'Tweaking memories' could help addicts avoid relapsing

Manipulating memories of drug use may help reformed addicts avoid a return to a life of drug abuse, according to scientists in China.
They said memories linking "cues" - such as needles or cigarettes - and the pleasurable effects of drugs caused cravings and relapsing.

Authors of the study, published in the journal Science, "rewrote" those memories to reduce cravings. Experts said targeting memories could become a new avenue for treatment.

Repeatedly showing people drug cues without actually giving patients the drug is a part of some therapies for addicts. It can break the link between cue and craving in the clinic. But this does not always translate to real life.

The researchers at Peking University tried to rewrite the original memory so that it would be as if the link between cue and the craving never existed.

Flexible memories
The work relies on the idea that a memory can become malleable after it is accessed, creating a brief window during which the memory can be "rewritten".

Twenty-two heroin addicts who had not taken the drug for - on average - 11 years, took part in the study. They were initially shown a brief video to remind them of taking drugs - opening the memory window. Ten minutes later they watched more videos and looked at pictures of heroin drug use.

Other addicts were shown an initial video of the countryside, which would not open the window. Tests 180 days later showed that levels of cravings were lower in those treated during the 'memory window' than in the other groups. These experiments were backed up by further tests on "addicted" rats.

The authors wrote: "The [memory] procedure decreased cue-induced drug craving and perhaps could reduce the likelihood of cue-induced relapse during prolonged abstinence periods."

Dr Amy Milton, who researches memory and addiction at the University of Cambridge, said: "I'm quite excited by this research." She said it was "such a minor" difference from current therapies which "tapped into an entirely different memory process" and the reconstruction of the original memory. "Full clinical studies are needed, but it could be really important for treatment of addiction," she said. Dr Milton added: "There is no theoretical reason it couldn't apply to other addictions such as alcohol. That's obviously very exciting."

But critics said the trial was 'meaningless'. 13.4.12

Brains may be hard-wired for addiction or junk science?

Addiction is in part a "disorder of the brain," say scientists.  

University of Cambridge scientists have found same abnormalities in the brains of addicts and their non-addicted brothers and sisters.  

It has long been established that the brains of drug addicts have some differences to other people, but explaining that finding has been more difficult.  

Experts were unsure whether drugs changed the wiring of the brain or if drug addicts' brains were wired differently in the first place.  

The new study, published in the journal Science, attempted to answer that by comparing the brains of 50 cocaine or crack addicts with the brain of their brother or sister, who had always been clean.  

Both the addicts and the non-addict siblings had the same abnormalities in the region of the brain, which controls behaviour, the fronto-striatal systems.  

The finding has led researchers to suggest that these brains may be "hard-wired" for addiction in the first place, the BBC reported.  

"These brothers and sisters who don't have addiction problems, what they can tell us is how they overcome these problems, how they manage self-control in their daily life," said lead researcher Dr Karen Ersche said.  

It is possible that the similarities in the sibling''s brains may not be down to genetics, but rather growing up in the same household. Research on the relationship between addiction and the structure of the brain is far from over.  

However, many specialists believe these findings open up new avenues for treatment. Other experts said the non-addicted siblings offered hope of new ways of teaching addicts "self-control".

"If we could get a handle on what makes unaffected relatives of addicts so resilient we might be able to prevent a lot of addiction from taking hold," said Dr Paul Keedwell, a consultant psychiatrist at Cardiff University.  

Prof Les Iversen, from the department of pharmacology at the University of Oxford , added: "These new findings reinforce the view that the propensity to addiction is dependent on inherited differences in brain circuitry, and offer the possibility of new ways of treating high-risk individuals to develop better ''self control."

Other experts said the study was deeply 'flawed' with too many assumptions. This study typifies the useless information spewed out by some scientists. As there is no difference between the addict's brain and their non-addicted sibling, this would suggest the area of the brain they are scanning is not important otherwise both siblings would be addicted.

They have assumed that because one sibling is an addict and the other isn't it must be because of this brain area, when clearly it is not. Useless studies like this then become 'accepted' by the drug professionals who want to prolong the addiciton problem while patients suffer as a result. It's damaging, dangerous and junk science. 3.2.12 & DM

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Drugs treatment policy for England 'doomed to failure'

Government policies for treating drug addicts in England are flawed and "doomed to failure", a think tank says. Fewer than 4% of addicts emerge from treatment free from dependency and drug deaths continue to rise.

The Centre for Policy Studies says rehabilitation is a better use of the £3.6bn now spent on treating users with drug substitutes like methadone and keeping them on benefits each year.

But it says plans to reward groups which treat addicts so they can return to work are open to manipulation.

The Department of Health said it aimed to get users "off drugs for good".

The coalition government wants to change the way drug addiction is tackled, with more people with problems diverted away from prison and into treatment as part of what it calls a "rehabilitation revolution".

Part of this involves rewarding treatment providers who show addicts have improved their health and employment prospects.

Transfer of power
A report from the right-of-centre think tank, which has links to the Conservative Party, says these payment-by-results schemes were being run by the very organisations "responsible for the current failure of policy".

It says the current annual cost of maintaining treatment for 320,000 problem drug users is made up of £1.7bn in benefits, £1.2bn for looking after their children and £730m for prescribing the heroin substitute methadone.

The think tank calls for "a real transfer of power from large distant organisations to small innovative providers" for rehabilitation.

It says such units have a better chance of getting addicts off drugs completely, adding: "There is one simple measure of success: That of six months abstinence from drugs."

According to the report's author Kathy Gyngell, chairwoman of the prisons and addictions policy forum at the CPS, prescribing methadone to addicts delays their recovery.

She told the BBC: "The state is subsidising people to be any number of years on methadone, which has turned out not to be a cheap option and will only subsidise the tiniest proportion - 2% - to go into a rehabilitation unit that would actually free them from dependency and allow them to live their life."

A Department of Health spokesman said: "The 2010 Drug Strategy is fundamentally different from those that have gone before.

"Instead of focusing primarily on reducing the harms caused by drug misuse, our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependence."

He added: "Work is under way to support local recovery systems tailored to the needs of communities, many of which are already showing positive results." 20.6.11

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Failure to help drug addicts is costing Britain £3.6bn a year

Residential rehab units are in 'near-terminal crisis', says scathing think-tank report. Failure to help hundreds of thousands of addicts get free of drugs is costing Britain £3.6bn a year in welfare and prescriptions for methadone, according to a report released today. The Centre for Policy Studies think-tank accuses David Cameron of failing to deliver on his pledge to help people get off drugs.

The report, Breaking the Habit: Why the State Should Stop Dealing Drugs and Start Doing Rehab, cites comments made by the Prime Minister late last year, when he described methadone as "a government-authorised form of opium".

Mr Cameron pledged to provide more residential treatment programmes and added: "The way you get drug addicts clean is by getting them off drugs altogether, challenging their addiction rather than just replacing one opiate with another."

Yet while the heroin substitute remains a common treatment for addicts, the number of referrals to rehabilitation units has fallen to an all-time low of 3,914. There are only 1,872 beds now available at "affordable" levels of around £500-£600 per week, with none on the NHS, and the sector is "in near-terminal crisis", according to the report.

Its author, Kathy Gyngell, said: "By sponsoring addiction, drug treatment has entrenched a costly dual dependency – on drugs and on welfare."

Three-quarters of those in treatment programmes are on methadone, amounting to 150,000 people. Many people spend years on the drug, which now accounts for a quarter of all drugs poisoning deaths, says the report from the right-wing think-tank.

The latest figures on prison drug tests, obtained by The Independent on Sunday, reveal 3,500 inmates tested positive for prescribed and illicit methadone – a 55-fold increase over the previous five years.

Methadone became a recommended treatment for heroin addicts in the late 1980s, when the Advisory Council on the Misuse of Drugs declared that the spread of HIV/Aids was a bigger threat to the public than drug misuse. Prescribing methadone – a drug that stops heroin addicts from experiencing the pain of withdrawal – and providing clean needles for addicts were part of a "harm reduction" response to drug addiction that continued under New Labour.

The cost to the state of maintaining addicts on methadone has doubled since 2002-03 to £730m a year. Drug users are estimated to receive £1.7bn in benefits a year, while the welfare costs of looking after the children of drug addicts are estimated at a further £1.2bn a year.

The report comes just weeks after British celebrities urged Mr Cameron to decriminalise drug possession, and the Global Commission on Drug Policy said that the war on drugs had failed and that it was time for "fundamental reforms" in drug policies.

A Department of Health spokesperson said the Government's drugs strategy, which includes the use of "talking therapies", detox and drug-based treatments is "fundamentally different from those that have gone before".

He added: "Instead of focusing on reducing the harms caused by drug misuse, our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependence."

"There is no 'one-size-fits-all' solution," said Martin Barnes, chief executive of DrugScope. "Access to a range of services and support is vital to supporting recovery, regardless of the types of treatment provided." 20.6.11

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Drug addicts cost taxpayers £1BILLION a year in jobless benefits

Crack cocaine and heroin addicts cost taxpayers £1billion a year in benefits alone, figures have revealed. Four in five of all those on hard drugs in England – an estimated 270,000 people – are claiming out of work benefits. Every year a further £160million is given to ex-offenders who go straight on the dole after coming out of prison.

Employment minister Chris Grayling, who disclosed the figures, will today blame social breakdown for the rising benefit costs. He will pledge that the Government will do more to help these people recover and get back to work, rather than just letting them continue to claim the dole for months and years on end.

Speaking to the think-tank Politeia, Mr Grayling will say: ‘The system we inherited from the previous government is woefully inadequate – people walk out of prison and on to benefits, with little support to actually find a job, and we as a nation are paying the price. ‘We believe it should be much more of a priority to get prison leavers into work, to stop them re-offending. ‘Getting them into the Work Programme quickly has the potential to break the cycle of benefit dependency and re-offending.'

The statistics were unveiled as Labour launches an attempt to water down Coalition proposals to limit households to receiving £26,000 a year in benefits.

Labour will attempt today to diminish the changes by putting down amendments to the legislation which would exempt three quarters of households affected by the £500 a week limit. They say no one in social housing should be restricted by the benefits cap. This would allow 35,000 more households to get more than £26,000 a year. 17.5.11

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SNP's new policy on drugs drops methadone

The Scottish government is to cut back on methadone treatment in favour of rehabilitation. The SNP has switched the emphasis in Scotland 's drugs strategy from harm reduction to 'recovery and rehabilitation'.

The Scottish government hopes that its new five-point plan will help Scots to live drug-free lives and go some way to ridding the country of its unenviable reputation for having more addicts than most comparable European nations.

Also implicit in the strategy, which was published yesterday, is an acceptance that methadone, the heroin substitute prescribed to addicts, has not made enough of an impact on recovery rates.

In 2006 there were about 420 drug-related deaths in Scotland and it is estimated that there are 52,000 problem drug-users. This last figure is almost certainly a conservative one since many other addicts have not reached the stage of seeking help and are thus not known to the authorities.

Drug-taking, according to official estimates, costs Scots about £2.6billion a year, with a large part of that attributed to crime, as heroin and other drug-users need up to £300 a week to feed their addiction.

As part of its five-point strategy, the SNP will spend £94million during the next three years on tackling drug abuse, and increase funding for health board drug-treatment programmes by almost 4 per cent. It will also overhaul for the first time services for tackling addiction and send every household an information leaflet, so that parents can warn their children off drugs.

Launching the initiative, Fergus Ewing, the Communities Minister, said that the “guiding purpose” of all drug treatment services would be helping addicts into recovery. He told MSPs: “In the past there has not been enough focus on achieving positive outcomes for people with drug problems. We must make this a priority for the future.

“We will achieve this by reforming how drugs services are planned, commissioned and delivered. The idea of recovery must be central. “There has been success in getting people into treatment. But we have been less good about getting them off methadone and into full recovery.”

Mr Ewing described recovery as embracing the principle that rather than concentrating on reducing risk and harm, services should support people to move on towards a drug-free life as active and contributing members of society.

As many as 60,000 youngsters are affected by parental drug abuse in Scotland and Mr Ewing pledged a programme of action to improve identification of children at risk. Existing powers to seize assets and cash from dealers would also be strengthened and Mr Ewing promised better quality and more consistent treatment for addicts in prisons.

Labour said that the SNP had broken a promise to boost spending on tackling drug abuse by 20 per cent. The Scottish Tories, who claim to have played a key part in encouraging the Nationalists to bring the new “recovery” strategy forward, welcomed the shift in focus.

Annabel Goldie, the Scottish Tory leader, hoped that it would herald a new dawn for Scotland 's drug policy. “I congratulate the Scottish government for coming to terms with the failures of recent years, characterised by an attempt to merely manage the problem rather than attack it head on,” she said. “For too long, we have left those who have surrendered their lives to drugs in desperation and devastation. Let today be the day when we offered new hope and real help.”

David Liddell, director of Scottish Drugs Forum, described the strategy as highly ambitious, and acknowledged that medical help or prison sentences on their own were not nearly adequate to help people to overcome their addiction. 29.5.2008

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Re-Branding: New Therapy Battles Soaring Drug Addiction  

The failed drug policy of ‘harm reduction' and methadone prescribing has been re-packaged and re-branded as a ‘pioneering drug substitution programme' in conflict-wracked Afghanistan and has been hailed as a ‘resounding success' as local doctors and international health organisations battle soaring heroin addiction rates and an HIV/AIDS epidemic.

Doctors on the programme, which gives patients controlled doses of methadone to help them control their heroin addiction, say its results show the benefit ‘harm reduction treatment' can have in tackling the spread of blood-borne diseases among injecting drug users and help often ostracised addicts reintegrate into society.  

"In a setting like Afghanistan, where there are no referrals possible to a social worker or a psychosocial counsellor and where you need to integrate everything in the same programme, the results are quite impressive," Dr. Zemaray Amin from the Medecins du Monde (MDM) health group which has headed the programme, told IPS.  

"Drug addiction is growing in Afghanistan and health care implementers including harm reduction organisations and the health sector of the government have accepted the importance of comprehensive harm reduction including opiate substitution therapy as the backbone of treatment for drug addiction," he added.  

Dr. Amin is "completely optimistic that, in spite of many barriers, the success rate of our methadone treatment will lead to regular opiate substitution therapy in Afghanistan."  

Afghanistan is known as the global opium production centre, accounting for more than 90 percent of the world's opium supply.  

But three decades of war and resulting poverty, devastation and social upheaval have fuelled drug use in a country where street opium and heroin are widely available, affordable and of high purity.  

Injection of heroin has escalated in urban areas of the country. A survey on Drug Use in Afghanistan, issued on Jun. 21 last year by the United Nations Office on Drugs and Crime (UNODC) and the government of Afghanistan, pointed out that around one million Afghans between 15-64 years suffer from drug addiction. At eight per cent of the population, this rate is twice the global average.  

Dr Amin said that heroin use was "even more alarming". The MDM group said that in 2005, there were an estimated 50,000 heroin users in the country but that by 2009 that figure had jumped 140 percent to 120,000.  

The exploding rates of injecting drug use have been accompanied by an HIV/AIDS epidemic. The prevalence of HIV among its highest risk group - injecting drug users - reached seven per cent in three cities in 2009, compared to three per cent in one city in 2006, according to MDM.  

The prevalence of Hepatitis C also rose, jumping from 36.6 per cent in 2006 to 40.3 per cent in 2009.  

The sharing of contaminated needles and syringes accounts for more than 80 per cent of all new HIV cases in Central Asia, according to the World Health Organisation (WHO).  

In a recent joint survey between the Afghan Ministry of Health and UNODC more than 85 per cent of injecting drug users said they had shared a needle or syringe to inject drugs. Other surveys have showed that awareness of HIV/AIDS and its transmission among Afghanis is low to non-existent in many communities.  

Until last year the only treatment option for heroin addicts was detoxification.  

Local doctors and international health groups say that detoxification treatment is not as effective in helping drug addicts as harm reduction programmes such as the methadone substitution therapy run by the MDM.  

"With detoxification, relapse rates for heroin injectors are very high," Dr Amin told IPS.  

But the current trial - the first major methadone drug substitution trial in Afghanistan - saw more than 70 patients travel for hours to Kabul to receive treatment.  

The results, publicised at the International Harm Reduction Association's annual conference in the Lebanese capital Beirut this week (starting Apr. 4), show that after six months the trial had a patient retention rate of 83 per cent.  

Similar trials have, according to MDM, had rates closer to just over 75 per cent.  

The trial also showed crime rates among patients dropped and their mental health also improved significantly.  

International health experts say that the use of drug substitution therapy has been proven to help slow the spread of HIV/AIDS in epidemics fuelled by injection drug use. It has been endorsed by the U.N. and the WHO.  

The UNODC has called on Afghani authorities to scale up their harm reduction programmes urgently as the best way to help tackle the epidemic.  

The Afghan health ministry has backed the methadone trial, which is funded by the World Bank, but there are concerns over its future. The methadone used in the trial is imported and permission to do so is coordinated with the Ministry of Counter Narcotics.  

Months into the trial there were problems with permission for importing the methadone, which for a period led to a drastic and potentially dangerous reduction in dosages for patients. In view of this, the Afghan Ministry for Counter Narcotics has called for an independent review of the results - despite what doctors agree reflect the trial's success. A freeze has also been placed on adding new patients to the trial.  

But the medical staff involved in the trial say that the testimonies of those involved as well as the results show the benefits it can bring to the growing numbers of injecting drug users in Afghanistan.  

"The response of the patients and their families has been really positive. They have seen a positive change in their health status, reintegration into family and society as well as greater self-confidence and improvement in many aspects of their lives," Dr Amin told IPS.  

"Every day we receive many requests from people and their families who want to be included in our methadone programme," he added. Critics said 'it's a clear example of how the medical profession lie to their patients, harm reduction is a failed policy that has been re-package for another market where people don't know it doesn't work'. 7.4.11

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A middle-class mother spends £28,000 in 2 rehabs to be rid of cocaine

The bedroom door swung open to reveal a female figure huddled over a wooden chest of drawers. Try as she might to hide the evidence, the tell-tale trail of white powder and tightly rolled £20 note had already been spotted. ‘I've only done it a couple of times,' she stammered. ‘It's under control. Please don't tell Dad.' It's the sort of excuse and pleading that many a shocked mother has heard from a rebellious child caught dabbling in drugs.

But Sandra Salmons wasn't a troubled teen, she was a 46-year-old middle-class mother of one who had — unbeknown to her family — been addicted to cocaine for four years. And that afternoon she had just been discovered taking the drug by her daughter, Lauren, 21.

What took place over the ensuing years is both a shocking tale of one affluent mother's descent into addiction, and testimony to a daughter's unstinting love in the face of repeated betrayals. ‘Looking back, I will always be sorry for what I put Lauren through,' says Sandra, now 55. ‘If it hadn't been for her, I wouldn't be here today. Lauren saved my life.'

This is no exaggeration. At the height of her addiction, Sandra spent a staggering £1,000 a week on cocaine. Ultimately, it would cost her almost everything she held dear — a loving husband, a lavish five-bedroom home in Essex and every last penny she'd earned.

When she hit rock bottom, there was only one person left willing to assist her — Lauren, who footed the £28,000 bill for a rehab programme that would eventually rid her mother of her addiction. It was in 1997 that Sandra's life began to unravel. In quick succession, her husband had a debilitating heart attack and her father died, then Lauren left home to attend Exeter University . Lonely and depressed, Sandra took refuge in alcohol more frequently.

Then came the turning point. Out on a night with the girls in a London club, she was offered cocaine. She was 42. ‘I knew that a few of my friends had tried it, and thought: “Why not?” ' she says.

‘Unfortunately for me, I absolutely loved it straight away. I couldn't believe how confident and attractive it made me feel. I could drink more, I didn't get hangovers and I could talk to anyone. I started using it every weekend.'

Within two months, Sandra was using the drug on weekdays, too, and got a dealer of her own. Like many addicts, she kidded herself that her habit wasn't a problem. And in one sense, she was right. With her husband's business — where she now worked in administration — thriving, finding the money to pay for the cocaine wasn't an issue, even when she soon found she needed more and more of the drug to experience the same sensation.

But beneath the surface her personal life was falling apart. Her husband became increasingly intolerant of her wild mood swings, though he did not suspect the true cause.

Even when Sandra moved out of the marital bed so she could get up and take cocaine unnoticed during the night, she told him it was because he was snoring too much. ‘He seemed shocked and hurt, but he let me go. Some nights I would watch him quietly go up to his room and it made me feel so sad. I could see how lonely he was. But I couldn't give up, so I pulled away from him completely.

‘He thought I had lost my marbles. I'd recently had a hysterectomy, and I think he thought that might be to blame. He was always quite private about how he was feeling. He buried his head in the sand, hoping it was just a phase I was going through.' It was only when her daughter Lauren returned home to live with them after university that she was finally caught taking the drug red-handed.

Lauren was shocked, but after much pleading, agreed not to tell her father. ‘From then on, Lauren watched me like a hawk,' recalls Sandra. ‘I found it so frustrating. She followed me everywhere, even into the toilets, and used to search me for drugs when we went out. But I just hid the cocaine in my bra.'

Eventually the constant deception and disparity in lifestyle took its toll on Sandra's marriage. In 2004, the couple went their separate ways — with her husband still none the wiser about her drug use. Sandra moved into her own flat and at first her hefty divorce settlement (which included proceeds of the house sale) funded her £1,000-a-week habit. By then, she was snorting a staggering five grams of cocaine a day — that's a line every ten minutes — at a cost of £40 to £50.

Over the next few years, Sandra descended into the abyss — selling her car, jewellery and furniture to fuel her habit. Facing repossession of her flat, she emotionally blackmailed Lauren into giving her £10,000. ‘I was so desperate that I'd taken out a £20,000 loan to pay for a place in a UK rehabilitation centre,' says Lauren. ‘Thankfully, when I showed up at her home with a former addict in tow, something seemed to click with Mum.'

Sandra agreed to check into rehab. But over the next 28 days, surrounded by other middle-class addicts, she became abusive and unpleasant to the staff. Before she left, she was advised to seek further treatment — which required a further £8,000 from  Lauren (scraped together from savings, her boyfriend's bonus and selling jewellery) for a more intensive three-month programme in South Africa (why didn't they send her there first?).

It was only there — as the drugs and alcohol eventually left her system — that Sandra finally began to face her demons. In the meantime, Sandra cut off all ties to her old life. She has now been clean of drugs and alcohol for two years, seven months and 22 days. Even now, every day is a struggle.

‘It's still a constant battle to stay away,' she admits. ‘Just the smell of champagne brings back my craving for cocaine. But I have to stay strong, for Lauren as well as myself.

‘She sacrificed so much for me, including thousands of pounds that she spent on my treatment. She never gave up on me. That's something I will never forget.' As for the reversal of the mother/ child relationship, she says simply: ‘I have had to put my guilt behind me. If I dwell on it, I will never be able to recover.'

For her part, Lauren says her devotion to her mother is unwavering. ‘I'll never regret the money I spent on helping my mum,' she says. ‘If your mother was dying of cancer, would you think twice about spending anything you could on her treatment? Most of us would do anything to save a person we love.' 31.3.11

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True cost of drug addiction in Scotland

Drugs are a major problem in our society but if we want to turn the drugs problem around, we have to stick to the facts. THE cost of drug addiction in Scotland has been estimated to be as high as £3.5 billion per year.

Research by the Centre for Drugs Misuse at the University of Glasgow estimated that, on average, each addict costs Scotland around £60,703 a year. There are thought to be around 55,000 addicts in Scotland, and the annual bill includes health care, criminal activity, drug driving and other social costs.

In 2007, for example, problem drug users made 45,034 visits to accident and emergency departments at a total cost of £9,804,388, while the annual shoplifting bill is £50,611,921.

The head of a drug rehabilitation facility has claimed the centre is being prevented from treating Scots, and raised concerns about Scottish Government drug policy. Peter McCann, chair of Castle Craig in Peebleshire, said NHS referrals were at a "pitiful level" and patients faced obstacles to receive in-patient or residential treatment.

Mr McCann also said it was "bizarre" to say that the Scottish Government does not promote one form of treatment over another considering the amount reportedly spent on heroin substitute methadone.

He has outlined his concerns in a letter to Scottish Conservative leader Annabel Goldie, and asked her to raise the matter with the Government.
He wrote: "We cannot switch people from an illegal drug and park them on a prescribed one."

In The Lothians, nearly 200 people a month are reported to a drugs database for the first time, figures have shown. The rate of addicts appears to be rising, according to the Scottish Government statistics, which reveal 2300 new patients were registered last year, compared to 2140 in 2008.

Lothians Conservative MSP Gavin Brown said: "It is clear that we still have an enormous problem trying to get people off drugs completely.

"While the figures have gone down slightly Scotland-wide, it is concerning that there has been an increase across the NHS Lothian area. "While there is a huge economic impact due to drug addiction there is also a human cost." 9.2.11

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End addiction, new government drugs strategy urges

More addicts will be helped to become drug free, and not simply kept on substitute drugs, the Government has said. The previous Labour Government was slammed for its ‘harm reduction' method of dealing with drug addicts, which includes keeping abusers hooked on methadone as a substitute for heroin.

But the coalition Government has hit out at situations where addicts are ‘parked' on a substitute drug. “This must change”, its new drugs strategy stated. Ministers said their "drugs-free recovery" policy would include former addicts mentoring current ones. The plans could see addicts lose benefits if they do not co-operate.

The failed Labour government's strategy was to reduce the harm caused by drugs by initially stabilising addictions, rather than trying to end them. Under the new plans, treatment services will be overhauled to offer drug-free recovery as a route out of dependency.

Parts of the strategy will apply to the whole of the UK , but in England ministers want to set up a network of former addicts to help drug users overcome their dependency. Under the Home Office plans, treatment and rehabilitation centres would fall under the control of local partnerships which would target the specific needs of communities.

The strategy outlines the setting up of "Community Recovery Champions" networks where people who have recovered from drug dependency could mentor others who seek their help.

Ministers said they will also target the supply of drugs in the UK , with a renewed focus on seizing the assets of those involved in the drugs trade, both at home and abroad.

'Legal highs'
Prescription-based treatments, such as the heroin-substitute methadone will continue, but it is not yet clear how much funding will be allocated.

Ministers also want to link drug treatment with welfare benefits in England , Wales and Scotland. They launched a consultation paper in August that suggested a "financial benefit sanction" if addicts did not take action to address their substance dependency.

Powers to temporarily ban 'legal highs' until they are proven to be medically safe will come into effect immediately. But Oscar Dagnone, medical director at CRI, an organisation that works with drug addicts, warned against trying to implement a "one-size fits all" anti-drugs policy.

"We have to focus on the individual. Everyone is different," he said.

"I have never seen a drugs problem. I have seen people with problems and using drugs to deal with their problems. The issue we have in the UK is we have just been focussing on what we see as 'problematic drug users'. Everyone is in a different situation." 8.12.10

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Are fewer addicts really seeking treatment?

The number of addicts entering specialist drug treatment programmes in Scotland has fallen to its lowest level in 12 years, according to the latest figures. Data gathered from specialist drug treatment agencies by ISD Scotland – the body which collates health statistics for the Scottish Government – reveals that 10,325 people began addiction treatment during the 2009/10 financial year, the lowest number since 1997/98, when 10,010 people entered treatment programmes. In 2008/9 the number stood at 12,270.

The figures refer to the number of people added to the ISD's Drug Misuse Database, which records every person entering a drug treatment programme in Scotland following a referral from GPs, social workers, the criminal justice system or self-referral.

However, Laura Wood, senior information researcher at ISD Scotland, said the change can be explained by a shift in how the data is compiled – from paper records to an online system – which has for the first time reduced the number of duplications.

The change in method means the latest figures, published yesterday, give the most accurate picture of addiction in Scotland to date.

But critics said the claim was ‘misleading'. ‘Fewer addicts entering treatment does not mean there are fewer addicts, it could mean they are disillusioned with the treatment system and so don't bother to register or it could be due to swapping to an online system from a paper system. One thing is clear, when they leave the system they are recorded as ‘treatment complete – drug free' this does not mean they are actually drug free, it's just an accounting term, in the same way treatment means ‘the management of' and not combating the condition in the medical sense'. 15.12.10

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Half million Scotts are on methadone

The number of methadone prescriptions doled out to Scotland 's heroin addicts has soared to more than half a million over the past year, new figures have revealed. The bill to treat addicts across the country was found to have increased by 25 per cent over the past five years after Scotland 's NHS boards forked out more than £15million on the heroin substitute.

The number of prescriptions also increased by almost 53,000 to 510,000 over the past five years. It means that almost 30 new methadone prescriptions have been handed out every day since 2005 which is startling failure of the treatment system.

The figures also show that 40 per cent of addicts start taking drugs at the age of 15, while almost 500 women were found to be regularly using drugs during pregnancy over the past year.

As well as a £15million-a year bill for the methadone itself, the cost of pharmacies supervising doses pushes the price of treating junkies up by an extra £11.5million a year. 

Critics said that Scotland has become “over-dependent” on methadone and called for a new approach to tackling addicts.

Tory justice spokesman John Lamont said: “It is all too evident that we have become over-dependent on methadone as a ‘treatment' and the problem was 'escalating'. “Scottish Conservatives worked relentlessly to create a new national drugs strategy, based on recovery and leading to abstinence.”

And the Liberal Democrats' Robert Brown said: “With more money being spent on methadone, the public will be asking serious questions about what is being done to curtail Scotland 's addiction problems and questioning the effectiveness of the methadone programme.”

The report revealed that a total of 10,325 people entered drug treatment services in 2009-10, a drop in around 2,000 on the previous year.

Heroin users spent on average £33, while cocaine users spent on average £108 a day. A fifth said they funded their habits through crime and 72 per cent said they spent state benefits on drugs.

The study also found that 482 new mothers were recorded as drug users, including 330 heroin addicts.

Of the total of 573,000 litres of methadone dished out during 2009-10, 225,000 litres were prescribed in the Greater Glasgow and Clyde health board area.

Community Safety Minister Fergus Ewing said: “Drugs wreck lives, families and communities and getting them out of our society is a battle we will all be in for the long term. We are very clear in all of our educational campaigns that there are alternatives in life – yet there are those who continue to be drawn into using highly addictive and dangerous drugs.”

Critics said 'educational campaigns won't stop methadone use new treatments need to be found to tackle this problem'. 15.12.10

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Coalitions' long term drug strategy

Coalition wants to pay drug treatment agencies 'by result' and while abstinence remains the goal its strategy falls short of demands by the Tory right. Plans for an "abstinence-based" drug strategy and to cut benefits for problem drug users who refused treatment, which were championed by Iain Duncan Smith and the Tory right, have been shelved.

The coalition's first official drug strategy, published today, includes plans to pay drug treatment providers "by results", but it acknowledges the difficulties of treating chronic users by talking of "recovery" rather than abstinence.

The Conservative party manifesto criticised existing programmes, saying too many addicts received treatment that maintained their habit, such as methadone as a heroin substitute.

The party promised instead to allow courts to use abstinence-based drug rehabilitation orders to "help offenders kick drugs once and for all", but there is no requirement for the rehabilitation to be "abstinence-based" in the strategy.

The plans for "drug-free wings" in prisons have been renamed as "drug-recovery wings", although they would need to be "abstinence-focused". The justice secretary, Kenneth Clarke, underlined that point last week when he told Tory critics demanding a "drug-free" approach in prisons that simply making problem drug users go "cold turkey" was clinically dangerous. Clarke said he didn't oppose the use of methadone as long as the objective was to get the user off drugs completely.

James Brokenshire, the Home Office minister responsible for drugs policy, said the new strategy was a major policy shift, putting more responsibility on individuals to seek help and overcome their dependency. The document marks a step away from the language of "harm reduction" that has dominated the past 10 years, but it stops far short of the abstinence-based policy demanded by some rightwing Tory thinktanks.

"There are no quick fixes," said Brokenshire. "Today's focus is clear: simply focusing on reducing the harms caused by illicit drug use is no longer enough – we must focus on recovery as the most effective route out of dependency."

The Home Office says there are about 320,000 heroin and crack cocaine users in England , of which 170,000 are treated in any one year.

Drugs policy has been a key social policy dividing line between David Cameron's more socially liberal Conservatives and the Tory right. Earlier proposals to introduce a compulsory residential element of drug treatment appear also to have been postponed. There is no new money attached to the strategy but the budget of the National Treatment Agency, which is being absorbed into a new agency, Public Health England , has been ringfenced.

Six pilot schemes will explore how a payments-by-results system could work. The precise benchmark as to what constitutes recovery – either reducing drug use or total abstinence – has yet to be spelled out. Former addicts would also be promoted as "drug recovery champions", to act as mentors to problem drug users.

While it contains no proposals to reform the classification system for illegal drugs, it confirms the intention to introduce temporary bans on so-called "legal highs".

The strategy received a positive response from those who work with problem drug users. Martin Barnes, the chief executive of DrugScope , welcomed the use of the benefit system to support recovery, rather than additional targeted sanctions. "In promoting a recovery agenda the government needs to ensure doors are opened for people wanting to reintegrate into society and get back into work," he said.

Lord Adebowale, of the charity Turning Point, said: "Abstinence is of course the end goal but there are many paths that can be taken and this should be recognised by the drug treatment system. Harm reduction policies remain important but they must be pursued with an ambition to support people on the journey towards recovery."

Critics said 'we must be careful of listening to people with vested interests, who would rather maintain the present system, every avenue should be explored to help end dependency'. 9.12.10

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Heroin shortage in UK is 'putting lives at risk'

• Afghan poppy harvest blighted by fungus
• Dealers mixing heroin with 'rubbish' to maintain profits

Hospitals are treating a growing number of drug users who have overdosed on heroin mixed with other substances by dealers because of a huge shortage of the opiate across the UK.

One of the most severe heroin 'droughts' for five years has been reported in areas across the UK , including, London, Lancashire, Surrey, and Stockton-on-Tees. The shortage has been linked not to seizures of the drug by law enforcement agencies but to a fungus that has blighted this year's poppy crop in Afghanistan, reducing it by half.

Users are overdosing on either adulterated heroin, or, in some cases, what has been found to be a combination of a powerful sedative, caffeine and paracetamol. Some have become unconscious very soon after injecting or smoking it, while others have reported vomiting, flu-like symptoms and amnesia, drug agencies say.

One of the most recent reports of overdoses and hospital admissions came last week from Hastings, where four users overdosed even though they had only taken a small amount of what they thought was heroin. Toxicologist Dr John Ramsey, head of the Tictac Communications drugs database at St George's medical school, London , said he had had about 50 recent requests to analyse adulterated heroin.

While sedatives of the type turning up in recent batches used to be found only in the occasional sample of heroin, there appeared to be much more of it around now, he said.

Gary Sutton, head of drugs at the charity Release, said: "There is a very significant heroin shortage across the UK at the moment. It has been going on for some time now, but the last two months have seen stockpiles exhausted." He expressed concern that what was being sold as heroin at the moment appeared to be adulterated with a powerful sedative and mixed with a high percentage of bulking agents like talcum powder or paracetamol.

"If people use this intravenously, perhaps on top of alcohol and methadone [the prescribed substitute drug for heroin], it is extremely risky. We have had many reports of people overdosing. It's really important that accident and emergency departments understand that they may not be dealing with a 'normal' heroin overdose when people are brought in," he said.

"When the drought ends, prices will rise. Heroin tolerance will be reduced, so the risk of fatal overdose will be much higher."

Such is the alarm about the current situation that several drugs agencies committed to harm reduction held an urgent meeting last week to discuss setting up an online warning system about contaminated street drugs.

Neil Hunt, director of research at KCA, a nationwide community drug treatment service, said: "This 'heroin drought' appears to be serious and geographically widespread. Street heroin is in a complete and utter muddle at the moment, and users are collapsing unexpectedly. We need to standardise information about what's out there."

Among heroin users commenting in online forums about the drought, one long-term user said: "I've never known anything like it in 30 years." 25.11.10

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UK is cocaine capital of the western world as cocaine use shoots up by 50 per cent

• Men are twice as likely to die from cocaine than women
• One in seven 15 to 34-year-olds have taken cocaine
• Almost 400,000 coke-users aged under 25

British youngsters have become the greatest consumers of cocaine in the developed world, according to a major international study. It found that numbers of young people using the drug in this country have shot up by 50 per cent over five years. This means Britain has left other countries which face major cocaine problems – in particular the U.S. and Spain – far behind in the league table of those worst-affected.

However critics say, 'the National Treatment Agency (NTA) claim 'new figures show a sharp drop for the first time in the numbers of drug users seeking treatment for addiction to cocaine' and 'the fall affects all age groups but is particularly marked among young adults aged 18-24, and reverses the recent trend of steadily increasing treatment demand from users of these Class A drugs' and 'there is evidence of a decline in popularity of cocaine', the NTA's figures can't be out of date so they must be are entirely fictional'.  

Cocaine use among teenagers and young adults has rocketed since the 1990s as the popularity of other drugs has fallen off and prices have dropped to the point where a line of coke can be bought for just £2.

But the study by the European Union drugs monitoring agency said that consumption of cannabis, ecstasy and amphetamine in Britain still remain the highest or close to the highest in Europe. The findings brought fresh promises from ministers to tackle the supply and use of cocaine, a Class A drug which can both kill when an overdose is taken and produce high levels of dependency among users.

Crime Prevention Minister James Brokenshire promised police operations against big-time dealers, more treatment for addicts and new efforts to block imports.  ‘Drugs destroy lives and damage our communities and this report makes clear more needs to be done to tackle the problem,' he said.  ‘I am concerned about the high levels of drug abuse and deaths in this country, particularly from cocaine.' 

The European agency, the EMCDDA, said that in the five years up to 2008, cocaine use ‘increased by 50 per cent in the United Kingdom and Ireland and was stable or decreased in eight countries'.

Figures for numbers of those looking for treatment for drug dependency showed a similar picture. ‘Among the countries with the highest numbers of cocaine clients, since 2005 a stable situation or a downward trend in the number of new clients citing cocaine as their principle drug is reported in Spain, Italy and the Netherlands, while the United Kingdom reports an increase.'

In a section on British drug habits produced by British experts, the report noted: ‘Recent cocaine powder use has increased significantly in a year.' The figures show that three in 100 Britons aged between 16 and retirement age had used cocaine recently in 2008 compared to 2.3 per cent in 2007. In 2003, the level was two per cent.

Nearly one in six Britons aged under 34 said last year that they had tried cocaine at least once, and 6.2 per cent said they had used it over the previous 12 months. Some 6 per cent of 16-year-old children in this country have tried the drug. In Spain , where cocaine use has been driven up by high levels of immigration from Latin America , the figure was 5.5 per cent. 

The next in the European league table was Denmark , with 3.4 per cent, and then Ireland , with 3.1 per cent of people under 34 having used the drug over the previous year. A reputable survey taken last year in bars and clubs in Manchester found that more than four out of five clubgoers had used cocaine.

Britain was also top of the league for users of ecstasy and amphetamine, and in the top four for cannabis use. The popularity of cannabis has declined over the past seven years as users have been put off by the growing evidence of a link between it and mental illness, especially schizophrenia. Ecstasy and amphetamines have become less common as cocaine has become cheaper.

According to the Drugscope carity, cocaine cost £70 a gram in 2003 but can now be found as cheaply as £40 a gram. A gram, depending on purity, can provide ten or 20 hits or ‘lines' for the user. The falling price has been one of the major reasons why a drug that 30 years ago was used only by the wealthy and fashionable gradually spread through young professionals and to schoolchildren. 11.11.10

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Cannabis use soars by a third as more than 4,000-a-year need treatment

The number of young people needing treatment for mental or other serious problems caused by smoking cannabis has rocketed by a third, experts revealed last night. The NHS National Treatment Agency for Substance Misuse revealed cannabis use had taken a heavy toll on 4,400 youngsters last year - or more than ten every day.

They were referred for treatment by psychiatric services or families worried the person's life was falling apart. In many cases, the user was aged just 18 or 19., the NTA said. The figures come amid significant falls in the number of 18-24 year old's needing treatment for abusing other illegal drugs - including cocaine and heroin.

Experts say it reflects drug users increasingly opting for cannabis rather than other banned substances. Four years ago, the number of youngsters with serious cannabis problems was only 3,300. Last year, it was around 3,700. Cannabis users accounted for 29 per cent of all new treatment cases aged under 25 in 2009-10, up from 18 per cent four years previously.

Young people are also turning to so-called legal highs as they seek alternatives to poor-quality cocaine on the streets. NTA chief executive Paul Hayes said: 'As young adults turn their backs on heroin, crack and cocaine, more of the 18 to 24 age group are seeking treatment for problems with cannabis.

'There are also indications that some who shun cocaine are taking risks with designer drugs like methedrone, dubbed a legal high until it was banned. 'Treatment services need to be on the alert, able to respond to changing patterns of drug use and drug dependency.

'In relation to legal highs, we don't know what the treatment demand will be. They haven't been around long enough, we don't know what their potential to cause addiction is. We know they can cause health harms.' It follows concern about the increasing availability of the super-strength skunk variety of cannabis - which now accounts for between 70 and 80 per cent of police seizures.

Doctors warn that people who smoke skunk are 18 times more likely to develop psychosis than those who use milder forms of the drug. The researchers, from the Institute of Psychiatry in London , compared data on the health and habits of almost 200 cannabis users.

More than half were being treated for psychosis, in which hallucinations and delusions leave people unable to distinguish between reality and their imagination. Analysis showed skunk was the drug of choice of those being treated for psychosis, while hash was more likely to be smoked by those without mental health problems.

Cannabis has been linked to a string of vicious killings by young people, including the murder and mutilation of teenager Jodi Jones by her boyfriend Luke Mitchell and the stabbing of fashion designer Lucy Braham by Oxford University student William Jaggs.

In 2004, the then Home Secretary David Blunkett approved the reclassification of cannabis from Class B  to Class C. The decision was reversed four years later, on the orders of Prime Minister Gordon Brown, on the grounds it was sending out the wrong message to children that cannabis was harmless.

The government has also stated a determination to crack down on the so-called legal highs. Mephedrone - also known as Meow, Bubbles and M-Cat - was banned and made a class B drug in April.

The Home Office has also announced plans for year-long bans that could be put in place quickly to take new  drugs off the market while a comprehensive review of their potential harm is carried out. Roger Howard, chief executive of the UK Drug Policy Commission, said: 'With the changing nature of drug use, we do need to pay more focus on these new emerging drugs. 'I think that's something that people in the field are very aware of. 'How quickly can the system adjust?' 8.10.10

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Spin - rewriting the dictionary to achieve treatment success

The words below –  from the government's National Treatment Agency for Substance Misuse – are given a meaning perceived by people generally. This is followed by the ‘target on paper' definition, or Top, set in the NTA context.

Problematic drug user: Someone whose drug use causes a problem for them or others.
NTA definition: someone who uses heroin or crack cocaine; only these make you eligible for ‘treatment', only these are counted in targets.

PDU.   A dehumanising word for a problematic drug user. 
NTA definition: a statistic.

Legal drugs.  These include addictive drugs which can destroy lives, such as benzodiazepines; kill more people in the UK than illegal drugs
NTA definition: does not come under definition of a PDU, so does not count towards targets, so you are ineligible for treatment/funding.

Treatment: The general public thinks that this means addicts and people with drug problems get help to become drug free and rebuild lives.
NTA definition: someone somewhere made an appointment for you and got your name on file.

Retention/retained in treatment: Patient given consistent proactive therapy and other support to become drug free and reclaim life.
NTA definition: patient is seen at one appointment, can be given a second appointment 12 weeks later (during which some died or were imprisoned), defined as hitting target of 12 weeks' retention.

Rehab: More rigorously researched than NTA preferments, also proven to be the most successful in getting people off drugs long term. Also help people overcome methadone addiction.
NTA definition: something to find a less-effective alternative to; over 20 rehabs closed under our regime.

Balancing the treatment system: The need to balance a failed system created by the NTA where only 2-4% of patients manage to get to rehab, and a similar number to become drug free.
NTA definition: aim of ARF and Recovery Group UK ;  copying phrase in NTA Business Plan 2010/2011  blurs NTA role in creating such imbalance.

Dependency: Another word for addiction, a “dysregulation of the mesolimbic dopamine system” or brain-chemical disorder, as opposed to misusing drugs through choice. Diagnosing between dependency and misuse is vital as each requires different care.
NTA definition: “We don't define dependency, just as we don't define recovery,” stated NTA senior managers – which means targets in the NTA Annual Reports submitted to parliament are meaningless.
(2): drug users become dependent on state drugs and handouts due to lack of appropriate care.
(3): providers are dependent on NTA for referral revenue, cannot whistle-blow.

Free from dependency: The general public thinks that this means patients have been helped to quit drugs, are rebuilding their lives.
NTA definition: patient stopped using main drug briefly, uses other drugs; patient is kept dependent on prescribing organisations for decades.

Recovery: First mention I found is in a book copyrighted 1954 to Alcoholics Anonymous and means quitting alcohol/other drugs, living in such a way as to stay stopped, repairing relationships and making amends for any wrongs done.
NTA definition: “We do not define recovery” (see dependency); plus UKDPC redefinition as “control over drug use” – eg, control over using exactly nine grams of cocaine every day.

Prescribing: If used, should be for brief detox and/or stabilise patients, but drugs such as methadone are more addictive and harder to withdraw from than even heroin.
NTA definition: “treatment”.

Harm reduction: Aims to reduce harm from drug use, addresses fallout not the cause.
NTA definition: “treatment”.

Detox/ification. Getting toxic substances out of the body
NTA definition:: “treatment”, “rehab”, “abstinence”, “successfully leaving treatment”.

Retox: Put patients back on drugs instead of giving recovery treatment after detox.
NTA definition: recommended in papers by John Strang due to number of patients dying after detox at Maudsley clinic where he works; Strang is co-heading the NTA Business Plan 2010-2011

Patient placement criteria: Created by the American Society of Addiction Medicine to give the most fitting type(s) of care to people with drug problems, in the most clinically- and cost-effective ways
NTA definition: “[UK] criteria are based on failure,” NTA CEO Paul Hayes said this year; not the ASAM criteria, something to be created.

Top: Targets on paper; an unverified page of boxes to tick to show ‘treatment' results, which omits legal addictive drugs and other outcomes which quality rehabs offer, including treating worse cases.
NTA definition: Treatment Outcomes Profile, used by the NTA as official data for UK statistics.

Drug deaths: Something the NTA was set up to reduce, have instead increased under its regime. The number of drug-related deaths in Britain rose by almost 12 per cent to 2,182 last year.
NTA definition: "drug deaths have reduced" - [despite an 86% increase in drug deaths over the last 6 years] click here for facts. Critics say 'the fact the NTA declares drug deaths have reduced, when they have actually increased by 86% shows the level of deceit and spin they employ in their statistics'.

Ideologists. Top definition: people who question us.

Source: Addiction Today - 8.8.10

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Number of drug deaths in Britain soars 12 per cent in a year & 86% over the last 6 years

The number of drug-related deaths in Britain rose by almost 12 per cent to 2,182 last year, figures showed today. The number of deaths has risen steadily from 1,174 in 2003 to 2,182 in 2009 an increase of 86% in just 6 years.

Heroin and morphine were involved in more than half (52.9 per cent) of the deaths, up from 45.3 per cent in 2008, and more than four in five were accidental overdoses, the National Programme on Substance Abuse Deaths report showed.

The increase in the number of deaths, up from 1,952 in 2008, showed the UK still has a 'major problem', the researchers said.

The figures, based on information reported by coroners, showed the number of deaths in England last year was 1,524, up from 1,374 in 2008, while figures for Scotland remained broadly the same - up to 479 from 477.

The number of deaths in Wales (102) a rise of 67%, Northern Ireland (65) and the islands (12) all rose, up from 62, 30 and nine respectively.

Professor Hamid Ghodse, director of the International Centre for Drug Policy (ICDP) at St George's Hospital, London, which released the report, said the continuing rise was 'very concerning and shows that we must not waver in our efforts to prevent the loss of life'.

'The effectiveness of both drug abuse prevention and treatment is reflected in the mortality data, so we know we still have a major problem,' he said. 'An immediate impact in reducing drug-related deaths could be achieved by improving the availability of effective treatment and rehabilitation services.

'However, in the long run, finding primary prevention strategies that work may be crucial if we want to have a major effect on drug-related mortality.' 25.8.10

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Change of policy required as calling drug users 'junkies' hinders recovery, says study

Policy shift to abstinence-based approach for treating problem drug users won't work unless prejudice is tackled, warns report.

The use of stigmatising terms such as "junkie" and "addict" is proving a major obstacle to the rehabilitation and recovery of problem drug users, according to a report published today by a leading drug policy thinktank. The UK Drugs Policy Commission says a shift by the government towards a more abstinence-based approach to treatment is unlikely to work unless prejudices about addiction are tackled.

The UKDPC study, Sinning and Sinned Against: The Stigmatisation of Problem Drug Users, suggests that celebrities and public figures who are prepared to talk openly about their recovery from drug addiction should be encouraged. The report also says that unthinking media reporting of drug addiction should be challenged, education campaigns should be mounted and greater use made of voluntary work placement schemes to help get beyond the "junkie" stereotype.

The report comes as the drugs minister, James Brokenshire, confirmed a clear shift in the rhetoric surrounding official drug policy with the ultimate aim of helping the 210,000 problem drug users currently in treatment to achieve a drug-free life.

But he also acknowledged that the use of methadone treatment programmes to stabilise problem drug users remains an important part of that process. His statement follows reports that the work and pensions secretary, Iain Duncan Smith, had failed in an attempt to wrest control of drug policy from the home secretary, Theresa May.

It is believed that any drug strategy that adopted a policy of time-limiting methadone use as a substitute for heroin would provoke strong objections from doctors and other leading medical figures. The current policy of long-term methadone treatment has been criticised by Tory reformers as a method of "parking" problem drug users on a substitute pharmaceutical.

A proposal by the Department for Work and Pensions to dock the welfare benefits of problem drug users appeared in a Home Office consultation paper published last week but only as a possible option for those who fail to take any action to address their drug or alcohol dependency. It is believed, however, that David Cameron's policy tsar, Oliver Letwin, based in the Cabinet Office, is also pushing for a stronger abstinence-based approach behind the scenes.

The National Treatment Agency, which is to become part of a new public health service, is already recasting its approach with a focus on enabling people to become "free of their addictions, including alcohol", and talks of problem drug users recovering and contributing to society.

Brokenshire said yesterday: "We need a new approach and need to be more ambitious. More focus on a pathway to recovery, so users are free of addiction and can contribute to society. We want users to be clear of addition. "However, we acknowledge that stabilising someone is still a part of that process, particularly in relation to chaotic and vulnerable users such as sex workers. Stabilising users can then lead to a pathway of recovery where they are free of drugs and can contribute to society by gaining employment, not held in addiction."

But the UKDPC report says the stigma attached to drug addiction remains a big obstacle to that goal. It says people think of users and former users as the "junk of society" – dangerous, unpredictable and, crucially, only having themselves to blame. It adds that this attitude is hindering access to treatment, securing work and housing, and rejoining society.

The report is the first published in a four-part study led by Colin Blakemore, professor of neuroscience at Oxford University . He said: "'Junkie' and 'addict' have become pejorative shorthand for perceived social decay, conveying a sense of anxiety out of all proportion to reality, but such hostile attitudes only add to the barriers of escape from drug dependence.

"When drug use is so common in our society we need to inform the public about the true nature of addiction so that addiction is no longer a lifelong handicap."

The report found that those involved in treating problem drug users, including pharmacy staff dispensing methadone, can be distrustful and judgmental in dealing with users. These stigmatising attitudes can have a profound impact on problem drug users' lives.

Charlie Lloyd, its author, cited Arnold Schwarzenegger's "recovery month", held in California every September, as an example of moving towards greater compassion for problem drug users. 24.8.10

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From hopelessness to action, moving addicts into recovery

In June, prime minister David Cameron stated that “First, there is a problem in our national health service, in that we spend too much time treating the symptoms rather than necessarily dealing with the causes...  Second, all addictions need proper attention, and proper treatment and therapy, to rid people of their addictions, whatever they happen to be.”

In July, he added that “We've got to get rid of the centralised bureaucracy that wastes money and undermines morale... If you've got an idea to make life better, don't just think about it – tell us what you want to do and we will try and give you the tools to make this happen”.

So let's outline some factors which stop people getting “proper attention and proper treatment and therapy” to rid them of their addictions. Then let's look at broad policy proposals down to a simple suggestion from Addiction Today to add to the jigsaw of recovery solutions.

BLOCKS IN THE CURRENT SYSTEM
For 21 years, the Addiction Recovery Foundation charity – mainly via Addiction Today – has been identifying ways to recover from addiction/dependency and sharing best practice. In more recent years, we have questioned why ‘problematic drug users' have not been given fair opportunities for recovery: less than 4% of people who turn to statutory services for help to quit drugs actually get a referral to ‘rehab': rehab/quasi-residential/daycare programmes with a record of creating sustainable recovery.

Hansard , which prints all MPs' speeches in the House of Commons, reported a comment in July by David Burrowes which encapsulates the chaos of the UK 's addiction-treatment system. “The annual report of the National Treatment Agency for Substance Misuse, which was presented to the House... is in stark contrast with the 30th report of the Public Accounts Committee in March, which concluded that £1.2billion is spent on tackling drug misuse without the government knowing the overall effect of that approach.”

If we do get a new drugs policy aiming to get people off drugs and positively transforming their lives, how can it be implemented? With the coalition government, it is not a problem of willingness, but of how its goodwill can be turned into a reality reaching addicts and their families desperate for help.

On top of the sheer logistics of transition from a monolithic failed system to a dynamic inspirational one, implementation must run an obstacle course of 'vested interests, ignorance and supposedly-neutral civil servants with political allegiances to the last government'. For example, Addiction Today has heard rumours of civil servants in the Department of Health stating that rehabilitation is not "treatment" - and that 95% of the treatment budget should be spent on non-rehabilitation, accelerating the downward spiral of failure rather than helping the country towards recovery.

ABOLISH THE NTA
The National Treatment Agency for Substance Misuse has been recognised as the biggest block to getting this country into recovery – Addiction Today was perhaps the first to expose its failings and publicly call for it to be abolished, after attempts to negotiate failed. In July came the first saltation: health secretary Andrew Lansley abolished the NTA.

PROTECTIONISM, OVERPRESCRIBING & LACK OF SOCIAL INPUT IN THE NHS
The NHS has become more not less protectionist, keeping patients within its own control rather than referring them to more clinically-effective and cost-effective rehabilitation specialists. For example, although the NTA trumpets Liverpool as the “city of recovery”, Mersey Care NHS Trust has placed few patients with Sharp or Park View Project, local organisations which enable drug-free goals. Also, Nottinghamshire County Primary Care Trust decommissioned both day and residential services helping people to quit drugs – quoting as justification an out-of-context sentence from the NTA Effectiveness Review.

Add to this a NHS culture of overprescribing addictive legal drugs, and lack of integration with, for example, employment and crime, from funding to outcome measures. It all points to the necessity of sharing responsibility and power for addiction treatment between not merely the DoH via the NTA but also the Home Office, the Ministry of Justice and Department of Work and Pensions. This leads us to the next saltation...

ADDICTION RECOVERY BOARD
At ARF's UK/European Symposium on Addictive Disorders in 2009, the idea of an Addiction Recovery Board to replace the NTA was floated to delegates in a policies workshop. It could create policy, manage finance:performance more simply than the current system with less but more key outcome measures, and have a carrot-and-stick inspection system. Also, there is an acute need for more rehab places, which will require higher standards of training across the workforce, which could also come under the remit of an ARB.

The most popular recommendations for an ARB are that it must be less bureaucratic than the NTA, be more transparent and accountable, be able to influence budgets – and run alongside a ‘grievance system' so that poor commissioning can be exposed and troubleshooting teams sent in to correct it without the current punitive backlashes on providers or patients who make legitimate complaints. Given the number of reports to Addiction Today , this will have to be clear, robust and staffed asap!

The ARB should be backed up by a cross-ministerial committee/council which can feed information to and from ministers in relevant departments such as Health, Home Office, Ministry of Justice, Work & Pensions – even Education, Family, Treasury and Cabinet.

This could also remove the need for reporting of unseemly rows between ministers for control of drug policies, such as on the front page of the Times on 23 August between Theresa May and Iain Duncan Smith.

TREAT ALCOHOL AND ALL DRUGS
Combining policy and funding for both drugs and alcohol treatment should remove artificial barriers and duplicated bureaucracies. Treatment should be offered to people who have problems with any psychoactive addictive drug. Given the proliferation of polydrug use, this also opens the door to tackle cross-addiction, leading to long-term sustainable independence - and independent lives, which can improve their families also.

GREATER NUMBERS NEED HELP
The NTA quotes 330,000 problematic drug users needing help – but its definition covers only heroin and crack cocaine. Add in powder cocaine, marijuana, ketamine, ecstasy, amphetamines and other mind-altering drugs, as well as methadone addiction, and the numbers needing help are recognised as much larger. They will be multiplied when/if people dependent on alcohol and legal drugs such as benzodiazepines are also helped.

ARE THERE ENOUGH REHAB PLACES?
If there are more patients to treat, alongside a move for more patients to be placed in rehabs – residential, quasi-residential or daycare – are there enough places? It is estimated that there might be only about 1,500 residential beds left – and that is available over the year as clients come and go, not at any one time.

DRUG/ALCOHOL ACTION TEAMS
A decade ago, Addiction Today forecast that implementing drug policy through D/AATs was doomed to failure; only a handful were competent, and there were no sanctions for poor practices. Today, most D/AATs spend too much of the treatment resources on their own bureaucracy.

And, as financial power sits with Primary Care Trusts, commissioning decisions are dominated by the NHS – a major factor in overprescribing. 

Local commissioners must be free of central bureaucracy, but there must also be safeguards against creating local bureaucracy.  Perhaps responsibility for receiving funds and coordinating local partnerships should rest with local authorities? LAs are the only local public bodies with responsibility across the social policy agenda, and should not have an interest in directing resources into their own structures.

UNBALANCED CONTRACT BIDDING
Harm reduction has a role alongside treatment, but not as a substitute for it. Tier 2/3 organisations offer lower-level services from advice to harm reduction, sometimes therapy – not rehabilitation. But 96-98% of those seeking help to quit drugs are referred to harm-reduction services. When treatment budgets are diverted here, that should be clearly stated: they have different outcomes.

Some tier 2/3 organisations get over 90% of their income from our taxes, via the statutory system. Indeed, just two of these organisations can account for over £100million of our taxes a year. For this, up to 25,000 people could have been treated to rehab annually and be working towards lives independent of drugs and of the state and of our taxes. But the budget for the whole country refers only a third of that number to rehab. This is a hugely imbalanced system. And those who received such largesse since the NTA was created in 2001 are determined to protect it.

PAYMENT BY RESULTS – IF YOU SURVIVE
Payment by results, or PbR, sounds fair in theory – but risks becoming the most inequitable tool in the new drugs policy. Let's leave the measures of success – the choosing of which results matter – to one side, as these are being worked on by many groups. It has been suggested that PbR will mean no payment until after results are evidenced – perhaps up to a year later. The small quality rehabs and their like survive on meagre budgets, powered by vocation more than profit. They could not survive six months, far less a year, paying without real-time reimbursement for patients to get well. Only the largest tier 2/3 players enriched in the past decade have the financial reserves.

“It is anxiety provoking to see the potential for vested interests to corner the pooled treatment budget into their own pockets and pretend that the drug problem will be solved by their organisations alone,” one commissioner explained. “As placements are funded out of social care monies, it will let LAs off the hook and they will bail out of treatment as soon as possible. Payment by results will see off the small independents. Then prices will rise, competition reduce and some ‘one size fits all' county providers will do for the rest. If the coalition rows back from an integrated locally determined approach, then we'll be back right where we are, or worse.

"It can be likened to It's A Knockout , with people seeking recovery and those helping them being placed on a slippery pole with more and more obstacles being put between them and the prize of recovery.” 

DEMORALISED STAFF
While rehab staff are under financial pressure due to lack of referrals from the unbalanced treatment system, NHS and other tier 2/3 providers are demoralised due to not seeing clients recover – too many drug workers say they have never seen addicts quit. This has an exponential effect in that, as Project Match proved, more people get better when their therapists believe they will.

A PIECE IN THE JIGSAW OF SOLUTIONS: THE ‘SALTATION' WEEK
So here's another Addiction Today “idea to make life better”, as Cameron phrased it. It started when Dr Francis Keaney, vice chair of the Royal College of Psychiatrists and senior lecturer at King's College London, and Dr Alison Battersby, research secretary and recovery lead of the RCPsych and consultant psychiatrist in Plymouth addiction services, asked how tier-2/3 services could move clients into recovery – and in the face of budget cuts.

This was a time period that we had not previously looked at indepth to identify and share best practice: a period before people reach rehabilitation services, when many staff have given up on drug users' ability to change. It was a  welcome challenge, showing a shift in thinking towards recovery and collaboration. The idea of a ‘saltation' week developed from there.

Benefits of the saltation week are as follows.
>>  Participants get a thorough assessment – in what other health field are patients given a course of ‘treatment' without a diagnosis?
>>  Assessment and consequent referrals are seen to be transparent, removing heated debates about whether tier 2/3/4/other are appropriate.
>>  Appropriate assessment, particularly with Asam patient placement criteria at the end of the week, will identify who can get into recovery with less intensive, less expensive services – without clinical compromise; it is cost- and clinically-effective.
>>  The saltation week is a ‘brief' intervention – yet offers clients more therapy in a week than they currently get in a year on methadone maintenance (see research by David Best).
>>  It will propel clients through stages of change, from precontemplation to readiness for action, through Maslow's hierarchies of need to safety and a sense of belonging; these not only motivate clients into recovery and related services but also reduce dropouts, so services give greater value.
>>  If there is a sudden demand for rehab, there might not be enough capacity – so the saltation week will act as a filter, a funnel.
>>  For some patients, this intervention might be enough in itself, with no need for more services. It will also act as a pretreatment week for patients on waiting lists due to lack of capacity, holding participants safely while they await treatment.
>>  Ideally, the saltation weeks should be run by people with no financial interest in organisations to which participants might be referred. This could be within the NHS – it might be easier to let go of protectionism if so – run by people such as Keaney and Battersby.
>>  On the other hand, if we are not to abolish tier 2/3 services, they could, with a few expert professionals, run such saltation weeks, adding capacity and enhancing services; referrals at the end of the week will need to be independent.
>>  If this week were incorporated in tier 2/3 services, it would increase throughput of patients at lower cost – and lead to recovery not same patients maintained on scripts the following year.
>>  Just as crucial is staff morale: witnessing positive results of their own work will boost motivation.
>>  Payment-by-results: results can be validated as soon as the saltation week is completed.

Read the September issue of Addiction Today for the saltation week programme, details of therapies behind the week, and results of a similar week trialled by Nottingham Community Alcohol Services. Source: Addiction Today. 23.8.10

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NTA and other health quangos to be abolished in £180m of cuts

Eighteen health quangos will be reduced to between eight and 10 over the next four years. The fertility watchdog the Human Fertilisation and Embryology Authority (HFEA) and the Health Protection Agency (HPA), which deals with infectious diseases, are both slated to disappear in the shakeup, including the National Treatment Agency for Substance Misuse (NTA).

The National Treatment Agency for Substance Misuse was heavily criticised by Lansley's cabinet colleague Iain Duncan Smith for spending billions of pounds on schemes with little evidence they worked.

The Health Secretary Andrew Lansley justifies the cuts on the grounds that it would produce savings of more than £180m over the next four years by streamlining the functions of these organisations and slashing their bureaucracy. Although the Department of Health's overall budget is being "ring-fenced", the ever expanding demands on the NHS each year mean that significant savings must be found.

Experts in infectious diseases criticised the plan to abolish the HPA as a statutory organisation and transfer its functions to the Department of Health and the new Public Health Service. "It's a very bad idea because the HPA is an absolutely essential national resource," said Hugh Pennington, emeritus professor of bacteriology at Aberdeen University . "There is no merit in making changes to the HPA other than those that strengthen it. It's quasi-independent and a degree of separation between it and the rest of government gives it more scientific freedom and independence," Professor Pennington said.

The HPA was central to advising the Government on the recent flu pandemic and has played an important role in monitoring HIV and Aids in the UK . It has also recently absorbed the functions of the National Radiological Protection Board, which was responsible for assessing the health risks of radioactive materials.

The fertility watchdog, the HFEA, was set up in 1991 to oversee the licensing of IVF clinics and lay down the guidelines for how this service should function. It was a model for other countries to adopt. But fertility clinics have complained of overzealous regulation and bureaucracy. Lord Winston, the fertility pioneer, criticised the authority in 2004 for incompetence and mismanagement, questioning why fertility medicine should receive special regulatory treatment.

Mr Lansley said yesterday that the HFEA will be retained for the time being but by the end of the current Parliament its functions will be divided between the Care Quality Commission and the Health and Social Care Information Centre, two of the health quangos to survive.

Lisa Jardine, the chair of the HFEA, said that IVF treatment still needs to be effectively regulated and that the authority's task is now to make sure this continues after the organisational change ordered by the Government.

David Cameron vowed in opposition to rein in Britain 's quango state in an attack on a bloated public sector. His threatened cull of taxpayer-funded organisations yesterday became reality for thousands of workers as the Health Secretary, Andrew Lansley, announced that half of the "arms-length bodies" run by his department were to be abolished.

ABOLISHED: HEALTH
*Health Protection Agency (HPA)
*National Patient Safety Agency (NPSA)
*National Treatment Agency for Substance Misuse
*Alcohol Education and Research Council
*Appointments Commission (CQC)
*Human Fertilisation and Embryology Authority (by end of this Parliament)
*Human Tissue Authority
*Council for Healthcare Regulatory Excellence (to be made a self-funding body by charging a levy on regulators)
*NHS Institute for Innovation and Improvement 27.7.10

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Abolish the NTA to cut drug addiction

Methadone prescriptions for heroin addicts would be cut and the National Treatment Agency that runs the programme scrapped under plans from the Tories favourite think-tank.

The Centre for Social Justice, set up by Iain Duncan Smith, the Work and Pensions Secretary, said it was unacceptable that only 4% of addicts in treatment ever get “clean” and accused the agency of “pushing aside” proper rehabilitation. The Times has also learnt that the highly influential think-tank will use a report on Monday to throw its weight behind Ken Clarke, the Justice Secretary, who called for short prison sentences to be scrapped. The report will state that the CSJ agrees with him that short sentences of two months do nothing to help to rehabilitate offenders and should be replaced by community orders.".

The CSJ's Green Paper on Criminal Justice and Addiction comes as the government considers major changes to drug policy and the future of the National Treatment Agency. Set up in 2001, the NTA oversees the controversial “harm reduction” strategy - most recent NTA treatment statistics show that of the 207,000 addicts a year who use 'treatment' services, only 8,980 completed their treatment drug free. 4,600 addicts have access to residential rehabilitation. Numerous residential drug rehabilitation centres have closed because of lack of patients, despite no sharp fall in the number of addicts.

The CSJ said that the NTA, the running costs of which have spiraled to £18million a year, merely processes addicts with a “fatalistic” belief that they can never get clean. It wants it scrapped and replaced by an Addiction Recovery Board, chaired by a minister and charged with getting addicts off drugs altogether, using the best local private sector and charity programmes, or “recovery communities”.

The report says there is a role for methadone, but it should be used only as part of a wider treatment programme, with abstinence the goal.

"There is no strategy or incentive to reduce the numbers on maintenance treatment and move people into recovery," the CSJ said. The report is also highly critical of how drug use is tolerated in prison: 55% of prisoners received into custody each year are classified as problematic drug users. According to the Ministry of Justice, one in five men who reports using mainstream drugs first used them in prison. 10.7.10

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Limits to methadone prescription proposed by drugs agency

National Treatment Agency for Substance Misuse wants open-ended heroin substitute use ended. Strict limits on how long drug addicts are allowed to stay on heroin substitute methadone have been proposed by the government body responsible for treatment strategy, in what will be seen as a watershed in UK drugs policy.

The National Treatment Agency for Substance Misuse (NTA) is describing the move as a rebalancing of the system in favour of doing more to get addicts clean. But cynics will regard the shift by the NTA, which has faced criticism and calls for it to be scrapped, as a late attempt to save itself before the coalition review of arm's-length government bodies.

Martin Barnes, the chief executive of the DrugScope charity, which represents 700 local drugs agencies, said: "A goal of avoiding open-ended prescribing through improved practice is not the same as, and should not be confused with, the setting of time limits."

An estimated 330,000 people in England and Wales are addicted to heroin, crack cocaine or both. More than 200,000 are in contact with treatment agencies, but most are "maintained" on methadone or other synthetic opiates, at a cost of £300m a year, rather than pushed towards abstaining from all drugs, whether prescribed or illegal. Strict time limits on methadone treatment would require a big expansion of residential care for addicts.

In a report last week the influential Centre for Social Justice, set up by former Conservative party leader Iain Duncan Smith, called for the NTA to be scrapped and replaced by an "addiction recovery board" covering drugs and alcohol misuse. The report repeated claims that only 4% of drug addicts are emerging clean from treatment.

The NTA, which is responsible for England, disputes this figure, saying that the number of people "successfully completing treatment free of dependency" rose to 25,000 in 2008-09, about 12% of those who were in "effective" treatment.

However, the agency has accepted that it needs to revise its approach in view of the change of government. In draft changes to its business plan, approved by the NTA board but not yet signed off by ministers, it states: "We intend to take forward the government's ambition for a rapid transformation of the treatment system to promote sustained recovery and get more people off illegal drugs for good."

The aim, the draft says, is to rebalance the system and "ensure successful completion and rehabilitation is an achievable aspiration for the majority in treatment".

The idea of time limits is drawn from new Department of Health clinical guidance for opiate prescription in prisons. The guidance requires that offenders serving sentences of six months or more should have any prescription reviewed at least every three months. The prison guidance states: "If there is some exceptional reason why abstinence cannot be considered, then the reason must be clearly documented on the clinical record at each three-month review."

In the draft revision of its business plan, the NTA says: "No one should be 'parked' indefinitely on methadone or similar opiate substitutes without the opportunity to get off drugs. New clinical guidance has introduced strict time limits to end the practice of open-ended substitute prescribing in prisons. This principle will be extended into community settings.

"New clinical protocols will focus practitioners and clients on abstinence as the desired outcome of treatment, and time limits in prescribing will prevent unplanned drift into long-term maintenance."

The NTA declined to comment on its proposals. But word of its policy shift is prompting excited debate in the £1.2bn drugs treatment sector. The methadone issue became totemic for critics of the Labour government's social and criminal justice policies, and was raised repeatedly by David Cameron during the general election campaign.

Karen Biggs, the chief executive of Phoenix Futures, a leading treatment provider, welcomed the move towards a "better balance" in the treatment system. "There are excellent examples across the country of recovery-orientated treatment systems that help people move from the most chronic addictions to a life of recovery," Biggs said. "A balanced treatment system which is ambitious for the individuals and communities with which it works will contribute to the wider social policy objectives of the coalition government." 18.7.10

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Lives destroyed by not so happy pills

As our use of antidepressants DOUBLES in a decade, experts say thousands are being given dangerous drugs they don't need. Clare Morgan was going through a rocky patch: her long-standing relationship had hit difficulties and she was struggling financially. But the self-described 'optimist' felt she was managing to cope.

Then the 35-year-old biologist started experiencing unusual symptoms. 'Out of the blue, I felt really agitated - I couldn't concentrate, I couldn't sleep, and I felt very shaky,' she recalls. 'I'd been under some stress. But my symptoms seemed too odd for that to be the whole explanation.' After about six weeks she went to see her doctor, who diagnosed depression and anxiety. 'I asked him if he was sure, because there were other symptoms such as diarrhoea, weight-loss and vomiting. But he confirmed his diagnosis and prescribed an antidepressant.'

Unfortunately this only made her feel worse; she developed the shakes as well as suicidal thoughts. In an attempt to remedy this, her GP changed the medication three weeks later. But nothing changed. And after mentioning her suicidal thoughts to her doctor, she was put under the supervision of a mental health team.

Six weeks later, Clare was put on yet another antidepressant, along with a tranquilliser and an anti-psychotic drug. She was now sleeping 14 hours a day; unable to work, she had to rely on her boyfriend for support. 'I was zombified, but still felt the anxiety and the terror, and that didn't seem right. However, my doctor simply increased my dose.'

After six miserable months, Clare's doctor admitted the drug treatment wasn't working and suggested electric shock treatment. 'I said "no way" and decided to come off the antidepressants,' she says. This proved 'fantastically hard - worse, actually, than being on them'. 'The only good part was a brilliant nurse, who took me seriously when I said I'd always felt that something physical had caused my symptoms and put me in touch with a sympathetic private doctor,' she says.

A year-and-a-half after her symptoms began, Clare was diagnosed with an overactive thyroid and a problem with her adrenal glands. 'That was why I had been so bizarrely agitated, had diarrhoea and had lost weight.' Clare's story is extreme, but it is far from unique. Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month. In 2000, there were 20 million prescriptions - this rose to 39 million last year.

While this rise is partly being blamed on the recession, experts are concerned that misdiagnosis is a major factor. Indeed, a study published recently in The Lancet found that the average GP will wrongly diagnose 16 out of every 100 patients they see with depression and anxiety. As Dr Alex Mitchell, consultant psychiatrist at Leicester General Hospital , explains: 'A busy GP sees about 100 patients a week. Out of those, 20 will be suffering from depression, but he will spot only ten of them and treat five, usually with drugs.' Not only are the depressed missing out on treatment, 16 of those 100 patients will be told they are suffering from depression when they aren't.

One of the reasons this happens is because the official test GPs use to check if you're depressed involves two very basic questions: During the past month, have you been bothered by feeling down, depressed or hopeless? During the past month, have you been bothered by having little interest or pleasure in doing things?

'Ideally, GPs shouldn't just rely on these two questions, although they are a NICE -approved way of diagnosing depression,' says Dr Mitchell. 'It's not really GPs' fault,' he adds. 'They haven't got enough time to give longer questionnaires. We did find that serious cases were less likely to be missed than milder ones.'

But Dr Mitchell's research shows that at least two patients a week will walk out from an average surgery with a prescription for a totally unnecessary and possibly damaging antidepressant. That adds up to hundreds of thousands of patients in the UK every year. The most commonly used drugs for depression are SSRIs, or selective serotonin reuptake inhibitors - they come with a range of nasty potential side-effects.

Those for Seroxat, for instance, include loss of appetite, severe mental/ mood changes, uncontrolled movements, irregular heartbeat and a raised risk of cataracts. As well as side-effects from a drug you possibly shouldn't even be taking, coming off such drugs can be extremely difficult, as Clare Morgan found.

The doctors said there were no withdrawal problems, but when I tried to stop taking them, the panic and horror became so great I wanted to kill myself. I even searched for details on the internet about hanging myself. I didn't want to live like that.' Then she came across a charity which specialised in withdrawal from prescription medication.

The Liverpool-based Council for Information on Tranquillisers and Antidepressants is one of the few such centres in the UK . 'We are seeing an increasing amount of people who have a serious problem coming off SSRI antidepressants,' says Pam Armstrong, a nurse consultant and co-founder of the charity. 'Doctors are happy to put people on them, but they haven't a clue about getting them off.'

For the majority of people, misdiagnosis and withdrawal problems are not, however, an issue. For them, the real question is whether the drugs are actually effective. Many say antidepressants have really helped them. But now, one dogged researcher has found the drugs are no better than a placebo - and that the drugs industry has tried to hide this.

Professor Irving Kirsch, a psychologist at Hull University, used the Freedom of Information Act in the U.S. to get access to all the data the pharmaceutical companies had submitted when their drugs were licensed. As well as finding that the negative results were not published, when Professor Kirsch combined the results from the published and unpublished trials, all brands of SSRIs showed up as little better than a placebo.

Even worse, Kirsch says that both the drugs companies and the U.S. regulators knew this, but chose to keep it from doctors and their patients.

He quotes an internal Federal Drug Administration memo saying it was 'of no practical value to patient or physician' to reveal that SSRIs are no better than placebos. But if people do get better on antidepressants, what's the problem? 'The problem is that antidepressants have side-effects and can increase the risk of suicide when given to children or young adults,' replies Professor Kirsch.

'There are safer and more effective alternatives,' he says, referring to talking therapies. In fact, officially these are precisely the sort of treatment Clare Morgan and many others should be getting, instead of 'harmful' drugs. Since 2004, NICE has recommended that patients with mild to moderate depression or anxiety should be offered a talking therapy.

The one with the best evidence is called cognitive behaviour therapy (CBT), which concentrates on changing the thoughts that go with negative feelings. The benefits are clear: those getting this treatment are less likely to relapse than those on antidepressant medication. In one study, the relapse rate was 5 per cent on therapy, 40 per cent on the drugs.

Even patients who feel they have benefited from antidepressants often appreciate help from a therapist as well, as Louise Luxton, a 36-year-old make-up artist living in London , discovered. She'd suffered from anxiety and was put on Prozac, ­but 'felt terrible'. She says:­ 'Seroxat worked better for a while. ­ But years later when things got really bad, ­Seroxat didn't help at all.'

What did help was medication in combination with a talking therapy. 'The therapist taught me techniques to use when the anxiety gets too bad and he found the right drug for me. I wish I'd been able to see him a lot earlier.' She's now happily married and planning to have a baby.

But talking therapy is infamously hard to find. Nearly three-quarters of GPs say they hand out pills becasue therapy just isn't available, a recent study by the Mental Health Foundation found. Indeed, Louise had to pay for treatment privately. 'If you don't have that sort of money, your prospects can be pretty grim,' she says.

Three years ago, the Government announced it was spending £173million on training an army of 3,600 extra therapists which could be rolled out across the country by 2011 to provide CBT to all those suffering from depression and anxiety. Professor David Clark, who heads up the scheme, is optimistic about reaching this target: 'By 2011, we are due to have all the therapists in place and we will have provided treatments to an extra 900,000 patients over the three years,' he says. So far, 115 out of 154 primary care trusts in England have agreed to set up a centre.

But as Good Health has discovered, the roll-out of the scheme nationally may be having the effect of actually reducing the number of therapists in some areas. Mariam Kemple, of the mental health charity Mind, explains. 'We've been getting reports that when the money to set up one of the new centres comes through, the primary care trust cancels contracts with existing therapists, saying the centre will be providing treatment for depression and anxiety in future.'

Similar reports have come in from the British Association for Counselling and Psychotherapy. 'The whole point of the project to roll out new therapy centres was to make up for the serious shortage of talking treatments,' says Paul Farmer, chief executive of Mind. 'We would be extremely worried if some trusts are axing existing services and using the new one as a replacement.'

Professor Clark blames the way funding is going into the local trusts' general pot - 'some may have been deciding to save money on existing provision'. Although the Government has just pledged to spend £70 million over the next year providing more therapists and centres, this is not going to be ring-fenced.

This provision matters, as Clare Morgan knows only too well. 'If I'd been able to see a therapist initially, everything might have been different. Someone might have spotted that my symptoms weren't necessarily depression,' she says. Now taking steroids for her condition, she is training to become a science teacher.

'Lots of people say they benefit from antidepressants, but doctors need to be more responsive when patients say they are having a bad time with them. Increasing the dose is often not the answer.' 29.6.10

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Action on Britain 's epidemic of pill addiction

Peer to use House of Lords speech to reveal relative's addiction to prescription drugs. The Department of Health has launched a review of the million-plus patients addicted to prescribed drugs in the UK in a tacit admission that attempts to control the problem over the last two decades have failed.

An estimated 1.5 million people are addicted to prescription and over-the-counter drugs including benzodiazepine tranquillisers, sleeping pills such as zoplicone - implicated in the death of Hollywood star Heath Ledger - and painkillers containing codeine.

The review, which began in July, was disclosed in a Westminster hall debate last June but has not been formally announced. It followed a report by the House of Commons all-party group on drugs misuse which called for better training for doctors in the risks of over-prescribing, greater awareness of the scale of addiction and more centres for treatment.

On Tuesday, Lord Montagu, the Earl of Sandwich, is to seek details of the Government review in the House of Lords and will say how the problem of addiction has impacted his own family.

He said: “Since January a member of my family has been suffering from acute withdrawal from this prescribed drug [a benzodiazepine]: his dreadful symptoms mean he is confined to his room, unable to work and attend to his family. He receives no government or medical support because there is none.”

Lord Montagu said the government should take “urgent action” to help victims of benzodiazepine withdrawal and develop a network of clinics to care for them. “I would like to see direct support for people who are victims like the member of my family,” he said.

The addictive properties of benzodiazepines and similar tranquillisers, for which 11 million prescriptions were written last year, were first recognised three decades ago when the best known among them - Valium - was widely prescribed for stress. It became known as “mother's little helper”, after the Rolling Stones 1960s hit, because GPs handed out large quantities of the pills to women trapped with small children in high rise blocks.

In 1980, an item on Esther Rantzen's BBC TV programme “That's Life” detailing the difficulty some people had withrawing from Valium, provoked the biggest response in the programme's history, exposing a problem on a huge scale that had gone unnoticed by doctors. GPs had until then assumed, when patients complained of symptoms of withdrawal, that this was the anxiety returning - and prescribed more drugs. “That's life” was later celebrated as the TV programme that changed the course of medicine.

In 1988, doctors were warned by the Committee on Safety of Medicines that prescriptions for the benzodiazepines should be limited to a maximum of four weeks . The warning was re-iterated by Sir Liam Donaldson, the Government's Chief Medical Officer in 2004. Campaigners say these measures have proved inadequate. The growth of on-line pharmacies, and the ease with which “legal” drugs can be obtained and used compared with the risks involved in illegal drug use, are contributing to the problem, they say.

Pam Armstrong, of the Council for Information on Tranquillisers and Antidepressants (CITA) in Liverpool said: “There are still lots and lots of patients being put on these drugs and kept on them for a long time. I have some sympathy with GPs - they get a lot of pressure from patients who want these drugs. But the problem has been ignored. These are patients who don't go out mugging old ladies and creating trouble - and their needs are not being met.”

CITA has run clinics for addicted patients in GP surgeries across five primary care trusts in the north west for the last 15 years, helping wean patients off their drugs. This month the first private in-patient unit, the Sefton Suite, is due to open in Aintree, Liverpool . “We need services to be established on a national basis,” Ms Armstrong said.

A spokesperson for the Department of Health said prescribing of benzodiazepines had “declined substantially” in the last ten eyars.

“Misuse of any prescription medication can be extremely serious. Our main focus has been on prevention and we are currently looking at how we can further strengthen such measures. This includes reviewing prescribing guidelines and getting the full picture on over-the-counter and prescription drug dependence. We are also working closely with GPs to ensure they are fully aware of any potential side-effects from prescription drugs.”

Case study: 'My life has been shattered'
Matthew (not his real name), was prescribed Efexor, an antidepressant, and Clonazepam, a benzodiazepine, to help him sleep following the failure of a business venture in 2001.

He was living abroad but returned to Britain where the prescription was continued. “For seven years I was fine. I didn't really think about the pills, I took them as vitamins. It was something I did at the end of the day.”

Earlier this year increasing fatigue prompted him to try and withdraw from them. His doctor advised a “cold turkey” approach involving a few days in hospital, after which he would be drug free.

“I went in as a happy confident person and in two days I was a train wreck. I felt I had woken up in a horror film, I couldn't walk or think and I had lost my memory. It was indescribable torture.”

Nine months on, he is still trying to put his life back together. Married with two children, he has been unable to return to work.

“I am still terrified of going outside, I can't think straight or concentrate and I have very bad depression. Every single stimulus seems scary and heightened. It is absolutely extraordinary a prescription drug can do this to you. My life has been shattered.”

“There is nowhere for me to go for support except to other sufferers on the internet and one or two people who have set up support groups round the country.”

“I have seen several doctors since and they cannot believe my doctor kept me on these drugs for seven years. I have lodged a formal complaint about him.” 31.10.09

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The Heroin Trial Failure

The Lancet report (29 May 2010) of a recent heroin prescription trial has been widely promoted as a success. But only five out of 43 clients (11.7%) - who received a 450 mg of legal heroin twice a day plus a nightly oral methadone supplement over a 26 week period - managed to get off street heroin. The remaining 38 decreased their consumption of street heroin while on the legal stuff but are still involved in the illegal heroin market, still involved in the crime, harm and misery related to it.

Regardless of the results, the authors make the following recommendation based on their study: "UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts." 

What is a significan and surprise finding is that, even when offering free heroin, the programme has such a limited impact on the use of street heroin. And it is far costlier than rehab - up to five patients could go to rehab with a possibility of becoming drug free for the cost of each one still on drugs and with unchanged lifestyles in the Riott trial.

The cost of heroin prescription per client is estimated to be about €18,000 a year, far more than for other treatment options. The UK government has spent about €700,000 on two heroin trials last year.

MISLEADING MEDIA REPORTS
Even Reuters fell victim to the prescribers' interpretation. "Prescribing heroin to addicts who can't kick their habit helps them stay off street drugs, British researchers said Friday", under the headline "Prescription heroin helps addicts off street drugs". This is misleading. 

Associated Press reports that "Some heroin addicts who got the drug under medical supervision had a better chance of kicking the habit than those who got methadone, a new study says", under the title "Study: heroin better than methadone to kick habit".

First of all, to "kick the habit" means to get off the addiction. The aim of the trial was not to get people off addiction, and it did not even measure that. Second, the study does not say that heroin is better than methadone, it suggests that for some hard to treat clients (5-10% of the heroin addicts) heroin might give better results.

To see such inacurate and misleading reporting by the world's two most serious news agencies should worry everyone who is interested in how science is translated. What this trial illustrates is the limitations of such harm reduction measures rather than its strengths. It also illustrates how scientific results may be distorted and misleading, possibly intentionally.

The researchers display a profound lack of understanding of what addiction is. The report's lead author Johon Strang says the results shows they have "turned around" the users' drug problem. What is in fact "turned around" is a small piece of the symptoms of addiction in a small group of people. The drug problem is not turned around and certainly not the addiction.

REFERENCE 
The study is called Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial, written by John Strang and collegues. Source: Addiction Today 11.6.10

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Prisoners' drug habits maintained, not stopped - report

Thousands of drug-addicted prisoners are having their habit "maintained" rather than halted while serving their sentence, a think-tank has said. The centre-right group Policy Exchange said most of the 45,135 prisoners in treatment in 2008-9 were given drug substitutes for three months or more. Its report suggested the approach by the previous government had "failed".

Author Max Chambers said it had become the "easy option for prisoners' habits to simply be maintained by the state". He added that "little effort" was being made to "properly address [prisoners'] addictions".

The research report, called Coming Clean, suggested the setting up of the Integrated Drug Treatment System (IDTS) in 2007 had led to an increase in the frequency and length of prescriptions for methadone and a decline in shorter detoxification programmes. But the Department of Health said IDTS was being continued.

The system is being brought in across prisons in England and Wales to provide "evidence-based treatment tailored to the needs of the offender". "It is currently the subject of a rigorous and extensive four-year prison research programme," said a spokesperson.

They added: "Clinical guidance recommends that prisoners jailed for more than six months should not be maintained on methadone unless there are exceptional circumstances. "All treatment, whether in or outside prison, should be aimed at getting people off drugs and maintenance can be part of that programme."

The Policy Exchange report calls for longer-term prisoners to be expected to become drug-free as part of their parole and for more focus on abstinence-based treatments. Its report begins by saying: "It is an open secret that our prisons, traditionally thought of as secure institutions, are awash with drugs. "The easy availability of drugs in prisons undermines treatment programmes, allows prisoners to maintain anti-social habits during their sentence, and leaves them unprepared for release and primed to reoffend."

It said there was "no doubt that significant additional funding was provided... by the previous government, attempting to both reduce the supply of drugs and to reduce demand for them through engaging prisoners in treatment programmes". But it concluded there were still problems with the way the issue was being approached.

Director of the Prison Reform Trust Juliet Lyon said about three-quarters of people entering prison tested positive for class A drugs. "To cut crime, save money and improve public health, more effort needs to be put into treating addicts in the community and reviewing current drug policies." 2.6.10

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Heroin therapy call for 'chronic addicts'

Injectable "medical" grade heroin should be offered under supervision to the most hardened addicts, say UK researchers. A trial in 127 addicts who had persistently failed to quit the drug showed a significant drop in use of "street" heroin after six months. Writing in The Lancet, the researchers said the "robust evidence" supports wider provision of heroin treatment.

A spokesman for the government said it would consider the findings. Around 5-10% of heroin addicts fail to quit despite use of conventional treatments, such as methadone. Those who took part in the trial had been using the drug for an average of 17 years and had been in treatment for 10 years. When they took part in the programme they were on methadone treatment but were still taking street heroin on a regular basis.

The researchers - working at clinics in south London , Brighton and Darlington - found that those offered injectable heroin under the supervision of a nurse were significantly more likely to cut down their use of street heroin than those receiving oral or injectable methadone.

Improvements were seen within six weeks of starting the programme, they reported. In further analysis yet to be published, it was noted that the benefits remained after two years and some patients were able to stop use of the drug altogether.

Treatable
Study leader, Professor John Strang, from the National Addiction Centre at King's College London, said the supervised heroin programme enables patients to start thinking about employment, re-engaging with their families and taking responsibility for their lives.

"This is a treatment for a severe group of heroin addicts that ordinary treatments have failed with and the question we're answering is 'are these patients untreatable?'." "The very good news is that you can get these people on a constructive trajectory."

He said the latest study plus a series of other trials now provide clear evidence that this type of treatment should be offered more widely. It was outlined in the UK government's 2008 Drug Strategy, subject to the results from this trial. He added that although more expensive than conventional treatments, heroin therapy is considerably cheaper than imprisonment.

A Department of Health spokesman said any approach that gets people off drugs for good should be explored. "We will look at evidence and both the clinical and cost effectiveness of these treatments. "However, it is vital that we do all we can to prevent people using drugs in the first place."

Dr Roy Robertson a reader in the Department of Community Health Sciences at Edinburgh University , said whilst none of the outcomes are close to achieving abstinence, treatment with supervised injectable heroin "seems to be our best option". "This is the intensive care for those heroin users who have failed after all sorts of other available treatments and continue to inject."

DrugScope chief executive Martin Barnes added that there is no "magic bullet" and several treatment interventions may be needed before someone becomes drug free or cuts down their drug use. "On the basis of the outcomes described, there is a strong case for extending heroin prescribing as a carefully targeted and closely supervised form of treatment for chronic addiction."

But critics said 'the scheme was out of date and belongs to the old Labour regime of trapping people in state sponsored drug addiction. It is obvious if you give addicts free heroin they are going to use less 'street heroin' however this does not mean the scheme is a success, now the tax payer is directly funding addiction. New treatments are required to help stop addiction rather than finding new ways to prolong it'. 28.5.10

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Home Office does not know what impact its £1.2bn-a-year drug user scheme provides

Committee of MPs finds department in the dark over whether programme to treat problem users reduced drug-related crime. The Home Office does not know what impact its £1.2bn-a-year programme to tackle problem drug use is having, a report by a cross-party group of MPs discloses today.

The Commons public accounts committee says it is unacceptable that the Home Office has failed to properly evaluate its programme to tackle the 330,000 problem drug users in England and does not know whether the strategy is cutting the cost of drug-related crime. The MPs say that the number of problem drug users, mainly chronic heroin or cocaine users, is estimated on 2003-04 figures to cost society £15bn a year – mainly as a result of their criminal activities.

The committee reports that a quarter of all problem drug users are hardcore offenders for whom drug treatment has proved ineffective. In many cases their criminal activity actually increased after going into treatment. "Given the amount of public money that is being spent, it is unacceptable that the Home Office does not know what overall effect this spending is having. It does not carry out enough evaluation of its work and does not know if its drug strategy is directly reducing the overall cost of drug-related crimes," said Edward Leigh, the chair of the committee.

He said it was of particular concern that measures to cut problem drug use by young people were having limited effect. The report, which is based on an investigation by the National Audit Office, says that all drug users receiving treatment need motivation to stay off drugs when back in their local communities, with some problem drug users who have been through prison treatment programmes quickly relapsing on release.

New schemes to ensure that prisoners are met on release at the prison gates and escorted to community services and ongoing treatment may be important to prevent their relapse. The MPs' report also suggests that residential rehabilitation may be effective for those who have failed to "go clean" in other forms of treatment.

Sir David Normington, the Home Office's permanent secretary, told the committee's inquiry that his department had evaluated the main areas of spending on problem drug use but accepted that it had not done an overall evaluation. Giving evidence, he said: "We evaluated, for example, for instance, the huge spending that there has been on treatment and there is a very good return on investment for every pound. We estimate – and this is well validated – a £2.50 return for every pound spent on treatment in terms of benefit in cutting crime and other harms."

Normington added that the other large element of spending – on drug intervention programmes that ensure problem drug users are referred to an assessment for treatment on arrest – was also showing very good returns. "Although we have not evaluated the whole programme and we accept that, we have evaluated the main areas of spending," he said.

But critics said 'the figures are entirely made up and the term 'in treatment' does not mean addicts are stopping their drug use it's just an accounting term, most people 'in treatment' are still using and complete their treatment still drug dependent, current treatment methods are a waste of £1.2bn per annum'. 24.5.10

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A Conservative Government, Science and UK Drugs Policy Failure

A new Conservative Government's antennae need to be on alert from day one for the ‘evidence based' justifications for Brown's bloated state and overreaching policies. For these cliches are symptoms of 'scientism': Evidence based is over-rated, experience and reason underrated. These are the clues to the poisoned chalice of secular, morally unimpeachable thought that the Conservatives must avoid drinking from if they are to make real change.

Earlier this year, Paul Ormerod and Helen Jackson spotted that a mechanistic and reductionist ‘what works' approach to policy had taken over whole swathes of it, eroding the exercise of choice and judgement. 

Even though the empirical evidence be incomplete, narrowly based or totally contrary to experiential knowledge, they noted, its orthodoxy is such that it is what counts.

For an explanation of Labour's dysfunctional drugs policy, we need look no further.  The Conservatives' new drugs policy will be a testing ground for the exceptional political determination it will take to overcome this mindset. My recent encounter with Professor Nutt, the sacked Chair of the Advisory Council on the Misuse of Drugs and Roger Howard, from the United Kingdom Drug Policy Commission, at a Goodenough College debate, gave a taster of what's to come.

My points were met, not with reasoned argument, but by a crude attempt to marginalise, discredit and demonize them.  For suggesting that drugs policy failure could not fairly be attributed to a policy abandoned years ago, but to the lavishly financed harm reduction policy of the last 10 years; for arguing that its unintended consequences merited review, I was styled by Roger Howard (whose task is meant to be the dispassionate bringing together of evidence and analysis to inform policy) as half Jehovah's Witness, half Taliban member.

Yet the ‘evidence based' policy he defends, now costing £1.2 billion a year and upwards, has patently failed to ‘tackle problem drug use', as the PAC's recent excoriation of the Home Office and the National Treatment Agency confirmed.

My plea for policy makers to draw on the real life, non laboratory, experience of those who have recovered from addiction and those who successfully help others to do so might have won some sympathy. Instead it provoked from Professor Nutt the categorical announcement that ‘abstinence' does not work when, arguably, it is the only thing that does.

This disregard for experience is the mark of the philosophical fundamentalism – or scientism – that has dictated Labour's all-encompassing ‘harm reduction' approach to drug policy. The absence of scientific ‘evidence' (randomised control trial evidence alone counts) that people can get better has been ruthlessly used to disqualify this most reasonable and rational of policy aims – that people should and can get better, the history of the epidemiology of addiction confirms.

The harm reduction policy takeover has truly been a case of where, as Phillips puts it, “ideology, by wrenching evidence to fit a prior idea is inimical to reason and sacrifices truth to power”. Its creed that drug use is morally neutral, even a human right, gives unending responsibility to government to prevent harm in those unwilling or unable to stop. Any ideas of free will, choice or responsibility are anathema.

Applying science to meet this belief has led to the most perverse of policy outcomes. The most limited of evidence (for a review of it see The Phoney War of Drugs) has indeed been wrenched to shape all aspects of drug policy. A few methadone trials and an unproven but widely accepted assumption by public health doctors that needle exchanges have saved us from an Aids epidemic are the only justification for the mass expansion of both (at the expense of any other form of treatment or prevention).  Under a platitudinous nomenclature of harm reduction they have been accepted almost without question as the panacea for drug related crime, for public health, community safety and child welfare.

The ‘what works' orthodoxy sustains this illogic. Policy interventions can only be assessed on the basis of a limited set of provable consequences, or evaluated through expert research.  In this world view evidence of relapse after abstinence treatment is taken as proof of its failure – not as experience tells us, the likely beginning of a period of sustained recovery. In this world view enquiry into the well being of children of addicts is neither demanded nor considered. It is irrelevant. For the evidence says methadone stabilises their parents' lives. No matter that it does not or is insufficient.

The policy outcome is today's utilitarian harm reduction treadmill of methadone maintenance, needle exchange and lifetime dependency on ‘treatment' and welfare in which children come a poor third to these competing demands. It is 'scientism' in action: “where the transgressive become the norm, while the normal is discriminatory”.

Thankfully there are limits as to how much of this madness human nature can sustain. I was cheered to hear that one DAAT team is urgently reviewing everyone on its books that has been on methadone for four years. It now plans to offer them a detox, a short residential programme and community support to remain abstinent and is scrambling to get hold of any detox capacity going – not for philosophical reasons but because they simply cannot afford their rocketing prescribing costs anymore.

Prisons of course used to have the greatest detox capacity nationally, before the fashion for harm reduction community treatment. In fact ten years ago the seven London prisons had more detox beds than the whole of the NHS.

But thanks to the ideologically inspired Integrated Drug Treatment System that Labour has so efficiently imposed on the entire estate in less than four years, its detox capacity has plummeted. Now the prison service is a net exporter of drug users on methadone, putting a further burden on community prescribers.

For back in prison predictions of those needing methadone have been wildly exceeded – not surprising in the absence of detox beds and the end to the culture of detoxification.  Double or treble the anticipated number ‘need' methadone, making services unsafe and prisoners unable to move on.  Such is the sacred cow of overdose prevention that retox not detox is now the order of the day.

Awareness of this upside down policy world has yet to permeate the committee corridors of Westminster where the All Party Parliamentary Group on Drug Misuse still lives in a ‘treatment works' and ‘evidence based policy' la la land.

Enlightenment too, has yet to reach the Liberal Democrats (active on the drugs groups), who stand in the vanguard of the belief that science can deal with every aspect of human existence. Their manifesto promise is to “always base drug policy on independent scientific advice…” (my italics).

And any hope that Labour parliamentarians might see reason and  upset the edifice of scientism in face of this policy catastrophe was dashed by Paul Hayes' (of the National Treatment Agency) aggressive defence, on behalf of himself and NICE, of the evidence base, to the Public Accounts Committee.

The Conservatives will undoubtedly be put  beyond ‘the moral pale of evidence'  when they turn their back, as they must, on “today's pragmatic approach”, which the latest official EU homage to ‘harm reduction and the mainstream' now fully endorses. But this self styled scientific monograph that demands the policy balance be “tipped to what can be shown to work rather than what policy makers might wish would work” should be greeted with the derision it dererves. Just another piece of scientism. Kathy Gyngell Centre for Policy Studies 21.5.10

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Will Conservative plans to overhaul heroin addiction treatment work?

Prescribing methadone to addicts has become a favoured option to cut drug-related crime and treat users, but a Tory government would overhaul the system. What are the implications?

The policy of giving problematic drug users the heroin substitute methadone – a cornerstone of official efforts to cut the huge amount of crime linked to illicit substance misuse – is being criticised as a waste of money that does little to wean people off drugs and leaves too many of those receiving regular doses of the green liquid living "half-lives".

The fact that David Cameron, during last week's televised party leaders' debate, voiced his concern that too many problem drug users do not manage to shake off their addiction shows that the issue has attracted attention in high places.

A coalition of opponents of methadone maintenance includes the Centre for Policy Studies rightwing thinktank, leading drugs researcher Neil McKeganey and, most ominously for the vast majority of workers in the drugs field who are pro-methadone, many senior figures in the Conservative party.

There are an estimated 330,000 people in England alone who are addicted to heroin, crack cocaine, or both. They are extremely challenging, cost the country an estimated £15bn a year, and commit an estimated £13.9bn of crime annually. A record 200,000 of those 330,000 are in treatment, which usually involves methadone. Drug treatment has expanded in recent years, with around 11,000 drugs workers in England and at least 1,000 drug projects across the UK, variously funded by the NHS, councils, the police, charities or combinations of some of them. Some £800m a year is spent on drug treatment, half of it by the NHS's National Treatment Agency for Substance Misuse.

The Tories want an overhaul of the system, with many more people going into residential rehabilitation and making a serious effort to become drug-free, and fewer being given methadone. "Methadone maintenance is under the spotlight," says Martin Barnes, chief executive of DrugScope, which represents about 700 local drugs agencies. "There had been differences of opinion in the field for a while because some people weren't comfortable with methadone maintenance."

Their case has been bolstered by the cross-party public accounts committee, which two weeks ago issued a highly-critical report, called Tackling Problem Drug Use. It said that just 15,000 of 165,000 problem drug users who underwent community-based treatment last year emerged free of dependence but critics questioned the validity of the term 'drug free'. In NTA speak it means free of their drug of choice not necessary free of ALL drug dependency.

In addition, it said it was "unacceptable" that the Home Office had not properly evaluated whether key elements of its £1.2bn-a-year strategy to tackle drugs misuse in England actually worked, and did not know if that strategy directly reduced the huge cost of crime committed by addicts.

"The department [Home Office] does not know how to most effectively tackle problem drug use," the MPs said, before adding that "residential rehabilitation may be effective for those who have failed to 'go clean' in other forms of treatment". That is what the Tories want more of.

The gathering storm over methadone began in late 2006, when former Tory leader Iain Duncan Smith's Centre for Social Justice thinktank published its Breakdown Britain report. Partly informed by Duncan Smith's scathing critique of methadone, the Tories have in the last two years attacked the reliance on methadone to treat large numbers of addicts as "failed" and "wrong". Shadow justice secretary Dominic Grieve, for example, has claimed: "The government's approach of trying to 'manage' addiction is an admission of failure."

David Burrowes, a shadow spokesman on criminal justice, is one of the Tories who have been consistently questioning the cost and efficacy of methadone treatment, both in the community and in prisons. "It's not for me to cast moral judgments about whether methadone is wrong or right," says Burrowes, a former criminal solicitor whose interest in drugs policy developed from seeing clients with chaotic or ruined lives fail to kick drugs. "We need to look at outcomes, and the outcomes are just not good enough.

"The public expect that addicts have to get off their drugs, but too many end up parked up on methadone. They become dependent on it and end up not being able to contribute to their families or society. I've seen too many individuals on methadone who are living half-lives, and that's not good enough." Burrowes also claims that it does not cut crime – the main justification for the policy.

The Tories want much more effort put into getting drug-using offenders to go clean – what they call "recovery" – and their manifesto proposes abstinence-based drug rehabilitation orders. But some say that is a simplistic response to the complex problem of opiate dependency. Defenders of methadone point out that the policy was introduced by the previous Tory government as a vital harm-reduction measure.

Roy Robertson, an Edinburgh GP and ex-member of the Advisory Council on the Misuse of Drugs, is dubious that abstinence will work for many users. "Most governments have endorsed methadone treatment, not because they liked the implications that drugs are only controlled by this palliative method, but because there are few alternatives," he says.

Barnes argues that every drugs worker wants their clients to get clean, and the "maintenance v recovery" debate is a polarised argument that doesn't help anybody. "The evidence is that methadone is a very effective treatment for helping many people out of their chaos, such as cutting crime," he says. "It stabilises people and helps them re-establish relations with their family."

DrugScope is calling for a balanced treatment system tailored to the needs of the client, incorporating both maintenance and abstinence options.

It is hard to predict what a change of policy under the Tories would mean. While some addicts would accept a place in an abstinence-based rehabilitation centre, many would not. "If there's a shift away from methadone, and spending on services offering maintenance [through methadone] is cut, the danger is that drug users might vote with their feet and drop out of treatment or not come forward in the first place," Barnes warns. "It's a major attraction for heroin users going into treatment that they'll be offered a methadone script." But others say 'it goes to show just how out of touch Mr Barnes is as most heroin users don't want to go on methadone, so they don't come forward for treatment'. 14.5.10

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Mephedrone ban 'could do more harm than good'

The Government's former drugs tsar has warned that banning the dance drug mephedrone could do more harm than good. Professor David Nutt said a ''new approach'' to dealing with synthetic drugs was needed. He suggested the regulated use of drugs like mephedrone and ecstasy in controlled environments, such as clubs, may be the way forward.

Home office minister David Hanson earlier announced mephedrone could be made a class B drug by April 16. Home Secretary Alan Johnson has laid a draft order before Parliament to approve a ban on the substance, which is also known as M-Cat or miaow miaow, and similar cathinone derivatives.

The drug has been linked to up to 25 deaths in England and Scotland by the media but there is no scientific evidence to support these claims.

Mr Hanson said chairman of the Advisory Council on the Misuse of Drugs (ACMD), Les Iversen, had made clear ''the harms that these drugs undertake justify control'' under the Misuse of Drugs Act. But Professor Nutt, who was sacked as ACMD chairman after saying ecstasy was less harmful than alcohol, criticised the Government's ''knee-jerk'' approach to mephedrone.

He said the Government should have waited for the results of a study from The European Monitoring Centre on Drugs and Drug Addiction, which is due to report in July. Speaking ahead of a lecture at Greenwich University , he said: ''We need a new approach with dealing with these synthetic drugs. "'I wonder if there may be alternative approaches". ''I find it very difficult to support criminalisation of people who are using drugs which are less dangerous than alcohol.''

He criticised the Government's ''knee-jerk'' reaction over the ''supposed problem'' which has been ''whipped up'' into a hysteria. He said: ''These knee-jerk reactions aren't dealing with the core of the problem. ''They need to have a proper, mature debate about how best to deal with drugs.

''Why don't we at least think about alternatives and allow people like me to mention them without being vilified. "'We regulate other drugs, alcohol and tobacco. Why are we so hostile to (regulating) new drugs? ''One way of reducing drug harm may be to regulate their use in controlled environments.

''Maybe we would allow clubs to sell small amounts of drugs, like mephedrone and ecstasy, in a safe environment, just like we sell alcohol. ''There is no scientific reason why mephedrone and alcohol should be seen as different.'' He continued: ''I hope that we start doing some very careful assessments of the consequences of making it illegal. ''We have to make sure there is not a rise in criminality, with gangs getting involved.

''We've heard already the Chinese are gearing up to make another drug. ''We will be in the same boat in a few more months, possibly with a more dangerous drug.'' On Sunday Dr Polly Taylor quit as the veterinary member on the ACMD, accusing ministers of not dealing fairly with independent scientific advice.

Mr Johnson denied the resignation would affect the legality of the ban and said the committee was "legally constituted" when its advice was put forward.

But Professor Nutt said: "I think it's not properly constituted and I think a legal challenge (to the ban) is a tenable approach but it doesn't make any difference in the long term. "I think we need to think more broadly about the question of scientific advice and whether the Government is going to do things based on rational science."

Shadow Home Office minister James Brokenshire welcomed the move to ban the drug, saying: "The tragic cases of those who are thought to have died as a consequence of taking mephedrone have highlighted the dangers of this drug." Liberal Democrat spokesman Chris Huhne also welcomed the proposed ban but expressed concern at the length of time it had taken to achieve. The ACMD said mephedrone has similar effects to amphetamines and can cause temperature changes, heart palpitations and paranoia.

Prof Iversen said his message to users was: "This is not a simple, harmless party drug. Just because it is legal doesn't mean it is safe." 31.3.10

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1,000 new drug addicts every month

A THOUSAND new junkies were registered every MONTH in Scotland last year, it emerged yesterday. Shock new figures show 11,995 new patients were added to the Scottish Drugs Misuse Database. And the cost of doling out methadone to addicts topped £16MILLION.

Chemists handed out 493,770 prescriptions for the heroin substitute - now used by 1 per cent of the population. There were also ten babies a WEEK born to junkie mums. More than half of the new addicts were heroin users, with 3,247 using diazepam, 3,051 cannabis, 1,231 cocaine users and 526 on crack.

The chilling stats were released as drugs expert Professor Neil McKeganey warned that each addict costs Scotland £60,000 a year. That adds up to an annual bill of £3.5BILLION. And last night he insisted it's time to get addicts off all drugs - including methadone.

Dangers
Prof McKeganey said: "Our political leaders are passing responsibility to those prescribing the drug in the first place. "This situation is going to get worse." Scots Tory leader Annabel Goldiesaid: "It is shocking that 42 per cent of addicts have dependent children. "The focus of treatment has to be shifted to effective recovery."

Lib-Dem Robert Brown said: "The Government has not cut the number of addicts, and more people than ever are on methadone. Labour's James Kelly said: "Almost a quarter of 16 to 24 year olds took illegal drugs in the last year. "More has to be done to educate them about the dangers of drug use."

A Scottish Government spokesman passed the book and said: "It is for individual clinicians to decide the most appropriate medical treatment for any person." 31.3.10

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Methadone for addicts cost Scotland £16m a year

Prescribing the heroin-substitute methadone to drug addicts is costing Scotland more than £16 million a year, according to the latest official figures. Nearly 495,000 doses were handed out to addicts during 2008/09, the last year for which data is available. The prescription rate is equivalent to a national average of 96 in every 1,000 Scots – an increase of nearly 20% in the last five years alone.

Last night experts said it was time to rethink the way methadone is used to treat addiction, with concern that the current model is unsustainable. There are currently about 22,000 people on Scotland 's methadone programme. Professor Neil McKeganey, director for the Centre of Drug Misuse Research, has frequently criticised the country's over-reliance on the heroin substitute. He told The Herald: “We should have a cap on that programme. We should either limit the number of addicts who can be on the programme, or we should limit the length of time addicts can be on the programme.

“It's substituting one addiction for another and it isn't leading the addicts along the road to recovery. It's leading them down an avenue of continuing drug dependence and, in the current financial climate, it's absolutely unsustainable to fund a programme of that scale indefinitely when it's delivering such modest benefits.”

A spokeswoman for the Scottish Drugs Forum said that focusing on the treatment of addiction obscured the underlying causes of drug abuse. “Rehabilitation is about more than just detox,” she said. “If the psychosocial therapy is not there, then recovery will fail regardless of whether it's through abstinence or methadone substitute.”

Methadone oral solution is the most commonly used pharmacological treatment for opioid dependency in Scotland. It is given to heroin addicts to aid the transition from drug dependency to rehabilitation, but it has attracted controversy over fears that recovering addicts end up “parked” on methadone.

According to the latest figures from the Scottish Drugs Misuse database, the rate of prescriptions has more than trebled since the mid-1990s, when it stood at 26 per 1,000 Scots. It has risen 19% during the last five years – from 81 per 1,000 population in 2004/5 – but there are signs that it has begun to level off more recently, remaining unchanged over the last three years.

The NHS statistics showed there were 493,770 prescriptions for methadone in 2008/09, up by 862 compared to the year before. The cost has now reached £16.1m – up from £15.2m the year before and from £12.9m in 2004/05.

The west of Scotland displays the highest prevalence of methadone use, with the prescription rate in Greater Glasgow and Clyde health board almost double the national average at 179 per 1,000 population. Ayrshire and Arran comes in second, with 126 users per 1,000 population. Most addicts are in their late 20s and early 30s, around 75% are males and more than 95% describe their ethnic origin as white Scottish.

Conservative justice spokesman Bill Aitken said: “Methadone does have a part to play but we are doing neither the addict nor the NHS any favours by leaving people parked on methadone long-term.” LibDem justice spokesman Robert Brown said the figures showed Scotland was not properly “getting to grips” with drug misuse.

Meanwhile, Labour's community safety spokesman James Kelly described a 4% increase in drugs-related offences as a “wake-up call” for the Scottish Government. A Government spokesman said £28.6m was being invested in frontline drug treatment services to help drive down waiting times for treatment. He added: “In October-December 2009, 86% of those offered an appointment for assessment were offered a date within four weeks of referral.”

But critics say 'the 4 week figure is meaningless as the number of methadone addicts continues to grow as current treatments are ineffective'. 31.3.10

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Big jump in cocaine use 'deeply concerning'

New figures show the use of cocaine has increased five-fold among 16 to 59 year olds over the last 12 years, prompting a review into the effects of the drug. The Advisory Council on the Misuse of Drugs (ACMD) also said the purity of street samples had decreased.

The council's chairman Professor Les Iversen, who took over from Professor David Nutt after he was sacked last year, wrote to the home secretary about a review of the drug. He said he hoped it would "counteract the increasingly common misapprehension that cocaine is a relatively safe drug", but said he did not expect it to result in a call for a change in the classification of cocaine. The review is expected to take about a year.

He also referred to British Crime Survey statistics showing that 6.6 per cent of young people aged between 16 and 24 used cocaine last year , compared to 1.3 per cent in 1996. Usage among those aged 16 to 59 also jumped from 0.6 per cent to 3 per cent during the same period.

The professor wrote: "Cocaine is a very harmful drug to individuals and more broadly society and evidence of the continued increasing prevalence of cocaine use is deeply concerning."

Yesterday NHS figures showed that the number of under-18s being helped to stop using cocaine has increased by more than 65 per cent since 2005. Treatment numbers for 18 to 24-year-olds also doubled in the same period, but critics said 'the NTA figures could not be trusted'. 2.3.10

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Scheme to let new drugs bypass NHS value watchdog

• Drayson plans fast track for 'innovative' medicines
• Treasury fund would pay for high-cost treatments

Drug companies with "innovative" medicines would be able to bypass current safeguards and sell to the NHS at a high price under a fast-track procedure to be proposed next week by the Office for Life Sciences (OLS), run by science minister Lord Drayson.

The proposal, in a blueprint being prepared behind closed doors with input from the pharmaceutical industry, will effectively undermine the present system of approving medicines for the NHS. It will allow companies with medicines they claim are valuable and original to bypass the National Institute for Health and Clinical Excellence (Nice), which currently must assess every new drug to ensure it offers value for money before it can be used in the health service.

The pharmaceutical industry has been fiercely critical of Nice since its inception in 1999 because it blocks sales of expensive drugs to the NHS that are of only limited benefit. Its protests have been backed by an outcry from patient groups, often partly funded by the pharmaceutical industry, which want new drugs to treat their particular condition.

The proposal comes from OLS, run by Drayson, a former drug company boss. His remit is the promotion of the life sciences as potential big earners for Britain. Lord Mandelson, whose business department oversees the OLS, believes pharmaceuticals are key to the revival of the economy.

The blueprint will recommend that medicines thought suitable for fast-tracking should be allowed into the NHS for a period of time without Nice scrutiny.

Pharmaceutical companies are reluctant to launch new drugs in the UK at low cost because 25% of the global market is influenced by the UK price. Under the OLS proposal, Nice would appraise the drug after perhaps three years – but at that point the company may be willing to drop the price here. Critics will say the proposal threatens to undermine Nice by allowing into the NHS costly drugs that may offer no real health gain.

It comes at a time when other countries are actively considering setting up equivalents to Nice. First among them, and most important for the pharmaceutical industry, is the US . President Obama is known to be interested in some sort of cost-effectiveness scrutiny of medicines, which is bitterly opposed by the industry.

Joe Collier, emeritus professor of medicines policy at St George's , University of London and an adviser to the select committee on health's inquiry into the pharmaceutical industry, said there were already safeguards in Nice to propel medicines that are truly innovative and needed into the NHS rapidly, and a fast-track proposal was not needed. "It should not need to embarrass the current arrangements. If it either is designed to, or it does, then the system has got to be rethought," he said.

"If it is an attempt to undermine the Nice process or throw the Nice process, then it is misguided and mischievous."

While the scheme is the brainchild of Drayson's office, the implications for the Department of Health have led to cross-departmental negotiations, which were still going on at a late stage this week.

Crucial to winning the support of health ministers and primary care trusts‚ which foot drugs bills locally‚ has been the Treasury, which agreed to fund a pot of money to pay for "innovative" drugs, so the NHS does not have to bear the cost.

Who decides which drugs are sufficiently innovative may be more difficult. It is likely that Nice itself will be invited to help select them. Those that are original and claim to offer better treatment or a longer life – but to small groups of patients – will be prime candidates. One of the arguments for this approach is the invention of "targeted" drugs such as Herceptin, which work on people with a certain genetic make-up but not others. 10.7.09

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Benzodiazepines anxiety drugs like Valium are addictive in the same way as heroin, warn scientists

A popular form of anxiety drugs use the same potentially addictive 'reward pathways' in the brain as heroin and cannabis, scientists have warned. Researchers from Switzerland and the U.S found benzodiazepine drugs such as Valium and Xanax exert a calming effect by boosting the action of a neurotransmitter. This in turn activates the gratification hormone, dopamine, in the brain, and is the same 'reward pathway' activated by some illegal drugs.

The findings may help in developing a next generation of non-addictive benzodiazepines, they wrote in the journal Nature. Roche's drug Valium, known generically as diazepam, is the best known of the benzodiazepine class of drugs, and is prescribed on the NHS.

It and Ativan were among a host of other prescription drugs found in the blood of American pop star Michael Jackson when he died in June last year. The study found that benzodiazepines seemed to work by binding to a particular part of the neurotransmitter called gamma-aminobutyric acid.

The findings show that developing similar benzodiazepines that bind to a different part may offer the same drug benefits without the addictive side effects, they said.

A study published earlier this month found that people with higher levels of dopamine in the brain tend to be more prone to addictive behavior.

Drug companies have been trying for some time to develop next-generation benzodiazepines by tweaking their chemical make-up to deliver a more selective effect that avoids unwanted side effects, but it has so far proved an uphill struggle.

German scientists conducting early research into a new compound said last year they thought they may have found a better anxiety drug which could counteract panic attacks without the side effects of existing drugs. 11.2.10

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One hundred babies a month born with drug dependency to mothers hooked on heroin and crack

One hundred babies are born with drug withdrawal symptoms every month, it has been revealed. The symptoms associated with babies who are addicted to drugs are a loud, high-pitched crying, sweating, fever and stomach upsets. These babies often need specialised care in hospital before they are allowed home and on occasions are taken from their mothers and placed in care.

A total of 1,233 cases in England - 102 a month - were reported last year, according to statistics from the Department of Health. While only 751 infants were diagnosed with the problem in hospitals in 1998. In five years, the number of cases has risen by 179.

The North-West of the country was the worst hit area last year with 168 cases of babies born with drug withdrawal symptoms. South-West was second with 159 cases, while Yorkshire and Humber were third with 155.

Norman Wells of the Family Education Trust said the figures showed how drug addiction of one generation could have destructive consequences for the future generation. 'The Government needs to recognise the connection between family breakdown and social decay,' he told The Sun.

A Department of Health spokesman said: 'It is unclear whether there has been a real rise in the number of babies born suffering from the mother's addiction, as we suspect that a better of awareness of drug misuse has led to an increase of awareness and identification'. 'The Department wants to make sure that pregnant women who misuse drugs are properly cared for during and after their pregnancy.

'We have issued guidance to the NHS to ensure that mothers in this situation are supported and monitored, and the health needs of the baby are assessed to minimise any health risks arising from the mother's drug misuse, including withdrawal symptoms at birth.' Critics say the DoH response is meaningless. 27.1.10

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Obesity drug used by 86,000 patients is banned over heart attack fears

Tens of thousands of patients have been ordered to stop taking a popular fat-busting drug suspected of raising the risk of heart attacks and stroke. The European Medicines Agency last night suspended the licence of the drug Reductil, which was taken by 86,000 Britons last year. The safety watchdog fears it could threaten the health of the overweight and obese - although it says any side-effects should not be fatal.

However, some 17 deaths have been linked to the drug in Britain since 2001 - six of which were caused by heart attacks and strokes. Some 1,105 suspected adverse reactions have been reported, a third of them serious. Last night doctors and pharmacists were told to stop handing out Reductil. And experts urged everyone who takes it to make an appointment with their GP to discuss alternative ways of losing weight.

It is the second popular antiobesity drug to have its licence suspended. Two years ago, the EMA suspended Acomplia over fears it could lead to suicidal thoughts. The agency came to its decision on Reductil after examining an international clinical trial, which showed that its main ingredient - sibutramine - increases the risk of heart problems. Sibutramine tricks patients' brains into making them feel full, meaning they eat up to 20 per cent less.

Last night, Dr June Raine, of the UK Medicines and Healthcare Products Regulatory Agency, said: 'Evidence suggests that there is an increased risk of non-fatal heart attacks and strokes with this medicine that outweigh the benefits of weight loss, which is modest and may not be sustained in the long term after stopping treatment.

'Prescribers are advised not to issue any new prescriptions for Reductil and to review the treatmentof patients taking the drug. Pharmacists are asked to cease dispensing the medicine. 'There are no health implications if people wish to stop treatment before seeing their doctor.'

The international trial examined by EMA followed 10,000 patients over six years. It found a 16 per cent increased risk of heart attack and stroke.

Many of those who took part in the trial had cardiovascular problems - even though one of the listed side effects of the drug is that it can raise blood pressure. The agency said that although the drug was off limits to those with heart problems, those needing it were likely to have undiagnosed cardiac conditions because of their weight.

It pointed to studies which showed that weight loss achieved with Reductil was often modest and may not be maintained after stopping. This meant the benefits did not outweigh the cardiovascular risks. Reductil is made by Abbott Laboratories and its official side effects are listed as high blood pressure, insomnia, constipation and dry mouth.

It is prescribed to those who have made serious attempts to slim by other means, such as dieting and exercise. Treatments cost the NHS about £45 a month. Last night, Eugene Sun of Chicago-based Abbott said: 'Many people benefit from sibutramine and we respectfully disagree with the committee's opinion and recommendation to suspend the medicine. 'However we will act promptly to comply with the committee's recommendations.'

David Haslam of the National Obesity Forum said he was surprised by the decision and knew of no study proving that Reductil had led to a death from a heart attack or stroke. The EMA's decision leaves Orlistat as the only anti-obesity drug still freely available in the UK. 22.1.10