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
Where Have We Come From A lot has been done
Drug treatment improves health
Drug treatment improves health
10% fall in opiate and crack users since 2004/05
Drug-related deaths are falling Projected deaths if 1993-2001 increase had continued Deaths Related to Drug Poisoning in England and Wales, 2012, Office for National Statistics, 2013
The treatment system s achievements
Global HIV prevalence in PWID
High drug treatment penetration has delivered USA England Treatment penetration rate - opiate and crack users 15% 57% Drug-related deaths per million 15-64 year olds 102 42 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 2013 - Alcohol & Drugs
Drug treatment cuts Crime
A lot done This could only be achieved with the integral involvement and support of primary care and SMMGP
A lot more to do
Global Burden of Disease Lancet 2013
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.
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
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)
Liver disease deaths in England 20 PHE Conference 2013 - Alcohol & Drugs
Liver disease deaths in Europe Mortality from Chronic Liver Disease, European comparison, 1970-2005 Mortality rate per 100,000 population 40 30 20 10 0 UK EU* France Norway 1970 1975 1980 1985 1990 1995 2000 2005 Source: Eurostat, 2008 *EU members before May 2004
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
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 2013 - Alcohol & Drugs
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
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.
NATIONAL Behaviour of clients by length of time in treatment
ONS- DRD-2013
28 PHE H&WB 300913 Alcohol & Drugs Novel Psychoactive and Allied Substances
ONS- DRD-2013
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).
Prescription Opioid Deaths in USA
Prescription Drug Dependence and Abuse 32 PHE Conference 2013 - Alcohol & Drugs
It could never happen here
Smoking Prevalence in SLaM Camilla Cookson, Professor Ann McNeill General population prevalence: 20%
Finally A changed regulatory landscape
The safety and quality of services are the clear responsibility of: Commissioners and regulators Service providers Individual clinicians