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Lack of harm reduction services impeding HIV progress, warns UNAIDS

Around 99 per cent of people who inject drugs live in countries that are failing to provide adequate harm reduction services, says a new report from UNAIDS.

Despite overall new HIV infections declining globally, infection rates among people who use drugs remain unchanged, says Health, rights and drugs: harm reduction, decriminalisation and zero discrimination for people who use drugs.

One in eight of the 10.6m people who inject drugs are living with HIV.

Although ensuring comprehensive harm reduction service coverage such as NSP programmes, substitute prescribing and HIV testing would ‘kick start progress’ on stopping new infections, few UN member states were living up to the 2016 agreement that came out of the UN General Assembly Special Session (UNGASS) on the World Drug Problem to establish an effective public health response (DDN, May 2016, page 4). Investment in harm reduction measures is falling ‘far short’ of what is needed for an effective HIV response, says the document – in a third of low and middle-income countries, more than 70 per cent of spending on HIV services for people who use drugs came from external donors.

More than half of the 10.6m people who inject drugs were living with hepatitis C, and one in eight were living with HIV, says the report. UNAIDS is calling for the full implementation of comprehensive harm reduction services, as well as ensuring that people who use drugs have access to prevention, testing and HIV and hepatitis medication. It also wants to see the decriminalisation of drug possession for personal use, and action to tackle drug and HIV-related stigma.

Criminalisation and ‘severe punishments’ remain commonplace despite the evidence showing that decriminalisation of personal use and possession can increase the uptake of health and treatment services, says UNAIDS. Around one in five prisoners worldwide is incarcerated for drug-related offences, of which around 80 per cent are for personal use only. Meanwhile, the death penalty for drug-related offences remains on the statute books of 35 nations.

‘UNAIDS is greatly concerned about the lack of progress for people who inject drugs, which is due to the failure of many countries to implement evidence-informed, human rights-based approaches to drug use,’ said UNAIDS executive director Michel Sidibé. ‘By putting people at the centre and ensuring that they have access to health and social services with dignity and without discrimination or criminalisation, lives can be saved and new HIV infections drastically reduced.’

Report at www.unaids.org


DDN Conference 2019

DDN Conference Magazine Cover

Speakers at the DDN conference embraced the theme ‘Keep on Moving’. What came out very strongly was that we need to take others along with us as we move – not just peers and colleagues, but people who are not in treatment or connected to services.

Read the full reports, and view videos and presentations

Read reports and watch highlights of the opening session – Moving Forward.

Read reports and watch highlights of session two – The big Conversation.

Read reports and watch highlights of the afternoon session – Insightful stories.


DDN would like to say a big thank you to all the speakers, sponsors, exhibitors, and magazine partners, the volunteers from Changes UK and CGL Coventry, Nigel Brunsdon, Paolo Sedazzari, Lee Collingham, Marcus Wolf, and all the delegates and groups who made it such a fantastic event.

If you have any feedback on this year’s conference or would like to be involved in the planning consultation for next year please click here.

End of Life Care – a guide

A special supplement on end of life care

People with alcohol and other drug problems, and their families, deserve the same respect and dignity at the end of their lives as everybody else. 

Read this special supplement written by the expert team at Manchester Metropolitan University as a mobile publication or download the PDF



As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the third of his series of articles, he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces.. Read it in DDN Magazine.

Mike Trace is CEO of Forward Trust

What is substance misuse treatment for?

In my last article, I summarised what I think have been the achievements, and failures, of the substance misuse sector over the last 20 years. One of the disappointments is that the sector has not facilitated a higher rate of recovery – helping more people to make transformational changes to the circumstances and behaviours that led them into drug and alcohol problems. The sector argues endlessly about definitions of recovery, and how best to enable people to find it, but I think we can all agree that we should be helping people to move from chaos and dependence to self-control, self-respect and independence.

The reason I started work in this sector 30 years ago was to help people who had been dealt a poor hand in life to confront the emotional and economic hardships they had endured, resolve to overcome them, and build a new life. That remains my reason for going to work. And observing the courage and determination of people going through that journey, and their joy in finding recovery, is my main job satisfaction.

So it amazes me that the sector does not focus more on this function – of inspiring and supporting transformational change. All drug and alcohol services are called recovery now – but my experience is that too much of what they do is neither inspirational nor ambitious for clients. Funding and performance management systems too often seem to encourage this focus on delivering basic care and case management processes, with not enough focus on the human factors that inspire change – organisations can win contracts to provide millions of pounds worth of services without demonstrating (or even describing) how they will help people to become independent.

The National Treatment Agency (NTA) blew its last chance to create the right incentives for a more recovery-oriented system. It created the national Key Performance Indicator around the number of people leaving treatment and not returning within a specified time. I said at the time that this is just another measure of our own processes, not of an individual’s real personal development. The aggregation of these sort of proxy indicators tells us little about a service’s real effectiveness, just the nature of its record keeping. But it is currently the main measure that is used to judge a service’s recovery credentials.

So real recovery – changes in attitudes and lifestyle – is not systematically embedded into, and incentivised within, our system. It is left to the initiative of good projects and good people (those projects that welcome, inspire, support and affirm – and fill their environment with positive, ambitious messages for clients, and role models and mentors to show what is possible). A great development in recent years has been the growth of peer-led recovery networks and communities. These are essential elements of a local treatment system, but it is shameful to see how little of the available funding goes to them, and most I speak to these days are struggling to grow.

Where this lack of vision and ambition exists, it not only misses opportunities for clients to show their potential, it creates a ‘system’ problem – if we have 270,000 people in treatment, hundreds of thousands more who should be in treatment, and around 120,000 new entrants per year, we need to have many more than the current 50,000 leaving the system per year (meaningfully leaving, not just ducking in and out) to make the numbers sustainable. In the absence of more effective move on/recovery, the treatment sector ‘bucket’ overflows and quality suffers in an overextended system.

In a context of an overall reduction in resources, this problem is acute – I will use my next article to suggest some ways out of this downward spiral.

DDN March 2019

Speakers at the DDN conference embraced the theme ‘Keep on Moving’. What came out very strongly was that we need to take others along with us as we move – not just peers and colleagues, but people who are not in treatment or connected to services.

We know that many drug-related deaths are outside of treatment, and Rosanna O’Connor of PHE was among those urging us to reach out. Lord Victor Adebowale said we ‘have to work together like never before’ to reach those at the sharp end of the inverse care law (where those in need of health and social care the most tend to get it the least).

Mat Southwell made the strong point of calling on the treatment community to look beyond its doors to the active drug user networks, because ‘when you engage with us you can interact with all those people who don’t use treatment’.

Our debate session on forming a service user network acknowledged that good communication is vital if we are to get anywhere. As Radha Allen from B3 pointed out, ‘chaotic drug users aren’t represented in a lot of service user groups’. Throughout the conference we heard inspirational words and saw the best networking in action. We heard new ideas and real enthusiasm for joining up with others to form an active, diverse and representative network that ‘agrees to disagree’, in the words of Tim Sampey, and gets everybody on board.

Can we do this? We hope so at DDN, and are ready to support communications within a service user initiative. As Jacquie Johnston said, ‘everyone is hardwired for connection’ and this whole diverse community could be its own strongest asset.

Claire Brown, editor

Read the latest issue as a mobile magazine or download the PDF

This issue also contains a supplement on end of life care, produced for Manchester Metropolitan University. 



Local authorities failing to provide sufficient naloxone

The amounts of naloxone being provided by local councils and prisons are ‘extremely limited’, warns a new report from Release. While all but three of the 152 local authorities who responded to Freedom of Information requests now supply the overdose-reversing medication – up from 90 per cent a year ago (DDN, February 2018, page 4) – the amount being dispensed is still ‘drastically insufficient’, says Release.

Zoe Carre from Release: ‘This life-saving medication is not reaching those who most need it.’ (pic: Nigel Brunsdon)

Just 16 take-home kits were provided for every 100 people using opiates in 2017-18, equating to 16 per cent coverage, with many areas also failing to provide kits to ‘key populations most likely to experience or witness’ an overdose. Almost 60 per cent failed to provide kits to clients accessing opioid-related treatment or services at community pharmacies, a quarter did not provide them to people in contact with outreach services for homeless populations, and more than 10 per cent failed to supply them to families and friends of people who use opioids.

While Darlington was the only local authority in England that did not report either having a take-home programme or plans to introduce one, low levels of coverage elsewhere were ‘particularly shameful’ given record rates of opioid-related deaths and the fact that naloxone is ‘cheap to acquire and has no potential for misuse’, says Release.

Many prisons were also failing to provide naloxone despite the acknowledged high risk of overdose in the first two weeks after people are released, the report says. Just over half of the 109 prisons that reported on take-home naloxone had a programme in place, and only one in five young offenders institutions. Failing to provide kits to people upon release meant that prisons were not fulfilling their duty of care, the charity states.

Release is calling for each authority to provide at least one kit to every person in the community using opiates, as well as making kits available to anyone else who requests them. People not in contact with treatment should be able to easily access naloxone through distribution points like community pharmacies, GP surgeries, ambulance services and peer networks, it adds, while every adult prison should also offer kits and training to everyone prior to release on an ‘opt-out’ basis.

‘There is a crisis of drug-related deaths in this country and many local authorities are failing to protect people from fatally overdosing on opioids,’ said policy researcher at Release, Zoe Carre. ‘The amount of take-home naloxone given out nationally has been abysmally low. This life-saving medication is not reaching those who most need it. People who use drugs are an extremely stigmatised group in society, facing significant health risks which are exacerbated by the government’s ideological abstinence-focused approach to drug use. If any other group of people were needlessly facing barriers to accessing a cheap and effective life-saving medication, there would be widespread public outrage.’

Meanwhile, the number of men dying from drug-related causes in Northern Ireland has doubled in a decade, according to figures from the Northern Ireland Statistics and Research Agency (NISRA). More than 100 of the 136 drug-related deaths registered in 2017 were males, compared to 51 in 2007. Female drug-related death rates have remained unchanged.

Finding a needle in a haystack: take-home naloxone in England 2017/18 at www.release.org.uk

Drug-related deaths and deaths due to drug misuse in Northern Ireland 2007-2017 at www.nisra.gov.uk


CGL and Sova announce full merger

Change Grow Live (CGL) and its subsidiary Sova are to fully merge, the charities have announced. The merger will mean integration of the infrastructure, expertise and service delivery of both organisations to allow service users to ‘benefit from a wider range of support, seamlessly delivered under one name’.

CGL chief exec Mark Moody: ‘Fully merging will create greater stability.’

Sova supports people with multiple and complex needs, and last year reported income of almost £4m, delivering more than 40 services across England and Wales. These included mentoring for young people, families and young and adult offenders, as well as mental health services, befriending, training and employment support. From this month all services will continue to be provided under the ‘Change Grow Live’ moniker, with the intention to make the change as seamless as possible – all service users have been informed of the new arrangement.

CGL’s work includes areas such as family services, domestic violence and homelessness alongside substance misuse, with the organisation changing its name from Crime Reduction Initiatives (CRI) three years ago to more accurately reflect its wider remit (DDN, February 2017, page 11).

‘We’ve achieved a great deal under the Sova brand over the years, however this seems like the right time to work more closely with Change Grow Live,’ said Sova’s head of operational delivery, John Leach. ‘We are making this change from a position of financial strength and this is a move that makes sense for us as an organisation as part of a strategy to have a bigger impact for the people we help.’

‘Everyone should feel proud of what Sova has achieved over the last six years as an independent entity within Change Grow Live,’ added CGL chief executive Mark Moody. ‘The two organisations already work closely together and share a lot of systems and processes and, as the number of people we support increases, this feels like the right time to bring all the services together. Fully merging the two organisations will create greater stability, allow us to deliver more impact and will ultimately benefit the people who we help. It will allow us to provide a more holistic approach to our services, benefitting the people who use them, and will also mean that we can run our services as efficiently as possible and plan effectively for the future.’

Home Office gives go-ahead for pilot drug-testing scheme

The University of Hertfordshire working with Addaction in Weston-super-Mare

The Home Office has granted the UK’s first official licence for a drug checking service. Anyone over the age of 18 can now take a sample of their drugs to Addaction’s service in Weston-super-Mare for the contents to be tested. The service is completely anonymous, with staff available to discuss support options and offer harm reduction advice.

The pilot project will operate in partnership with the University of Hertfordshire, with additional support from drug testing service The Loop. The testing process takes around ten minutes, during which people will fill in a short questionnaire to ‘allow harm reduction advice to be tailored to their needs’.

Fiona Meesham welcomes ‘an exciting development’

Along with identifying the content of drug samples, the service will help to gain an understanding of new drug trends, identify potential sources of harm and raise alerts. The drug samples will not be returned to their owners.

‘This is an exciting development for Addaction, the Loop and for UK harm reduction generally, resulting from several years of hard work,’ said director of The Loop, Fiona Measham. ‘Three summers piloting festival testing and a year piloting city centre testing has shown that drug safety testing can identify substances of concern, productively engage with service users and reduce drug-related harm.’

Roz Gittins
Roz Gittins: ‘It’s our job to help people make informed choices about the risks.’

‘This is about saving lives,’ said Addaction’s director of pharmacy, and project lead, Roz Gittins. ‘We know people take drugs. We don’t have to condone it but nor should we judge people or bury our heads in the sand. It’s our job to do whatever we can to help people make informed choices about the risks they’re taking. Checking the content of drugs is a sensible and progressive way to do that. If people know what’s in something, they can be better informed about the potential harm of taking it.’

Welsh Government to press ahead with 50p minimum price

The Welsh Government has committed to introducing a 50p minimum unit price for alcohol, following the results of a public consultation. ‘Ministers remain of the view that a 50p minimum unit price is a proportionate response to tackling the health risks of excessive alcohol consumption,’ the government announced.

Vaughan Gething: minimum pricing is part of a wider strategy in Wales

The government will now ‘lay regulations’ to the National Assembly for Wales for consideration later this year, it states – the assembly has already supporting minimum pricing when the Public Health (Minimum Price for Alcohol) (Wales) Bill was passed last year (DDN, July/August 2018, page 4).

There were almost 55,000 alcohol-related hospital admissions in Wales in 2017, as well as 540 deaths.

Minimum pricing came into force in Scotland last May following years of legal battles, while more than 100 MPs, health bodies and charities signed an open letter to the Sunday Times last year calling for it to be introduced in England ‘immediately’ (DDN, February 2018, page 5).

‘The Welsh Government has always said that minimum pricing forms part of a wider strategy and approach to reducing substance misuse,’ said health minister, Vaughan Gething. ‘Following a public consultation, I’m pleased to confirm we will now ask the National Assembly for Wales to approve a 50p minimum unit price. We believe a 50p minimum unit price strikes a reasonable balance between the anticipated public health and social benefits and intervention in the market. We will continue to use all available levers to reduce the harms caused by the excessive consumption of alcohol, as we develop and take forward a new delivery plan for substance misuse.’

The late Paul Flynn MP – an early advocate of drug law reform

Meanwhile, veteran Welsh MP Paul Flynn has died, aged 84. The Newport West MP was an early and vocal advocate of drug law reform – including around medicinal cannabis – and as chair of the All Party Parliamentary Group (APPG) for Prescribed Drug Dependence led the call for Public Health England to establish a helpline for people struggling with issues around prescription drugs (DDN, April 2017, page 4).

An early day motion he tabled on the Psychoactive Substances Bill stated that, ‘This House regrets the depth of scientific illiteracy’ in the document (DDN, February 2016, page 4) while he told DDN that the 2010 Drug Strategy was ‘exactly the same as every other drug strategy – self-admiring, futile and the product of the cowardice and stupidity of politicians,’ (DDN, June 2011, page 21). ‘The adjective that has been used about me over the years is “controversial”, which means that everyone agrees with every word you say years after you say it,’ he added. ‘It’s just a question of being patient.’

Tougher rules to protect children from gambling ads

New standards to protect children from ‘irresponsible’ gambling adverts have been published by the Committee of Advertising Practice (CAP). The new guidelines prohibit online adverts for gambling products being targeted at people ‘likely to be under 18’, along with the use of celebrities, sportspeople or others who are – or appear to be – under 25.

A 2016 report from the Gambling Commission estimated that around 9,000 children in England and Wales were ‘problem gamblers’, with 450,000 gambling every week via fruit machines, scratch cards or other means. Twice as many 11-15 year olds had gambled in the last week than had drunk alcohol, the review found, with three quarters reporting seeing gambling ads on TV.

The new standards, which come into force in April, include a list of unacceptable content that includes licensed characters from films or TV, certain types of animated characters such as cartoon animals, references to youth culture, and use of sportspeople and celebrities ‘likely to be of particular appeal to children’.

‘More freedom for gambling operators to market their products has gone hand-in-hand with huge growth of digital gambling platforms,’ says the report. ‘Online gambling is now readily accessible through smartphones and other internet-connected devices. Developments in social media have given rise to new marketing channels through which operators seek to engage more directly with consumers.’

Games that feature elements of simulated gambling are also not to be used to promote ‘real money’ gambling products, and gambling companies also need to avoid placing their adverts on web pages likely to appeal to under-18s, such as the parts of football club websites aimed at younger supporters. They must also ‘use all the tools available to them’ to prevent targeting young people on social network platforms, including information around browsing behaviour and users’ interests.

‘Playing at the margins of regulatory compliance is a gamble at the best of times, but for gambling advertisers it’s particularly ill-advised, especially when the welfare of children is at stake,’ said CAP director Shahriar Coupal. ‘Our new standards respond to the latest evidence and lessons from ASA rulings, and require that greater care is taken in the placement and content of gambling ads to ensure they are not inadvertently targeted at under 18s.’

Protecting children and young people – gambling guidance here and at www.asa.org.uk

This year’s DDN conference includes a dedicated session on gambling addiction and treatment. Book here