borns diagnosed with substance dependency.
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NPS Come of Age: A UK Overview
This report, written by Drug Wise, focuses on the issue of New Psychoactive Substances (NPS) and the Psychoactive Substances Act 2016, which came into effect on 26th May 2016. Since 2006, there has been a growing interest in and availability of NPS, also known as ‘legal highs’ and, less frequently, ‘research chemicals’. The rise of NPS was fueled by the use of the internet as a new route of wholesale and retail supply distribution and information exchange. Trying to ascertain the extent of NPS use has been problematic; mainly because the main indicator of drug use in the general population for England and Wales (the Crime Survey) does not include several groups that might be expected to be more regular users of NPS, such as students, adult prisoners, young offenders and the homeless. Other data relies on self-reporting and self-selecting surveys. Relatively few NPS users are coming forward to treatment services citing NPS as their primary drug problem, suggesting that NPS could be a stepping-stone for users to exacerbate their drug-use problems. Regarding treatment service intervention, there is limited specific guidance on how to intervene with those who do present with NPS problems, and there are relatively few people coming forward citing NPS as a primary substance of concern. Taking into account that NPS’ mimic controlled drugs; in theory, health-care staff should be able to identify similar presenting symptoms and issues.
The Psychoactive Substances Act bans the manufacture, sale and distribution of any and all psychoactive substances, accompanied by a list of exemptions including tobacco and alcohol, with penalties on conviction ranging from six months to two years and/or a fine. Similar to the reclassification of cannabis from a Class B to C in 2004, the Act has caused controversy, and has been met with criticism from both mainstream and social media. It is seen as another failed attempt of the drugs war and may drive activities underground, causing greater damage to society. The Act is subject to review after 30 months. It is expected that sales of NPS are likely to move to the streets via mobile food outlets and regular street dealers.
For more information on the prevalence and problems of NPS and general drug use in the UK, see the Home Office Forensic Early Warning System (FEWS) and the Welsh Emerging Drugs and Identification of Novel Substance Project (WEDINOS).
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