drug trategy eview DRINK AUGISE - Drink and Drugs News · Forcing stable people off their scripts...

DRINK AND DRUGS NEWS ISSN 1755-6236 DECEMBER 2015

Merry Christmas and a Happy New Year to all our readers

PLAYING SAFEENSURING PROPER SAFEGUARDING FOR CHILDREN

INSIDEShaping the 2016 drug strategy2015 in review

get the pIcture!

See you on 25 February 2016 in Birmingham

Information and booking at www.drinkanddrugsnews.comFor exhibition and sponsorship packages email [email protected]

9th DDN national service user involvement conference

This year we want you to contribute to an important initiative, mapping what’s happening to services.

Give us a snapshot of your experience and help us build a picture of what’s going on all overthe UK. Visit www.drinkanddrugsnews.com now and fill in our quick and easy form.

Have your say and be there on the day!

InspIratIon - Ideas - networkIng - actIon

* Are you happy with what’s going on inyour area?

* Do you have the right treatment options?

* Is money reaching essential priorities?

* Are you treated with respect?

* Can you communicate your needs?

ON THE COVER

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Publishers: Partners:

Federation of Drug and Alcohol ProfessionalsSupporting organisations:

4 NEWSIreland considers introducing consumption rooms and decriminalising

small amounts of drugs for personal use. DDN’s round-up of local and

national news.

6 THE STATE WE’RE INThe benefits of diamorphine prescribing are proven, says Erin O’Mara.

Forcing stable people off their scripts shows a treatment system in

terminal decline.

10 COVER STORY‘We lack honesty and courage as a sector.’ Trying to get the balance right

in the tricky issue of safeguarding children.

14 LEANER AND KEENER’The 2010 strategy got the big calls right.’ Paul Hayes of Collective Voice

looks at what shape the next drug strategy should take.

16 LETTERS AND COMMENTMoral maze: taking issue with ‘divisive terms’ and ‘moral narratives’

18 DARK DAYSDDN looks back on a challenging for year for the drug sector.

December 2015 | drinkanddrugsnews | 3www.drinkanddrugsnews.com

editor’s letter

‘Agencies must worktogether... what a differencethey can make when engaged’

Contents

Talking about child safeguarding requires such a delicate balance.Why are we missing signs that children are at risk? The recentAdfam/DDN conference (page 10) highlights ‘one of the most

difficult and fraught areas of practice’, ‘a Pandora’s Box’, that finds uswanting in ‘honesty and courage as a sector’. How can we redress this?

Adfam’s research finds training to be crucial, as well as agenciesworking more effectively together to minimise risk – a point illustratedby Karen Hammond, speaking at the HIT Hot Topics conference aboutthe (potentially pivotal) role of public health nurses. What a differencethey can make, when properly informed and engaged.

I don’t need to remind you that it’s been a tough year (page 18).Gathering thoughts on where we should head for a new drug strategy,Paul Hayes wants to build on the vision of keeping the individual at thecentre of treatment. But for some, this is already a far cry from reality,as diamorphine prescribing is driven from the treatment landscape(page 6). Who cares about the evidence base now, asks Erin O’Mara.

We need to hear about your experience of treatment in time for theninth national service user involvement conference in February. Ourtheme is ‘Get the picture’ and we want your experiences – please headto our website to get involved. While you’re there, don’t forget torenew your free subscription if you want to keep receiving DDN!

I hope there’s plenty in this issue to keep you in touch with us overthe break – we’ll be back with our next issue on 1 February. In themeantime, have a happy and restful Christmas and new year.

Claire Brown, editor

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Safeguarding children, p10

SAFEGUARDINGACTIONMORE CHILDREN than previouslythought are dying or being hospitalisedafter ingesting opioid substitutiontherapy (OST) medications, according toa new report from Adfam. The charitysays lessons from previous tragic caseshave still not been learned and wantsto see all incidents of children ingestingOST medication ‘fully investigated andrecorded’, with the information properlyanalysed and shared with local services.Adfam is calling for proper training forparents as well as for all professionalswho come into contact with parents andcarers prescribed OST drugs.Medications in drug treatment: tackling the risks to children – one year on at www.adfam.org.ukSee feature, page 12

HEP UNAWARENESSAlmost half of injecting drug users areunaware of having hepatitis C, according toPHE figures. Despite uptake of testingstanding at more than 80 per cent of users,around 48 per cent of infections wereundiagnosed, says the latest Shooting upreport. Regular testing – whether throughtreatment services or primary care –remains ‘crucial’ to protecting health, saysPHE. Meanwhile, the World HepatitisAlliance has stressed that the fasterprogression of viral hepatitis in HIVpatients means this group is three timesmore likely to suffer liver disease, liverfailure or liver-related deaths. Theorganisation is calling for more recognitionof hepatitis and HIV co-infections. Shootingup: infections among people who inject drugsin the UK, 2014 – an update at www.gov.uk

‘NO EVIDENCE’ MEANSIRRESPONSIBLE DEALThe government’s public healthresponsibility deal for alcohol has pursuedinitiatives ‘known to have limited efficacy’while obstructing more meaningful action,according to a report by the Institute ofAlcohol Studies (IAS). ‘With no supportfrom the health community, and noevidence of effectiveness, it would beabsurd for this government to continuewith such a farcical initiative,’ said IASdirector Katherine Brown. Dead on arrival?Evaluating the public health responsibilitydeal for alcohol at www.ias.org.uk

News

BRIEF BRIEFING‘Decisive’ coordinated action is needed toensure a future for alcohol briefinterventions, according to a report from theAlcohol Academy and Alcohol Research UK.Alcohol identification and brief advice (IBA)has proved difficult to implement effectively,says the document, with ongoing issuesaround primary care as the key setting and‘understanding what brief interventionactually involves’. Alcohol brief intervention:where next for IBA? at alcoholresearchuk.org

SEIZURE STATSThe number of drug seizures in England andWales fell by 14 per cent in 2014-15 to justover 167,000, according to figures from theHome Office. More than 124,000 of thesewere seizures of cannabis – down by 17 percent on the previous year. Overall class A

seizures were also down by 10 per cent,despite seizures of heroin increasing by morethan 70 per cent. Seizures of drugs in Englandand Wales, 2014/15 at www.gov.uk

HELP IN SIGHTThe first guide to substance use and sightloss has been published by the ThomasPocklington Trust, and includes keyresources for professionals and bestpractice examples. ‘Our research found thatboth sight loss and substance abuseservices are not adequately equipped todeal with these overlapping issues,’ saidlead author Sarah Galvani. ‘Substanceabuse can sometimes be used as a copingmechanism for sight loss, but thecombination of both issues can create acomplex challenge for supportprofessionals.’ Substance use and sight lossat alcoholresearchuk.org

Read the full stories, and more, online

www.drinkanddrugsnews.com

IRELAND CONSIDERS CONSUMPTIONROOMS AND DECRIMINALISATION FORPERSONAL USETHE GOVERNMENT OF IRELAND is considering the introduction of drugconsumption rooms, as well as decriminalising small amounts of drugs forpersonal use.

The announcement was made as part of a speech by new communities,culture and equality minister Aodhán Ó Ríordáin, who has responsibility forthe country’s national drugs strategy, to the London School of EconomicsIDEAS Forum.

Consumption rooms had proven effective in engaging hard-to-reachpopulations, said Ó Ríordáin, and he had asked officials to examine‘proposals for the provision of medically supervised injection facilities’ inline with European and Australian models. This was partly to addressproblems with street injecting in Dublin and elsewhere, as well as a recentspike in blood-borne viruses, he said, telling the Irish Times newspaper thatthe facilities would ‘happen next year’. The country’s health minister LeoVaradkar, however, has stressed that while he supported the proposal itwould require a change in the law and would not be ‘a simple matter’.

A drugs policy review has also been launched to consider whether adecriminalisation approach to the possession of ‘small quantities’ of drugs– such as currently operates in Portugal – should be considered in Ireland,although there was ‘certainly no desire for a permissive approach to drugs’,Ó Ríordáin emphasised.

While the country’s drug strategy was one that was ‘firmly focused onrecovery’, a changing drugs landscape required renewed focus andinnovation, he stated. ‘I am in favour of a decriminalisation model, but itmust be one that suits the Irish context and be evidence based. I believethat this kind of approach will only work if it is accompanied by timelytreatment and harm reduction services, backed up by wrap-aroundsupports which foster recovery – such as housing, health and social care.Above all, the model must be person-centred and involve an integratedapproach to treatment and rehabilitation based on a continuum of carewith clearly defined referral pathways.’ Full speech at www.merrionstreet.ie

‘I am in favour of adecriminalisationmodel, but it mustbe one that suits theIrish context and beevidence based.’

AODHÁN Ó RÍORDÁIN

4 | drinkanddrugsnews | December 2015 www.drinkanddrugsnews.com

Pic:

Nei

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Lessons fromprevious tragiccases have stillnot been learned.

December 2015 | drinkanddrugsnews | 5

‘LOCK, STOCK’ STARGIVES BOOST TO RAPTDAY PROGRAMMESJASON FLEMYNG, star of Lock, Stock and TwoSmoking Barrels, lent his support to AlcoholAwareness Week (16-22 November) with a visitto two of RAPt’s London community pro gra mm -es – the Tower Hamlets Community AlcoholTeam (THCAT) and the Island Day Programme.

He was among those at the event to speakabout the effects of addiction, having seen hisfather struggle with alcohol.

‘I am only too aware of the stigma aroundit,’ he said. ‘These projects are brilliant – notonly because of the incredible transformationit can help bring for those struggling withdrink or drugs, but because of the support andunderstanding there is for families too.’

DRINKAWARE PILOTKEEPS CLUBBERSSTREETWISEYOUNG CLUBBERS in the south west will betargeted through the Drinkaware Club, a six-month pilot by the alcohol education charity.

Joining forces with local police, communitypartnerships and police and crime com miss -ioners (PCCs), Drinkaware has trained staff inbars and clubs to increase safety by reducing

HELPING CHILDREN TALKABOUT PARENTS’ TREATMENT A NEW RESOURCE BOOKLET has been produced by The Children’sSociety to help young people affected by a parent or carer’s alcohol ordrug treatment.

Help me understand aims to encourage ten to 14-year-olds to talkto support workers and has been designed to communicate simplyand directly, including messages from others in the same situation.

‘While having a parent or carer in treatment can be a positivething, it can also be very confusing and distressing,’ said JoannaManning, national lead on substance misuse at The Children’sSociety. ‘[This] will be a valuable tool for workers to use in helpingchildren and young people to stay safe and to understand theimportance of accepting and sharing their feelings.’

The booklet was launched at Adfam/DDN’s safeguardingconference Everybody’s business, held in Birmingham.

Available to download at www.starsnationalinitiative.org.uk

WELCOME EVENTSPROVE POPULAR ATFORWARD LEEDS A SERIES OF OPEN MORNINGS across the city have proved asuccessful venture for alcohol and drug charity Forward Leeds.

The Wednesday morning events have introduced serviceusers, local residents and businesses the facilities and giventhem the chance to meet staff, ask questions and learnabout what goes on at the charity, including the needleexchange and other harm reduction activities.

The service’s executive director, Lisa Parker, said they wereextremely pleased at the turnout at the events and added,‘The events have also been an opportunity for us torecognise the hard work our staff do… we made sure eachstaff member got a Forward Leeds purple and pink cupcake.’

‘The events havealso been anopportunity for us torecognise the hardwork our staff do…’

Lisa PaRkeR

DYFRIG HOUSE OPENSNEW DOORS TO HELPCARDIFF’S HOMELESSA SPECIALISTACCOMMODATION andsupport centre has beenset up at Dyfrig House inCardiff to help homelesspeople with alcohol orsubstance misuseproblems.

The 21 self-containedbedrooms with privateensuite toilet and showerfacilities, will supportresidents towards independent living andhave been described as ‘not a hostel [but]therapy’ by one resident.

Since opening in 1967, Dyfrig House hasprovided one of the few ‘dry’ homelessservices in the city. The completely refurbishedservice – result of a partnership between Solas(which provides accommodation for homelesspeople), Cardiff City Council and the WelshGovernment – offers an individually tailoredtherapeutic support model.

Lee Sutcliffe, who feels he owes his life toDyfrig House, said: ‘I was made to feel safestraightaway, which I hadn’t felt in a very longtime… it’s a very, very special place indeed.’

drunken anti-social behaviour. Working inpairs, club hosts will begin by talking tocustomers as the queue is forming andensure they leave safely as the venue closes.

‘I am delighted at the level of engagementand support we have had from local partners,’said PCC for Devon and Cornwall, Tony Hogg.‘We have been working closely with localauthorities, street pastors and the venues toput this pilot together.’

AWARDS RECOGNISESTERLING EFFORT INTACKLING STIGMATHE FIRST MARSH RECOVERY AWARDS havebeen presented at Addaction’s recovery con -ference in Manchester – a result of the charity’spartnership with the Marsh Christian Trust.

Chosen for their outstanding contributionsto raising awareness and reducing stigma inthe field of recovery, the winners were: KerrieHudson for ‘exceptional individual’; Club Sodafor ‘exceptional activity’; peer supporters atRISE in Devon for ‘exceptional group’; MaxDaly, author of the Narcomania column inVice and Sarah Hepola, author of Blackout:Remember ing the things I drank to forget, for‘exceptional media’.

TREAT YOURSELF ATONLINE AUCTION BROADWAY LODGE has launched an onlineauction to raise funds for treatment. To be inwith a chance of winning two full-hospitalitytickets for a day at the races, framed shirtsfrom football stars, Sunday lunch at theDoubletree Hilton, a laptop and many moreprizes, visit www.broadwaylodge.org.uk.

Jason Flemyngwas amongthose at theevent to speakabout theeffects ofaddiction,having seenhis fatherstruggle withalcohol.

The 21 self-containedbedrooms...will supportresidentstowardsindependentliving.


Heroin prescribing

6 | drinkanddrugsnews | December 2015

The game ofhistory isusually playedby the bestand the worstover theheads of themajority inthe middle.Eric Hoffer

‘I feel like they are waiting for the lasthandful of us to die off and that will be theend of heroin prescribing in Britain, as weknow it’, I said miserably.

Gary Sutton, Release’s head of drugsservices, turned and looked at me seriouslythrough his spectacles: ‘If we don't try and dosomething now there will be no diamorphineprescribing left anywhere in the UK.’

Gary tapped away on the computer infront of me, putting the last few lines on aletter to yet another treatment service whohad been forcibly extracting a long-term clientoff his diamorphine ampoules and onto anoral medication. It was proving to be a painfuland destructive decision for the client, whowas experiencing a new daily torment as hisonce stable life began to unravel around him.

The drug team and its helpline (knownaffectionately as ‘Narco’), all part of the UKcharity Release, receives phone calls frompeople in drug treatment from all over the UK.By doing so it serves as the proverbialstethoscope clamped to the arrhythmic heartof our nation’s drug politik and bears witnessto the fallout from Number 10 affecting theindividual, on the street and in treatment. Inother words, we witness the consequences ofpolicy and treatment decisions, and try tosupport or advocate for the caller.

But as winter draws the shades on yetanother year in the drugs field, we find we arebearing witness to a tragedy, one of smallproportions but with huge implications. Itinvolves the last vestiges of the British systemof drug treatment, the ‘jewel in its crown’ –heroin prescribing – and the decline of theNHS, under assault from a mercilesslycompetitive tendering process and the crudeprocurement that is defining its replacement.Is that where we are really heading?

Forcing stable people off their heroinscripts and into chaos is evidence of aBritish drug treatment system in terminaldecline, says Erin O’Mara

‘If we don't try and dosomething now there will be nodiamorphine prescribing leftanywhere in the UK.’

GARY SUTTON

It may be true to say that to try to definethe old ‘British system’ is to trap its wingsunder a microscope and allow for a possiblycontentious dissection; the late ‘Bing’ Spear,formerly chief inspector of the Home Officedrugs branch, might be first in line byreminding us that the implications of‘“system” and “programme” suggests acoordination, order and an element of (state)planning and direction, all totally alien to thefundamental ethos of the British approach,which is to allow doctors to practise medicinewith minimal bureaucratic interference’. Hispoint being that the essence of the ‘British

THE STATE

For the stories behind the newswww.drinkanddrugsnews.com

and public ignorance have forced us tocollapse any new diamorphine prescribinginto a tight wad of supervision, medicalisationand regulation while prohibition, politics andthe soundbite media have meant that wehave been doomed to discuss this subjectunder the umbrella of ‘treating the mostintractable, the most damaged, the treatmentfailures, the failures of treatment’.

Why must a treatment that has proven tobe the optimum for so many people be leftuntil people had been forced to suffer througha series of personal disasters and treatmentfailures? Did this narrative help to diminishthe intervention?

The last few dozen people left on takehome diamorphine prescriptions in the UKtoday seem to be stable, functioning, oftenworking people who no longer have so much a‘drug problem’ as a manageable drug

dependence. This last group of diamorphineclients are remnants of the old system with, itappears, no new people taking their placesonce they leave. Today these are some of thevery people who are now ringing the Releasehelpline to try to save their prescriptionsaltogether. They are frightened, most of themare in their fifties and had qualified fordiamorphine many years ago because ‘nothingelse worked’; what now are they to do?

Diamorphine prescribing has beenensconced in a political and clinical debateabout the expense and fears of an imaginarytsunami of diversion. Yet what of today’sfinancial wastage? We have ways to deal withdiversion, yet poor and frequentcommissioning has a number of seriousconsequences, including a lack of continuity ofcare, a slide back to postcode variance and,not least, cost. An exercise to quantify thecosts of tendering services more than tenyears ago came up with a figure of £300,000as the sum expended by all bidders and thecommissioner, per tender – money that couldbe better spent, surely?

A few weeks ago the LSE put on a mini-symposium on diamorphine with a panel ofinternational clinicians, academics andresearch experts. Everyone present agreedthat prescribing diamorphine, albeit in a verycontrolled, supervised manner, hadtremendous merit. Taking the idea from thesuccess in Britain (eg Dr John Marks), today wesee a method that has evolved across Europe;the Swiss, the Dutch, the Germans and theDanes, among others are all doing it – treatingthousands of clients and with great results. Soit was more than frustrating to hear that ourown diamorphine clinical trials had beenclosed this year with no plans to restart them.

Diamorphine should not end upmarginalised and discarded because acontroversial new ‘system’ finds it far harder totolerate than the patients who receive it do.The benefit is proven. It’s not a choice betweenmaintenance and abstinence. Addiction is notreductive to either/or and, as treatment isneither just a science nor an art, cliniciansshould not be restricted to methadone orsubutex, or our clients subjected to a binary‘take it or leave it’ choice in services.

Erin O’Mara is editor of Black Poppy mag azineand it currently volunteering at Release


system’ was that it ‘allows the individualdoctor total clinical freedom to decide how totreat an addict patient’.

John Strang and Michael Gossop, in theirthoroughly researched double volume bookHeroin Addiction and the British System,stated in the epilogue of volume two, that‘amongst the (probably unintended) benefitsof [this] approach may be the avoidance ofthe pursuit of extreme solutions and hencean ability to tolerate imperfection, alongsidea greater freedom, and hence a particularcapacity for evolution.’

The British ‘approach’ (as may arguably bea more appropriate phrase to use) had onceallowed for a level of evolution; ofexperimentation and pharmaceuticalflexibility; three characteristics that areglaringly missing from frontline drugtreatment today. Although we have no roomto discuss clinical guidance here, it is often thecase that when presenting services withcomplex individual cases at Release, we arerebuffed by the response ‘it’s not in theguidelines’, ‘it's not licensed’, or even, as ifdrug workers are loyal party backbenchers, ’it’snot government policy’!

Hindsight is a gift, and although many of uscould while away the hours pontificating aboutjust how and why it all went so publicallywrong for our ‘unhindered prescribers’ back inthe day (think Drs Petro, (Lady) Frankau, and ahandful of others), that would be to miss thepoint. The reality is, once we pick up andexamine the pieces of the last 100 years, thereare shining areas of light in our Britishapproach. Marked by both a simple humanityand a brilliant audacity, it permitted a privateand dignified discussion between doctor andpatient to find the drug that created thepreconditions for the ‘patient’ (today the‘client’) to find the necessary balance in life.

Are we really back to the days of having toask to be treated as an individual? Policy isnow interfering in treatment to such anextent that the formulation that the patientfeels works best for them (physeptone tablets,heroin, morphine, oxycodone, DF118s etc) mayno longer fit into today’s homogenous andfixated theme of methadone orbuprenorphine, one part of a backwards step.

The days when heroin prescribing wasdefended as tenaciously as a doctor's right toprescribe unhindered are almost gone. Fear

‘Why must a treatment that hasproven to be the optimum for somany people be left until peoplehad been forced to sufferthrough a series of personaldisasters and treatmentfailures? Did this narrative helpto diminish the intervention?’

WE’RE IN

AS PREVIOUSLY REPORTED in DDN (October, page 4),according to data from the Office for NationalStatistics (ONS), a total of 2,248 deaths from drugmisuse were registered in England and Wales in 2014– a rise of 14.9 per cent on 2013. Building on the near20 per cent increase in drug misuse deaths from theprevious year, a notable change in the pattern of drugdeaths seemed to be emerging.

However, this paints an inaccurate picture. Whiledrug misuse deaths in England have risen dramaticallyover the last two years, drug deaths in Wales havefallen year-on-year since 2010, with a 30 per centdecrease in the last five years to a total of 113 deaths– a rate of 3.90 per 100,000 population.

With drug misuse deaths in England now at theirhighest level over the 22 years for which the ONSpublishes figures, the need for credible explanationsfor the rise became urgent.

One set of explanations has focused on changes todrugs and those who use them. The ONS, in thestatistical bulletin (http://bit.ly/1VyvAR9)accompanying the release of the 2014 figures, pointsto changes in the purity of street heroin (as reportedby SOCA, the UK’s Serious Organised Crime Agency) asa possible influence on variations in drug deaths overrecent years. Sustained rises in reported puritycoincided with increases in deaths involving

heroin/morphine in England. The ONS also suggeststhat, with increasing numbers of deaths among olderdrug users, the generation who began injecting in the1980s and 1990s are aging and therefore at higher riskof dying from drug-related causes as other healthproblems take their toll.

However, the same ONS report provides anotherkey piece of information that challenges the focus onchanges to drugs and this demographic of drug usersas key reasons for rising drug deaths. It comes on page19: ‘…whilst drug-related deaths in England have nowreached an all time high, those in Wales have fallenover the same period, down 16.3 per cent in 2014 to113. Indeed, the rate of drug misuse deaths across theWelsh population, at 39 per million, is now less thanEngland for the first time since 2004.’

With no reason to believe that either heroin marketsor drug-using careers in Wales are substantially differentto England, how can we explain the difference?

The second narrative to emerge following therelease of the figures is that the difference is down topolicy and philosophy. With health policy devolvedwithin the UK, it is the Welsh Government that decidesthe priorities for substance misuse in Wales. In contrastto England, where – as reported in last month’s articleon the National Needle Exchange Forum meeting(DDN, October, page 16) – many users, frontline staffand managers are finding reduced funding andsupport for well-evidenced harm reduction approachesin favour of abstinence based ‘recovery’ models, Waleshas maintained focus and funding for harm reduction.

In response to the release of the 2014 figures,deputy minister for health Vaughan Gething said,‘These figures represent lives lost to families andcommunities across Wales and while I welcome thenews of a further decrease, any death attributable todrugs is one too many.

‘Tackling drug misuse is a complex issue, which theWelsh Government has been working hard to address.The fact that drug-related deaths are falling at such arate in Wales is testament to the significant workwhich we and our partners are undertaking.

‘We are investing almost £50m a year inprogrammes including a bilingual substance misusehelpline, a take-home naloxone programme whichreverses opiate overdose and the WEDINOS harmreduction project which tests substances. These figuresshow that this money is delivering tangible benefits.’

Also commenting on the figures, Josie Smith said,‘It is a testament to the National Substance MisuseStrategy in Wales, Working together to reduce harm,ongoing support for harm reduction services and awillingness to innovate new approaches to reduce risk,that have resulted in fewer drug deaths in Wales.Problematic drug use in Wales remains but the mostsevere of consequences, that of premature death, isdeclining through better engagement, appropriateand evidence-informed interventions andcollaborative working.’

Josie Smith is head of substance misuse programmeand Chris Emmerson is information analyst specialist atPublic Health Wales

With drug misuse deaths inEngland now at their highestlevel over the 22 years forwhich the ONS publishesfigures, the need for credibleexplanations for the rise hasbecome urgent.

drug deaths More on harm reduction at:www.drinkanddrugsnews.com

Unlike in England, drug deaths in Wales have beenfalling since 2010 – a result that can be traced to Welsh public health policy and harm reduction practice,say Josie Smith and Chris Emmerson


Bucking the trend

EMERGINGHORIZONS’facilitators oftenbegin training by

asking delegates to describe why they do thejob they do. Answers rarely deviate fromthemes such as being naturally engaging, anability to build rapport, strengths incommunicating empathy and a genuinedesire to help.

These qualities are at the very heart ofconducting an effective assessment, one thatbegins the non-judgemental process ofsupporting individuals to establish values,uncover strengths and build upon them.

Frequently, however, staff report that therushed box ticking, contract signing and formfilling required at first point of contact hasbecome professionally debilitating. It seems

widely accepted that therapeutic interventionbegins during the second appointment(provided the client has come back).

Despite positive improvements across thesubstance misuse sector, it seeminglyremains widely acknowledged thattraditional health and social care assessmentsare too focused on deficits and inadequacies,with some practitioners expressing concernsthat their deficit-based assessmentprocedures may actually disempower andintimidate those who have found the courageto seek their help. Given the space to reflect,delegates often also realise howcommonplace it has become for this crucialfirst meeting to be facilitated in a room‘decorated’ exclusively in posters threateningcertain death from overdose, HIV andhepatitis, often precariously tacked next to

First impressions

they use the product, it will change the waythey view the world immediately, and thatthey will be stress and problem free.

In the break-up of a relationship, even ifthe decision to part was the right one, theparties will continue to yearn for oneanother, and the loss they experience will beextreme. This could be said of the serviceuser’s relationship with substances, as theywill miss their drug of choice and experiencelonging and desire as well as grief for theloss. Cravings – the salesperson – will fullyunderstand this and will know how to targetthose feelings, either blatantly or silently, tokeep selling the product.

When we help service users to look attheir relationship with a drug, it isimportant to acknowledge the yearningthey may experience and the grievingprocess they are going through. Rather


Comment


More comment and opinion atwww.drinkanddrugsnews.com

IT’S A FACT that a craving has to strikebefore a person uses drugs or alcohol, andthat’s why they can be terrifying for serviceusers. A common technique in dealing withcravings is to distract the individual fromtheir desire to ‘use’. Yet, if someone avoidssomething the result is often a sense offear, and from fear comes powerlessness.The substance user must be able to facetheir fear!

A craving is like a salesperson. Itspurpose is to sell the thought of using tothe customer and make it look attractive. It sells the idea of pleasure and euphoria. It doesn’t talk about comedowns, or anyother side effects, as that informationwould get in the way of the pleasure. Thesalesperson reminds the customer that if

A craving is the salesperson we can choose to ignore, says Chris Robin

greyscale warnings of the latest bad batch ofheroin in local circulation.

Workers often report feeling pressured tohurriedly collect meaningful and reliable dataon highly personal experiences such as sexworking, abuse and illegal behaviour. Somestaff have admitted during training that it wasnot until they had built rapport with theirclients that they realised how much of theinformation collected at point of assessmentwas inaccurate.

Assessment protocols need to besystematically reviewed, updated andfacilitated in a welcoming environment thatmodels recovery. The paperwork should bedesigned as a tool to assist practitioners incollaborating with their clients on thedevelopment of a strength-based, person-centred recovery plan. For this to happen, evenessential data capturing needs to be concise,accessible and client-led, as well as designedto focus on establishing recovery capital inareas such as relationships, social pursuits andlife purpose.

Shahroo Izadi is development manager atEmerging Horizons, www.emerginghorizons.org

The pressure to collect data from newclients should not replace essentialrapport, says Shahroo Izadi

than distract them from these feelings,give them permission to be honest aboutthe craving, so they can be aware of thesales pitch that is being used on them.This recognition will then inform thecraving that it has been exposed, so it willhave to become less blatant, more subtle,more silent, more devious, to make thesale. Again the worker’s job is to help theservice user to investigate these deviouscravings so they can understand theirsophistication.

Equipped with this information, theservice user then has the tools tocommunicate with their cravings, stand upto them and say: ‘I see you, I know youragenda, and I am no longer afraid of you!’

Chris Robin offers treatment and training atJanus Solutions, www.janussolutions.co.uk

A service userwill miss theirdrug of choiceand experiencelonging anddesire as wellas grief for theloss.

‘It seeminglyremains widelyacknowledgedthat traditionalhealth andsocial careassessmentsare too focusedon deficits andinadequacies.’

Cold Caller

OST and felt that having theseconversations might riskdisengagement.

‘We’re so busy we forget to ask theright questions,’ commented Sue Smith,CRI’s national safeguarding lead. ‘Butwe need to challenge… it’s our role.’

‘I was bemused and shocked that mystaff used to struggle around askingabout safeguarding,’ said Birminghamcommissioning manager, Max Vaughan.But, he added, ‘the combination ofpolicing and being supportive can bereally difficult.’ It was aboutconfidence, suggested one delegate,adding ‘It shocks me that otheragencies say “how do we ask thosequestions?” You just do. You have to.’

So apart from asking the rightquestions – about drug and alcohol use,drug storage, and making sure that risksto children were minimised – whatwere the key areas for improvement?

Better engagement between all ofthe professional partners involved withthe family came high on the list.

In Birmingham, the safeguarding

‘Graham Greene said“There is always onemoment in childhoodwhen the door opensand lets the future

in”. We are responsible for opening thatdoor,’ Joy Barlow told the Adfam/DDNEverybody’s business safeguardingconference, sharing her vision that weshould refocus on the rights of the child.

The event brought togetherprofessionals with an interest in thissensitive issue and did not shy awayfrom the challenging questions. Whywere we missing signs that childrenwere at risk? Were we aware thatmethadone soothing took place? Howcould we work more effectively withfewer resources? Why were we scaredof even talking about this issue?

‘This is one of the most difficult andfraught areas of practice,’ said Barlow,who was formerly head of STRADA(Scottish Training on Drugs andAlcohol). ‘We need to incorporaterespectful uncertainty,’ she said,quoting Dr Marion Brandon’s researchfrom serious case reviews. ‘We need todemonstrate empathy and acceptance,but balance it with a healthy dose ofscepticism… if the truth is not alwayspresented to us, we have to ask why.’

Tackling safeguarding needed afundamental shift in thinking,according to many of the day’s speakersand workshop contributors. NicAdamson, CRI director, said drug andalcohol workers ‘often used to see it astheir job to rock up and defend theclient.’ But this area required a differentway of working: ‘We need to learn tochallenge clients’ behaviour – reallychallenge it,’ she said.

‘It’s a Pandora’s Box – there’s a fear

in what we do,’ said one delegate, andthis theme kept resurfacing, in relationto safeguarding, methadone, and thedelicate issue of challenging clients andasking them difficult questions.

‘There are around 400 adult deathsinvolving methadone a year. Say this inthe wrong room and you can beintellectually decapitated,’ said MartinSmith of Derbyshire Safeguarding Team,who brought the risks to children intosharp focus.

‘Hair testing has shown thatmethadone soothing is more commonthan we like to acknowledge,’ he said.Examples from his caseload included achild death which the mother had saidwas accidental, but tests had shown thechild had been routinely givenmethadone: ‘A methadone storage boxhad been in place, she attendedappointments, her engagement wasgood, there was a supportivegrandmother – she gave the picturethat all was OK.’ In another case, ‘awoman let a toddler ingest enoughmethadone to kill an adult’.

‘We lack honesty and courage as asector – let’s not shy away from difficultchallenges,’ he said. ‘It’s really hard tohear the bar is so low in certain areas…we’ve all got work to do.’

Rachael Evans, policy and researchofficer at Adfam, brought evidence fromcase reviews that the charity hadexamined to produce the new report,Medications in drug treatment: tacklingthe risks to children – one year on. Themain findings confirmed that there wasinsufficient appreciation of the dangersof OST by parents and professionals,and critical issues around safe storage.Practitioners were struggling to acceptthe idea of intentional administration of

www.drinkanddrugsnews.com10 | drinkanddrugsnews | December 2015

Austerity is ‘thespoiler’ that leadsto ‘the deadeninghand of conflictingpriorities’.

Pete Burkinshaw, PHE

Safeguarding

Playing safeAre we doing enough to protectchildren from their parents’ drug andalcohol use? At a recent safeguardingconference there was plenty of causefor concern, as DDN reports

structure involved team leaders, whohad been fully trained in safeguarding ,providing real-time updates to socialworkers, explained Micky Browne, CRI’ssafeguarding lead. The Multi-AgencySafeguarding Hub (MASH) not onlyimproved collaborative practice, but italso reduced inappropriate referrals, hesaid. ‘The better agencies worktogether, the more efficiency willdevelop in the long term.’

DS Steve Rudd, of Birmingham police,added: ‘When we sit round the Mashtable now, we look a what’s happening –do police actually need to run off andlock mum and dad up? In multi-agencyworking we all come from a different

angle. We’ve developed an under -standing of where we’re all coming fromand issues are very quickly resolved.’

Exchanging data that was easy tocomprehend was key to creating multi-agency risk assessments, said Sue Smith.Joy Barlow believed that we needed tooverturn our culture of ‘educating insilos’, bringing drug and alcohol contentto social work courses. ‘You’ve got to getpeople together in terms of learning anddevelopment,’ she said.

The Federation of Drug and AlcoholProfessionals (FDAP) were working withAdfam to develop standards and identifycompetencies that people working withfamilies should all have, said FDAP’schief executive, Carole Sharma, whoadded: ‘This sector has been guilty ofgenerating mystique around ourselves.We need to undo this.’

Dr Judith Yates was hopeful thatAdfam’s new report would providefocus and remind commissioners oftheir power to make a difference.

‘I remember the Hidden Harm reportlanding on my desk and it’s stayed withme,’ she said. ‘Four years ago healthvisitors hadn’t had training on alcohol. Ihope Adfam’s report will encouragepeople, including pharmacists, to talkto each other.’

Inevitably the question of dimin ish -

‘I WAS SPOTTED, SUPPORTEDAND ENCOURAGED’In an emotional speech to the main conference, Ian Day looked back to 12 years ago when he was‘deeply entrenched in addiction’.WHEN HIS PARTNER BECAME PREGNANT he made a decision to be ‘agreat dad’ – but nine months later he was in prison.

‘We slipped through the social services net,’ he said. ‘They had to be theenemy. But we were difficult people to work with.’

With his daughter taken into care he had spells of homelessness before beingintroduced to treatment service by an old friend, who was in treatment now herselfand ‘looked good’. This is where ‘interventions came into play… it was a smallwindow of opportunity to help a person. I was spotted, supported and encouraged’.

Six months out of treatment, he approached social services to try to wincustody of his daughter who had been taken into foster care. He was ‘not, onpaper, the person you’d give custody of a child to’ – ‘at that time the reactionwas “you’re male”, I had nowhere to live and I hadn’t seen my five-year-old forthree years. So I had to prove I could be that person.’

Securing a flat took two years, during which time he was tested continuallyby the agencies involved.

‘I had to see my daughter in a room with a person taking notes – I was verynervous,’ he said. ‘I got enrolled on courses and at the time it felt verydemeaning – they asked very obvious questions. It was very frustrating, butlooking back it was the right thing because of my previous history.’

With ‘all of the agencies speaking to each other throughout’ he had his day incourt and won custody. Now settled with his daughter and current partner of sixyears, he says he is grateful for the ‘safe environment’ created by agenciesworking in partnership, which led him to an outcome he never dreamed possible.


More conference reports at:www.drinkanddrugsnews.com

‘This is one of themost difficult andfraught areas ofpractice.’Joy Barlow (below left),pictured with (clockwise)Sue Smith, Max Vaughan,Martin Smith, CaroleSharma and Judith Yates.

Safeguarding

ing resources came up throughout theday, and PHE’s Pete Burkinshaw describ -ed austerity as ‘the spoiler’ that led to‘the deadening hand of conflictingpriorities’.

But Martin Smith urged delegates toremember that ‘profit should nevercome before the needs of children’.

‘We’ve got to have courage andhonesty – and we’ve got to findevidence to back up what we’re tryingto change,’ he said.

Among the challenging questionsfired at the panel during the finalsession was the issue of whether child -ren should be trained and support ed toadminister naloxone to their parent inthe event of an overdose. Should theybe given that responsibility?

While Dr Judith Yates was amongcampaigners who had welcomed therecent extension of naloxone prescrib ing,she was worried about ‘children havingto parent their parent’: ‘It depends onthe age of the child,’ she said. ‘There’ssomething not right about a six-year-oldbeing entrusted to save a life.’

Martin Smith said the level ofresponsibility was too high, while MaxVaughan agreed ‘it doesn’t feel safe orright’. Sue Smith said that it shouldn’tbe entrusted to a child ‘at this stage’.

But several delegates threw back achallenge of double standards, referringto the ‘stigma of this client group’.

‘Many children are left to managechaotic drug use who haven’t hadproper support,’ said one. ‘Children,whether we like it or not, are managingtheir parents’ drug use. We’re guilty ofdouble standards.’

At the beginning of the day, JoyBarlow had said: ‘I’m elated at whatwe’ve achieved and also severelydisappointed at what we’ve achieved’ inthis area of practice. Adfam’s chiefexecutive, Vivienne Evans, finished on anoptimistic note by saying that workers inthis field had passion and commitment,which was ‘harder than rocket science’.

‘This is hugely complex and difficultwork,’ she said. ‘We need to have thatoptimism that we can give children thebest start.’


A GRIM PICTUREAdfam’s new report shows childrenare still dying after ingestingmedications used to treat drugaddiction. Its author Rachael Evans,Adfam’s policy and research officer,shares findings

ADFAM has particularly focused on safeguarding overthe past couple of years. Publishing our new reportMedications in drug treatment: tackling the risks tochildren – one year on, our research revealed that farmore children than previously thought are dying andbeing hospitalised after ingesting medicationsprescribed to treat their parents’ drug addiction.

In the ten years to 2013, at least 110 children andteenagers aged 18 and under in the UK died from thetoxic effects of OST medications. In the same time, atleast 328 children in England were hospitalised anddiagnosed with methadone poisoning. Of the 73deaths in England and Wales, only seven resulted inserious case reviews (SCRs).

Since Adfam first reported on this tragicphenomenon in 2014, these cases have continued tohappen, with at least three new SCRs in the last year.While many children will have consumed themedications accidentally, some were given them bytheir parents in a misguided attempt to help sootheor send them to sleep. The statistics also show themajority of fatal poisonings involve older, rather thanyounger children – but little is known about how orwhy these incidents occur.

OST is proven to reduce dependence on streetheroin, and by doing so it saves lives, improveshealth and wellbeing and cuts crime. The rightfulplace of these medications in addiction treatment isnot at issue, but it’s imperative that the risks theypose to children are better addressed and futureincidents prevented.

Our report makes a number of recommendationsto help do this, starting with the need for allincidents involving a child’s ingestion of thesemedications to be fully investigated and recorded –and analysed centrally by government, with thelearning shared with local services. The wide rangeof professionals who come into contact withparents and carers prescribed OST medications mustall be trained about their potential harm tochildren, and services must work together and shareinformation more effectively to minimise risk.Parents must also be educated about the potentiallyfatal risk posed by OST medications, and given asecure box to store them.

Vivienne Evans, Adfam’s chief executive, said: ‘Thelessons from previous tragic cases have not beenheeded, and a year after we called attention to theissue, children are still dying. The vast majority ofparents prescribed these medications will use themsafely and appropriately – but the number of childrennow identified as having been harmed lends theissue even greater urgency. Systemic and culturalfailure means services are still not working closelyenough to safeguard vulnerable children.’

Our research, along with the training we havedelivered to local authorities, has identified someareas of good practice. One drug treatment servicehas appointed two specialist family workers to workwith pregnant service users and families. Specialist

workers and midwives can help a service maintain awhole-family focus, and this model was praised bySCR panels. Another promising model is thedevelopment of inter-agency joint protocols betweendrug services and health visiting teams, so thatinformation is shared and joint home visits can beconducted. More information and examples of goodpractice can be found throughout the report.

By the end of 2015, Adfam will have trained 19local councils to reduce the risks to children posed bythese medications, and we hope to continue thiscrucial work in 2016.

‘Specialist workers andmidwives can help aservice maintain a whole-family focus’.

Rachael Evans

‘Workers in this field have passion and commitment, it’s harder than rocket science.’ Vivienne Evans, Adfam


DRUG ABUSE AND HIV continue topresent profound challenges to thehealth of gay people, but a climate ofmoral panic and blaming the gay sceneis counterproductive… We need a moresophisticated analysis of the reasonsdriving high-risk behaviour amongsome gay men. Without this under -standing, any future NHS responses tochemsex are destined to fail.Marco Scalvini, Guardian, 10 November

A MAJOR REASON for themedia coverage of chemsexas destructive is that mostof the first-hand accounts ofthe experience come frompeople who present it as aproblem at sexual healthclinics. The media then selectthe most horrifying ofthese…. As for theconnection between

chemsex and HIVtransmission, there is littleacademic consensus on this.

Jamie Hakim, Independent, 25 November

ADDRESSING CHEMSEX-relatedmorbidities should be a public healthpriority. However, in England fundingfor specialist sexual health and drugsservices is waning and commissioningfor these services is complex. Englishsexual health services tend to be openaccess, with costs charged back to

Safeguarding Renew your free DDN subscriptionwww.drinkanddrugsnews.com/subscribe

‘THIS FOCUS ON CHILD PROTECTION is a goodthing – but there are real consequences offocusing on it too much,’ said KarenHammond of the Centre for Alcohol and DrugStudies, speaking at the recent HIT Hot Topicsconference in Liverpool.

Hammond gave insight into the changingrole of public health nurses in relation tomothers who used drugs – and described avery fragile relationship. Having access tofamilies had been seen as ‘an opportunity forsurveillance’, with nurses expected to take onan additional social work role, reporting oncases that they felt were high risk.

The effect of this could be to breed an‘atmosphere of fear’ and ‘erode an alreadyfragile trust’, denying these women a valuablesource of support.

One-to-one interviews with public healthnurses who worked with this group ofwomen revealed problems with engagement:women were tending to withdraw from

contact with nurses, for fear of having theirchildren removed.

This failure to keep appointments was beingblamed on their engagement with drugs andthe notion of their ‘chaotic lives’, rather than ‘thecycle of fear and mistrust that had been created’.

The consistent issue to be highlighted waslack of training; many of the nurses had onlyhad child protection as a training route to dealwith these issues and thought they onlyneeded to know about the names of drugs.This gave them perceptions such as: ‘addictionresults in a loss of control and affects theability to parent properly’; and ‘recovery isequated with abstinence’ – so any continueduse signaled danger to them.

Hammond relayed some typical commentsfrom the interviews with nurses: ‘The drug usetakes over – that’s all they think about,’ and‘They want to stop it but they can’t – the pull isjust too strong.’ Children were also still deemedto be at risk when they were not actually

present during drug-taking, and had been leftwith family members. ‘Nurses still thought [themothers] wouldn’t manage their intoxicationand it would end in chaos,’ she said.

‘Overall it was quite shocking – the beliefthat drug use makes you a bad mother,’ saidHammond. ‘We need to not only teachparents about risks, but also be able tofacilitate some critical self-reflection that’slacking at the moment.

‘Professional practice should reflect theevid ence base, not political or moral frame -works,’ she said. ‘What we really need is todismantle prohibition – but in the meantimewe need to recognise that the way we’redealing with it makes it worse.’

During the question time at the end of thissession, a woman from Belfast commented: ‘Iasked for help and my children were taken offme. You’re damned if you do ask for help anddamned if you don’t.’

More from Hit Hot Topics in our next issue

How can we tackle child safeguarding without riskingdisengagement? DDN hears a cautionary perspectivefrom public health nurses

‘I asked forhelp and mychildrenwere takenoff me.You’redamned ifyou do askfor help anddamned ifyou don’t.’

local authorities. Drug services tend tobe authority specific with usershaving to attend a service within theirborough of residence. Despite thedifferent funding streams, creatingcentres of excellence for sexual healthand drug services could be a costeffective solution to diminishedresources in both sectors. BMJ editorial, 3 November

AROUND THE WORLD, about 25countries including Australia, theCzech Republic, Portugal andSwitzerland have initiated reform.Even Iran’s theocracy brought inprogressive harm-reduction measuresand has influential voices calling forcannabis and opium legal isation.Slowly but surely we are seeing theend of stupid policies to prohibit druguse that are not only stunninglyilliberal but damage users, families,communities and entire countries.Ian Birrell, Independent, 9 November

IF GOVERNMENTS really want to limitthe harm from drugs – saving addicts’lives, crushing dealers’ profits andslashing the number of people whotake them in the first place – then theymust seize control of the marketthemselves.Economist editorial, 7 November

IF PEOPLE are going to use narcotics, itis best they do so safely. Relaxing thelegislation on drug use, coupled withaccess to injection rooms, really is ouronly way forward.Lorraine Courtney, Irish Independent, 6 November

WHAT DO MODERN TERRORISTS havein common? Yes, they are fanatical, andusually (but not always) from ethnicminorities. But there’s something elsevery interesting. They are invariably onmind-altering drugs, usually cannabis.Peter Hitchens, Mail on Sunday, 22 November

The news, and the skews, in the national mediaMEDIA SAVVY

Tread sofTly

happen. However it also called for supporting action on jobs, houses, mental health,and a range of other crucial interventions which have not been delivered. The taskfor the 2016 version is to continue to deliver evidence-based, recovery-focusedinterventions, but to also overcome the strategy’s failures in the following areas(see opposite for details):

• Drug-related deaths• Jobs and houses• Integrating prison and community• Mental health• ‘Locally led, locally owned’

Knitting all of this together would be health and wellbeing boards, which wouldintegrate the local authority’s concerns with the Clinical Commissioning Groups’(CCGs) continuing responsibility for drug users’physical and mental health, andpolice and crime commissioners’interest in the crime

Drug Strategy

www.drinkanddrugsnews.com14 | drinkanddrugsnews | December 2015

‘The ideal 2016 strategy wouldlook very like its predecessor –the key difference being toidentify how to deliver the joined-up services everyone has knownwe need for at least 30 years.’

In a climate of austerity the

new drug strategy must

grow from our successes,

says Paul Hayes on behalf

of Collective Voice

LEANER AND

Next month the government will begin its formal consultation toinform the drug strategy due in March. So how far has the 2010strategy delivered its aspirations, and what insights have the last fiveyears given us to help shape drug recovery for the rest of thisparliament?

In the 2010 strategy the home secretary set out an ambition to ‘reduce demand,restrict supply, and support and achieve recovery’. The prime minister’s view at the endof 2012 was that this had been achieved: ‘We have a policy which actually is workingin Britain,’ he said. ‘Drug use is coming down, the emphasis on treatment is absolutelyright and we need to continue with this to make sure we can really make a difference.’

Despite the day-to-day challenges of delivery and the uncertainty of futurefunding following the spending review, we should not lose sight of the big picture –what the PM said was right in 2012, and remains right now. The policy is broadlyachieving its aims and has been built on three pillars: a powerful positive narrative,endorse ment of the clinical evidence, and a commitment to continue to invest.

The strategy successfully reframed the treatment system around recovery as anorganising principle. The balance between ambition and evidence established anew consensus about best practice, steering clinicians to use opiate substitutiontherapy (OST) to provide a gateway to recovery for everyone who could takeadvantage of this opportunity. It also gave a secure place to build motivation andcapacity to change for those not yet able to take the next step. This enabled thetreatment system to promote recovery at the same time as continuing to delivercrime reduction and public health benefits – the bedrock of the success describedby David Cameron, which it would be extremely unwise to unpick.

Crucially the government also backed the strategy with cash. Despite theextreme pressure on the public sector, funding committed to delivering the drugstrategy was protected as part of NHS expenditure.

The 2010 strategy got the big calls right. It shaped a new ambition for the sectorfocused on the individual drug user, reached consensus on how to best achieve thistogether with wider societal benefits, and gave the resources to enable it to

reduction yield from treatment.With some notable local exceptions, very few peoplewould argue that the system is working on a national level. Health and wellbeingboards are understandably focused on social care as their overriding priority. Drugusers are not a priority for either LAs or CCGs, and the decline in acquisitive crimewhich access to drug treatment has helped bring about has eroded the police’s roleas local champions of treatment.

Commitment to drug treatment varies among directors of public health who leadon this for local authorities. Public Health England (PHE) has disinvested from its localpresence, limiting not only its ability to promote and share best practice, but also thelocal intelligence it previously provided which enabled Home Office and Department

of Health to understand what was really happening on the ground. From 2018, local control of public health will be furtherstrengthened as the public health grant is replaced by directlocal authority responsibility for funding from business ratesreceipts. Unlike in 2010, drug and alcohol treatment is nolonger part of the protected NHS spend but will have tocompete for resources in the much harsher local governmentenvironment. Continuing to deliver what has worked and overcoming the

deficits will become increasingly challenging over the next fouryears, as the cumulative 20 per cent real terms reduction in thepublic health grant, announced in the spending review,removes the stability of investment that underpinned the2010 strategy. Investment in drug treatment increasedthreefold between 2001 and 2008, since when it hasbeen broadly flat with a slight decline since 2010,and a significant shift of existing resources from

drugs towards alcohol since 2013.There will always be scope for moreefficient use of resources, and thebest commissioners are workingwith providers to use innovationand integration to sustain or evenimprove outcomes. However toooften the response ismechanistic recommissioningresulting in wasteful churn, or todemand reductions in contractprice only deliverable throughreductions in the quality of

delivery. The sector needs tocollectively and realistically assess

what can be delivered, and the new drugstrategy provides a timely opportunity to matchambition with resource.

The ideal 2016 strategy would look very like itspredecessor – the key difference being to identifyhow to deliver the joined-up services everyonehas known we need for at least 30 years. Key tothis will be how best to champion an agenda thatis not a natural priority for most of the individualsand institutions responsible for its funding anddelivery. Collective Voice will work closely withgovernment to identify workable solutions to thislong-standing problem on behalf of all providersand in the interests of service users, their familiesand their communities.

Paul Hayes leads the Collective Voice project, a group of third sector treatmentproviders including Addaction, Blenheim, Cranstoun, CRI, Lifeline Project, PhoenixFutures, Swanswell and Turning Point


Join the debate by visitingwww.drinkanddrugsnews.com

DRUG-RELATED DEATHSUntil 2014 drug-related deaths were assumed to be in slow decline.Reversing the dramatic increases reported over the past two years has to bea key priority. The underlying causes of the increase are complex andprobably result from the interaction of different factors, particularly theageing and increasing vulnerability of the population. The first step must beto understand the phenomenon and then resource and implementevidence-based responses.

JOBS AND HOUSES‘Treatment success has been eroded by the failure to gain stableaccommodation and employment’ (2010 drug strategy). The very existence ofDame Carol Black’s review is testament to the failure of the current strategy toroute people via treatment into long-term employment that will help cementtheir recovery. Collective Voice’s contact with Dame Carol and her team give usconfidence that she will provide realistic and deliverable plans to promoteaccess to employment, which if resourced will offer a new way forward. Thereis no such initiative, and therefore no similar optimism, on the housing front.

INTEGRATING PRISON AND COMMUNITYThe ‘seamless transition’ between prison and community sought by thestrategy has not been delivered. Before 2013, prison and communitytreatment were commissioned as one system. They are now two separatesystems, with NHS England responsible in prison and local authoritiesresponsible in the community. The added complexity introduced by the‘rehabilitation revolution’ has created even more opportunities for vulnerableprisoners to fall between the cracks on release.

MENTAL HEALTHEvery drug strategy has identified a failure to align mental health and drugservices and none has been able to solve the problem. In essence this isbecause the root cause has been the NHS’s consistent failure to invest inmental health services. The £600m investment in mental health announcedin the spending review provides an opportunity to change this pattern,which we must seize.

‘LOCALLY LED, LOCALLY OWNED’Devolving responsibility to localities to enable ‘joined-up local solutions’ toreplace ‘one size fits all top-down targets’ was at the heart of the 2010strategy’s approach to accountability. Local authorities were allocatedtreatment resources previously routed through PCTs in recognition of theNHS’ historic reluctance to invest in drug and alcohol treatment and thepotential to align drug investment with other LA responsibilities to providecost-effective solutions.

The 2016 strategy aims to overcome failures in:

KEENER

Moral MazeI was dismayed to read ‘Tackling thedeficit’ (DDN, November, page 12).The authors (Mark Gilman, PeterSheath and Peter McDermott, whotold me recently that the article didnot represent his views) referencedthe importance of asset-basedcommunity development (ABCD)principles but, ironically, the entirepiece was framed in divisive anddeficit-focused terms. Having thought we’d moved on

from ‘moral’ narratives, with all theiraccompanying blame, stigma anddiscrimination, I read that ‘There areright and wrong ways of living’ and‘the right way is to get a job, pay yourrent and care for your friends andfamily’. Many people, most on thewrong side of the poverty/inequalitychasm in this country, are apparentlyliving the ‘wrong way’, described as‘methadone, booze and benefits;watching daytime TV while the statetakes care of your kids’. Try and find afocus on strengths (ABCD principles?)in that dehumanising and reductivestatement. According to Gilman et al you can

reduce the huge diversity foundwithin services and communities to‘two tribes’ – harm reductionists areprimarily concerned with aConservative ‘attack on theentitlement to remain on long-termsickness benefits’ and themaintenance of a treatment systemthat ‘has been living high on the hogfor much of the last 20 years’; while

those affiliated with the recoverymodel (note the singular) are closelylinked (they make the link four times)to Conservative values and policy.This will be news to many people Iknow that work in services,desperately trying to offer support asfunding is slashed, and to the manyservice users and recovery activiststhat I meet as I travel the country. The suggestion by Gilman et al

that these ‘right ways of living’ alongwith ‘voluntarism…need to takepersonal responsibility and buildingcommunity’ are somehow the solepreserve of conservatives and in linewith Conservative policy is againreductive, offensive and, in theseaustere times, rather bizarre. Jobs,friends and homes are central torecovery, as is social justice, and thereis a huge amount of evidence thatConservative policy is impactingnegatively on all these areas.Conservative policy tore communitiesapart in the 1980s, sowing the seedsof poverty and dislocation that weface today, and their current policy ofdisinvestment and privatisation isfuelling inequality and injustice at analarming rate. A version of ‘recovery’ (there are

many) and ABCD is being promotedand used by some recovery capitalistsfor private gain, presumably in linewith their neo-liberal values. They areproviding cover, alongside those whoremain silent, for the dismantling ofa welfare state born out of a spirit ofcollective responsibility andcommunity building in the 1940s. However there are many people

who are resisting this, whether theyuse the language of ‘recovery’ or notand the article by Gilman et al doesthem a great disservice. We can dobetter. There’s a version of ‘recovery’grounded in social justice andempathy.

Alistair Sinclair, director, UKRF

Cavalier CoMMentsI found two aspects of 'Tackling theDeficit' alarming.

Firstly, pitting harm reductionagainst recovery reiterates divisiveand sterile arguments that very manyof us had hoped were put to bed

years ago. In addition, people whosee harm reduction as one of theessential components of acomprehensive approach, along withmany who are finding that ORT hashelped to improve their lives, maywell feel that the comment about‘entitlement to remain on long-termsickness benefit’ is offensive.

Even more concerning is theapparent suggestion that peopledying is a price worth paying. No it isnot! Of course people choosing tomove on from methadone should besupported to do so, but this must bewithin a system that helps themachieve this in as risk-free a way aspossible. Too many people continueto die in the first weeks after comingoff ORT or being detoxed.

Each drug death is a life wastedand a family devastated, and to makesomewhat cavalier remarks aboutthis issue is irresponsible.George Allan, Ellon, Aberdeenshire

DeaD enDDespite the governments of Scotlandand England being unanimous in thebenefits of promoting naloxone torelatives and friends of people whoare at risk of overdosing, there seemsto be little attempt to get theinformation out there.Many people use the telephone

service FRANK [UK helpline] andKnow The Score [Scottish helpline]for advice regarding substance useand rely on quality information beingprovided to them to help them tonavigate themselves through verydifficult situations.They come through initially to a

tier 1 adviser who can give thembasic information regardingsubstance/alcohol use and then theywill be put through to a morespecialised adviser to help withfurther support, depending on thenature of the call.There are some very dedicated

advisers on both tiers butunfortunately, tier 1 cannot informthe caller about naloxone, either onFRANK or Know The Score. They can’tmention naloxone on web chat

Letters and Comment

‘Having thoughtwe’d moved onfrom “moral”narratives, with all theiraccompanyingblame, stigma anddiscrimination, I read that “There are rightand wrong ways of living” and “the right way is to get a job, payyour rent and carefor your friendsand family”.’


either. Very often the tier 2 advisersare so busy that they can’t get putthrough.

There have been cases where

employees have had to break their

remit and inform a caller about

naloxone. The sense of relief is

palpable in the caller’s voice when

they discover that an overdose does

not have to end in fatality and that

they are not totally powerless in the

chaos round about them.

The problem is that FRANK and

Know The Score discourage this and

have ended people’s contracts for

mentioning naloxone and refusing

not to give information. KTS and

FRANK are run by Serco and neither

Scottish Government nor PHE have

briefed the employees. Most tier 1

employees do not appear to know

what naloxone is either, and face

being sacked if they do research and

provide information on it.

No one from PHE or Scottish

Government has responded to any of

my emails asking for a remit to be

given to FRANK or KTS on naloxone. I

telephoned DAN [Welsh helpline] last

night also and mentioned several

times that my partner will not

engage with any services and I was

worried about her overdosing. They

tried to signpost me to a service and I

kept saying she wouldn’t go and that

I was really worried about her over -

dosing. After five minutes I asked

why they hadn’t mentioned naloxone

– ‘I’m not medically trained’ was the

answer.

Neither the Scottish Government

nor PHE have got back to me, and

the only response I have had was a

verbal assurance from someone that

they would bring this up with Serco

at their next meeting.

Name and address supplied

losing BalanCeI get DDN every month as I am veryinterested in all recovery fromaddiction issues. However, I ambecoming increasingly dismayed bythe increasing amount of articles,letters and overall focus on harmreduction. I believe there is a place inDDN and in the recovery world forharm reduction issues and articles,but not at the expense of balancingthis with abstinence issues andarticles. A year or so ago it was thesame – then there was an abundanceof articles about abstinence/recoveryfor a while, and now DDN seems tohave swung back to harm reduction.

Can you and your editorial teamplease try and find some balance inthis? I believe DDN was at its bestbetween the swings when there wasa more equal balance of articlesabout both of these issues.Alex McKinlay, by email


more at our website:www.drinkanddrugsnews.com

DDN welcomes your lettersPlease email the editor, [email protected], or post them to

DDN, cJ wellings ltd, 57 High street, Ashford, Kent tN24 8sG.

letters may be edited for space or clarity.

‘The sense of reliefis palpable in thecaller’s voice whenthey discover thatan overdose doesnot have to end infatality and thatthey are nottotally powerless.’

LAST WEEK I ASKED VIKTOR HOW HE WAS, as his health seemed to bedeteriorating. He relapsed again despite a desperate attempt to undergo drugtreatment at Russia’s most renowned drug treatment clinic, the NationalResearch Center for Drug Dependence. He had started using ‘khanka’, whichcontains opium, aged 16 years, and then tried a number of other drugs, but healways went back to injecting opioids.

For the next few years he was in and out of prison, and then in about 2004 hefound out that he was HIV and HCV positive. Prison was followed by severalattempts at detoxification, as this was the only drug treatment available, buteach time he relapsed.

Last October the Russian government’s health committee held a meeting todiscuss the rapidly growing HIV epidemic. The minister of health said that, at thecurrent pace, the epidemic would grow 250 per cent by 2020 and any controlwould be lost completely – and suggested that HIV treatment coverage should besignificantly expanded to include more people from vulnerable populations,including people who use drugs.

Authorities in Russia are aware that sharing contaminated injectingequipment remains the main driver of the epidemic. Despite this, Russianofficials continue with their dogmatic approach to harm reduction and maintaina criminal ban on OST.

The Russian government argues that the legal ban on OST is to promote theright to health; the legal ban is mandatory for all, so there is no discrimination ofany kind. The arguments that they present to the European Court of HumanRights (ECHR) are based on the notion that the low level of retention inabstinence-based treatment, which is the only method of treatment available inRussia, has nothing to do with the treatment’s low effectiveness, and that peoplereturn to drug use because of their lack of motivation to stay abstinent.

According to the government, the introduction of OST will further demotivatepeople who use drugs from abstinence. Taking this one step further, theauthorities insist that the awful health and legal risks people who use drugs faceshould scare and ‘motivate’ them into abstinence – in spite of there being noscientific evidence to support such an argument.

The ECHR hearings will take place sometime in 2016. Meanwhile, because of thegovernment’s stubborn resistance to OST, thousands of people who inject drugscontract HIV every year. The current denial of access to OST in Russia is not unlikethe denial of access to antiretroviral therapy (ARVT) in South Africa at one time,when myths and ignoring clear evidence led to millions of unnecessary deaths.

Mikhail Golichenko is at the Canadian HIV/AIDS Legal Network; Chris Ford is atInternational Doctors for Healthier Drug Policies (IDHDP)

Russian drug policies are fuelling the escalatingHIV epidemic, says Chris Ford with input fromMikhail Golichenko

From our Foreign Correspondent

Zero tolerance, zero cure

18 | drinkanddrugsnews | December 2015

Review of the year | 2015


JANUARYAmong ever-increasing fears aboutthe impact of new psychoactivesubstances, the Ministry of Justiceannounces a raft of punitivemeasures for anyone found using orsupplying them in prisons. ‘Ifprisoners think they can get awaywith using these substances theyneed to think again,’ warns justicesecretary Chris Grayling.

There wasn’t very much to celebrate in 2015, a year that saw bothEngland and Scotland record their highest ever number of drug-relatedfatalities, while a surprise outright Conservative election win heraldedyet more belt-tightening and austerity

Dark Days

FEBRUARYDDN’s eighth national service userconference, The Challenge, proves to bethe liveliest yet, with a day of powerfulpresentations against a background ofincreasing anxiety in the field.DrugScope’s State of the sector reportindicates that the fears may be well

founded, with more than half ofsurvey respondents reporting areduction in frontline staff alongsidewidespread concerns about jobinsecurity and rapid commissioningcycles. The highly controversial notionof linking treatment to benefitentitlement hits the headlines again asthe prime minister commissions ProfDame Carol Black to conduct a reviewinto sickness benefits, while AlcoholConcern chief executive Jackie Ballardbacks the call for health warnings onalcohol labels. ‘Every other bottle ofpoison in the supermarket has awarning label on it,’ she tells DDN.

MARCHThe government announces that it isdeveloping plans for a general ban onthe supply of all emerging drugs – thefirst stirrings of what is to becomethe controversial PsychoactiveSubstances Bill – and DrugScope goesinto liquidation, blaming itsworsening financial situation. ‘It iswith a heavy heart that the board hastaken this extremely difficultdecision’, says chair Edwin Richards.

APRILFive more NPS become subject totemporary banning orders, and AlcoholConcern accuses the drinks industry ofusing responsible drinking messagesas just another way to promote itsbrands. Meanwhile, Dr Joss Bray writesin DDN that it’s time to put com -passion back into service provision.

MAYThere’s widespread surprise – notleast within the party itself – whenthe Conservatives win a majority inthe general election. The newgovernment loses no time inannouncing its ‘landmark’ blanketban on all NPS, described by Releaseas ‘full blown regression’.

JUNENew substances are now beingidentified at a rate of two a week,the latest EMCDDA European drugreport warns, although demand forheroin appears to be ‘stagnating’across the continent. Delegates atthe RCGP’s national drug and alcoholconference argue that GPs need tostay central to substance treatment,while the ‘Support. Don’t Punish’campaign holds its third global dayof action. Naloxone campaignerPhilippe Bonnet, meanwhile, urgesDDN readers to identify localchampions, create networks andraise awareness of how cost-effective the intervention can be.


Review of the year | 2015


OBITUARY

JUDYBURYChris Ford says goodbye to a passionateand inspirational colleague It’s with great sadness that we announce the death of Judy Bury, who died peacefully on 13 October 2015 in Edinburgh. Judy was one of the most inspirational, passionate and intelligent women I haveever known.

Judy started her career in sexual health services and alwayscampaigned for the underdog. She was a proactive founder member ofDoctors for a Woman’s Choice on Abortion (DWCA) – always defendingwomen’s right to choice.

Later she became a hardworking GP in Craigmillar, a socially deprivedarea of Edinburgh, where she was a tireless and popular doctor. Whenthe epidemic of HIV spread amongst Edinburgh’s people who useddrugs and gay men, Judy quickly became involved and before long wasappointed GP facilitator to one of the first HIV facilitation teams, withthe remit of educating GPs to cope with this new disease and managepeople who use drugs in their practices. She was a brilliant teacher,and communicated effectively with fellow GPs, the community drugproblem service and HIV agencies.

Before long, the Scottish Office asked her to help in the production ofnational guidelines for the management of drug users in generalpractice which, when published, were timely and well received.

Close to our SMMGP hearts, Judy was there at the beginning, helpingto arrange both the first conference (now in its 20th year) and thenewsletter. I remember her speaking at that first conference andsaying we (general practitioners) needed to care for people and neverjudge them until they wanted to change.

Some of you ‘young uns’ might not remember her as she retired,because of ill health, about 11 years ago. But true to form even whenunwell she fought tirelessly for the ‘Yes’ campaign in Scotland andgathered together a group of doctors to form Doctors for AssistedSuicide (DAS).

Judy always gave such a lot to people and causes she believed in. Manyof us loved her, and after a difficult last illness she is at peace now.

Dr Chris Ford

JULY/AUGUSTBleak news as Scotland records itshighest ever number of drug-relateddeaths, 16 per cent up on theprevious year. The country still faces a‘huge challenge in tackling thedamaging effects of long-term druguse among an aging cohort’, sayscommunity safety minister PaulWheelhouse. Prof Dame Carol blacklaunches her review into ‘supportingbenefit claimants with addictionsand potentially treatable conditionsback into work’ and ASH tells DDNthat the Welsh government’s plans toban the use of e-cigarettes in publicplaces amounts to a misguidedattack on an effective harm reductiontool, although the claim in a PHEreport that the devices are 95 percent less harmful than smokingtobacco proves divisive.

SEPTEMBERMore grim news as England followsScotland to announce its highestdrug death toll – although fatalitiesin Wales are down – promptingAddaction chief Simon Antrobus tocall on the government to re-thinkproposed cuts to local authorityhealth spending. ‘The stakes aresimply too high to do otherwise’, hestates. The European Court of Justicedeals a blow to Scotland’s minimumpricing plans by stating that theycould breach EU trade laws, whilePortuguese health minister FernandoLeal Da Costa tells the pan-EuropeanLisbon addictions conference thatPortugal’s decriminalisationapproach is a ‘sensible and rational’one that other countries couldfollow. Recovery month sees avibrant range of activities across theUK, and Dave Marteau’s DDN pieceon the risks of diverted methadoneruffles some feathers.

OCTOBERAnother month, another stark report– this time from the ACMD, whosesecond publication on opioidreplacement therapy for the Inter-Ministerial Group on Drugs warnsthat heroin treatment is beingthreatened by diminishing resourcesand constant rounds of ‘disruptivere-procurement’. Another group ofMPs, the Home Affairs Committee,concludes that the government isrushing, and weakening, itspsychoactive substances legislation,while Phoenix Futures cautions thatpeople’s recovery is under threatfrom a ‘perfect storm’ of conditionsin the UK’s over-heated rentalmarket.

NOVEMBERChemsex hits the national headlineswhen a BMJ editorial calls it a ‘publichealth priority’ and a scathing reportfrom the Institute of Alcohol Studiessays the government’s ‘laughable’public health responsibility deal foralcohol may be ‘worsening’ thehealth of the nation. StirlingUniversity’s Rowdy Yates tells DDNthat it’s time to get over the‘residential bad, community good’attitude, while Ian Sherwood writesthat the sector needs to be braver incalling for drug law reform. Thegovernment’s spending reviewmakes more cuts to cash-strappedlocal authorities, sending furthershivers through a drug treatmentsector expecting the worst andincreasing demand for a meaningfuldrug strategy in the new year.

DECEMBERPlans are already well under way forthe ninth national service userinvolvement conference, Get thepicture. See you there!

EndnotE

The Christmas Day event for ourservice users and volunteers is tohelp support them through anemotionally difficult time of year,with a full Christmas dinner servedto 50 or more individuals.

THIS CHRISTMAS DAY will see the fifth Bubic Christmas dinner for our service users.Previous years’ events have been a huge success and provided a welcome and warmenvironment with a great community atmosphere.

Bubic (Bringing Unity Back Into the Community) is an award winning community-based organisation that provides support for drug users, ex-drug users, their familiesand friends. Our strength lies in our approach. We work in and around communitiesencouraging peer mentors to give those who are using drugs practical advice andemotional support to help change their lifestyle and learn life skills.

The Christmas Day event for our service users and volunteers is to help support themthrough an emotionally difficult time of year, with a full Christmas dinner served to 50or more individuals. ‘It’s a worthwhile, charitable and peaceful event says Derwyn, aBubic volunteer mentor and ex-service-user. ‘I enjoyed being a part of last year’sfestivities and am eagerly anticipating this year’s event.’

In true Bubic style, the event is a community initiative and is only possible throughthe donation of people’s time and effort. A big thank you to organisations from withinthe community, including local Sainsbury’s stores in Tottenham, who support Bubicthrough providing donations. Haringey Mencap not only donate the use of theirbeautiful Grade II listed building but also assist, alongside Bubic’s staff and volunteers,in setting up for the event on Christmas Eve and provide transportation for our serviceusers on Christmas Day.

John, a Haringey Recovery Service user, volunteered on Christmas Day last year. ‘I wasstruck by the diversity of the group, from single men like me to single women andcouples, from the elderly to families, people with young children and babies, to peoplewhom society has chosen to forget,’ he told The Wormmagazine (featured in DDN,November, page 10).

Bubic prides itself on providing a platform from which members of our communitycan raise themselves up and aspire to greater things. Those who have previouslyencountered negative responses due to past behaviour and criminal records are givenopportunity, and through proving their skills and abilities with Bubic, move onwards andupwards. Mark Nash, now a successful programme manager both in prison and thecommunity, says, ‘Coming through Bubic gave me a platform. If there was no Bubic therewould be no-one to assist those coming out of prison.’

With Bubic gaining centre recognition from Gateway Qualifications, followed bydirect claims status in 2015, we are now able to further build on this platform byproviding relevant, recognised, bite-size qualifications that are achievable within amatter of weeks. These qualifications centre on increasing your confidence and self-awareness, learning new skills and enhancing existing knowledge with the goal ofhelping others within your community. They embody what Bubic is about and provide arecognised next step in the recovery process for our service users, as well as anopportunity for others to educate themselves and give back to their community.

We’re also planning to further expand our outreach programme, which is essential toour organisation as it enables us to connect with the hard-to-reach clients; we bring theservice to them. Our client Dodger recalls, ‘Bubic have engaged me in the snow, when itwas cold. They’ve come into crack houses and given me food and supported me in theearly hours of the morning.’

We go where others fear to tread!Contact Bubic at www.bubic.org.uk or 020 8808 6550 for further details about services

– or if you are a service user in Haringey and would like to join them for Christmas dinner

FEstivE

Lindsay Oliver tells us how Bubic arepreparing to throw open their doors forChristmas dinner In their usual inclusive spirit


CHEER


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CASSIOBURYCOURTRECOVER REBALANCE RENEW

“Phoenix Futures’ Hampshire Residential Service taught me a lot about recovery – staying clean, living a positive life, helping one another when needed and learning to stand alone.”

For more info on Phoenix Futures’ range of Residential Services

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Merry Christmasto all our readers, and a huge thank you

to all our advertisers in 2015!

We will be back in print on 1 February, but stay up to date on www.drinkanddrugsnews.com,

@ddnmagazinewww.facebook.com/DDNMagazine


Swanswell are recruiting...We’re expanding our services and

have a number of exciting roles to fill:

• Substance Misuse Workers –Worcestershire (Ref 303) £22,665

• Support Workers –Birmingham (Ref 304) £15,300

• AIRS workers – Somerset,Bridgewater and Yeovil (Ref 305) £19,000-£20,000

• AIRS workers – Bristol, Keynshamand Patchway (Ref 306) £19,000-£20,000

• AIRS Recovery Workers –Somerset, Bridgewater and Yeovil(Ref 307) £16,402

• AIRS Recovery Workers –Bristol, Keynsham and Patchway (Ref 308) £16,402

To join our team, apply at: www.swanswell.org/current-vacancies

Swanswell is a national recovery charity that believes in a society free from

problem alcohol and drug use; that everyone deserves the chance to change

and be happy. Our friendly, professional team are committed to helping

people turn their lives around. We know people are our greatest asset, so

we recruit those whose desire to change lives for the better can help us make

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Classified advertising | Recruitment, services

DDN FREE SUBSCRIPTIONSDDN is a free magazine with copies availableboth in print and online. We work very hard toensure our circulation is up to date, and thatall copies are getting to the right people.

To help us do this we need you to quicklyconfirm your details are all correct.

Simply visitwww.drinkanddrugsnews.com/subscribe and fill in the short online form to continue to

receive your free magazine in 2016.

THANK YOU!

DDN FREE SUBSCRIPTIONSDDN is a free magazine with copies availableboth in print and online. We work very hard toensure our circulation is up to date, and thatall copies are getting to the right people.

To help us do this we need you to quicklyconfirm your details are all correct.

Simply visitwww.drinkanddrugsnews.com/subscribe and fill in the short online form to continue to

receive your free magazine in 2016.

THANK YOU!

HIGH QUALITY PROMOTIONALFILMS AT AFFORDABLE PRICESThat’s what we’re offering. BRANDNEW FILMS is a multi award-winningproduction company working across the drama, observationaldocumentary and promotional worlds, bringing a unique andpersonalised service to its clients. We have made a number of excellentfilms in the rehab field, which are available on request.

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Apply online at www.jobs.tas.gov.au from Wednesday 9 December 2015

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The Tasmanian Health Service has a number of permanent and fixed term vacancies for experienced Addiction Medicine Specialists and Specialist Medical Practitioners and Career Medical Officers with an interest in addiction medicine to join the Alcohol and Drug Service as a senior clinician within a multidisciplinary team. Our services include community clinics, inpatient detoxification, pharmacotherapy, consultation and liaison and strong engagement in under-graduate and post-graduate medical and other health professional teaching. There may also be the opportunity to negotiate research related conjoint appointments with the University of Tasmania for relevant applicants.

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Addiction Medicine SpecialistsSpecialist Medical PractitionersCareer Medical OfficersAlcohol and Drug Service, Tasmania, Australia

Applications close: Friday 5 February 2016

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PLEASE NOTE - Applications submitted by an Agent on behalf of an applicant will not be considered for this recruitment campaign.

Classified advertising | Recruitment


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