Collective Voice response to the Dame Carol Black Review

The ACMD’s excellent new report “Reducing opiate-related deaths in the UK” provides powerful independent support for the emerging consensus about understanding drug-related deaths captured earlier this year in the joint Local Government Association/Public Health England report “Understanding and preventing drug-related deaths”. Both reports identify the rise in deaths as being driven by the increasing vulnerability of the prematurely ageing cohort of heroin users whose drug use began in the 1980s. Despite predictable media interest in the potential role of drug consumption rooms and heroin assisted therapy, the ACMD is clear; the most important thing government can do to prevent further increases in deaths is to support continued investment in evidence-based treatment, particularly the provision of well-delivered opioid substitution therapy.

In his letter to the Home Secretary accompanying the report, the ACMD’s chair Prof Les Iversen says:
“The ACMD welcomes the considerable expansion in the use of OST (opioid substitution therapy) in the UK since the mid-1990s. The ACMD would like to reiterate the evidence that being in OST protects heroin users from overdose and increasing coverage of OST has had a substantial effect in limiting the increase in drug-related deaths that would otherwise have occurred. The most important recommendation in this report is that government ensures that investment in OST of optimal dosage and duration is at least maintained.”

This endorsement of the value and effectiveness of treatment comes at a time when the treatment system is under considerable threat. The crisis in Local Government funding, particularly its impact on social care, is nearing the top of the political agenda. Less visible is the consequent impact on services for marginalised, unpopular groups such as drug users, which are being squeezed year on year. Collective Voice members, who deliver half of all treatment in England, have absorbed reductions in the value of contracts to deliver services of 30% since 2013 while making every effort to protect access and quality. Analysis of provision across England by the Association of Directors of Public Health and the National Audit Office paints a similar picture.

Drawing on analysis from PHE, the ACMD argues that without access to evidence-based treatment deaths in England will be 880 a year more than they are now i.e. a 48% increase. If the gap between the need for treatment and the resources available to deliver it continues to grow, this will undermine all efforts to reduce drug-related deaths no matter how well evidenced or how well intentioned.