Drugs

Lord Patel of Bradford Excerpts

Thursday 4th February 2016 Grand Committee

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government what is their response to the Office for National Statistics’ report on deaths related to drug poisoning in England and Wales in 2014.

[Lord Patel of Bradford (Lab)]

My Lords, I am grateful to have the opportunity to raise the important issue of deaths related to drug poisoning. I thank the noble Baroness, Lady Walmsley, and my noble friend Lord Hunt for speaking on this today. The Office for National Statistics report on deaths related to drug poisoning highlights a number of concerns which I have been raising in questions and debates in this House for some time. I cannot begin to cover all these issues today. Suffice it to say that I have grave concerns that the Government’s drugs policy may have contributed to the increase in drug-related deaths in England. I am aware that this is a serious assertion and I hope the Minister will take my concerns with the sincerity with which they are meant.

Heroin is involved in more fatal overdoses than any other illegal drug. The most common form of treatment for dependence on heroin is opioid substitution therapy. Under this treatment, the street heroin to which a person has become addicted is replaced by a pharmaceutical substitute, usually methadone. The evidence is clear that this treatment can halve a patient’s risk of death for as long as they remain in treatment but, because relapse is common, the patient’s risk of death increases significantly when treatment ends. So the longer a patient remains in treatment, the better their chances of staying alive. However, rather than being evidence-based, I strongly suggest that the 2010 drug strategy reflects the Government’s concerns that there were too many people on methadone for too long—a point vigorously reinforced by the Work and Pensions Secretary, lain Duncan Smith, who said that he felt too many people were “parked on methadone”. Therefore the Government introduced a payment-by-results system to incentivise service providers to encourage drug users to more quickly complete treatment and achieve abstinence.

What is wrong, you may ask, with encouraging more drug users to become abstinent more quickly? Surely that is a good thing. However, UK and international evidence clearly shows that there are major risks in pressuring drug users to withdraw from treatment. The Government’s own Advisory Council on the Misuse of Drugs stated that there was strong evidence that time-limiting opioid substitution therapy would increase the rate of overdose death. Of course I understand that the Government’s decision-making must include public opinion and there is a fear of being seen as soft on drugs—there has been from every Government who have been in power. However, I know from working with drug users myself for many years that the first treatment a drug user receives must be about stabilising the chaos in their lives, and abstinence should be about providing the right range of treatment options at the right time. The evidence shows that heroin addiction is a long-lived condition, averaging around 10 years, so drug users must be ready to achieve abstinence, because if they relapse after they have left treatment they are at a high risk of fatal overdose, since their tolerance to heroin is obviously greatly reduced.

What has been the result of the Government’s approach? On a positive note, between 2011 and 2012 an estimated 8.9% of adults used an illegal drug. This is the lowest level of drug use since figures were first collected in 1996. The number of people who completed drug treatment, free of dependence, is at record levels. However, perversely, in 2014 there were 3,346 drug-poisoning deaths in England and Wales, the highest number since records began in 1993. Deaths involving heroin increased by almost two-thirds between 2012 and 2014, from 579 to 952.

More worryingly, Public Health England’s own network—the National Intelligence Network on the health harms associated with drug use, which exchanges intelligence on blood-borne viruses, new and emerging trends in drug use and drug-related deaths—reported in December 2015 that the number of drug-related deaths is increasing, and that the rate of increase is probably accelerating. Amphetamine and cocaine deaths have also been increasing in recent years. However, the network’s analysis showed that treatment is protective against drug-misuse deaths.

I have cited a number of facts and figures, but let me put a human face on this and highlight some wider impacts. A number of local areas have conducted their own drug-related death reviews. Some have found an increase in female drug-related deaths, some individuals are parents, some people were released from prison and needed further support and treatment. In fact, in 2010 I produced a national report reviewing drug treatment in prisons and highlighted the importance of ensuring good continuing care for vulnerable people leaving prison to prevent relapses and drug-related deaths.

More people had complex health issues involving repeated presentations to hospital wards and A&E departments. Some have mental problems requiring treatment and repeated admission to mental health wards. They have a dual diagnosis of substance misuse and mental ill health. Only last week, as the Minister will know, we heard that the number of deaths annually among mental health patients in England rose by 21% over the past three years, from 1,412 to 1,713. The number of those killing themselves or trying to do so has also increased, by 26%, from 595 in 2012-13 to 751 in 2014-15. I wonder how many of those people had a dual diagnosis.

In light of this, will the Minister agree to see if an investigation can be set up to look into the causes of the drug-related deaths and the mental health deaths, and to see how many had a dual diagnosis? I understand that an update of the UK clinical guidelines on drug misuse and dependence is expected this year. In fact, I thought it was going to be published by February. These are essential guidelines for all clinicians who provide pharmacological interventions for drug misusers as part of their drug-treatment programme. This is a positive move, but I strongly suggest that it is also time that the Government carried out not just an annual review but, more importantly, a full impact assessment of the current drug strategy. Will the Minister therefore agree to ask the relevant government department that a risk and impact assessment of the current drug strategies be carried out, ensuring that an evidence-based approach be developed that tackles the failures and weaknesses of the current strategy, including, obviously, reducing drug-related deaths; training, employment and housing for drug users; integrating prison and community services; and, as I have already mentioned, the important issue of provision of dual diagnosis?

Finally, we know that there is a major funding issue within the NHS, and this is having an impact on services that work for these vulnerable people. Drug and alcohol treatment are no longer part of the protected NHS spend, but will have to compete for resources in the much harsher local government public health environment, which is likely to result in a reduction in services. In fact, I have seen a reduction in services in many environments already.

As for mental health, suicides among people in touch with crisis resolution home treatment teams, which are there to support people in crisis to stay in their own homes rather than being admitted to hospital, have increased significantly. It has been reported that these teams have lost their funding and have been disbanded or merged into community teams. So their specialist function has been lost, at a time of increasing demand. We also know that the number of specialist mental health nurses has fallen by more than 10% in the past five years.

In conclusion, I ask the Minister to say in his reply what steps are being taken to tackle the lack of funding for drug misuse and mental health services, which deal with some of the most vulnerable people in our communities, particularly those with a dual diagnosis of drug misuse and mental health problems. Because I have the time, I shall also make one other point. I understood that the evaluation of the payment-by-results pilot studies was to be published either last year or early this year. Can the Minister update me on when publication will happen? I look forward to hearing from other noble Lords, and to the Minister’s response.