The first part of Dame Carol Black’s independent review was published in February 2020, which covered context in relation to the harm caused by the drugs market and evaluated current service provisions. The second part was published on 8th July 2021 and provides recommendations for policy solutions. There were 32 recommendations enlisted altogether, which covered topics surrounding funding, accountability, leverage, requisite, integration and interventions.
What are the CDPRG’s biggest take-aways from Dame Carol Black’s recommendations in the Independent Review of Drugs, (Part 2)?
Increase expenditure on drug treatment services
Hold local and national bodies accountable for drug treatment outcomes
How will these recommendations be implemented by the new drugs unit?
Are current proposals going far enough?
Interventions to improve current systems
Increase expenditure on drug treatment services
On top of current expenditure, the Department of Health and Social Care was asked to invest an extra £552 million to tackle drug misuse.
Dame Carol Black stated this would be a valuable expense in the long run, with savings of £4 for every £1 spent. The first few recommendations underscore the need for additional funding to invest in the drug treatment system, which would include support for health, housing, employment and the way people with addiction are dealt with by the criminal justice system.
Further recommendations were made for the opening of a joint combating drugs unit to help "end illegal drug-related illnesses and deaths". The unit would bring together multiple government departments, including the Department of Health and Social Care, Home Office, Ministry of Housing, Communities and Local Government, Department for Work and Pensions, Department for Education, and Ministry of Justice.
Hold local and national bodies accountable for drug treatment outcomes
To ensure comprehensive treatment services, and to increase accountability and transparency, new national quality standards have been introduced. This will make sure different services are working together at local and international levels, and to hold local authorities accountable for their treatment and recovery outcomes. Those with poor outcomes would be obliged to work with the Office for Health Promotion to improve their services.
The financial recommendations recognise the lack of systemic funding for current drug misuse treatment services. The report acknowledges there is a need to better invest in services, such as inpatient detoxification at regional and sub-regional level. This is excellent as it highlights the plight of organisations such as NHS SMPA, which is in fact unique in providing this service across the country, and could now receive more support for long-term funding of medically managed NHS and community detox services.
“Improved treatment services will not be enough on their own to help people achieve and maintain recovery. A broader package of services is needed, involving also well-coordinated housing and housing support, employment support, and mental health services.”
(Photo by Craige McGonigle on Unsplash)
How will these recommendations be implemented by the new drugs unit?
With the many offices involved in the development of the new drugs unit, it remains unclear which exact minister will be in charge of monitoring the progress, and effort needs to be taken to not implement treatment and services which promote the present ‘just say no’ type of ineffective programmes. Furthermore, we also caution that the proposed unit may be too limited to address the many broader longstanding issues of governance in this area.
Are current proposals going far enough?
It is heartening to see that local authorities will be held accountable and there will be more transparency for treatment and recovery outcomes. However, the lack of outcome evaluations in the current context means we are not aware to the full extent how current services are lacking and where more support is required, in terms of regional areas and treatment concerns.
The recommendation to increase the number of professionally qualified drug treatment staff, such as psychiatrists and psychologists, and to develop a professional body for all the members of the substance misuse workforce, is a positive step in the right direction. The report emphasises leverage on new financial opportunities, in addition to enhancing significance on understanding and meeting the care and needs for people who use drugs. New requirements are recommended, intended to improve prison services for people with substance misuse and open new pathways for people who use drugs to access treatment in the community as soon as possible after release.
It will be interesting to see whether these outcomes and new implementations improve current service provision options. We anticipate they will point towards trial diversion schemes, such as heroin assisted treatment and drug conversion rooms, which improve access to emergency services, reduce the spread of disease, and save lives.
These recommendations should also welcome opportunities to work with organisations like “User Voice,” who give voice to the people in the criminal justice system.
Substance misuse services are some of the most neglected. This has had an increasingly severely detrimental effect in recent years, including an exponential increase in drug-related deaths. In Dame Carol Black’s recommendations, it is encouraging to see action plans to develop an integrated care system for people with mental health and drug dependence. Re-building of current services is a requirement and sincerely acknowledged, but more clarity is needed on exactly how schemes, which meet the wider health needs of drug users with co-morbidities, will be integrated.
Intervene to improve treatment outcomes: improving the current systems
A variety of intervention approaches were mentioned from curriculum delivery to evidence-based services. We strongly support the calling for more specialist substance misuse prevention services and support for young people.
A need for greater innovation in research was stressed, especially within pharmaceuticals, with recommendations of incentives or rewards to companies and organisations whose developments prove beneficial in practice and in the addiction field. With this recommendation in mind, we want to bring attention to the huge gap between the evidence based on drug harms and the UK drug classification and scheduling system.
Building on the recommendations to improve public health: treatment development with cannabis and psychedelic compounds with therapeutic potential
Overall, the report has highlighted the need for change, especially:
The need for better treatment services for substance misuse;
An integrated system; and
Better support from the criminal justice system.
Further clarity is required on exactly how the action plans for new schemes to address addiction and improvement wellbeing in relation to drug-related issues will be implemented into practice, and how the outcomes from local authorities will be evaluated. The CDPRG would add to these recommendations that it is imperative that the gaps in the regulatory framework for the emerging production and prescription of cannabis-based products for medicinal use are recognised.
The barriers holding back scientific and medical research, with controlled drugs, need to be acknowledged and challenged. There are on-going issues around access to cannabis-based medicines resulting from the outdated scheduling and classification of controlled drugs, which creates unnecessary barriers to legitimate research into such substances needed to determine risks, social harms and whether or not these substances have useful medical applications. Ignoring recommendations to reschedule, as Government did with cannabis 20 years ago, creates unjustified knowledge gaps which means patients who could benefit from such treatments miss out or are criminalised for taking matters into their own hands, as well as holding the UK back in terms of medicine development and life sciences.
Psychedelic drugs, like psilocybin and MDMA, which are in schedule 1, are being investigated for their therapeutic potential for a range of mental health and substance misuse disorders, including depression and nicotine addiction.
Early phase trials have shown the safety and feasibility of these drugs; they are well tolerated by patients, could be used to treat comorbidities associated with drug dependence, and perform better than currently established treatment options. However, the scheduling of these potential medicines is a major barrier in further investigating their treatment potential in large phase 3 controlled clinical trials in the UK, which would be significantly facilitated by moving them to Schedule 2 on a research-only basis, a change which would not increase their accessibility or availability outside of this context or have any impact on recreational use. We are witnessing the development of effective alternative treatment therapy for addiction overseas in countries which are adopting more evidence-based drug laws. For example, in the United States, where British psychedelic treatment researchers are relocating to better move forward with these treatment options.