If treatment is to survive it needs to make a more convincing case and reach out to new groups, argues Paul North.
Seven years ago I, along with several hundred drug treatment workers, sat at CRI’s (now CGL) annual conference and listened to the opening speech by CEO David Royce. The mood was positive. Money was coming into the sector, CRI was growing month by month and treatment centres were, on the whole, robustly staffed.
David stood centre stage and whilst enthusiastically praising staff for their continued hard work and commitment, he delivered a stark warning to the room. The future might not be so bright for drug treatment – we must be careful, prepared and fluid. The money that the sector relied upon might not be ring-fenced in the years to come, and we must be ready to change. It might be that treatment needed to branch out and look for money elsewhere. It was likely there would be fewer jobs, and higher caseloads.
Six years later when I was sat in a council meeting listening to the proposed cuts to the treatment budget in York, the reality of the situation finally hit me. Of the four councillors in front of me, one was unashamedly falling asleep. Another, who despite having taken the time to research the subject, asked questions with next to no passion or concern for the excessive reductions in funding. The whole process was a formality, with no press coverage and no real challenge from treatment, all overseen by a powerless commissioner watching the precious budget slip through their hands like sand.
Having left treatment and now working in policy, I have spent a lot of time considering how this situation can be reversed. How can services reach previous levels of funding? What needs to be done to stop the budget cuts?
In order to answer these questions the first step is to accept a cold hard truth. The public are not concerned by a reduction in drug treatment budgets. The heroin cohort single-handedly created, funded and sustained treatment for years. From concerns around the spread of blood-borne viruses to drug-related offending, providing treatment with money was not a political hot potato – it simply made sense.
Years later, heroin deaths are at an all-time high, treatment services have seen record budget cuts and there has been no significant public fallout. While it is easy to blame austerity and government, the truth is that the majority of the PHE budget is happily spent elsewhere – a decision ignored by local communities and the media. As the heroin cohort dies and leaves treatment, so does the money to support them.
The challenge that treatment must confront, and a surefire way of creating funding, is to connect public need with public concern – raising awareness of an issue to attract new referrals, whilst at the same time educating society on the benefits of doing so. This is no small task for treatment and requires innovative outreach. The truth though is that if treatment does not find treatment-naive groups and make a convincing case for supporting them, the government is unlikely to give out funding on the off-chance of success. There needs to be a clear justification for funding, and concern to match it.
Creating public concern often requires a good narrative, and these narratives must also be backed up by data and evidence. The first step then is to prove the need, by evidencing that there are hundreds of thousands of people who require support. All these people who would benefit so much from treatment need to walk in through the front door – these stats then need to find themselves on the desks of commissioners as well as the local press. At a local level, let people know the great work the treatment service is doing and encourage others to get support. Identify a group and prepare them for treatment, get them on NDTMS and prove treatment still has a use outside of the heroin cohort.
The first group that treatment could target is an easy win. Last year, 23.8m opiate prescriptions were dispensed in the UK. Use of painkillers has risen by 80 per cent in ten years and is costing the NHS billions of pounds – there are no doubt hundreds of thousands of people using opiates problematically on prescription. They are easily accessible, in every community across the UK, and reducing their use would save the NHS millions of pounds. Furthermore such an approach would bring significant health benefits, as it is estimated that up to 90 per cent of prescribed opiates are ineffective at addressing chronic pain. Treatment services are essential if such a reliance is to be reduced – without a planned therapeutic intervention a situation similar to that in the US could emerge where those taken off ineffective prescriptions simply seek out illicit opiates.
It is clear that a very strong economic and health argument could be made for engaging this group. Save money, put some of it into treatment and reduce the vast numbers of people on poorly managed opiate prescriptions.
The next key group is the hundreds of thousands of cannabis users that do not enter treatment. Last year we showed in Liz McCulloch’s report Black sheep that cannabis presentations have risen by 55 per cent in ten years. My report Street lottery estimated that this equates to 200,000 cannabis users in the UK. Cannabis represents both the fastest growing cohort of drug users, and the most commonly used drug among young people and adults. As outlined in Black sheep treatment has not yet made a convincing case for engaging this group as we are ignorant of the health and economic benefits of doing so. This group require bespoke outreach interventions and campaigns to engage. Without any effort at all the group has doubled in size in ten years. Imagine what it would look like if treatment made a more concerted effort.
If services around the country looked up from managing the heroin cohort and engaged treatment-naive groups then the money would emerge – the national press would have a story, further educating the public on the changing face of treatment and encouraging others to seek support. The issue of funding services would then likely receive far more public support. Such a strategy would unite public concern with public support, thereby validating funding.
This is not about ditching the important service that treatment provides for the heroin cohort. It is about ensuring in years to come it can continue to do so effectively. Treatment needs to stay well funded and healthy to support heroin users at a time when overdoses are at an all- time high. Those on the frontline of drug treatment know full well the importance of continued support for this group.
This is an exciting proposition for those working in treatment. The chance to explore a new frontier and engage groups who have historically avoided support. A chance to show government the innovation that the sector is capable of and share the life-changing work that has been going on in key-work rooms up and down the UK for years.
To those who are sat with overwhelming caseloads, complex clients and demanding targets, the only way out of that picture is to adapt. The heroin cohort created treatment but if services don’t act they might also spell the end of it. They are no doubt a vulnerable and difficult cohort to work with who need bespoke support, but they are not the key to future funding. If treatment does not grasp this opportunity quickly and make a convincing case for more money then it will disappear into irrelevance, and only have itself to blame.
Graph data from Beyond the tipping point at www.recovery-partnership.org