Charities unite in opposition to government drugs policy

An alliance of influential charities has condemned a key government drugs strategy document, calling it an "ideological attack" on proven addiction treatments and "dangerously and deeply flawed". It warns that ministers will be putting lives at risk if proposed plans to push through "abstinence-based" approaches go ahead.

The group, which includes leading HIV/Aids charities Terrence Higgins Trust (THT) and the National Aids Trust (Nat), and the drugs and human rights charity Release, have delivered a highly critical letter to drugs minister Lord Henley and the prime minister, David Cameron, warning that the "recovery roadmap" in the government's document Putting Full Recovery First would be "disastrous" for drug-dependent people.

Published last month, and endorsed by eight government departments including the Home Office and the Department of Health, the document was billed as a blueprint "for building a new treatment system based on recovery". It followed the government's official drugs strategy, which was published in December 2010.

Top priorities

However, the charities argue that the roadmap goes much further than the strategy by positioning abstinence and "full recovery" as the top priorities for drugs policy at the expense of "proven" harm-reduction treatments such as methadone for heroin addiction, says the group.

The letter stresses that a goal of full recovery is misleading because many people are susceptible to relapse, and the risk of contracting blood-borne viruses resumes if needle exchanges are difficult to access. It points out that people who relapse are at higher risk of overdose if adequate support and treatment is not available. It says "well-established, evidence-based interventions" such as needle/syringe exchanges would be dismantled, making it more difficult for people in need to access appropriate drugs services.

The challenge from charities coincides with an anonymous survey carried out by the alliance. The results reveal widespread unease about the government's drugs policies among service users, providers and NHS staff across the UK.

The roadmap lays out government plans to incentivise service providers to get individuals off drugs through a system of payment by results – paying service providers per person who becomes "chemical-free". The document concludes that the proposed reforms "will shake the maintenance-oriented status quo". It goes on: "The payment-by-results approach will encourage providers to supply services that achieve a set of defined and measurable outcomes that include being free of their drug of dependence."

Campaigners claim that ministers do not understand the complexities of addiction. "Some people enter treatment to become abstinent – others may not be able or willing to reach this goal," the charities' letter states. "Imposing a 'one-size-fits-all' abstinence goal upon this diverse population is dangerous, legally problematic and may contravene medical ethics." It continues: "The roadmap claims it will 'deliver much better value for taxpayers' money in the short and longer terms as ultimately payment will be made for full recovery only'. This statement trivialises the complex nature of drug dependence."

The absence of a full analysis of the cost implications is highlighted, and the group argues that payment by results could encourage services to exclude people for whom "full recovery" is unlikely.

The charities cite the low prevalence of HIV among the UK's 156,000 or so injecting drug users as evidence of the success of harm-reduction techniques. They also point to evidence showing the significance of needle/syringe programmes in bringing this about and to studies showing that substitute treatments reduce overdose rates.

Lisa Power, THT policy director, says Britain risks undoing much of its achievements on preventing the spread of HIV among injecting drug users, stemming from the 1980s when the Tory government embraced harm-reduction models before many of its European counterparts. The early adoption also helped to curb the spread of HIV among the heterosexual population in Britain, she argues.

"'Abstinence or nothing' doesn't work for sexual transmission and it doesn't work for injecting drug use," Power says. "All the evidence shows it works well as one of a range of options, but badly as the only one."

Yusef Azad, director of policy and campaigns at Nat, says the charity has "grave concerns" about the government's "change of direction" and that it "risks alienating drug users from much-needed support."

Lives at risk

Niamh Eastwood, executive director of Release, is even more damning, calling the roadmap "an ideological attack" on evidence-based treatments. "The proposals would see the most radical overhaul of the UK treatment system for decades," she says. "This puts people's lives at risk and demonstrates a deeply flawed understanding of the nature of addiction."

A government spokeswoman denied that the document was a shift away from the drugs strategy. Conservative MP David Burrowes, who was involved in drafting the roadmap, said "it does not seek to diminish" harm-reduction treatments. He added that one of its strengths was that it was "not a government diktat" but came from a "collaboration" with charities and service providers.

However, the umbrella group, DrugScope, which is heavily name-checked in the roadmap as endorsing the drugs strategy, has distanced itself from the document. Its chief executive Martin Barnes says that, while the organisation "still supported" the government's treatment and recovery approach "as set out in the drug strategy in 2010", it "did not support or endorse where [the roadmap] clearly differs from the government's commitments to an integrated and balanced system".