Dundee Partnership Community Conference 17th September 2011

What are we trying to achieve?

The national picture

Dr Brian Kidd – NHS Tayside

Plan

• Context & history• Harm reduction & recovery• National strategy – The Road to Recovery• Wicked problems• Stigma• Making it happen – The delivery reform process• Conclusions

Context

• Substance use a considerable problem in Scotland

• ~52,000 problem users in Scotland (1/50 adults)

• Many types of substance • Many types of problems• Health effects – eg Drug deaths• Social effects – eg on families, parenting &

criminal justice

History of Treatment

• <1960s – “The British System”“masterly inactivity in the face of a non-existent

problem”• 1960s/70s – “Hedonistic drug use”

– Leads to misuse of drugs act & regulations and access to detoxification

• 1970s/80s – Blood borne virus infection– Leads to rise of “harm reduction”

• 1990s/2000s – Consolidation/investment• 2007……..”The new Abstentionists”• 2008 – The Road to Recovery

National Strategy

Treatment in Scotland: Definition of Recovery

“a process through which an individual is enabled to move on from their problem drug use, towards a drug-free life as an active and contributing member of society”

“In practice, recovery will mean different things at different times to each individual.. (It)..might mean developing the skills to prevent relapse..rebuilding broken relationships..Milestones may be as simple as gaining weight..or building self-esteem. What is key is that recovery is sustained”

“There is no right or wrong way to recover. Recovery is about helping an individual achieve their full potential – with the ultimate goal being what is important to the individual, rather than the means by which it is achieved”

Harm reduction & Recovery

• Continuum of progress• Strong evidence for harm reduction

– Risk taking; death; parenting; social functioning

• Services may become risk averse & limit options• Recovery does not necessarily mean abstinence

– Continued progress in a range of domains

– Empowerment

– Person-centred

– Aspirational

Treatment in Scotland: “the Great Debate”

“harm reduction is often made an unnecessarily contraversial issue, as if there were a contradiction between treatment & prevention on the one hand and reducing the adverse health and social consequences of drug use on the other. This is a false dichotomy. They are

complementary.” (UN 2008)

Scottish Methadone Review – SG 2007

In summary, replacement prescribing with methadone remains the main plank of medical treatment for opiate dependency in the UK. Harm reduction approaches, incorporating methadone treatment, have evolved rapidly in the face of blood-borne virus infection. It has also been seen to be effective in the Criminal Justice arena by reducing the need for imprisonment. Methadone is more cost effective than any other medical treatment for dependency, though other effective interventions should be part of any comprehensive programme, improving patient choice. Outcomes improve if delivered with associated counselling interventions and these should also be standard. The challenge with methadone is to optimise delivery of harm reduction whilst ensuring that progress to recovery is encouraged, facilitating a way out of methadone treatment whenever appropriate.

In summary, replacement prescribing with methadone remains the main plank of medical treatment for opiate dependency in the UK. Harm reduction approaches, incorporating methadone treatment, have evolved rapidly in the face of blood-borne virus infection. It has also been seen to be effective in the Criminal Justice arena by reducing the need for imprisonment. Methadone is more cost effective than any other medical treatment for dependency, though other effective interventions should be part of any comprehensive programme, improving patient choice. Outcomes improve if delivered with associated counselling interventions and these should also be standard. The challenge with methadone is to optimise delivery of harm reduction whilst ensuring that progress to recovery is encouraged, facilitating a way out of methadone treatment whenever appropriate.

Essential care

• Personalised care • Range of options• “Generic” services• Standards of care

Essential care

““Substance users have the right Substance users have the right to the same quality of care as to the same quality of care as

the rest of us”the rest of us”

Evidence Based Recovery

Evidence Based Recovery

Wicked Problems

• How can communities become part of the solution?

• How can we ensure that substance users and their families are given access to interventions that help?

• How do we get more generic local services involved?

• What is the role of the CPP?

Stigma

Why is Stigma a problem?

Ambivalence?

The Published Media

The Road to Recovery…..The Road to Recovery…..

Making it happen

• ADPs– Part of CPP

– Local accountability

– Local responses

This meeting!!

Conclusions

National strategies are trying to achieve two things:

• Reducing drug related harm – to the individual and their community

• Helping people to continually progress away from substance use problems

• Evidence bases make it clear how these are best achieved

• The community is pivotal in achieving these goals

Brian.kidd@nhs.netTel: 01382 424512