 Centre for Drug Misuse Research Glasgow Scotland From Harm Reduction to Abstinence: A Journey in Drug Treatment Pol From Harm Reduction to Abstinence: A Journey in From F From Harm Reduction to Recovery: A Journey in Drug Treatment Policy and Practice Neil McKeganey Ph.D Director

Harm Reduction Defined  Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption (IHRA 2009)

The Ascent of Harm Reduction  2002 Updated UK Drug Strategy:  All problematic drug users must have access to treatment and harm minimization services both within the community and through the criminal justice system.(Home Office 2002)  Nearly al Drug Action Teams (97%) have harm reduction services and 87% provide access to drug prescribing services (Home Office 2002) Centre for Drug Misuse Research Scotland

Harm Reduction Falls from Political Favour Centre for Drug Misuse Research Scotland

2010 UK Drug Strategy Reducing Demand Restricting Supply and Building Recovery A fundamental difference between this strategy and those that have gone before is that instead of focussing primarily on reducing the harms caused by drug misuse our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependency. (Theresa May: Home Secretary)

The Reasons for the Shift in Policy and Provision  Research  Media  Political Interest Centre for Drug Misuse Research Scotland

Drug Outcome Research in Scotland Study (2004):Treatment Goals n=1007)

2007 National Treatment Agency Client Survey England n=12,398 DrugHappy with UseLike to Reduce Use Like to Stop Using Heroin Methadone Crack Cocaine Amphetamines Cannabis Alcohol Benzodiazepines Centre for Drug Misuse Research Scotland

Treatment Outcome  In 2007 National Treatment Agency Reports that  In 2006/07 there were 180,000 drug users in treatment of whom only 3.2% (5,829) left treatment that year drug free. Centre for Drug Misuse Research Scotland

Drug Related Deaths in Scotland Linked to Methadone yearTotal Number of Addict Deaths Total Number of Methadone Related Deaths % of Total Deaths linked to Methadone Centre for Drug Misuse Research Scotland

Drugs and Addict Deaths in England % Increase All Deaths Heroin Methadone Cocaine MDMA Benzos Centre for Drug Misuse Research Scotland

Injecting Risk Behaviour in England (Last Month) Passing On >24 31 (31) 33 (36) 34 (44) 29 (37) 28 (36) 28 (38) 23 (29) 23 (26) 19 (22) 19 (27) 21 (30) Passing /Rec Scot Any Sharing

Media Coverage  Additional spend of £130m on drug treatment for 2004/05 only 70more people had become drug free. National Treatment Agency responded that in fact out of 66,123 people leaving treatment 8.8% were drug free.  Report on BBC that drug users were being prescribed additional doses of methadone as a reward for positive behaviour change.  Report that only 2% of drug users in treatment offered residential rehabilitation Centre for Drug Misuse Research Scotland

Political Criticism  Political criticism that many thousands of drug users were being “parked” on methadone, that the methadone programme amounted to a form of state sponsored drug addiction that was failing to enable drug users to become drug free. Centre for Drug Misuse Research Scotland

Prime Ministerial Assessment of UK Drug Policy  "Drugs policy has been a failure over recent years... We have spent too much time on heroin replacement and methadone rather than on trying to get people clean and clear up all the things in their lives that perhaps cause them to take drugs in the first place,” (David Cameron 29 June 2011 Hansard 954). Centre for Drug Misuse Research Scotland

Reorienting Clinical Guidelines: Medications in Recovery 2012  The ambition for more people to recover is legitimate, deliverable and overdue. Previous drug strategies focused on reducing crime and drug related harm to public health, where the benefit to society accrued from people being retained in treatment programmes as much from completing them. However, this allowed a culture of commissioning and practice to develop that gave insufficient priority to an individual’s desire to overcome his or her drug or alcohol dependence. Centre for Drug Misuse Research Scotland

Recovery the Cornerstone of Drug Treatment  The focus now in on trying to ensure that drug treatment services are working to enable drug users to become free of their dependence. Centre for Drug Misuse Research Scotland