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consuming recommissioning round, and we didn’t know who was going to be
running treatment services anyway. So we’ve been collecting information and
improving our understanding of what could be done and what would be cost-
effective. We’ve spoken to some people among the police and the local authority
who are cautiously interested, but we obviously need the clinical arm.’
The city’s main clinical provider is likely to be announced this month and ICDCR
is confident that they’ll be interested if it can be shown that consumption rooms
are both necessary and value for money. ‘I think we can prove that it’s cost-
effective if we don’t have grandiose ideas. The Vancouver and Sydney ones are big,
all-singing, all-dancing versions but we see a Birmingham version as being part of
the existing needle and syringe and outreach programme – there’d be no new staff
or new budget. If we could find a backroom associated with the existing services,
with a few sinks for people to wash their hands and a kettle to offer people a cup
of tea and a listening ear, that would be fine. It’s not a high-tech answer to
anything – it’s not like heroin-assisted treatment, which is very expensive.’
What about the legal status of consumption rooms – how much of a barrier
could that be? ‘In parts of Europe allowing your premises to be used for taking
drugs is still against the law but there are local accords with the police, and we see
that as the way it could happen in the UK, although we’d obviously like to change
the law eventually,’ she states. ‘If you think about needle and syringe programmes,
the police don’t arrest everyone going into those, which they could because they
know they’ve got heroin on them. The same would apply to consumption rooms –
they’d know they were people who used drugs but they’re not the big dealers,
they’re people with a dependency who are street injectors.’
The international evidence also shows that people ‘tend to up their game’ once
they start using consumption rooms, she says. ‘The staff wax lyrical about the
transformation in their behaviour, and they carry on those learned habits when
they’re not in the centre – their health improves, they no longer attend A&E and
they begin to re-engage with society.’
Being able to provide the service without a new budget could clearly go some
way towards making it more attractive in today’s environment – how optimistic is
she about the state of the sector overall? ‘There’s no doubt that the money is tight
and not ring-fenced any more, so we have to be smarter with it,’ she says.
‘Obviously the more resources you have the more quality you can offer but there
isn’t any choice about it, I suppose. But in terms of human beings I tend to be an
optimist and I’m hoping that we’re still learning.’
Indeed the whole of her involvement with the sector has been a learning curve,
she states. ‘It has been for all of us – before the 1980s there wasn’t a big heroin-
using population in the UK. It was small numbers of people, mostly dependent on
pharmaceuticals – they’d blag their GPs for Diconal and all those things. So the
huge flood of heroin that came into the country and the huge increase in people
using it involved us initially working out how to keep people alive and help them
with substitution treatment.’
As has been widely documented, that heroin-using population is now growing
older, and so far the indications are that it’s not being replaced by a significant
younger one. ‘I do hope that’s a societal change and gradually people will not get
into this dependency on opiates, because it’s such a long-term trap,’ she says.
‘Some of the stimulants and novel psychoactives have their own problems but –
even with cocaine – they’re things that you can walk away from a bit more easily
than an opiate habit. So I’m hoping that we won’t be seeing families affected quite
so much, and the policies have kind of followed that learning curve in a way. We’re
kind of all learning together.’
She’d long been part of SMMGP (Substance Misuse Management in General
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Dr Judith Yates
Practice) and when SMMGP’s Chris Ford set up IDHDP (International Doctors for
Healthier Drug Policies) she was asked to become a director. This year has seen her
visit the Commission on Narcotic Drugs (CND) in Vienna, representing IDHDP’s
rapidly growing membership of almost 600 doctors from more than 70 countries
who ‘believe we need health-based rather than criminal justice based drug
policies’, she says.
And it’s in arenas like this that real change can be brought about, she believes.
‘I’ve always supported the test-and-treat approach to hepatitis C and HIV, for
example, but while you’ve got to do it on a one-to-one basis you do also need to
have it as national and international policy to make a real difference. If you can get
people into treatment you can also defeat the disease, because even if they’re not
immediately completely cured their virus count goes down so they’re not so likely
to pass on the infection, and it’s the same with HIV. The liver specialists are now
very excited, saying that we’re on the “cusp of a new dawn” and that the new
treatments mean that we could eliminate hepatitis C within 15 years.’
She praises the Scottish plan to treat more people for hep C each year than are
becoming infected with it as a way to ultimately eradicate the virus. ‘Also you don’t
end up bankrupted by the exponential growth of cirrhosis and liver failure,’ she
says. ‘And they’ve got a national naloxone programme of course – if they vote to
opt out of the UK, we should all vote to join Scotland!’
While there’s ‘no simple step’ to eradicating drug-related deaths or harm it’s
essential to be part of the ‘international conversation’, she stresses. ‘Take-home
naloxone has been shown to reduce drug-related deaths in parts of the US by up to
50 per cent, and I hope there’ll be new regulations to allow its even wider provision
in the UK.’ It was also announced at the Vienna CND that forthcoming WHO
guidelines will state that everybody who could potentially be at the scene of an
opiate overdose should have access to naloxone, she adds.
‘I believe that it may come to be seen as negligent to prescribe methadone
without also prescribing a take-home naloxone kit. Drug consumption rooms have
also been shown to be a cost-effective step as part of existing treatment services
around the world, and I believe we should look seriously at small pilots in parts of the
UK where there’s a need. Applying a criminal penalties to drug use has never made
any drug safer, and the sky hasn’t fallen in on countries like Portugal and the Czech
Republic where steps towards decriminalisation have been in place for many years.
‘These are all areas where policy and central guidance and leadership are needed
to drive change. I see my pension as a government grant that allows me time to
apply my past clinical experience to these broader areas, where policy change can
make such a difference to the wellbeing, not just of individuals, but of populations.’
www.idhdp.com
‘Liver specialists are now
very excited, saying... that
the new treatments mean
that we could eliminate
hepatitis C within 15 years.’
ry position