Models of care for treatment of adult drug misusers: Update 2006
adversely affected their physical and mental health and was accompanied by high rates of unemployment.
Injecting behaviour. The latest Shooting Up report (2005)13 the Health Protection Agency (HPA) stated that needle and syringe sharing increased in the late 1990s, and since then has been relatively stable, but with drug users still reporting the sharing of injecting equipment. A 2004 anonymous sample study of injecting drug users (IDUs) in contact with drug agencies found that 28 per cent shared needles or syringes in the previous four weeks. However, sharing of other injecting equipment, such as filters, spoons and flushing water, is more prevalent with 50 per cent of current injectors reporting this in the same study. More recent research (Rhodes, 2006)14 into drug injecting trends, among those using heroin and crack or cocaine, suggests growing risks of blood-borne virus (BBV) transmission, infections from
and venous damage. Hepatitis C. Shooting Up (2003),15
and the 200416
updates, have also reported an increase in the prevalence of hepatitis C infection among injecting drug users both in and out of treatment. This has increased from 36 per cent in 1998 to 41 per cent in 2003 (with only half of those hepatitis C seropositive being aware of this). Furthermore, an increase in the incidence of hepatitis C infection was reported among new injectors, indicating that transmission is increasing. There are marked regional variations in rates of hepatitis C infection among injecting drug users, with prevalence rates of over 50 per cent found in London and north-west England. Even higher rates have been seen in treatment populations – Best et al (1999)17 found an 86 per cent hepatitis C prevalence rate in one London drug treatment service.
Hepatitis B. In 2004, infection rates for hepatitis B virus of 21 per cent were found among injecting drug users in England, Wales and Northern Ireland. Infection rates among new injectors were low, but had risen from five per cent in 1998 to nine per cent in 2003 (decreasing to 6.7 per cent in 2004). Increasing hepatitis B vaccination rates were reported by samples of drug users, rising from 25 per cent in 1998 to 54 per cent in 2004.
HIV. Shooting Up (2005) reported a recent increase in the prevalence of HIV infection among current IDUs in England. Although HIV infection remains comparatively rare among IDUs there are higher rates among IDUs in London, with around one in 25 infected. Although the numbers of IDUs infected elsewhere in England are much lower, the 2004 prevalence rate (0.6 per cent) is the highest seen outside London in this survey since 1993.
Site infections. Shooting Up (2005) noted continuing increases in injecting site infections of various kinds, including tetanus and wound botulism. This indicates both poor hygiene while injecting and also some contaminated doses of drugs (particularly heroin).
Deaths related to drug misuse. The total number of deaths related to drug misuse rose to 1,427 in 2004 (from 1,255 in
2003), the first increase since 2000 (ONS, 2006).18
number of deaths in 2004 was nine per cent lower than the number in the baseline year of 1999, these deaths are preventable and continued efforts should be made to reduce these and avoid further increases.
A reinvigoration of harm reduction in all tiers of drug treatment. These trends will require an immediate response from both commissioners and providers to stem the increase of BBVs and drug-related deaths among the drug-using population. Drug treatment clearly also needs to be able to respond to the whole of an individual’s pattern of substance misuse, including the misuse of stimulants and alcohol.
Drug treatment and the criminal justice system
The Drug Interventions Programme
The Drug Interventions Programme (DIP) is a critical part of the Government’s strategy for tackling drugs. DIP involves criminal justice and drug treatment providers working together with other services to provide a tailored solution for adults who commit crime to fund their drug misuse. Its principal focus is to reduce drug-related crime by engaging with problematic drug users and moving them into appropriate drug treatment and support. It aims to break the cycle of drug misuse and offending behaviour by intervening at every stage of the criminal justice system to engage offenders in drug treatment. Special measures for young people are also being implemented. Delivery at a local level is through drug action team partnerships, using criminal justice integrated teams (CJITs) with a case management approach to offer access to treatment and support. This begins at an offender’s first point of contact with the criminal justice system, through custody, court, sentencing and beyond, into resettlement.
2.5.2 The Drugs Act 2005
New measures have been introduced under the 2005 Drugs Act.19 These include “testing on arrest”, and “required assessment” in all DIP-intensive areas in England, where individuals testing positive for specified class A drugs, following arrest or charge for “trigger offences”, will be required to attend an initial assessment (known as a required assessment) of their drug misuse. The aims of the new provisions are to identify more problem drug users (by testing a larger sample of people) and to encourage more people who test positive to attend assessment (by adding a sanction of “failure to attend and remain – the required assessment”). Testing on arrest for people arrested for a trigger offence will enable adults misusing class A drugs to be steered into treatment and away from crime earlier. It will increase the volume of drug-misusing arrestees identified as having drug