Dialogue
Market
forces
A strong message from Addaction’s Mortality
Matters conference was that treatment
services need to put competition to one side
and challenge the conditions that are allowing
drug-related deaths to rise. DDN reports
H
ow should we tackle the alarming
increase in drug-related deaths head
on, asked Addaction’s medical director,
Dr Kostas Agath, opening the charity’s
one-day conference in Leeds.
‘Drug-related deaths have been
increasing year on year for the last
three years… we haven’t cracked it,’ he
said. The figures – 3,388 drug-related deaths in 2015
in the UK – didn’t give the whole story. He spoke about
Martin, who lost his life just recently – and about his
mother, struggling to make sense of the gaping hole in
her life. ‘Someone, somewhere must begin to ask the
right questions. The Martins out there must be
someone’s responsibility.’
We could take four steps to reduce drug-related
deaths, suggested Alex Stevens, professor of
criminology at the University of Kent, setting the scene
through his keynote speech. The steps were to care,
invest, innovate and integrate with other services. ‘We
know these would reduce DRDs. The question is
whether we care enough to do something about it.’
There had been a significant increase in opioid-
related deaths since 2012 and the government had
reacted by banning things (such as psychoactive sub -
stances) rather than looking at the contributing factors.
We should be looking at the ‘devastating’
consequences of short-term commissioning and
worsening socio-economic circumstances for
vulnerable groups, he said. ‘The government is
14 | drinkanddrugsnews | June 2017
reducing the income of people who are most
vulnerable to drug-related deaths.’ And from talking to
legal support charity Release, who provide help and
advice, he confirmed that ‘people are being given
arbitrary changes to their treatment plans related to
what their commissioners would prefer to provide.’
Changes in treatment and a focus on recovery had
sidelined harm reduction, and there was pressure on
services to achieve ‘drug-free exits’.
So what should we be doing? Two of the clearest
practical steps were to invest in high quality opioid
substitution therapy (OST) at optimal dosage and opti -
mal duration, and to provide naloxone to practition ers,
‘Drug-related deaths have
been increasing year on
year for the last three
years… Someone, some -
where must begin to ask
the right questions.’
Dr KoStaS agath
peers and potential bystanders – anyone who comes in
contact with a person who could be at risk of overdose.
‘Naloxone should be available and I’m saddened
and angry that commissioners haven’t got the
message,’ he said.
The risks were much higher out of treatment, ‘so
we don’t want to be pushing people out of treatment
before they’re ready, as this risks them dying,’ he
spelled out.
We need to innovate, he said, and give proper
consideration to heroin-assisted treatment, medically
supervised consumption rooms, and new routes for
administering naloxone.
Better service integration could also make a
significant difference. ‘Pulmonary (lung) health tends
to be very poor indeed,’ he said. We needed to provide
better access to smoking cessation, tobacco harm
reduction services, housing, dental health – ‘all the
stuff that makes life meaningful’.
‘Service users in drug clinics have a high burden of
respiratory disease,’ confirmed Dr Sandra Oelbaum,
Addaction’s associate medical director and primary
care lead, who gave her experience of improving
access to COPD diagnosis and treatment in Liverpool
shared care.
The links between drug use and breathlessness
meant drug users were three times more likely to be
admitted to hospital with respiratory conditions, she
said, ‘so the impact on health services is very dispro por -
tionate’. There was very poor follow-up, with many
feeling that they could not access care or go to their GPs.
Yet there were simple and effective measures that
could engage people in treatment, such as putting
spirometry (lung function tests) in drug treatment
clinics. Trialing this in Liverpool shared-care clinics had
achieved high levels of participation, diagnosis and
treatment, with participants comfortable with the
idea of having a COPD clinic located in drug treatment.
‘Sometimes we need to go back to principles and
make sure we’re doing what we know works,’ said Dr
Jan Melichar, consultant psychiatrist and medical
director at DHI, South Gloucestershire, who had been
asked to talk about ways of maximising treatment to
reduce opioid-related deaths.
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