How do we keep up this momentum?

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Fewer young people than ever are entering treatment for heroin and crack problems, and more people of all ages are successfully completing their treatment, says the NTA. What’s behind the trends, and can they be maintained? DDN reports

Figures released by the NTA last month (see news story, page 5) show that the number of young adults entering treatment for heroin or crack is now at its lowest recorded level. In 2011-12, 4,268 18-to-24-year-olds came into treatment for heroin, down from 5,532 the previous year and from more than 11,000 in 2005-06.

Overall drug use – problematic or otherwise – among the young also appears to be falling, with 19 per cent of 16-to-24-year olds reporting using drugs in 2011 compared to 25 per cent in 2005. Fears that large numbers of young people would start to experience problems with substances like mephedrone also appear – so far – to be unfounded. 

‘While the number treated for mephedrone has risen in recent years, this has been offset by a corresponding decline for similar substances, such as ecstasy,’ says the NTA’s report, with the actual numbers remaining ‘small compared to other drugs’. The total number of 18-to-24-year-olds coming into treatment for the first time for any drug fell from 18,500 in 2005-06 to 12,655 in 2011-12, a trend that’s ‘particularly encouraging’, says the agency. 

As the report states, the only age group where the numbers entering treatment are going up is the over-40s, who now make up almost a third of the entire treatment population. However, there’s ‘no evidence of swathes of people in their 40s and 50s starting to use heroin and crack’, says NTA chief executive Paul Hayes. ‘It’s a population that started using 20 or 30 years ago.’

Much has been made of these trends in the media, so what’s behind them?  ‘I’m surprised that everyone’s surprised,’ says Hayes. ‘It’s been going on for ten years.’ The ‘original pool’ of people with heroin and crack problems is shrinking, he points out, while the current recession has so far not produced the same levels of youth employment that led to the heroin epidemic of the 1980s. 

‘I also think that young people are savvier about drugs like heroin and crack than they were in the ’80s. And, like all social phenomena, drug use will ebb and flow as fashions change. One of my pet theories is that there’s been a reduction in smoking, and if there is a gateway drug – particularly to cannabis – then it’s tobacco. It’s also cheaper to drink alcohol than smoke cannabis, and there’s a plausible argument that the stronger cannabis that tends to dominate the market now puts a lot of people off.’ 

There is also a tendency to talk about the ‘demographic of young people as something that doesn’t change’, he says. ‘People are growing up in different familial and cultural environments than they were in the ’80s.’

While all of this is encouraging, as the agency says, Hayes isn’t complacent, warning of the risks associated with the economic climate and spending squeeze. ‘The lesson from Greece is that disinvestment comes at a heavy price,’ he says, with cuts in treatment and harm reduction services leading to the number of newly diagnosed HIV cases among injecting drug users rising from around ten in 2009-10 to 190 the following year. 

In the UK, however, the biggest funding threat remains to the ‘surrounding services – those allied to long-term recovery’, he stresses. Direct investment in drug treatment will form part of the budget going to local authorities from next year and there will be ‘mechanisms to ensure that’s protected’, he says, adding that ‘we would expect it to be in local authorities’ interests to continue to invest at that level’. As Public Health England will have responsibility for alcohol as well as drug treatment, however, another challenge will be balancing the two – ‘meeting the unmet need around alcohol without disinvesting in drugs’.

The UK’s treatment system has been ‘big enough to accommodate anyone who wants to take advantage of it’ for a number of years now, with methadone continuing to play a vital role, but the oft-made case for a need for more rehab places is overstated, he says. ‘Many people in rehab drop out and end up in the community system, and there’s no overwhelming evidence of a huge level of pent-up demand to go into rehab that’s not being met. In a small number of cases there are commissioners who are more reluctant to provide it than we’d like, but the big story isn’t community versus rehab, it’s the difference between the rehabs themselves.’

On the subject of polarisation, arguments around decriminalisation and legalisation add little of value to the debate about improving treatment outcomes, he believes. ‘Both extremes of this argument don’t want to acknowledge that things are getting better, because that doesn’t fit the radical change that either Peter Hitchens or Danny Kushlick want. It’s very difficult to get a hearing for boring, bureaucratic clinical stuff. Seventy seven per cent of MPs [in a UKDPC-commissioned ComRes poll] said the system wasn’t working. What I’d like to say to them – with more people successfully completing their treatment and drug-related crime falling – is what would it look like if it was?’

 

Drug treatment 2012: progress made, 

challenges ahead available at www.nta.nhs.uk