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Speech by Rt Hon Dawn Primarolo MP, Minister of State for Public Health, 28th October 2008: National Conference on Injecting Drug Use

It’s great to see so many of you here and I hope you are enjoying this very significant conference.

I want to frame my remarks today in the context of the drugs strategy we launched earlier this year, and the ongoing debate about the merits of drug assisted therapies like methadone versus abstinence.

I want to be clear that the primary objective of any treatment has to be abstinence. We want as many users as possible to be permanently drug-free and a positive influence in their families and communities. These objectives drive our whole drug strategy.
But I do think the debate has become distorted. I think partly because of public misconceptions about drug rehabilitation. ‘Cold turkey’ is so often viewed as a short, sharp shock – mildly unpleasant, but immediately effective. To the outside world, it’s viewed as tough love, and people can’t understand why we need anything else.

This is, of course, a crude simplification, drastically underplaying how difficult it is to achieve lasting success, and giving rise to the false belief that maintenance is a mark of failure, or a soft option.

So I’m quite clear that maintenance and abstinence are equally important. They’re twin parts of a socially responsible approach, and they explain why we now have record numbers – some 200,000 – currently in drug treatment programmes.

Sadly, this debate does a disservice to people working in the field – those on the front line, in the first stages of treatment. You don’t get the credit you deserve.

Because rather than being ostracised, abandoned or forced underground, your work means more users are getting help to control their addiction:

- Stopping them committing crime to feed their habit.
- Helping them take responsibility for their families and make a positive contribution to society.
- And, of course, reducing personal harm by giving them the support to be safer.

It’s the human stories that bring this home.

Take Jane. She came into treatment in 2003 via a prolific offenders scheme. She was aged 25, had two young children, and was injecting heroin and smoking crack cocaine.

Since starting a methadone maintenance programme, she has completely stopped using illicit drugs, recently moving from a hostel into her own accommodation, and is now working with social services towards the return of her children.

Maintenance has given her hope, and it’s given her the stability and support to rebuild her life. Without it, her predicament would have been grave.

Of course, that’s not to say we shouldn’t be more ambitious. Some providers can be too reticent about risking the gains made during stabilisation, and cautious about moving drug users through the treatment system more quickly.

Nonetheless, as you all know and I fully appreciate, maintenance is protective. It saves lives and gives users, like Jane, the space to overcome their addiction.

And the statistics bear this out. They reflect many hundreds and thousands of stories like Jane’s.

Take drug-related deaths. The numbers doubled in the 1990s when effective drug treatment was in short supply. We’ve since turned this around. Deaths have actually fallen since 2000, and we’re now saving sixteen hundred lives every year.

Take the reductions in drug-related crime, meaning each year thousands are spared the trauma of street robbery and burglary committed by drug users.

And take the progress on infection rates. The HPA’s latest figures show the number of current and former injected drug users contracting Hepatitis C fell two percentage points in the last 12 months. The rate of Hepatitis B infection also fell slightly.

Of course, despite this good progress, we haven’t won the battle yet.

But the high levels of users in treatment give us a platform to improve. And today I want to explain how we’ll help you lead the fight on drug-related harm.

My starting point is the NTA and Healthcare Commission’s joint report on harm reduction, which I’m sure you’re all familiar with.

It found eight out of ten partnerships are doing very well on harm reduction, which is very encouraging. But it also uncovered three specific areas for improvement:

-First, the provision of out of hours needle exchanges
-Second, the testing and treatment of hepatitis B
-And third, the responses to hepatitis C.

So how do we respond?

First, we’ve got to continue focusing on the basics. That is, getting the right services, in the right places, reaching the right people.

We therefore need stronger, more evidence-based commissioning – and while it may not seem particularly sexy, improving the quality of data available to local commissioners is essential.

That’s why we’re now, for the first time, providing local partnerships with the levels of Hepatitis C prevalence in their own areas.

And it’s why we’re now collecting information from needle and syringe exchange programmes – seeing how many exist, how much equipment they give out, and whether there’s sufficient coverage around the country.

Good data shines a light on local need and is vitally important. It stops us stumbling around in the dark, and I hope these new breakdowns will help local commissioners make more informed decisions.

Secondly, we must continue improving the quality and effectiveness of the treatment.

On the back of the Healthcare Commission report, the NTA’s regional teams have worked with all partnerships ranking below average, while the bottom 15% have received intensive support to help them raise standards. I hear this is yielding very positive results.

To build on this, the NTA is today publishing a Good Practice Guide, which will examine the practices of the top 10% and give others the chance to learn from the best.

I hope it will accelerate the good progress already made on improving local partnership performance, and I know the NTA will be speaking about this later.

We also need to put a special focus on helping prisoners and ex-prisoners.

Approximately half of those in the prison system at any one time require drug treatment. In the week following release, they are 37 times more likely to die of drug overdose. The rate is even higher for women.

Our drugs strategy said all prison drug treatment must meet adequate clinical standards by 2011, and I know there has already been considerable improvement thanks to the success of the Integrated Drug Treatment System. But there is still more to do.

To support this, my Department will quadruple its investment in prison drug treatment over the next three years – from £11 million in 2007/08, to £43 million in 2010/11.

Prison settings are also vital for reducing infections. In fact, English prisons now immunise more drug users against Hepatitis B than any other setting, thanks to the universal vaccination programme we established in 2001.

I want to capitalise on this. The Department of Health Offender Health Team has developed a number of resources for prisons, including various toolkits to help with this.

And we’ve also established a Review Group on Prison Drug Treatment Strategy, following a Price Waterhouse Coopers (PwC) report on the issue.

This will consider all the PwC recommendations in more detail, agree a single set of priorities and compile national guidance on streamlining the commissioning delivery, funding and performance management of drug treatment for offenders.

But of course successful treatment has to be personalised treatment – with individual drug users getting tailored support to meet their individual needs.

Let me put another human face on this. Steven had been using heroin for three years. He was working long hours as a carpet layer, and his work was suffering from his habit.

Steven was reluctant to enter treatment as he thought his employer would find out, so the service offered him appointments to fit around his work. Following key worker sessions, a link was identified between his drug use and his dissatisfaction with work, which were both leading to problems at home.

As a result, he received counselling and attended sessions with Progress to Work. This led to a new job in a garage – after which, he stopped using heroin completely. He’s now undergoing community detoxification, his relationship recovered, and his partner is now expecting their second baby.

That’s the power of flexibility, of understanding the deeper causes behind a person’s addiction, rather than just treating the symptoms.

It’s also a lesson in breaking down barriers between services so they work in more a integrated, joined-up way.

So we’ve got to do more to ensure all local services unite around users, providing them with a clear path to recovery. It’s not acceptable to expect vulnerable people to negotiate a complex web of different providers.

So in keeping with the Drugs action plan, we’re now going to pilot how we can use local budget streams to create more personalised, more integrated programmes for users. This will start in a handful of areas, but should give us some very useful pointers for how we can further improve treatment around the country.

We’re also going to fund new drug treatment co-ordinators to work with JobCentre Plus to help drug users get back to work.

Making these connections between services is vital, and the best time to negotiate the right link-ups is through the annual treatment round.

So we are doing everything we can to get the new co-ordinators in post from January onwards, and the NTA and JobCentre Plus will also be providing further advice.

While I am on the subject of reintegration, let me take this chance to clarify a myth that has built up.

At the launch of the Drug Strategy, we said that we wanted to get drug users off benefits and back into work. Unfortunately, despite our best efforts, this was reported to mean that cuts to benefits would be used as a threat against drug users.

I want to be absolutely clear and reassure you today that we’re not going to withdraw benefits from people just because they are drug users. That would be completely counterproductive.

We want to give users more, not less, support to recover, get their lives together and start making a positive contribution – as we know most want to do.

We had already taken some major strides forward on harm reduction, even before the drug strategy. Now we’ve got a chance to achieve even more.

Alongside the programmes I’ve just mentioned, we’re today launching a specific campaign aimed at drug users.

Exchange Supplies have done an excellent job in developing a range of materials, including DVDs, posters, leaflets, guidance and training materials – and have tested them to make sure they work for the audiences in question.

Some of these materials aren’t pleasant. They’re designed to shake users up, challenge some of the myths doing the rounds, and get them adopting safer practices.

We particularly want to get the message out to the most marginalised users. The heroin and crack addicts, the homeless users, new or potential users, and those who have been in prison.

Alongside this, the Chief Medical Officer is writing to all PCTs asking them to improve Hepatitis C detection in primary care settings.

Whilst existing users should be offered testing routinely, we think about 100,000 people in England are infected without realising it – mainly, but not exclusively, because of past injecting drug use.

So this letter will step up the increased hepatitis C testing and diagnosis by GPs in recent years, and help us reduce the levels of undiagnosed infection.

Like you, I believe we have a responsibility to do the best we can for all vulnerable people – regardless of their history, regardless of their circumstances.

Sometimes that means being pragmatic. If we can’t get people drug-free in the short term, then we must do everything we can to keep them safe and receiving ongoing treatment.

That’s the right thing for them, the right thing for their families, and the right thing for the communities they live in.

A great deal has been achieved since the dark days of the 1990s, but there is much more still to do. Your work may not get the recognition it’s due, but it is saving hundreds of lives every year. And I assure you I appreciate it, and I want to do everything I can to support you.

I hope this conference will be a catalyst for further progress. We can and must do more in the future to save lives and reduce harm – for people like Jane and Steven, and for the many like them.

So thank you again for all the work that you do, good luck, and I hope you enjoy the rest of the day