The Vision Project

“WE WILL NEED SOCIETY, AND IN PARTICULAR
THOSE WITH THE ABILITY TO BRING ABOUT
CHANGE, TO SEE THOSE AT RISK OF DEATH AS
DESERVING OF PUBLIC SERVICES - WITHOUT
CAVEAT.”
Unfortunately, the same is not true of heroinrelated
deaths. Media articles, if any even appear,
remain full of stigmatising language, usually
referring to the “addict” that has died, focusing
on the drug use and the failure of the individual
to have stopped. Rarely, if ever, do articles look
at the person, their history, what they may have
had to overcome in their lives - just one less junkie
being a drain on society. We’ve got an increasing
understanding of the role of trauma and adverse
childhood experiences that underpin many
people’s heroin use but the media continue to
push stories that paint the deceased as merely
lacking the necessary willpower or moral fibre to
stop.
Deaths from MDMA and other club drugs have
been mainly due to very high purity putting people
at risk of taking an unknowingly dangerous dose.
Without legally regulated production and supply
of these substances, it is left to organisations such
as The Loop to offer drug testing facilities to give
individuals an opportunity to better understand
what it is they have bought and to sit with a
health professional to better understand the risks
and allow informed choices to be made.
These measures, while still underfunded and
under-supported by local and central government,
have been widely accepted as a public good,
and are relatively uncontroversial. However, the
response to reducing opiate deaths has so far
been much more lacklustre. Naloxone, the opiate
overdose reversal drug, should now be easily
available through drug services and has been
saving lives up and down the country. Whilst
naloxone doesn’t prevent overdoses, just reduces
the risk of them being fatal, without it there
would be far more deaths. However, it is crucial we
don’t solely rely on the supply of this emergency
medication to prevent people from dying.
DEVELOPING HEALTH & INDEPENDENCE
To reduce opiate deaths, there are things we can
do right now: prioritise access to and retention
in treatment, ensure people aren’t booted out of
treatment for relatively minor non-compliance,
provide decent doses of substitute medication
for a decent length of time, as well as increasing
availability of naloxone wherever people are using
opiates. Improvements to these alone would
save a significant number of lives.If drug-related
deaths continue along the same trend that we’ve
seen since 2009, we would expect 90,000+ deaths
attributed to drug misuse over the next 20 years,
with opiates making up the bulk of these. At some
point you’d hope this would be recognised as
the public health emergency it already is. There
are things that could be introduced very quickly
that would further reduce the rate of deaths. Just
like drug safety testing first took place on the
continent before the UK, other initiatives provided
in Europe and elsewhere have been proven to
reduce the number of deaths related to opiate
use and we should adopt them where there is the
need to.
Heroin-assisted treatment (HAT) is the provision
of pharmaceutical grade heroin for use in a
clinical environment under medical supervision.
HAT is available in Switzerland, Germany, the
Netherlands, Canada and Denmark to reduce the
harms associated with heroin use. Ironically, it’s
based on the old “British System” of prescribing
heroin and other controlled drugs to the middle
class, which all but ceased decades ago.
Deaths, crime and anti-social behaviour have
all reduced where HAT has been introduced and
is far more effective than the mainstream drug
treatment currently available. Foundations drug
service in Middlesbrough will be the first service to
(re)introduce this approach in the UK but hopefully
not the last.
Drug consumption rooms (DCRs) have been
around for the last 30 years and are currently
operational in several countries in Europe, North
America and Australia. Similar to HAT, DCRs
are clinical environments where heroin can
be administered under medical supervision –
although in the case of DCRs the heroin is bought
on the illicit market by the individual using it rather
than being prescribed.
Whether these types of initiative are made
available across the country depends on two main
issues. HAT and DCRs have been shown to be
cost effective. Unfortunately, due to how budgets
are managed in England it is hard to make these
arguments as the one spending the money will not
be the one making the savings. Local authorities
are responsible for funding drug treatment but
nearly all savings will be in the NHS, police, courts
and prisons.
With little to no savings for local authorities
and billions of pounds cut from council budgets
following a decade of austerity, it will require
a shift to a more holistic view of public sector
spending, and for those civil institutions to work
together more closely.
Secondly, if we’re serious about reducing drug
deaths then something more fundamental will
need to take place. We will need to move beyond
just seeing the behaviour and start seeing the
people behind it. We will need society, and in
particular those with the ability to bring about
change, to see those at risk of death as deserving
of public services - without caveat. People who use
drugs have a right to life, to be safely and securely
housed, to have their health needs met. Rather
than changes to drug use being a precondition
for support, people should be able to benefit
from society’s rights, opportunities and resources
as freely as those who don’t (openly) use drugs.
Eliminating social exclusion is likely to have more
impact on the number of deaths than anything
else we may be able to achieve.
The solution to reducing drug-related deaths isn’t
clear and simple but we can’t let it continue to be
wrong. If we value the tens of thousands of lives
we’ll lose over the coming years we can’t keep on
following the same well-trodden path and expect
drug-related deaths to suddenly stop.
15