Drug Science Response to the UKs 10-Year Drug Strategy
Drug Science welcomes the fact that the government has agreed to accept many aspects of the Dame Carol Black review on addiction treatment services, to which Drug Science previously submitted evidence.
The major positive outcome appears to be a focus on the use of treatments rather than punishments to reduce drug use and harms. This suggests the government has at last caught up with the scientific community in understanding that addiction is a medical rather than a criminal issue and that criminalising drug users [as opposed to drug dealers] only perpetuates a cycle of use that drives more into drug dealing and hence more drug users.
As well as being humane this change of attitude makes sense for several reasons. These include the fact that the massive increase in prison numbers over the past 40 years for drug offences hasn’t reduced use. The rising deaths toll, especially from opioids, in the past five years, which now has reached an all-time high, reflects a failure of treatment availability.
However the proclaimed focus on recovery is worrying if that continues to translate into abstinence-only approaches. The recent calls by senior Tories to stop methadone use in prisons suggests that some still believe this dangerous idea that abstinence is the only acceptable outcome for addiction. Of course if it can be achieved abstinence is to be welcomed, and almost all opioid and alcohol addicts repeatedly try for this. But for most this is not immediately possible, and it comes with a greatly increased risk of death from accidental overdose when they relapse. So other policies must be pursued in parallel.
The three most important of these are:
Major investment into research for new treatments to promote abstinence. Currently there are no licensed treatments for opioid addiction other than substitute therapy with methadone and buprenorphine, two safer opioids that protect from the worst harms of i.v. opioid use but at the price of maintaining dependence. Proven non-dependence-producing abstinence-promoting treatments for alcohol addiction exist (e.g. acamprosate, nalmefene) and modern neuroscience suggests similar approaches to opioid and cocaine addiction are possible. This research should be made a priority for the MRC whose addiction research portfolio is currently very empty.
The development and then provision of new approaches to treatment especially the use of drugs that break down the brain circuits that perpetuate drug and alcohol seeking behaviour and cravings. When coupled with standard abstinence-based talking therapy they can offer greatly enhanced likelihood of abstinence. This is an area of major innovation with exciting new findings for just one or two treatments providing enduring outcomes. Examples include psilocybin in the treatment of tobacco and alcohol addiction and MDMA or ketamine in alcoholism. Trials in opioid and cocaine addiction are now a priority and given the UK leads the world in this research, psychedelic addiction treatment studies should be commissioned here asap. Also as the controlled status of these drugs makes research unnecessarily complicated and difficult these should be rectified as recommended by Drug Science and the CDPRG.
Encouraging pilot programmes for safe injecting rooms (drug consumption rooms). These are proven to save lives, but their other attributes are often not appreciated. They can be used to promote entry into addiction treatments, facilitate other health interventions plus facilitate social integration and moves towards employment. They also get needles and other drug paraphernalia off the streets so improving neighbourhood quality and protecting children from accidental harms. Scotland is beginning to see the benefits of the safe injecting vehicle that peter Kryant has set up in Glasgow so there is no reason for England and Wales to hold back.