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Dr Eliot Ross Albers
Soapbox
DDN’s monthly column
offering a platform for
a range of diverse views.
ROAD TO
RUIN
The puritanical recovery
agenda is stigmatising,
marginalising and
endangering the health of
people who use drugs or
have a maintenance script,
says
Dr Eliot Ross Albers
For some time now the drug using community in the UK has been in a state of
heightened alert
and significant concern triggered by the government’s ‘recovery
agenda’. This was first heralded by the launch of a document last year, bearing the
logos of eight the major interior ministries including the Department of Health and
Home Office, entitled
Putting full recovery first
– a document that has come to be
known as the ‘recovery roadmap’, given that it described itself as a ‘roadmap for
building a new treatment system based on recovery.’ Notable too is that the document
not only insists on abstinence from substances that are causing the individual
problems, but is also explicit in defining recovery as abstinence from all psychoactive
substances – including substitute prescriptions.
At a recent conference I asked Duncan Selbie, the head of Public Health England,
if he could provide any guarantee that those of us who are in receipt of
maintenance prescriptions of opiates would not be arbitrarily forced to come off
them (
DDN
, November 2012, page 12). In spite of insisting that drug services will
‘follow the evidence’, Selbie kept on insisting that: ‘Methadone support is a well-
established contribution to recovery. What I would like to have is a broader
contribution about how we can help people go beyond that... We will be concerned
about rehabilitation, which isn’t the end point, being maintained on methadone.’
This, to say the least was not reassuring, but was entirely in keeping with a
dominant theme of the government’s recent rhetoric in which ‘recovery’ has been
conflated with full abstinence and in which an ‘urgent end to the current drift of far
too many people into indefinite maintenance, which is a replacement of one
dependency with another’ has been identified as the key objective.
Indeed, the only indicator of success that drug treatment services will have in the
new Public Health Outcomes Framework is the number of people exiting services:
‘ultimately payment will be made for full recovery only.’ They will lose these payments
if people relapse and re-enter services within a given time period. In other words, the
metric by which the success of future drug treatment services will be measured will
be the speed with which they can get people off prescribed medications.
Furthermore, under the new Payment by Results (PbR) system which relates to
the ring-fenced treatment budget, boroughs will only receive 100 per cent of their
budget if they maintain steady levels of clients exiting services over a 12 month
period; failure to do so will result in a budgetary cut. These moves trivialise the
complexities of drug dependence and completely overlook the frequently attendant
co-morbidities. Such a financial incentive could very well lead to the exclusion of
people who are neither ready for, nor seeking, abstinence. This approach furthermore
minimises the importance of such proven public health measures as needle and
syringe programmes (NSP), HIV treatment and testing, comprehensive hepatitis
services, and overdose prevention.
Whatever one’s views on the value of the use of the term ‘recovery’ (I personally
do not find it helpful, as I do not see habitual drug use as an illness to be recovered
from, but rather a behaviour that people engage in), the insistence that the only
satisfactory or successful outcome of an engagement with drug dependence
services is abstinence is unrealistic and contrary to the well established evidence
enshrined in all internationally accepted guidelines, including the UK’s own clinical
guidelines. These documents all recognise that opiate maintenance programmes
20 |
drinkanddrugsnews
| February 2013
www.drinkanddrugsnews.com