Clinical Priorities for Alcohol and Drugs in Public Health

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1 Clinical Priorities for Alcohol and Drugs in Public Health What do we need to Measure up to? Dr Michael Kelleher Clinical Lead Alcohol and Drugs Team, Health and Wellbeing Directorate SMMGP 8 th Primary Care Development Conference

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3 Where Have We Come From A lot has been done

4 Drug treatment improves health

5 Drug treatment improves health

6 10% fall in opiate and crack users since 2004/05

7 Drug-related deaths are falling Projected deaths if increase had continued Deaths Related to Drug Poisoning in England and Wales, 2012, Office for National Statistics, 2013

8 The treatment system s achievements

9 Global HIV prevalence in PWID

10 High drug treatment penetration has delivered USA England Treatment penetration rate - opiate and crack users 15% 57% Drug-related deaths per million year olds Adult HIV prevalence among people who inject drugs 16% 1.3% Adult HCV prevalence among people who inject drugs Up to 88% 45% 10 PHE Conference Alcohol & Drugs

11 Drug treatment cuts Crime

12 A lot done This could only be achieved with the integral involvement and support of primary care and SMMGP

13 A lot more to do

14 Global Burden of Disease Lancet 2013

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16 Heroin Addiction A Metabolic Disease Vincent P. Dole, MD and Marie E. Nyswander, MD, New York Arch Intern Med Vol 120, July 1967 Of the 304 patients admitted to treatment 91% have continued in the program, 8% were discharged because of behavioural problems unrelated to heroin addiction, and 1% left voluntarily. Approximately 70% of the patients who have been in the program for six months or longer are employed or in school; the remaining patients, although not yet socially productive, have at least ended heroin usage and the related antisocial behaviour.

17 What are some of the challenges the treatment sector need to address This does not just apply to SMMGP members Safeguarding Children Alcohol Recovery Orientated Drug Treatment Novel Psychoactive Substances Prescription Drug Dependence Smoking All in a time of dwindling resources, competing priorities, a changed commissioning environment and localism

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19 The extent of alcohol misuse Alcohol is the third biggest risk factor for illness and death in the UK (after smoking and raised blood pressure)

20 Liver disease deaths in England 20 PHE Conference Alcohol & Drugs

21 Liver disease deaths in Europe Mortality from Chronic Liver Disease, European comparison, Mortality rate per 100,000 population UK EU* France Norway Source: Eurostat, 2008 *EU members before May 2004

22 Alcohol Treatment Interventions- What are PHE priorities Implementation of the alcohol Health Check in line with guidance Significant expansion of IBA in a range of settings, particularly primary care Specialist treatment that is accessible and matched to local need Effective use of hospital based alcohol services Treatment services that are good quality and compliant with NICE guidance

23 The role of Opioid Substitution Therapy in recovery 2010 drug strategy: Substitute prescribing continues to have a role to play in the treatment of heroin dependence, both in stabilising drug use and supporting detoxification. Medicallyassisted recovery can, and does, happen However, for too many people currently on a substitute prescription, what should be the first step on the journey to recovery risks ending there. This must change. 23 PHE Conference Alcohol & Drugs

24 Recovery Orientated Treatment Should be available and offered to all High-quality treatment system that substantially improves health Heroin is sticky- relapse is common Leaving treatment is important but it isn t recovery Lots of people haven t recovered Done right, OST is effective but a platform for recovery Don t end it too early Some people recover fast, some don t all need recovery support

25 This is not about time limited Opioid Substitution Therapy Let s be clear: This is about increasing recovery-oriented ambition and progress for individuals and in systems where there is not currently enough of it It is not about destabilising - to the point of unacceptable risk - individuals who are deriving benefit from OST.

26 NATIONAL Behaviour of clients by length of time in treatment

27 ONS- DRD-2013

28 28 PHE H&WB Alcohol & Drugs Novel Psychoactive and Allied Substances

29 ONS- DRD-2013

30 New psychoactive substances emerging rapidly and knowledge of harms slow to emerge - monitoring and surveillance struggling to keep up Acute harms: e.g. GHB and GBL can kill, very risky when used with alcohol/other sedatives. Heavy, frequent ketamine use can cause very serious bladder problems. Injecting: NPS mostly not injected, but increasing concern about the injection of mephedrone and methamphetamine. MSM: Some local reports of high rates of injecting and very high risk sexual behaviours in a small number of MSM raising concerns about transmission of STIs and hepatitis C. High injecting prevalence among people who use image and performance enhancing drugs (eg steroids).

31 Prescription Opioid Deaths in USA

32 Prescription Drug Dependence and Abuse 32 PHE Conference Alcohol & Drugs

33 It could never happen here

34 Smoking Prevalence in SLaM Camilla Cookson, Professor Ann McNeill General population prevalence: 20%

35 Finally A changed regulatory landscape

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37 The safety and quality of services are the clear responsibility of: Commissioners and regulators Service providers Individual clinicians

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