The Government’s serious approach to synthetic opioids is welcome, but it can do more to provide national leadership

Our Director, Will Haydock, responds to last week’s report from the Government outlining evidence and insights for Combating Drugs Partnerships, intending to help strengthen their preparedness for the synthetic opioid threat.

This report shows the Government is taking a serious interest in an issue that is seeing hundreds of people die each year, but we’re clear there’s still more that can and should be done: the Government needs to take a leadership role and go further and faster to respond to this developing emergency.

What do we mean by a ‘leadership’ role?  Well, although the report’s recommendations are sensible, they focus on what can be done at a local level, begging the question: what is the Government itself planning to do to address this potential crisis?

We offer two suggestions that are low cost and straightforward to implement that would reduce the risk not only from synthetic opioids but all illegal drugs.

We are calling on the Government to enable drug checking so that people who use drugs, the organisations that support them, and the Government itself can know what substances are actually in circulation, helping everyone to understand and respond to the risks.

We are also asking that if people do use drugs, they have the opportunity to do so with advice and support around them as part of enhanced harm reduction facilities, so that if they overdose they can be treated, and their life can be saved.

Charities and staff stand ready to offer these life-saving interventions support, but they need the Government to update legislation and guidance to allow them to confidently help save lives today.

Even if the Government chooses not to implement these two simple life-saving actions today, it should be planning to enable them in the event of an emergency.  Not to do so would put further lives at risk.  The Government is asking local areas to develop local preparedness plans and submit them for it to review.  We can reasonably ask: what is in the Government’s own preparedness plan?

As background, we’ve included below a bit more information about these two key interventions.  We’ve already called on the Government to support the wider use of drug checking and enhanced harm reduction centres – notably in our submission to the Treasury’s consultation on the forthcoming Spending Review – and the case is only getting stronger as the situation gets more urgent.

There’s one key intervention specific to opioids that could also be improved through national leadership.  As the report emphasises, Naloxone, as an ‘antidote’ to opioid overdose, is an invaluable tool and has saved countless lives across the country.  Unfortunately, we know that the level of access and the type of device used is still a postcode lottery.  Government should again show national leadership by coordinating and monitoring approaches across the country to ensure quality and consistency.

Finally, we do have one concern with the report – not regarding its content, but rather the way it was released.

The article published in the Daily Mail as an ‘exclusive’ ended up including shockingly stigmatising images and language which we know to be counterproductive in encouraging people to seek help with their substance use, or help others themselves.

The article even used the word ‘zombie’ in its headline, which research has shown specifically generates higher public stigma towards people who use drugs, and we know this kind of stigma then reduces people’s willingness to seek help.

The sector is doing its utmost to fight these misconceptions and barriers, through organisations like the Anti-Stigma Network and the NHS APA’s Stigma Kills campaign.  Even while I’ve been writing this blog I’ve been sent a new video by Rhubarb Farm – a small Community Interest Company based on the Derbyshire/Nottinghamshire border – specifically trying to challenge stigma around substance use and highlighting how this stops people from seeking help earlier.

This should feel uplifting, but taking a break from writing this blog to watch the video, I had an underlying sense of frustration – of feeling like we’re swimming against the tide.  But it shouldn’t feel like this – at least not in terms of charities working with the Government.  We look forward to working with the Government more closely in a genuine collaboration to ensure an effective, evidence-based approach to improve awareness and understanding around synthetic drugs, and how to respond to them.

That might sound like think-tank-speak (if that’s even a phrase) but I really mean all those words: we can do more together and we should use the evidence. We should feel optimistic about that: we already know a lot about what works.

So I’ll finish with a more uplifting thought from another article I read this morning (thanks DrugWise Daily!).  As Tom Kerridge says: “problems are always better solved as a collective force.”

Here’s some more detail on those two key interventions where we think the Government can make a real difference relatively quickly and easily:

1. Introduce widespread drug checking to ensure we know what drugs are actually in circulation

We cannot provide an effective response to the emergence of synthetic drugs without timely and accurate information about what drugs are actually available and being used.  Improving the information we have would help people who use drugs, organisations that support them, and the Government itself in planning how to respond through legislation and guidance.

The market in illegal drugs is complex and changeable.  People who use drugs bought illegally cannot be sure what they are taking, and therefore it is hard for them to judge risk and reduce the chances of harm.

However, if people who use drugs know what they are taking, they can take appropriate and proportionate action to reduce their exposure to risk.  This is almost impossible at present, as there are vanishingly few ‘front of house’ testing facilities that allow people to test their own drugs prior to taking them.

This is also an issue for organisations that support people who use drugs, as we do not have accurate information about what is circulating in local or national markets, and therefore how risky certain substances are at any given time.

This isn’t just about people who are planning to use opioids; nitazenes have been reportedly identified in other drugs including cocaine.   The risks are therefore potentially widespread, as the scenarios in the Government’s report describe.

Will Haydock said: “There are quick, low-cost and effective actions we should be taking now to save lives.  Testing equipment should be available in trusted locations – such as treatment services – across the country where people could provide a sample of a substance to be checked.  There are some treatment services that already have the equipment and could be running these tests already; they’re just waiting for the licence from the Home Office.  That’s a delay that could be costing lives.”

Collective Voice is calling on the Government to simplify the licensing process for local provision of drug checking and provide national leadership to drive the establishment and maintenance of a network of accessible labs for analysis.

2. Allow the operation of enhanced harm reduction centres to enable services to reduce people’s risk of dying if they do use drugs

Even where there is good intelligence about the likely content and strength of drugs being used, or substances are specifically tested prior to use, significant harm can occur, notably where people use alone, or in public locations.  This can pose a risk to the person using, as they may overdose or suffer an adverse reaction to the substance, but it can also create concerns and risk for the wider public.  These risks can be mitigated by people using under supervision in a private location.

Safer consumption spaces are common in other countries, and there is a good evidence base for their operation, such that the Advisory Council on the Misuse of Drugs recommended over eight years ago that they should be introduced in the UK.

Collective Voice has previously called on the Government to ensure that the legal framework and funding structures permit a range of models of enhanced harm reduction centres to be piloted across the UK.

Will Haydock said: “While a facility has been opened in Glasgow, and this should be monitored and evaluated closely, this is only one model for delivering this kind of service, and is unlikely to be the most effective or efficient approach outside of a city with a concentrated group of people using drugs in public.

“Other models should also be piloted and evaluated – for example small scale, low cost supervision.  Many organisations – such as supported housing and harm reduction centres – already have the staff and space to provide this service alongside other forms of support, but our staff need the legislation and guidance to change to allow them to confidently help save lives today.”