Centre for Drug Misuse Research
Glasgow Scotland
From Harm Reduction to Abstinence: A Journey
in Drug Treatment Pol
From Harm Reduction to Abstinence: A Journey
From Harm Reduction to Recovery: A
Journey in Drug Treatment Policy and
Practice
in From F
Neil McKeganey Ph.D
Director

Harm Reduction Defined
 Harm
Reduction’ refers to policies,
programmes and practices that aim
primarily to reduce the adverse health,
social and economic consequences of the
use of legal and illegal psychoactive drugs
without
necessarily
reducing
drug
consumption (IHRA 2009)
The Ascent of Harm Reduction
 2002 Updated UK Drug Strategy:
 All problematic drug users must have access to
treatment and harm minimization services both
within the community and through the criminal
justice system.(Home Office 2002)
 Nearly al Drug Action Teams (97%) have harm
reduction services and 87% provide access to drug
prescribing services (Home Office 2002)
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Harm Reduction Falls from Political
Favour
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
2010 UK Drug Strategy Reducing Demand
Restricting Supply and Building Recovery
A fundamental difference between this
strategy and those that have gone before is
that instead
of focussing primarily on
reducing the harms caused by drug misuse
our approach will be to go much further and
offer every support for people to choose
recovery as an achievable way out of
dependency.
(Theresa
May:
Home
Secretary)
The Reasons for the Shift in Policy and
Provision
 Research
 Media
 Political Interest
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Drug Outcome Research in Scotland Study
(2004):Treatment Goals n=1007)
80
57
60
40
24
20
0
7
7
Ab
st
St
in
e
nc
e
on
ab
ly
R
al
is
at
io
n
ed
on
uc
ed
ly
1
4
Sa
N
us
e
fe
on
l
ru
y
se
o
on
ly
>
go
al
s
1
G
oa
l
2007 National Treatment Agency Client
Survey England n=12,398
Drug
Happy with Use
Like to Reduce
Use
Like to Stop
Using
Heroin
11.4
8.1
80.5
Methadone
36.5
12.9
50.7
Crack Cocaine
16.3
10.5
73.2
Amphetamines
27.5
11.4
61.0
Cannabis
64.2
14.7
21.1
Alcohol
53.6
21.2
25.2
Benzodiazepines 50.4
12.7
36.9
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Treatment Outcome
 In 2007 National Treatment Agency Reports that
 In 2006/07 there were 180,000 drug users in
treatment of whom only 3.2% (5,829) left
treatment that year drug free.
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Drug Related Deaths in Scotland Linked
to Methadone
year
Total Number of
Addict Deaths
Total Number of
Methadone
Related Deaths
% of Total
Deaths linked to
Methadone
2004
356
80
22
2005
336
72
21
2006
421
97
23
2007
455
114
26
2008
54
169
29
2009
545
173
32
2010
485
174
35
2011
584
275
47
2012
581
237
40
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Drugs and Addict Deaths in England
2005
2006
2007
2008
2009
%
Increase
All Deaths
2762
2570
2640
2928
2878
+4.2
Heroin
842
713
829
897
880
+4.5
Methadone
220
241
325
378
408
+85.4
Cocaine
176
190
196
235
202
+14.7
MDMA
58
48
47
44
27
-53.4
Benzos
190
177
207
230
261
+37.3
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Injecting Risk Behaviour in England (Last
Month)
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Passing
On
>24
31
(31)
33
(36)
34
(44)
29
(37)
28
(36)
28
(38)
23
(29)
23
(26)
19
(22)
19
(27)
21
(30)
Passing
/Rec
Scot
34
35
33
34
31
27
Any
Sharing
60
59
60
55
53
53
48
47
41
37
40
Media Coverage
 Additional spend of £130m on drug treatment for
2004/05 only 70more people had become drug
free. National Treatment Agency responded that in
fact out of 66,123 people leaving treatment 8.8%
were drug free.
 Report on BBC that drug users were being
prescribed additional doses of methadone as a
reward for positive behaviour change.
 Report that only 2% of drug users in treatment
offered residential rehabilitation
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Political Criticism
 Political criticism that many thousands of drug users
were being “parked” on methadone, that the
methadone programme amounted to a form of
state sponsored drug addiction that was failing to
enable drug users to become drug free.
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Prime Ministerial Assessment of
UK Drug Policy
 "Drugs policy has been a failure over
recent years... We have spent too much
time on heroin replacement and
methadone rather than on trying to get
people clean and clear up all the things
in their lives that perhaps cause them to
take drugs in the first place,” (David
Cameron 29 June 2011 Hansard 954).
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Reorienting Clinical Guidelines:
Medications in Recovery 2012
 The ambition for more people to recover is
legitimate, deliverable and overdue. Previous drug
strategies focused on reducing crime and drug
related harm to public health, where the benefit to
society accrued from people being retained in
treatment programmes as much from completing
them. However, this allowed a culture of
commissioning and practice to develop that gave
insufficient priority to an individual’s desire to
overcome his or her drug or alcohol dependence.
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland
Recovery the Cornerstone of Drug
Treatment
 The focus now in on trying to ensure that drug
treatment services are working to enable drug users
to become free of their dependence.
www.drugmisuseresearch.org
Centre for Drug Misuse Research Scotland