AIMING HIGH MOVING ONWARDS AND UPWARDS TOGETHER - THE HEAT IS ON
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Drink and Drugs News
July/August 2020
ISSN 1755-6236
THE HEAT IS ON
Doctor wars: the
tumultuous days
of the 1980s
DON’T GIVE UP
Even in the
most difficult
circumstances
recovery is
always possible
AIMING HIGH
MOVING ONWARDS AND UPWARDS TOGETHER
UPFRONT
IN THIS ISSUE
6
Drink and Drugs News is
published by CJ Wellings Ltd, INSIDE
Romney House, School Road,
Ashford, Kent TN27 0LT 4 NEWS Gambling regulation weak;
t: 0845 299 3429 a new phase of the Carol Black review
Editor: Claire Brown
e: claire@cjwellings.com
9 OUTDOOR EVENTS Advice by Kevin Flemen
Advertising manager: Ian Ralph 10 REACHING OUT Just talk, says Forward
e: ian@cjwellings.com
11 WORLD HEPATITIS DAY with the Hep C Trust
Reporter: David Gilliver
e: david@cjwellings.com 14 BILL NELLES Doctor wars, part two
Designer: Jez Tucker
e: jez@cjwellings.com 18 SUPERVISED INJECTING FACILITIES – reality?
Subscriptions: 20 LETTERS Benzo trap, films, and being included
e: subs@cjwellings.com
website:
22 ZOOMING IN Wellbeing with Humankind
www.drinkanddrugsnews.com ON THE COVER: The service user experience 23 REFLECTIONS Thoughts from David Finney
Website support by
wiredupwales.com 24 THEY SAID WHAT..? Spotlight on the
12
Printed on environmentally Refuge from national media
friendly paper by the Manson domestic
Group Ltd abuse Recovery is
Cover by: Brain light / Alamy always possible The right questions
16 8
CJ Wellings Ltd does not accept
responsibility for the accuracy
of statements made by
contributors or advertisers.
The contents of this magazine
are the copyright of CJ Wellings
Ltd, but do not necessarily
represent its views, or those of
its partner organisations.
STAYING STRONG IN PARTNERSHIP ‘Service users are
Find the resources to stay ahead of central to everything’
coronavirus from the DDN partners CONVERSATIONS AT THE MOMENT often come back to feelings of
and community at anxiety and isolation, so we’re pleased to be able to keep sharing
the ways you’re responding positively to the COVID situation.
www.drinkanddrugsnews.com Forward Trust are among those looking for creative ways to
We are especially grateful to our network of engage their service user community (p10), while Open Road and
partners at this difficult time and thank each Humankind are also redoubling their efforts to connect with service
and every one of them for their loyal support. users and make sure no one is isolated (p16 and p22).
With lockdown likely to have a disproportionate effect on women
(June issue, p9), we have an insight into domestic abuse support
DDN is a self-funded independent publication. Our bespoke partnership packages provide (p12), while Kevin Flemen looks out for young people in the summer
an opportunity to work closely with the magazine. Please get in touch to find out more. party season with some targeted harm reduction advice (p9).
As Bill Nelles (p14) would be the first to remind us, harm
reduction must stay top of the agenda so we’re pleased to see
the cross-sector mobilisation to make injecting facilities a reality
(p18) and to support the call for redoubled efforts on eliminating
hepatitis C (p11) as World Hepatitis Day approaches on 28 July.
As one of our letter-writers points out (p20) service user
involvement should be central to everything
we do, so we hope you get involved with
the two initiatives from the research team
(p6) and PHE (p8) to bring lived experience
to the heart of informing treatment.
Claire Brown, editor
Keep in touch at
www.drinkanddrugsnews.com
and @DDNmagazine
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 3
NEWS ROUND-UP
Gambling oversight ‘complacent’ and
‘weak’, says Commons committee
T
he bodies overseeing ensure effective regulation to be regulator that doesn’t seem terribly
gambling are failing ‘slow’ and the penalties imposed interested in either the harms it
to protect people on companies that do too little to exists to reduce or the means it
who are vulnerable to address problem gambling ‘weak’. might use to achieve that,’ said
gambling harms, says a ‘Where gambling operators fail to committee chair Meg Hillier. ‘The
report from the House of Commons act responsibly, consumers do not commission needs a radical overhaul
Public Accounts Committee. The have the same rights to redress as in – it must be quicker at responding
Department for Digital, Culture, other sectors,’ it says. As gambling to problems, update company
Media & Sport (DCMS) and the increasingly moves online, DCMS licence conditions to protect
Gambling Commission – which it and the Gambling Commission vulnerable consumers and beef up
oversees – have an ‘unacceptably have failed to adequately protect those consumers’ rights to redress
weak understanding’ of the impact of consumers, even when problems when it fails. The issue of gambling
gambling harms and lack measurable such as increased risk of gambling harm is not high enough up the
targets to reduce them, says the harm during the COVID-19 lockdown government’s agenda.’ The review of 'What has emerged
document, which was published less
than two weeks after a report from
have been identified. The committee
is calling for a published league table
the Gambling Act was ‘long overdue’,
she added, and an opportunity to see
in evidence is a
the All Party Parliamentary Group of gambling operators’ behaviour a ‘step change’ in the treatment of picture of a torpid,
(APPG) for Gambling Related Harm towards customers, with ‘naming problem gambling. ‘The department
called for a complete overhaul of the and shaming’ of poor performers. must not keep dragging its feet – we toothless regulator
UK’s system of gambling regulation
alongside a ban on all gambling
It also wants to see DCMS embark
on an immediate review of the
need to see urgent moves on the
badly needed overhaul of the system.’
that doesn’t seem
advertising. Gambling Act. Gambling regulation: problem terribly interested.'
The public accounts committee ‘What has emerged in evidence gambling and protecting vulnerable
found the pace of change to is a picture of a torpid, toothless people at www.parliament.uk Meg Hillier MP
More than 120 children slain in Postal NSP
Duterte’s ‘war on drugs’ launches
AN ONLINE POSTAL NEEDLE EXCHANGE
MORE THAN 120 KILLINGS OF when the real targets could not children we are witnessing.’ How SERVICE has been launched by harm
CHILDREN and young people were be found’. Almost all of those could they do this to my child? at reduction specialists Exchange
carried out in the Philippines interviewed asked not to be www.omct.org Supplies to make sure people can
between 2016 and 2019, named, and access the equipment they need
according to Geneva-based World most did not during the COVID-19 pandemic, which
Organisation Against Torture even file a has seen reduced staffing levels at
(OMCT) and the Philippine case for the many pharmacies. NSPdirect allows
Children’s Legal Rights and murder of drug services to provide a full online
Development Center. Just under their children and postal needle exchange service
40 per cent of the killings were through fear during the pandemic and beyond.
carried out by the police, with of reprisals. Services or partnerships joining the
the remainder by ‘unknown ‘Over the scheme are supplied with a set of
individuals, often masked or past four secure activation codes, which can
hooded assailants, some of them years we then be distributed to service users to
with direct links to the police’. have hardly set up their own online accounts to
The report – which is based seen any order equipment.
on interviews with families, meaningful As with any NSP, clients have the
witnesses and local authorities, as reaction to option to use the service anonymously
well as official documents – states the wanton killing of thousands Philippines. 12th Apr 2019. – all data transfer to and from the
that the children’s ages ranged of people under the pretext Protestors against drug-related site is encrypted, and personal
from just 20 months up to 17. of the “war on drugs”,’ said killings rallied on the streets of information is securely stored. Clients
The deaths documented OMCT secretary general Gerald Manila carrying a cross and ‘stop can log in to review their order history,
were either the result of direct Staberock. ‘It is the total lack of the killings' placards. Credit: select favourites and repeat previous
targeting, mistaken identity, accountability that feeds the cycle Sherbien Dacalanio/Alamy orders. More information at www.
‘collateral damage’ or ‘as proxies of violence, including the war on exchangesupplies.org
4 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020 WWW.DRINKANDDRUGSNEWS.COM
News DDN EVERY DAY
All the news, updated daily
www.drinkanddrugsnews.com
Government launches Local News
second phase of Carol
Black review
T
he second part of to ‘ensure they are effective’. The
Professor Dame Carol review’s first phase concluded that
Black’s independent even if more money were made
review into illegal available for drug treatment, there
drug use in England would still be ‘a lot of work to do’ to
has now been launched, the build up capacity and expertise in PRIMARY PROJECT
government has announced. While the sector (DDN, March, page 4). A new London NHS
the initial phase looked at drug ‘In my foreword to part one I said primary care gambling
supply and demand, the second that behind the thorough analysis of 'We showed a service has been launched
will study treatment provision,
recovery services and prevention.
the market for illicit drugs that we
had just completed lay a very tragic
decade-long erosion, by the Hurley Group
GP partnership and
The review will look at how drug human story – about the effect on under previous GambleAware. Many
treatment interacts with housing, individuals, their families, youngsters people with issues ‘don’t
employment, mental health and caught up in the trade, and the governments, in necessarily talk about
criminal justice services, with the
overarching aim of ensuring that
economy,’ said Professor Black. ‘We
showed a decade-long erosion, under
almost every aspect their gambling,’ with their
GP, said service lead Dr
vulnerable people get the right previous governments, in almost of drug addiction, Clare Gerada. ‘We will be
support to ‘recover and turn their every aspect of drug addiction, exploring how to identify
lives around in the community and prevention, treatment and recovery. prevention, them’ – and help them get
in prison’. The final document will
contain policy recommendations
We now have the opportunity to
correct this and build a better world.
treatment and the right treatment. www.
primarycaregamblingservice.
to government, including around To do this many stakeholders and recovery.' co.uk
funding, commissioning and how government departments must
local bodies are held accountable work together as never before.’ Prof Dame Carol Black STRONG IDENTITY
The University of Brighton
A quarter
is working alongside youth
Address lockdown ‘time researchers who have
experienced mental health
bomb’, urges Adfam of drinkers issues to understand if
activism can boost identity
PEOPLE COPING consuming more and sense of belonging.
‘Research tells us that a
WITH A LOVED ONE’S strong and positive civic
DRUG USE, drinking or 85 per cent of MORE THAN A QUARTER OF PEOPLE who have identity offers us direction
gambling have been
hard hit by the COVID-19 respondents ever drunk alcohol think they have been drinking
more during lockdown, according to Alcohol
in life and indicates that we
matter in the world,’ said
lockdown, according
to an Adfam survey.
said lockdown Change UK. Almost half said they expected
to continue drinking at the same rate as the
principal researcher Angie
Hart. More information at
Half of respondents to had made a ‘bad lockdown eases, while 17 per cent said they www.ukri.org
Families in lockdown said anticipated drinking more. The figures are based
the situation had had a situation worse’ on a survey of more than 2,000 people, around APPROPRIATE SUPPORT
negative impact on their 1,600 of whom were current or former drinkers. Guidance on setting
own mental health, while Just under 20 per cent of this group said up specialist alcohol
28 per cent said they were experiencing more verbal abuse than they had been drinking to cope with stress or support for people from
usual, and 13 per cent admitted to being concerned for their safety. anxiety, with parents of under-18s more likely the Punjabi and other
Around 5m people are thought to be dealing with the negative to cite this as a reason than non-parents or communities been
effects of loved one’s alcohol or drug use in the UK, with 85 per parents of adult children. While 38 per cent of launched by Aquarius,
cent of respondents to the survey saying the lockdown had made those who typically drank seven or more units Manchester Metropolitan
a ‘bad situation worse’. Many will need urgent additional support a day said they were now drinking more, more University and
as lockdown conditions ease, warns the charity. ‘When you are than one in three people had been taking ‘active Birmingham University.
already isolated, fearful or in poor mental and physical health, steps’ to manage their alcohol consumption, ‘Far more attention is
lockdown takes an even bigger toll,’ said chief executive Vivienne including having alcohol-free days or looking for needed to support our
Evans. ‘Even when restrictions ease, people will need help and advice online. ‘From the very start of lockdown, diverse communities,’ said
support to recover. Now more than ever, we need a national charities and treatment services have warned project lead Sarah Galvani.
conversation about how we can help people to cope with the life- of the impact on people’s drinking,’ said chief www.mmu.ac.uk/rcass/our-
long impacts of a loved one’s alcohol, drug or gambling problem.’ executive Richard Piper. ‘This research shows expertise/suab
Survey at adfam.org.uk that we were right to worry.’
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 5
RESOURCES
A SURE start be invited to respond to a key
question that will be developed by
the recovery champion working Not everyone has
with the app development team,
which includes researchers from a smartphone or
King’s College London and people
with lived experience of addiction.
tablet computer,
Researchers from the app team will but there is
The new SURE Recovery app is a analyse the data from those who
consent and share the anonymised evidence that
vital resource powered by the lived findings with key policy makers,
including Public Health England people who
experience of its users, say Ed Day, and NHS England. The sharing of
use substances
anonymised data is completely
Jo Neale, Alice Bowen and Paul Lennon optional, and people can use increasingly have
the app without answering any
good access to
O
research questions.
SURE Recovery is available to
ne of the key voice is heard when policy is being download for free from Google mobile technology.
tasks of the developed. This is particularly so as Play and the App Store. The work
national recovery the country adjusts to the changes to produce SURE Recovery was
champion role is imposed by the COVID-19 pandemic, undertaken in collaboration with clinicians, Create Recovery (a small
to bring people and as the next phase of Dame Carol people using alcohol or other drugs, arts charity that supports people
together within Black’s review of drug treatment in treatment and in recovery. It was with experience of addiction
the addictions field to tackle a services begins (news, page 5). also supported by an addiction issues to develop their creativity)
common goal – overcoming the The SURE Recovery app offers service user research group linked and Mindwave Ventures (an
pain and misery that addiction can a new mechanism for supplying to a London-based peer mentoring app developer that focuses on
bring. People with lived experience anonymised feedback on important service called the Aurora Project. user-centred digital design). The
of addiction have a crucial part to topics relevant to the development A wide range of other people work was generously funded
play in recovery-oriented systems of of good quality treatment services. were also involved in developing from various sources, including
care, and it is important that their Each month users of the app will SURE Recovery, including addiction Action on Addiction, the Alexander
6 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020 WWW.DRINKANDDRUGSNEWS.COM
SURE AIMS AND FEATURES
SURE Recovery is intended for people who are using drugs
or alcohol, in recovery, or thinking about recovery. It has five
main aims and six key features. The five aims are:
1. To enable people to track and monitor their own recovery
journeys
2. To enable people to recognise when they might need help
3. To enable people to identify sources of support
4. To enable people to find inspiration from others in
recovery
5. To generate new data that will help researchers and policy
makers better understand substance use and recovery
The six key features are:
1. A recovery tracker: this allows people to monitor their own
recovery using a co-designed validated outcome measure
called the Substance Use Recovery Evaluator (or SURE).
Once SURE is completed within the app, personalised
feedback and a score are generated. Weekly, monthly and
Mosley Charitable Trust, the apps in a sustained way for months yearly scores can then be viewed in a graph, allowing app
Mackie Foundation, and the NIHR and years – instead they tend to be users to view and track how their scores change over time.
Maudsley Biomedical Research used as and when people feel they 2. A sleep tracker: this works in a similar way to the recovery
Centre, King’s College London. meet their current needs. This is
tracker. App users can complete a co-designed validated
In developing SURE Recovery, how the development team expect
the project team followed a that SURE Recovery will be used. scale of sleep problems called the Substance Use Sleep
co-design process to make sure It seems likely that different Scale (or SUSS). This will then produce personalised
that the app would meet the features of the app will appeal to feedback and a score that also allows app users to monitor
needs and expectations of people different populations at different and review their sleep problems over time.
experiencing addiction. They points in time and with different
conducted interviews and focus effects. For example, the recovery 3. A diary function: this provides a private space where
groups with people who were tracker, with its personalised people can record their thoughts and feelings.
using substances, in treatment feedback, may ‘nudge’ people to 4. Artwork: the app provides a platform for people to share
and in recovery, in order to better reduce their substance use, change
their artwork with the recovery community. App users can
understand the process of recovery their behaviours, or encourage those
and how an app might support who are not in treatment to enter submit their artwork for possible display in the banner on
this. Successive versions of the treatment. The artwork feature the home screen of the app.
app were also reviewed and tested may have a therapeutic effect, 5. A naloxone resource: this feature provides instruction on
by people with lived experience enhance self-esteem or appeal to
the use of naloxone in the event of overdose. There are
of addiction to make sure that those who find it difficult to express
functionality was optimised, the themselves in words. Meanwhile, also informational resources, including a training video
meaning of all text was clear, the naloxone feature may increase and a knowledge tracker which uses the Opioid Overdose
all graphics and images were engagement with take-home Attitudes Scale (OOAS), a validated measure of overdose
appropriate, and there were no naloxone and improve overdose management competency.
bugs or system crashes. management competency, so
Not everyone has a smartphone potentially saving lives. 6. Reading material: app users have free access to the book
or tablet computer, but there is We encourage anyone with The Everyday Lives of Recovering Heroin Users, based on
evidence that people who use lived experience of addiction and the lived experiences of people in recovery.
substances increasingly have an interest in recovery to download
good access to mobile technology. the app and give it a try. If you like
Mobile health apps, such as it, we ask that you tell other people If you have an Android device, • Ed Day is national drug recovery
SURE Recovery, tend to be easy to so they know about it too. If you the SURE Recovery app can be champion and clinical reader in
download and cheap to use. They think it can be improved, please downloaded from Google Play. If addiction psychiatry at University
can therefore be an additional let the research team know. People you have an iOS device, the SURE of Birmingham.
valuable resource for people with experience of addiction have Recovery app can be downloaded • Jo Neale is professor in addictions
who may not be in contact with a right to good mobile health apps from the App Store. People can also qualitative research at King’s College.
services, and for people who may just like any other population, and follow and communicate with the • Alice Bowen is research assistant
be thinking about, or working on, the aim is to ensure that the SURE SURE team via Facebook, Twitter (@ at King’s College.
their recovery. We know that people Recovery app is a resource that can SURE-Recovery), Instagram (sure- • Paul Lennon is director of the
do not generally use mobile health help as many people as possible. recovery) and YouTube. Aurora Project
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 7
RESEARCH
MF3d/iStock
THE RIGHT QUESTIONS
Now in its 30th year, the Unlinked
Anonymous Monitoring Survey is a vital
tool for harm reduction, says Emily Phipps
T
his year the Unlinked responses to help them understand collected is absolutely vital. If you information, please contact Claire
Anonymous Monitoring what the key priorities for their would like to join the UAM survey, Edmundson, at claire.edmundson@
Survey (UAM) of people clients are. Nationally, the report or have taken part previously and phe.gov.uk.
who inject drugs feeds in to key annual publications would like to restart, the UAM Dr Emily Phipps is consultant
celebrates its 30th such as Shooting up and Hepatitis team would love to hear from you. epidemiologist at the National
anniversary in England and Wales C in the UK. The survey data is Every survey completed is a hugely Infection Service, PHE. She prepared
and 18th anniversary in Northern also shared internationally with valuable source of information this work with Megan Bardsley,
Ireland, making it the longest the World Health Organization on this population group who are HIV/STI surveillance and prevention
running annual survey of this and European Centre for Disease otherwise often under-represented scientist, and Claire Edmundson,
cohort in the world. Control to support global BBV in policy and statistics. For further senior scientist, at PHE
Coordinated by Public Health elimination initiatives.
England (PHE), the survey consists In current times, championing
of a self-completed questionnaire the needs of people who inject ‘We have had a phenomenal
and biological sample that is drugs and ensuring continued
number of responses to
anonymously tested for HIV, access to services is incredibly
hepatitis B and hepatitis C to important. There are valid concerns the Unlinked Anonymous
monitor trends in blood-borne that reduced uptake of BBV testing Monitoring Survey, which
viruses (BBVs) and behaviours that and difficulties in delivering the
provides us with a wealth of
impact transmission, such as needle same level of needle and syringe
sharing, testing and treatment provision during the pandemic will information about our clients
uptake. No identifiable information lead to an increase in infections – the addition of a finger-prick
is collected, and the survey or test among this group. The UAM, now
test for the anonymous blood
result cannot be traced back to more than ever, is an essential tool
an individual, making it easier for for understanding the impact of sample part gives us another
us to ask questions about risky COVID-19 on people who inject opportunity to offer diagnostic
behaviours that might otherwise go drugs, and to keep track of progress
testing. Through this testing
unanswered. as services recover.
The UAM is a powerful tool for The UAM team would like to done alongside the survey, we have picked up 47 cases
advocacy and service planning, say a huge thank you to all of of hepatitis C that we may not have done otherwise.’
both nationally and locally. Each our volunteers and participants
centre undertaking more than who have been undertaking the Louise Hansford, regional hepatitis C elimination
thirty surveys each year is provided survey during the last few difficult co-ordinator for the South of England
with a free, detailed report of their months – the data you have
8 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020 WWW.DRINKANDDRUGSNEWS.COM
HARM REDUCTION
LONG HOT SUMMER
Summer weather and lack of other entertainment mean
that young people are once again turning to outdoor
partying on a large scale. Drug services are going to have
to get creative about harm reduction, says Kevin Flemen
between promoters, police and concern that scarcity of precursor
welfare services. chemicals could mean a shortage
This festival harm reduction of MDMA and the re-emergence of
doesn’t translocate to illegal more dangerous compounds such
events quite as easily, especially in as PMMA. Conversely there have
the current climate. Clandestine also been reports of extremely high-
events may be organised online potency pills, with peak doses in
with the final location announced excess of 350mg being reported.
at the last minute. Organisers are Without any doubt, as we
understandably wary of engaging exit lockdown, the explosion in
with any statutory bodies – unlicensed events will be the issue to
wariness that is likely to extend to contend with and drug services need
drug services. Even where workers to engage with this fast, creatively
Stephen Arnold
or volunteers could gain access, their and at a grassroots level, if they are to
own safety needs to be ensured in provide much-needed input.
terms of COVID-19, personal safety Kevin Flemen runs the drugs
and not getting caught up in any education and training initiative KFx
enforcement action. There had been www.kfx.org.uk
I
n many post-apocalyptic films with the police – the issue of
there’s an unbearably naff drugs and safety has not yet been Given that unlicensed events are going to be one of the issues over
sequence where everyone discussed so widely. the summer months, interventions are essential. And the ‘how to’
has a party. It’s like The Matrix The upsurge in unlicensed music for working with unlicensed events means revisiting earlier harm
Reloaded ‘Zion dance party’ events should come as no surprise. reduction and being less reliant on permitted access and high-tech
and usually involves everyone Pubs are only now reopening on a onsite testing. It’s going to need to be more grassroots, including:
getting into tribal drumming and restricted basis, nightclubs won’t • production of clear accessible literature
showing off their tattoos. It turns be reopening for the foreseeable • use of testing sites such as WEDINOS, Pill Reports and The
out that all these scriptwriters were, future and organised festivals Loop to promote awareness of contaminated pills, high-
in fact, absolutely on the money. have been cancelled. A cohort of strength and other dangerous products
While the COVID-19 pandemic people who have been furloughed, • safety advice about use of nitrous oxide
is nowhere near over and social
distancing is still in theory the order
have lost work or are entering the
summer unclear if they are going
• engaging with promoters via social media so that they
can make events safer – water onsite, access for emergency
of the day, we’re at the Zion dance on to higher education are bored
services, trained volunteers and engaging with drug services to
party stage of proceedings. and craving social interaction and
provide outreach if possible
A few weeks ago I ran a ‘young entertainment. And the weather’s
people and drugs’ webinar and hot. Partying outside is very clearly • peer education – as, more often than not, drug services won’t
be on site it’s essential to equip those attending events with
one of the things I flagged up going to be the order of the day.
the resources and tools to manage critical incidents. Making
was the likelihood as we exited The drug harm reduction input
sure attendees know how to spot signs of MDMA overdose and
lockdown of unlicensed events at some organised events pre-
manage it is critical
becoming a bigger issue. One lockdown has been very successful
participant highlighted that it was in making festivals and clubs • using What3Words https://what3words.com/ to ensure that
already happening in Bristol – that much safer. Onsite drug testing, emergency services can locate people at outdoor events with
was a month ago. Since then the festival welfare, trained staff and pinpoint accuracy
prediction has come to pass and harm reduction interventions • general harm reduction with a view to addressing COVID-19
there has been a massive upsurge were helping to raise awareness of, spread including the sharing of snorting tubes, spliffs, drinks
in house parties, block parties, and reduce the risks from, high- and balloons
illegal raves and spontaneous strength pills and powders and pills • legal advice cards such as Release ‘Bust Cards’ so that people
open-air events. Some of these containing unknown and possibly detained during enforcement activity know their rights and
have made the national news, but dangerous cuts, as well as providing can access legal advice
the media attention has so far help to those in distress. The best of • personal safety advice
mostly been on litter and conflict these were collaborative exercises
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 9
SUPPORT
REACHING OUT
Staying connected has never been
more important, says Jason Moore
Living through
a pandemic has
brought us all
Karen & Summer Kala / Alamy
challenges, but it
has been amazing
to see the creative
and positive
way our staff
T
and volunteers
he COVID-19 pandemic
has changed every
parent, let alone one who isn’t able
to physically see their child.
‘Forward Connect’ is our friendly
community of current and former have risen to
aspect of how we
live and interact with
We also piloted a live chat
service on our website, called Reach
clients, graduates and volunteers.
They – along with some of our
the challenge,
people, and left many Out. Open every weekday from alcohol pathway clients in East bringing a much-
feeling anxious and isolated. 9am to 3pm, Reach Out provides a Kent – have been using Kaizala, a
As an organisation that prides friendly voice and a sympathetic ear secure multimedia messaging app needed human
itself on our hands-on, face-to-
face approaches, one of the key
to anybody struggling or seeking
advice, particularly on matters
to keep in touch with each other as
a source of social support.
connection to
challenges for Forward has been
finding creative ways to engage
such as drug or alcohol issues,
mental health challenges, housing
And last but not least, our
recovery support service has been
those we support.
our service user community. We’ve problems or benefit concerns. working with prison teams to
also wanted to make sure we can In our community projects, identify clients who are due to be
do everything we can to help them we’ve been exploring the use released from prison and equip
feel connected – not just to us, of video conferencing software them with mobile phones when
but to their loved ones and wider to continue the delivery of they get out, to ensure they are still human connection to those we
recovery community. practitioner-led, structured group able to access remote assessments support.
Right from day one, our programmes in Hull and East and treatment services. We ‘Never underestimate the power
staff and volunteers rose to the Kent, as well as our Recovering are truly appreciative of some of a letter or card, particularly at a
challenge admirably, finding all Families groups. Our East Kent additional funding that has been difficult time like this,’ says Rebecca
sorts of inventive and novel ways team now also sends out weekly received from supportive partners Mistry. ‘It’s the small things that
to keep in touch. Our family work text messages to clients with to help fund this additional work. are really making a difference, and
coordinator Rebecca Mistry (along updates and advice on how to We’re incredibly lucky to a handwritten letter from someone
with a little help from her children stay safe. We’ve identified all OST have such a dedicated and you love can really put a smile on
Aaria and Ethan!) created packs clients without a contact number responsive team, as well as access their face. Aaria wanted to be able
for prisoners with children, to help and supplied them with their to technology that has made to help mummies and daddies who
them continue to connect with own mobile phone so that they it possible to stay connected weren’t able to see their children to
their families when family visits can stay in touch with their key with our clients and graduates. keep in touch with their little ones,
stopped. The packs contained workers. Meanwhile, our dedicated Living through a pandemic has and also to give prisoners some
items such as stationery, crayons prescription delivery team has brought us all challenges, but good drawing opportunities –
and jokes to tell little ones to keep been travelling all over East it has been amazing to see the because who doesn’t love drawing!’
them smiling and advice on how Kent, delivering prescriptions to creative and positive way our staff Jason Moore is divisional
to talk to children about COVID pharmacies to ensure clients have and volunteers have risen to the director of substance misuse at
– something difficult for every their medication on time. challenge, bringing a much-needed The Forward Trust
10 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020 WWW.DRINKANDDRUGSNEWS.COMHEPATITIS C
DOUBLING DOWN
With World Hepatitis Day on 28 July, now
is the time to redouble our efforts towards
hepatitis C elimination, says Rachel Halford
W
orld Hepatitis peer support staff and volunteers recover from
Day this year have been going into temporary the strain
will be unlike accommodation across the country of increased
any other we to test people who had been admittances
have celebrated living on the streets. This brilliant to intensive
before. Hepatitis C continues to partnership working between NHS care, it is
have a huge impact on people trusts, other charities, alcohol and essential we
who inject drugs, with the latest drug services, and the hotels and re-focus efforts
statistics showing the rate of new hostels themselves has allowed to address
infections among injecting drug many hundreds of people who had those disease
users remains worryingly high. The been rough sleeping to be tested areas which
surge of activity we have seen since and referred on to treatment – predominantly
last summer when NHS England engaging a population for whom affect
signed an elimination deal with the traditional treatment model is disadvantaged
the pharmaceutical industry – not often not accessible. and
only to provide medication but marginalised
also to commission case-finding populations, of
initiatives – has largely come to a which hepatitis
halt as a different virus has taken
centre stage.
‘Even with the C is one. With
easy-to-take
As with almost all other areas of persistence of drugs that
healthcare, the impact of COVID-19 have a short
on services providing hepatitis C laudable efforts to treatment
target those people
treatment has been sudden and term and high
dramatic: nurses and doctors were cure rate there
re-deployed overnight, clinics were
cancelled, most testing ceased
most at risk of is no excuse
for the UK not
and new treatment starts were infection, there has to meet its
generally delayed. HCV Action, a commitment to eliminate hepatitis their needs, heightening the risk of
network for professionals working been no notable C by 2030 – the World Health hepatitis C transmission through
reduction in new
in hepatitis C coordinated by Organization’s hepatitis elimination sharing injecting equipment. We
The Hepatitis C Trust, found that goal, which we joined many other must ensure people are supported
around one quarter of the 22
hepatitis C treatment networks
transmissions in countries in signing up to. Progress
has been positive on diagnosis
to access needle and syringe
exchanges adequate for their needs
(operational delivery networks) recent years. ‘ and reducing hepatitis C-related and so reduce the spread of blood-
were only able to treat patients deaths, but we have a long way to borne viruses such as hepatitis C.
already on their registers or no go before we can viably achieve and The majority of hepatitis C cases
cases at all at the end of May, even COVID-19 has laid bare the sustain elimination. in the UK remain undiagnosed,
as clinics began to recover. extent of health inequality in this Even with the persistence of resulting in potentially tens of
Understandably, as many country. In England, people living laudable efforts to target those thousands of people experiencing
doctors and nurses have had in the most deprived areas are people most at risk of infection, health complications including
their time diverted from clinics around twice as likely to die from there has been no notable liver damage and an increased risk
to wards in order to provide COVID-19 compared to those in reduction in new transmissions of mortality. This World Hepatitis
much needed additional capacity, the least deprived. Hepatitis C in recent years. Prevention is Day we must applaud services
some areas were under greater likewise impacts disproportionately absolutely vital to achieving for their incredible hard work and
strain than others. Despite these upon the most vulnerable in our elimination and yet currently harm dedication so far, and redouble our
difficulties, a number of services society – almost half of the people reduction provision does not go far efforts to prevent new infections
have demonstrated phenomenal with hepatitis C who go to hospital enough, with 36 per cent of people and expand testing and treatment
creativity and determination to come from the poorest fifth of the who inject drugs reporting in 2018 until we have achieved elimination.
continue to help people. Many of population. that they did not have adequate Rachel Halford is chief executive
The Hepatitis C Trust’s peer-to- As health services begin to needle and syringe equipment for officer at the Hepatitis C Trust
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 11DOMESTIC ABUSE
SAFEGUARDING
The lockdown has forced services providing domestic
abuse support to become even more resourceful and
innovative, says Miranda Hawtrey
W
orking in by SafeNet Domestic Abuse Support with complex needs who need
a setting Services, who provide domestic to escape from domestic abuse
supporting abuse support to women, men often results in outcomes such as ‘Jane’s Place is the
those with and children. They are also the lead women returning or staying with
addiction providers for Lancashire Refuges. the perpetrator, escalating risk and only one of its
issues
and complex needs is always a
Jane’s Place is the only one of
its kind in the North West – not
coping strategies such as increased
substance use, a lack of trust in
kind in the North
delicate balancing act. But when only does it help to support women services and sofa surfing, which West – not only
the coronavirus outbreak swept who are fleeing from all forms often results in rough sleeping.
through the UK in March 2020, the of domestic abuse, but it also does it help to
team at Jane’s Place in Burnley had breaks down barriers often posed A MAMMOTH TASK
an extra challenge on their hands. by traditional refuge. A lack of The challenge of implementing support women
Jane’s Place is a somewhat
unique service established in 2017
appropriate accommodation and
support for women and families
safety measures and managing
the extra risk posed by lockdown in
who are fleeing
this kind of specialist environment from all forms of
has been a mammoth task, and the
team knew they had to adapt the domestic abuse,
service fast to ensure they could
keep everyone involved safe and but it also breaks
continue to support their residents.
They started by expanding and
down barriers
increasing their safehouse provision often posed by
to provide safe spaces for those
residents who were shielding, traditional refuge.’
showing symptoms and needing
to self-isolate. Those with serious
drug and alcohol use issues and/ were, the team quickly pivoted the
or sex working women who found service to offer as much flexibility
it impossible to adhere to the and support as possible.
government guidelines had to be This hasn’t come without its
kept safe regardless of whether or setbacks. The team have faced
not they were able to comply, and difficulties accessing help from
the team achieved this by use of outside agencies that would
separate safehouse facilities with usually support residents, and
specialist intensive floating support. accessing healthcare has been
Each individual resident had an made much more difficult by
emergency COVID plan created and skeleton staff in other agencies
tailored to meet their needs. Along and lack of GP appointments. The
with various other measures, such residents also voiced that they
as extra cleaning, PPE and updating were missing group work; the need
residents and checking in to make for connection during their journey
sure they knew what the guidelines plays a big part in recovery.
GETTING CREATIVE
Jane’s Place is named in memory of Alongside the practical solutions
Jane Clough, who was killed by her – with staff members collecting
ex-partner in 2010. Jane’s parents, methadone for residents daily and
John and Penny Clough (pictured), assisting with non-molestation
are now SafeNet patrons. orders received via court sessions
12 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020 WWW.DRINKANDDRUGSNEWS.COMSANCTUARY
over the phone with residents – the More than ever, this highlighted previous routes to safety, manned with residents. This includes ‘walk
team got creative. They introduced the need to find other ways to by trained support workers. ‘n’ talk’ sessions, encouraging
ways for residents to connect reach victims who were not safe communal gardening as a
with professionals and loved ones at home. The team introduced a WHAT NEXT? soothing way to pass the time
virtually, created online recovery new online chat service via their So what next for Jane’s Place? No and, most importantly, continuing
groups and set up online quizzes website to enable victims to safely one knows how long restrictions to listen to what residents want
and games to help boost morale. access advice and support during will be in place or what the ‘new via their ‘finding our voice’
With the lockdown also came a periods of isolation or when they normal’ will look like, so the team consultations.
devastating rise in domestic abuse were confined at home with a are always thinking ahead and Miranda Hawtrey is a support
incidents, in the UK and beyond. perpetrator and unable to use looking at new ways to engage worker at Jane’s Place
CASE STUDIES: SARAH AND KERRY
FLEEING TRAUMA: support with her mental health. Jane’s crack and heroin, was on a methadone
SARAH, AGED 34 Place referred Sarah to Inspire Wellbeing script, and was also having physical
Sarah had begun taking prescription and she was allocated a key worker to help withdrawal symptoms – such as
medication and drinking alcohol at 14 support her with substance use. seizures – when she didn’t have alcohol.
years old as a way to numb the trauma Sarah is now abstinent from all She was also a prolific shoplifter to fund
of being gang raped. Both Sarah’s substances and back in contact with her addictions, and had spent time in
parents had issues with addiction and her children who live with family. She prison as a result.
she felt unsupported in dealing with is no longer shoplifting or sex working Kerry was still having regular
this horrific trauma. Growing up, she and wants to start volunteer work phone contact with the perpetrator
said she always felt ‘unloved’. During after lockdown. Staff referred Sarah for when she arrived, who would often
her adult life, Sarah was repeatedly specialist sexual trauma counselling try to manipulate her, use controlling
subjected to sexual abuse by various and she also is supported by attending a and coercive behaviour, give verbal
males, and her drug use escalated to trauma recovery group. abuse and threaten self-harm if she
using heroin and crack daily. Sarah has said her drug use was didn’t return home. SafeNet supported
Sarah then was in an abusive spiralling out of control but she has Kerry to stop contact and she attended
relationship and gave birth to two dramatically changed her life with the domestic abuse groups at Jane’s Place.
children. The children were subsequently support of staff. Sarah says the support Extensive safety planning work was
removed by social care due to domestic she has received to reconnect with her done as part of her support plan and as
abuse and substance abuse by both children has been very important to her mental health improved, Kerry was
parents. Sarah became street homeless her recovery and motivation. ‘Without able to focus on her recovery.
and soon got involved with another Jane’s Place I would be dead,’ she says. While at Jane’s Place, Kerry’s anxiety
abusive male who forced her into sex ‘You saved my life,’ reduced and she was no longer having
work to fund substances for them both. suicidal ideation. Kerry completed RAMP
Using heroin and crack daily, Sarah’s ESCAPING VIOLENCE: (reduction and motivation programme)
mental health and physical health KERRY, AGED 39 as part of her recovery support plan
dramatically deteriorated and she Upon referral, Kerry had been in a and, with the support of Jane’s Place
was also regularly shoplifting to fund physically violent relationship for the past and Inspire Wellbeing, she reduced her
substances. Things became too much for seven years. She had been threatened methadone and alcohol intake.
Sarah and she attempted to take her own with a knife and her children had been Kerry’s physical health greatly
life after a serious assault by her partner. removed for their own safety, as a result improved too – she gained weight,
She was then referred to SafeNet and of her addiction and domestic abuse in began to take pride in her appearance
accepted at Jane’s Place Recovery Refuge. the family home. Kerry referred herself and was focused on getting fitter and
Sarah’s life dramatically changed once into SafeNet’s services after trying several healthier. She also began to rebuild
admitted to Jane’s Place. Her self-esteem refuges who would not accept her as she relationships with her family and was
and confidence returned as staff supported was using alcohol and substances daily. then accepted for detox and rehab to
her to address health issues and receive Kerry was drinking heavily, using complete her journey.
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 13TREATMENT
THE HEAT IS
ON
Patrick Guenette/Alamy
In the second part of ‘Doctor Wars’, Bill Nelles
describes the tumultuous days of the 1980s
B
y 1983, the cold in 1986 at Dr Anne Dally’s General it was never adopted as policy.
war among doctors Medical Council (GMC) hearing. She These trends intersected in
treating drug users was was a feisty senior private doctor on By 1983, the cold early 1985, when a young GP in
becoming a lot hotter, the working group and one of the Edinburgh published a paper in
and there was still no signatories of the 1984 guidelines. war among doctors the BMJ which galvanised me, and
public health response to drug use.
The Home Office consultants still
I gave testimony supporting her at
her GMC hearing, having become treating drug users many others, into serious action. Dr
Roy Robertson, (now the Queen’s
met regularly, and included private
doctors as well as NHS consultants.
the drug education officer at the
Terrence Higgins Trust (THT) a year
was becoming a lot physician in Scotland and professor
of addiction at Edinburgh University),
The NHS doctors felt the private earlier, but her verdict was guilty of hotter, and there had been seeing drug users for
doctors prescribed overly generously, maintenance! While she was able some years, and maintaining some
didn’t demand reductions, left their to still be a doctor, she was never was still no public with dihydrocodeine. He was able
patients ‘still addicted’, and even
charged them fees. The private
allowed to prescribe controlled
drugs again. Her practice evaporated health response to to obtain HIV test kits in advance of
their national availability, and in late
doctors felt the NHS doctors were
too rigid and their patients poorly
almost overnight.
Because of its policy of avoiding
drug use. ’84 had taken blood for HIV antibody
assay from around 160 patients. He
treated. Guidelines on the treatment methadone and arresting users for knew they shared used needles, and
of drug misuse (‘orange guidelines’) the possession of syringes alone, the paper showed that 51 per cent
were the first national guidance Scotland was one of the first parts reveal themselves. The first was, had already been infected by HIV.
issued by this group in 1984 – they of the UK to see the unusual and of course, the AIDS epidemic, with The effect of this news cannot
pleased few. For instance, the mostly lethal illnesses associated the first Scottish drug user dying in be exaggerated. Research testing
guidelines considered that medically with AIDS and injecting drug Scotland in 1983. The second was in London was showing rates of
supervised detoxification was a use. Cheap heroin from Iran and the growing involvement of general under 5 per cent positive, so we
‘simple and short-term process with the easy availability of Temgesic, practitioners in providing services realised we had a short window
spontaneous remission possible’, (ironically, an early sublingual to drug users and their influence to make a difference if we moved
and also stated that maintenance form of buprenorphine) had vastly on practice. Britain had not made fast. By the summer of 1986, teams
was not acceptable. ‘Evidence-based increased the number of people methadone a drug needing a Home in London, Liverpool, Edinburgh
treatments’ didn’t really exist in injecting opioids, and police Office licence, and thanks largely and Amsterdam and, of course,
addiction medicine at that time. pressure had made clean needles to the efforts of dear Dr Tom Waller the US were working very hard to
Ironically, the main use of the impossible to obtain. – an ACMD member who batted it understand what they were facing,
orange guidelines was as evidence But two factors had yet to back every time it was put forward – and the UK and Holland had already
14 • DRINK AND DRUGS NEWS • JULY/AUGUST 2020 WWW.DRINKANDDRUGSNEWS.COMPARLIAMENTARY GROUP
implemented needle exchanges special report chaired by Ruth
to stop sharing and prescribing to Runciman gave the green light to
reduce injecting. access to clean needles, setting
But there were still battles up 15 pilot schemes in England
to be fought over clean injecting and Scotland. These were quickly
equipment. I had been seconded to expanded when the pilots reported
the Standing Conference on Drug favourably and both reports called
Addiction (SCODA) from the THT to for an immediate re-evaluation of
write a booklet about AIDS for drug methadone prescribing.
users, but in February ‘86 I spoke GPs had also become more
WHERE TIME
at a large National Haemophiliac independent and proactive especially
Society meeting in Newcastle at if they had no specialist prescriber.
which I represented SCODA and West Berkshire Health Authority
STANDS STILL
called for a serious examination of under Ailsa Duncan, their drugs
supplying clean needles. coordinator, engaged me in 1988 to
This was picked up on train a group of around 15 GPs to
Newsnight, and on Monday I found prescribe methadone. It was a five-
myself called to the office of the
director. In fact the Friday before,
day course with a written handbook.
Apart from Ailsa, none of the doctors
Things need to move faster to support
after six months of abstinence were aware they were being trained prisoners on release, heard the
from opiates, I had engaged a by a methadone patient!
private doctor to look after me I have great respect for all parliamentary group. DDN reports
A
so that I didn’t resume injecting. evidence-based treatment including
He strongly objected that I had non-prescribing approaches when ll probation services place, including housing, and just
supported needle exchanges. I it’s what the patient seeks. But would move to the £46 in their pockets. While the
was also told that I ‘looked stoned’ present policies that deny people public sector in June proportion of prisoners released
and under no circumstances such approaches are shameful and 2021 – ‘a massive step with naloxone had increased from
could someone work in a drugs should not be tolerated. In the last forward in providing 12-17 per cent in England, the pace
agency even on legal methadone. part of this series, we will look at the a unified service,’ according to of change was far too slow.
That same day I returned to the golden age of drug services – the Katie Lomas, chair of the National Amy Levy, Humankind’s assistant
THT where we concentrated on first eight years of 2000. And how Association of Probation Officers director for North East prisons
reducing the risk for drug users it all collapsed and we ended up (NAPO). Outsourcing the supervision reported positive results from
through advocacy with politicians, where we are now. and rehabilitation of offenders partnership working and mutual
speaking engagements, and writing Bill Nelles is an advocate and to community rehabilitation support during the COVID situation,
leaflets. By 1988, the McClelland activist, now in Canada. He founded companies (CRCs) in 2015 had had with a focus on continuity of care
report in Scotland and the ACMD The (Methadone) Alliance in the UK some disastrous consequences and and harm reduction. Jaya Karira
resulted in poor outcomes for the and Max Griffiths, working in WDP
people they were meant to serve, services, also emphasised the value
she told the Drugs, Alcohol and of improving communications
‘We know that the main
Justice Cross-Party Parliamentary between prisons and treatment
method of transmission
Group (which met online). services, specifically around prisoners’
[of AIDs] among drug
Clients had multiple needs medication needs on release. They
takers is the sharing of and services had to be flexible and also called for mandatory naloxone
dirty needles... It was responsive, against a background of distribution and diligence around
clearly documented in tightening resources. Partnerships BBV testing and information-sharing
a paper produced by were being hampered by a lack with community healthcare teams.
Edinburgh professionals of information sharing, which A prison officer for more
in February 1986. The was making it too easy for people than 30 years, Jo Simpson spoke
Scottish Office commissioned a report from a committee to ‘slip through the cracks’. of his frustration that despite
chaired by Brian McClelland published in September 1986, Everything in probation was improvements, the service had
which recommended decisively that the government should about relationships, she said, and ‘hardly come on in leaps and
we must ‘develop and maintain bounds’. ‘I have seen some good
bite the bullet and provide clean syringes at an exchange
excellent partnerships in prison, reports but nothing done with
centre, where drug injectors would be able to obtain free
resettlement and the community’. them,’ he said. Technology in
needles and syringes.
Despite reports by Lord Patel and prisons was ‘non-existent’ when
‘The government’s response to that call has been so Lord Bradford outlining problems it could have helped significantly
inadequate as to be positively irresponsible. They sat on the and recommendations, there had during COVID, enabling prisoners to
McClelland report for months. Eventually, they announced 15 been little analysis and follow-up talk to their families and continue
pilot schemes, 12 in England and three in Scotland. Of course or evidence that anything had been their education.
taken forward, said Professor Alex ‘People tend to blame the prison
such projects involve problems – the minister may wish to
Stevens, former chair of the ACMD’s staff, but we get frustrated that
comment on them – but we must make the projects work.’
Custody-Community Transitions things aren’t happening,’ he said.
Gavin Strang MP (Edinburgh, East), Working Group. Prisoners were ‘They keep saying we’ve got a drug
House of Commons debate 31 March 1988 still routinely released on a Friday strategy programme – but where
afternoon without any support in is it?’ DDN
WWW.DRINKANDDRUGSNEWS.COM JULY/AUGUST 2020 • DRINK AND DRUGS NEWS • 15You can also read
