1. DrugScope National Conference Policy, practice and passion: driving drugs work forward Homerton College, Cambridge - 12 July 2007 James Egan, Head of Policy & Practice james@sdf.org.uk

2. Some thoughts on passion Nothing great in the world has ever been accomplished without passion - Hegel He only employs his passion who can make no use of his reason - Cicero Most people are other people. Their thoughts are someone else's opinions, their lives a mimicry, their passions a quotation - Oscar Wilde

3. KPIs Key Passion Indicators

4. Realistic drug policies? Drug misusers have the same entitlement as other patients to the services provided by the National Health Service. In most cases, all new patients being prescribed methadone should be required to take their daily dose under the direct supervision of a professional for a period of time which may be around three months… ‘Orange’ prescribing guidelines - update 2007

5. Realistic drug policies?  Adult Drug Services  Paediatric Dispensing Services?  Politicised crowd control?  Robust evidence base it reduces harms?  “…specific recommendations, such as that regarding supervised consumption, are only very loosely evidence-based.” (Keen, J. 1999)

6. Realistic drug policies? Problem drug users useful scapegoat to deflect attention from the failings of socio-economic policies to benefit the full cross-section of society. Social change, not individual users, ought to be the main policy focus. (Friedman, 2002)  Has drug policy and practice also become a useful scapegoat?  Distracted by ‘ghettoised’ competing debates between health and criminal justice solutions?

7. Realistic drug policies? …they have got to give you about three different interviews with three different people before they will even put you on any sort of treatment and then wait six months and then by that time everything’s changed and you have managed to stop it yourself. Colin, 35, occasional non-dependent heroin user McSweeney & Turnbull (2007)  1988: four page assessment  2007: move to a single shared 26 page assessment  Search for exclusive individual solutions to wider inequalities beyond drug policy?

8. It cannot fix this?  Number of council and housing association homes in Scotland may drop by almost 70% by 2020.  May lead to a further increase in highly concentrated ‘poverty clustering’.  This changing market may lead to those with urgent housing needs, such as problem drug users, being clustered in fragmented, hard to let areas thus fuelling local ‘drug’ economies.  Reversing this clustering may require an increase in public/council housing provision in Scotland. (Shaw et al 2007)

9. Or even this? New contacts seeking help from Scotland’s drug services – averaged rate of 85% unemployment National unemployment rate of 5.2% Income Support & Jobseeker payments for households with children and pensioners have risen relative to earnings Working-age adults: 20% less, compared with 1997 (Palmer et al. 2006) Unemployed young woman, aged 20, prescribed Methadone, becomes pregnant for 1 st time: £46.85 per week

10. Conclusion Move from ghettoised health v criminal justice to drug policy being absorbed into social policy areas e.g. anti-poverty, housing and homelessness, regeneration, welfare and economy BUT not expense of special needs of problematic drug use Move from “target dancing” culture towards realistic and humane drug treatment outcomes e.g. improvements in health & wellbeing; ability to control and reduce harmful behaviours More “bottom-up” policy development to ignite passion and move practice beyond “bureaucratisation of misery’ (Pryor 2006)

11. References Friedman, S.R. (2002) ‘Sociopharmacology of drug use: initial thoughts’, International Journal of Drug Policy, Vol. 13, pp. 341–7 Keen, J. (199) (Editorial) Managing drug misuse in general practice, British Medical Journal ;318:1503-1504 ( 5 June ) McSweeney, T. & Turnbull, PJ. (2007) Exploring user perceptions of occasional and controlled heroin use - a follow-up study Palmer, G., MacInnes, T. & Kenway, P. (2006) Monitoring poverty and social exclusion in Scotland 2006. New Policy Institute & Joseph Rowntree Foundation. Pryor, W. (2006) ‘The Bureaucratisation of Misery’ Drink and Drug News (20 November). RSA (The Royal Society for the encouragement of Arts, Manufactures & Commerce) (2007) Drugs – facing facts The report of the RSA Commission on Illegal Drugs, Communities and Public Policy, March 2007. Shaw, A. et al (2007) Drugs and poverty: A literature review. A report produced by the Scottish Drugs Forum (SDF) on behalf of the Scottish Association of Alcohol and Drug Action Teams The Future for Social Renting in Scotland - Discussion Paper: A report for the CIH in Scotland (2006) http://www.cih.org/scotland/policy/future-socialrenting.pdf http://www.cih.org/scotland/policy/future-socialrenting.pdf Warburton, H. et al (2005) Occasional and controlled heroin use Not a problem? Joseph Rowntree Foundation