“Middlesbrough hosted the UK Recovery Walk 2019 a week last Saturday. The sun shone, the mood was buoyant and a fantastic crowd from all over the country gathered and marched in solidarity around the town centre and back into Centre Square, to mark some incredible struggles of people struggling with and overcoming alcohol and substance misuse.
I heard some really emotional accounts of how alcohol or drug problems had ruined marriages and careers with some losing their homes and being forced to sleep rough. One fabulous marcher from Lincolnshire told me how he’d regularly drunk 2 bottles of vodka a day, so much so that it bore a hole in his insides. He ended up completely yellow and was near death when he decided he wanted to live and the battle for sobriety started. His wife had her own battles as well, but together they fought to recover and repaired their own fractured relationship only for her to tragically succumb to cancer. But he proudly wore his tee shirt emblazoned with “Died Sober” in her memory.
There were many more powerful stories from marchers from Manchester, York and further afield.
The event also shone a light on the devastating issue of drug misuse. In recent times we’ve had a number of deaths in Middlesbrough due to substance misuse and it really does cause us all to reflect on the attitudes and perceptions of us a wider society towards the impact of problem substance misuse and whether those attitudes and perceptions are the right ones and whether we have an accurate picture of what is really happening to people on a daily basis.
I met the wonderful Danny Ahmed, Clinical Partner of Foundations at the march. He’s not only a highly experienced Registered Mental Health Nurse but also an integrative psychotherapist with 20 years of experience in supporting people who have problematic subsistence use. Some years ago he founded what we knew locally as the Fulcrum Practice now called Foundations.
I’ve had a number of conversations with Danny over recent years and the work that he and his colleagues do in responding to people in crisis, is truly wonderful.
He’s very clear that we have to adopt a harm reduction approach to drug use with the focus on recovery. This has to be about saving people’s lives in the first instance. Danny marks the spike in drug related deaths around 2012/2013. Increasingly across the world, the response to the inexorable rise in drug related deaths has been to remove as many barriers to engagement with medical treatment and support and focus on evidence based harm reduction approaches which concentrate on minimising the impact of substance use for the individual. The exception seems to be the United States which focuses on an abstinence based approach. That said, I did observe in Texas a few years ago, of all places, when I served on the Justice Select Committee, a more enlightened approach in the criminal justice system with the focus on case management and recovery, rather than the simple solution of putting more and more people with drug problems behind bars.
In Danny’s practice, people with drug problems have much easier access in seeing a clinician. A regular feature apparently is that people who use drugs problematically have urgent physical problems that need addressing and it’s symptomatic of substance misuse that patients have little regard for their own general health and well-being. I suppose it’s common sense that if a patient’s general health issues can be addressed and their conditions stabilised, there must be a better chance of addressing their fundamental substance use issues.
Once in the care of Foundations, patients are able to be prescribed methadone where that’s appropriate, but at the same time address their other health needs. They are also able to access support via Middlesbrough Recovering Together (MRT) services to help them address wider social needs and also work on developing skills and opportunities to recover from substance use problems.
Danny knows from his analysis of the figures that patients who stay with his practice are 80% more likely to survive than would otherwise be the case. It’s recognised that methadone, a heroin substitute, is an important treatment method, but the evidence is that methadone alone will not suffice in a number of cases. Another response beyond methadone is needed.
Working with Barry Coppinger the Police and Crime Commissioner, in partnership with Durham Tees Valley Community Rehabilitation Company and Middlesbrough Public Health, Danny and colleagues are together pioneering a Heroin Assisted Treatment (HAT) scheme. The evidence is there that Heroin Assisted Treatments are effective in securing better outcomes.
Of course current treatment provision that includes methadone, a heroin substitute, and psycho social interventions, have many benefits, but the evidence is that a number of people fail to benefit from current treatment provision and a second line response, beyond current treatment provision, is needed. There have been many studies that show HAT improves individual patients lives, improves community cohesion and reduces acute and sustained pressure on public services.
HAT, is a medical treatment for people with a long-term dependency on heroin, who have failed to respond to any other form of drug treatment. It provides a secure and dedicated clinical facility where prescribed medical-grade heroin, diamorphine, is self-administered under medical supervision. This goes alongside an intensive programme of specialist support to help individuals to rebuild their lives and reintegrate into society.
This forward thinking approach seeks to improve the health of individuals and reduce the amount of crime committed in the community as there’s no need to steal to secure the supply and the careless discarding of used needles, which is such a risk to the wider community, is much reduced. The initiative is about to come on line locally. It’s just that the medication is yet to arrive from Switzerland which is the world leader in this area. Apparently getting the medication from the UK is just too expensive.
Danny tells me that users often express their desire to change just after they’ve used drugs, but if that doesn’t happen in a controlled environment, no one is there at that crucial moment to step in and give effect to that desire to change. HAT offers the right intervention, at the right time, by seizing this ‘golden moment’ post administration.
Middlesbrough, as with other towns and cities, has an acute problem and in my view, we really have to support such initiatives. The resources to actually administer the treatment are quite modest. The real issue is the will and support to provide it.
HAT is not to be confused with drug consumption rooms that operate in other nations like Australia and Canada where people self-administer their own supply of drugs, and not those prescribed by medical professionals. Whilst the evidence shows that drug consumption rooms have been effective in reducing the number of drug related deaths, in our country the Home Office is taking a very conservative view and is reluctant to investigate the evidence.
Whilst there is a growing number of voices calling for a Royal Commission into drugs more broadly and the time for such a Commission is way overdue, I do however await the findings of Dame Carol Black’s independent review into drugs and how this review will be used by the Government to influence the development of a new drugs strategy. I hope it takes into consideration the strong evidence of ‘what works’ and recognises how the present regime can be much improved. It was David Cameron who signalled a retreat from informed policy making – no surprise there- when he announced the move away from methadone prescription in 2010 and setting time limits on treatment journeys.
Locally over the years, the drive to address substance misuse has continued, and has subsequently seen the development of a wide range of initiatives in Middlesbrough. Once such is the roll-out of the Naloxone programme which started in 2017.
When someone is in distress from an overdose and their life is in danger, the urgent and immediate administration of Naloxone can save lives. This programme provides one-to-one training and equips people with required knowledge and skills to administer the ‘yellow box’ life-saving injection to prevent what would otherwise be a fatality.
Also during these years, Middlesbrough has embraced and invested in the growth of the recovery community, which has seen the establishment of the peer-led abstinence based drug and alcohol recovery support service – Recovery Connections.
The human stories behind substance misuse are heartbreaking. In Danny’s considerable experience, people turn to heroin and become dependent on it, invariably as a direct consequence of suffering terrible trauma and pain. Some people’s stories of trauma, in one form or another, are hard to hear, but it does provide an understanding of why someone in such bleak despair might turn to drugs as a way to block out their mental torment.
So there is a great deal to do but what can help is if we as a community, can have an informed conversation about these important matters and listen to the evidence.
Huge congratulations to Middlesbrough Council who, in 2018, had the courage to bid for and secure the UK Recovery Walk 2019 which was such a wonderful success. Obviously Labour Mayor Dave Budd is no longer in office but he and his colleagues and officers deserve acknowledgement and congratulation for their courage in ensuring that the issue of substance misuse and the response to it, receives the attention it desperately needs.
And I do believe in experts. I believe in evidence and sadly I fear that there is far too often the tendency these days to ignore evidence and opt for a moralistic, condemnatory solution that is no solution at all. People who use substances are our sisters and brothers who are very great pain and they deserve our support and help.