The Pharmaceutical Journal
Vol 279 No 7477 p526
10 November 2007

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Why knock the National Treatment Agency? Look at its successes!

By Terry Maguire

Newspapers are awash with dismissive comment about England’s drug addiction treatment programme run by the National Treatment Agency.

A key pillar of current drug policy is easy access to a treatment programme for those in need; access is available yet, newspaper reporters suggest, in spite of strong government commitment and plenty of funding, success eludes the national programme.

The facts are sobering: £131m extra funding for the National Treatment Agency last year brought the total invested from £253m to a staggering £384m and even then the number walking out of treatment drug-free has barely changed — 5,759 three years ago, 5,829 last year.

Whereas a sanguine politician might argue that offering the service only costs about £2,000 per addict enrolled and that figures show an increase of 70 addicts drug-free on three years ago yet the fact is this represents a decrease, down from 3.5 per cent to 3.0 per cent of those in treatment.

If we qualify “success” as getting an addict “clean” then the current service costs £1.85m for each addict returned to normal life. This is a huge figure and it does not, I believe, include the cost of all the methadone dispensed or the dispensing fees pharmacists receive as these are paid for out of a different budget. And there is little to suggest that the other three home nations fair any better in the success of their drug treatment programmes.

Pity the poor old Department of Health, which must defend this failure. Yet it does, claiming that the figures distort the true picture; it is unrealistic to expect immediate results, it says, since successful treatment takes between five and seven years. The DoH is right there: addicts will decide when they want to come off drugs and many of them are happy to take their time.

A DoH spokeswoman made the point in the national press recently: “Drug treatment works, it saves lives and it saves money. Every £1 spent on drug treatment saves £9.50 to the rest of society.”

She added that more than 195,000 people are now accessing drug treatment programmes, 130 per cent more than in 1998, and that the programme is making progress. So failure to spend £384m on a drug treatment programme will end up costing society £3.6bn.

In England and Wales, the Drug and Therapeutics Bulletin (March 2007) has suggested that some 250,000 people have serious drug problems and when it is considered that this roughly equates to a cost of £14,400 for each addict the cost of the programme seems to be value for money as society is £12,000 better off per addict per year.

Of course the DoH prefers to quote a “success” rate for the national programme of 9 per cent; this is the figure found by the National Drug Treatment Monitoring System. The difference between the 3 per cent quoted above and the 9 per cent quoted by the DoH is explained by the DoH not including those who failed to complete the 12-week course; is it politically correct to call them drop-outs?

According to a separate report by the National Treatment Agency, 58 per cent of addicts who attended drug clinics last year failed to complete treatment. The problem here is that success is being measured in addicts stopping drugs; in this respect the national programme fails miserably. But we could spend all day trading statistics.

Shocking hypocrisy

UK drug policy and the Government’s attitude towards it suffers from a shocking level of hypocrisy — but perhaps a necessary hypocrisy if it spares the blushes of the politicians responsible for it. On the face of it much of the drugs policy is unpalatable to the sanctimonious green-wellington and headscarf brigade and supporters of both Labour and the Conservatives.

We should be clear on what is going on. UK drug policy is designed to support individuals in their drug habit rather than getting them off their drug habit. We live in a liberal democracy and one of the prices we must accept for this is an illicit drugs problem.

Much of my life has been spent in a political environment that was not so liberal or so democratic and we did not have much of a “drug problem”. Politically motivated paramilitary organisations, often incorrectly blamed by those outside Northern Ireland for drug trafficking, were opposed to the illicit drug trade and simply shot and murdered those involved for “anti-social activity”; if it were not so serious this irony is hilarious.

It was a policy that ensured we did not have an underclass whose sole purpose in life was the procurement of heroin or cocaine. Indeed the Northern Ireland Drug Substitution scheme was only introduced in 2003 on the orders of Westminster and was put in place mainly to treat addicts returning home to a “normal society” after living for years in Great Britain.

A look at the illicit drug problems of Singapore and most Arab states shows how an aggressive criminal justice stance on drugs works. But society must have the stomach for this.

The vast majority of people who experiment with illicit drugs will only do so for a short time or will use them on an intermittent basis and in such a way that does not interfere with their day jobs. Others, the 250,000 in England and Wales identified in the DTB, will go on to develop a severe problem where normal function takes a back seat to the daily procurement and taking their drug of choice.

The percentage of this problem user group exhibiting sociopathic tendencies before developing a serious drug problem would be an interesting fact to know. Environment, particularly social depravation, will off course have a major contributory effect. People living in toxic environments are more likely to misuse drugs.

Of the 100,000 American soldiers who were classified as “addicted to heroin” in the Vietnam war only about 7 per cent continued to use heroin on return to the US. On returning home the adverse environment of combat was removed and there was no need for them to continue their drug use.

Aldous Huxley put it best: “Most men and women lead lives at worst so painful, at the best so monotonous, poor and limited that the urge to escape, the longing to transcend themselves if only for a few moments, is and has always been one of the principal appetites of the soul.”

So why are we getting so challenged and upset by the apparent failure in the current drug treatment programme? We should not; we just need to be clear about its objectives. And this is not to get people off drugs; it is merely to reduce criminal offending.

This is why the focus has been to get addicts into, and keep them locked into, a drug treatment programme come what may. The difficulty is the drug treatment programme has been made so attractive to drug users many now see it as a useful adjunct to their daily illicit drug need. This has resulted in some drug workers having to resort to giving bonus (contingency) doses of the preferred drug or even antidepressants to keep them on board.

It is society’s fault in its unwillingness to deal firmly with the drug problem within the criminal justice system that is at the route of these poor outcomes. The national drug programme is about enrolling, corralling and quarantining addicts rather than offering proper high-quality treatment. It is this that ensures we only get a 3 per cent success rate for addicts stopping drugs.

The true success is that we get 75 per cent of problem drug users enrolled into a government treatment programme making them less likely to break into you home this evening to steal your DVD player.