The next magic bullet.....

There were several interesting news stories this week:

On Thursday The Guardian run a story reporting that the total social and economic cost of class A drug use is around £15.4 billion a year. The research was commissioned by the Home Office and also reported that 90% of this cost was accounted for by drug related crime.

The Guardian followed this up on Friday with another story which reported that the UK has 327,426 "problem drug users" and that the country spent £5.9 billion a year on illegal drugs.

These figures again came from the Home Office.

What is going on here - there are supposedly 181,000 people in "structured drug treatment" in England and Wales (NTA figures).

This represents around 55% of the Home Offices "total number of problematic drug users" (if the numbers in treatment in Scotland and Northern Ireland were taken into account the figure would be even higher!)

Sorry - but I don't believe a word of it! All the research that I have ever seen suggests that the percentage ""in treatment" at any one time is not likely to be more than 25 to 33 % of the total. If the governments research is right then they aren't commisssioning very effective treatment are they ? I mean if a minimum of 55% of all problematic drug users in the UK are in treatment and its still costing £15.4 billion?

Last year we were being told that each £ spent on drug treatment produced savings of £9.50. On this basis we need to be spending say an extra £1.5 billion a year - on top of the roughly half billion already spent. That would represent a 400% increase!

Spend £2 billion a year and the total cost in theory comes down to zero. Yeah well, thats not going to happen anyway - and it wouldn't work if they did spend the money because there will always be "treatment resistant" individuals.

Interesting to compare the Governments expenditure on drug treatment to the cost nevertheless. Interesting to see that we spend 10 times as much on illegal drugs as we do on treatment!

My final news story of the week was widely reported - the suggestion that we ought to consider prescribing heroin instead of methadone. A senior policeman suggested that this would reduce drug related crime - and guess what, he is right! He is after all a policeman, and it his job to reduce crime.

I suspect that this would be even more successful than he thinks - for one thing the bottom would fall out of the drugs market as the dealers could not compete on price and quality against the NHS!

My job however has always been about treating individuals rather than finding solutions to social problems such as crime and from the treatment point of view I would predict the following:

1. The numbers seeking treatment would greatly increase - many users do not seek treatment because they don't want methadone, it doesn't do what they want it to do. Many users who receive methadone on prescription use on top - for the euphoria that heroin provides and methadone does not!
2. Not many people would ever complete treatment "drug free" - although perhaps a few more would than now as the withdrawals are reconned to be less severe!

Either way don't for a moment believe that the Governments aim is to provide quality treatment for the individual - it isn't and hasn't been for a long while now.

It is to save money, to increase its popularity by reducing crime and to reduce the spread of blood borne viruses associated with drug use into the general community.

They really don't care if individual addicts sit in a corner and dribble while life passes them by if that is what it takes to achieve those goals (which are legitimate goals by the way - but not the only ones!)

To this end I suspect that prescribing heroin will be the next "magic bullet" which is going to achieve these goals!

We have now gone full circle and are rapidly coming back to the point where we were in 1966 - in 40 years there are now around 200 times as many heroin addicts as there were last time that prescribing heroin was official policy.

Whitehall's "Spinball" Drug of Choice!

There were two very interesting, yet contradictory, stories in the press this weekend regarding Methadone:

The Scottish press, in the form of Scotland on Sunday and The Scotsman, ran a story on Professor Neil McKeganey's research (from Glasgow University) which shows that only 3.4 percent of drug users who were prescribed Methadone were “drug-free” after 3 years as opposed to 29 percent of those who went into residential treatment.

Other differences were just as startling:

Of those who received Methadone:

• 29 percent were in employment or education.
• 47 percent said that they “felt better”.
• 91 percent admitted to committing crimes.

Of those who took the abstinence route:

• 59 percent were in employment or education.
• 79 percent said that they “felt better”.
• 13 percent admitted to committing crimes.

Professor McKeganey's research seemingly shows that Methadone “treatment” is only marginally better than no treatment at all.

There are apparently around 20,000 addicts receiving Methadone in Scotland.

Meanwhile in England the Sunday Mirror reported that 84,583 people were in treatment for Heroin addiction (in England). Caroline Flint MP (now the Health Minister, previously the Drugs Minister) reported that the figure had almost doubled over the past 2 years and that this was a sign that the government's drug strategy was a success.

It also reported “experts” as claiming that the true number of Heroin addicts could be 120,000 because many users “weren't receiving medical help” . We reckon that the real figure is likely to be at least double this – say 250,000?

Um........ We also note that the report talks about “medical help” - effectively prescribed Methadone. The article then went on to report that drug related crime had fallen by 16 percent from April 2004 to March 2006. It then trots out the old statement that “for every £1 spent on treatment £9.50 is saved in crime and health costs”.

Am I the only one to sense a contradiction here?

Either Scottish Addicts are very different from English ones (They are not – I have worked with both) or Scottish professionals are less competent than their English counterparts ( again we know that they are not) or something is wrong with the figures! Especially so when Caroline Flint's figures don't even seem to relly match up with those from the National Treatment Agency which last month reported 181,000 people in treatment for drug use! ( If 84,000 are Heroin addicts what are the other 97,000 doing?)

Could it actually be that someone, somewhere – perhaps not a million miles away from Central London – is massaging the figures?

If I have to chose between the 2 stories I would have to say that in my experience Professor McKeganey is the one that we should be believing! But Scotland and Glasgow are a very, very long way from Whitehall (unlike Baghdad and Kabul) so we very much doubt that anyone will take any notice whatsoever of this research.

"Evidence based Research" only counts when it says what they want to hear!

Lies, Damn Lies and Statistics!

Just recently the National Treatment Agency for Substance Misuse put out a press statement - see the NTA website for details - trumpeting the fact that a key government target (doubling the number of people in drug treatment) had been achieved 2 years early.

There than followed a lot of detail about substances used, retention rates, ethnic groups etc. Important as this information is (or might be - if it was ever used for anything!) I then spent a very frustrating 30 minutes looking for anything remotely resembling outcome data. There wasn't any.

I finally went back to the NTA website and found another report released on the same day giving outcomes for the year before. It turns out that for the year 2004/5:

• 160,453 clients received 238,149 episodes of "structured care". (About 1.48 treatment episodes per individual!)
• Opiate dependency accounted for 75% of presenting clients. This was comprised of Heroin (64%) and Methadone (8%) and other (3%).
• 57% of clients remained in treatment for 12 weeks or more. 52% of clients received treatment described as "prescribing modalities" and there was apparently an increased likelihood of these clients being retained in treatment. In other words we are more likely to retain opiate addicts in treatment if we give them drugs! Now there is a suprise!
• Of those individuals "discharged" from treatment during the year 30% had successfully completed treatment. However when one looks at this 30% it turns out that only 6% (5,759 treatment episodes - not individials - are shown as being "Completed Drug Free". (You can be "drug free in the UK and drink 2 bottles of spirits a day - alcohol doesn't count!) 11 out of the 30% "successfully completing treatment" were "referred on" - in other words the individuals had not completed treatment at all! As for the other 13% who "successfully completed treatment" without being drug free I can only assume that they "successfully completed treatment" still using drugs!

A large part of the paper is about "factors associated with retention and succesful discharge". While I agree that the study of such factors is important this report makes comments like: "The proportion of episodes which were successfully discharged was greatest for those with Chinese clients (40%), whereas only 20% of those episodes where the client was Bangladeshi were successfully discharged". The numbers of Chinese and Bangladeshi clients "successfully discharged" were 29 and 143 respectively. I personally believe that making sweeping assertions about treatment outcomes based on samples this small is unjustifiable.

How many agencies (let alone non-english speaking workers) worked with these 2 groups? With numbers this small I would need convincing that the differences do not have more to do with the effectiveness of the agencies concerned, or perhaps even the effectiveness of a few workers, rather than the client's ethnicity! That the UK government bases it's "evidence based approach" to drugs treatment on such dubious logic which resembles an O-Level project rather than any real science is alarming! Where are the controls?

Lest I get so carried away here that I forget the point of all this - in the year concerned £457 million was spent on drug treatment (ignoring the money spent in prisons) and in England at least there is only evidence that 5,759 episodes of treatment ended with the client being discharged drug free.

That's £79,354 each! The total money spent could have bought something like 100,000 individuals for 13 weeks residential treatment in South Africa- yes, South Africa, and I am pretty sure that we could reasonably expect perhaps 50,000 of those individuals to have "Successfully completed treatment drug free".

Why do we let the NTA trumpet such appaling outcomes as some sort of triumph? It's actually more like a cause for despair!