Some of the harsh realities on the frontlines of drug treatment can be overlooked, resulting in individuals needs not being met in services designed to support and care for them. Severe disinvestment in healthcare can have a profound and detrimental effect on providers ability to provide the standards of care set out in the 'new' drug strategy that, despite mounting evidence and political admission of failure, represents nothing more than a repetitive cycle that results in increasingly detrimental outcomes. How many more have to die before positive action replaces the negative impact our communities are currently experiencing? When people are paying with their lives we have gone beyond breaking point!!

1. Beyond breaking point….
NO ‘SUBSTANCE’ TO CURRENT SUBSTANCE MISUSE APPROACH
“Some of the needs of our clients that have changed are due to issues including increased
poverty, anxiety in relation to immigration status, challenges accessing housing and
accommodation, the increasingly hostile environment for migrants and changes to legal
aid. People are more anxious about what is going to happen to them in the community.
There is also a reduction in funding available for voluntary organisations which has led to
increased competition between them but has also led to some services raising their
thresholds for support and narrowing their offer”
The above statement was made by a small charity working within the criminal justice system
offering support in prisons, detention centres and young offender institutes and other secure
environments. It highlights not only the effects on the service users as a direct result of funding cuts,
but also the effects on the staff, the charity itself, and the necessary multi-disciplinary environments
that inspire positive, sustainable change. Various organisations/agencies that used to work closely
together have become increasingly competitive leaving huge gaps in care where high numbers of
clients are falling through the net. This is manifesting itself into a heavy burden on the smaller
charities who, without the benefits of a multi-disciplinary, multi-agency approach are struggling to
meet the needs of the individuals under their care in many ways.
This current culture of disinvestment is affecting all aspects pf social policy and is thus creating a
negative cycle that does not support recovery in any way, shape, or form, either to the individual
seeking support, the wider community, criminal justice, commercial enterprise, economic, financial,
etc. This can be seen in the current trend of negative statistics that are continuing to rise ay an
unprecedented rate.
Lack of training and education in specialised areas of care that used to be covered by various
multidisciplinary teams and partnership organisations are becoming more apparent and this, sadly,
has the devastating effect of rendering some services with a track record of ambitious standards in
successful outcomes, unfit for purpose when faced with the complex needs of the user community.
The ensuing negative outcome, once again, has a huge impact on the wider community in many
ways.
Low penetration levels because of continued funding restrictions in service provision, are becoming
evident and are a direct result of a growing inability to meet client needs, which then affects ‘all’
aspects of the welfare state and social policy in general. Less affluent areas where there are already
elevated levels of social, civil and health inequalities, morbidity, poverty, unemployment,
homelessness, etc, are showing an increase in negative outcome statistics around drug related

2. crime, the spread in life threatening infections, drug related fatalities, economic and financial strain,
over stretched emergency and legal services, and, consistent increases in long term absences in the
workplace as a result of ill health which ultimately results in additional costs, using much needed
funds that could be more effectively used to initiate and support preventative, proactive models of
care and support, measures to ensure equality based on current presenting issues, rather than
judgmental approaches based on historical biases. Approaches such as widening access to cost
effective, life-saving medications, the introduction of safe, secure, medically supervised
environments, reintroduction of ring-fenced budgets. Interventions based on reducing risks of
increased harms.
Scientific, evidence based principles rather than the current unevidenced, idealistic policies based
on years of misrepresentation and misguidance, should be the primary concern in all related
decisions made by central government, allowing for adequate funding, thus enabling local
authorities to effectively commission services to provide, full, appropriate and comprehensive
platforms on which to build an inclusive system that inspires interaction and retention, maintains
person centred approaches, (often replaced by group therapy, which is not suitable for many, ie:
gender specific, single parents, LGBTQ, etc) promotes positive change, and evades time limited
restrictions, all of which collectively ensures every chance of sustainable successful outcomes rather
than ever increasing downward trajectory that currently favours failure, and, an unprecedented rise
in fatalities.
A new and innovative approach that favours a more realistic, if not, radical reform, based on
unbiased, independent research, that has historically proven it effectiveness during the rise of
HIV/AIDS in the early to mid-80’s, is what is needed to reduce the current negative outcomes
reflected in the statistical increase, and growing fears of more deaths. The continued financial
restrictions cannot, will not, produce any of the desired outcomes that are set out in the current
agenda, but are instead having a negative impact on penetration and retention, which results in the
continued rise in demand for substances, which then escalates the criminal involvement of supply,
and together they increase the cost to the wider community, placing all other areas under financial
strain. Creating a cycle of robbing Peter to pay Paul…etc, etc, its not sustainable.
Increasing the financial awards within the sector, enabling a positive shift based on the outcomes
of previous tried and tested formula’s is the only sensible and effective way forward, other than
decriminalisation and regulation, which would then. in a brief period, generate enough income to
provide a self-supporting pocket of funding for treatment, as well as generate enough profit to
ensure economic recovery, a sensible proactive approach. Rather than the continuation of the
undeniably, extremely costly, non-effective, punitive, prohibitive, reactive approach that quite
clearly has no relevant impact on ‘any’ of the projected, desired outcomes set out in ‘any’ previous
agenda’s designed to reduce supply, demand, mortality rates, national costings and other negative
impacts associated with substance use and the perceived risks to ‘whole’ communities that are
dangerously unbalanced in their promotion of ‘specific’ routes towards positive change, thus
ultimately undermining all other outcomes that do not meet the ‘restricting ideals’ of one specific
desired outcomes is counterproductive, and not representative of the majority of individuals it is
designed to engage, making penetration into the user community ultimately harder to achieve and
retain.
When there is inconsistency in care, due to the constant fear of future security and stability making
it impossible to maintain the standard of care that the UK were once held in international high
esteem for. Constantly, relentlessly, being made subject to more financially imposed penalties,
affecting all aspects of future safety and security of the user community, their much-valued service

3. providers, and inevitably, the wider community, would, considering we are now beyond breaking
point already and paying with our lives, border on negligence in practice, and some might say,
eugenic in content. Already pushed way beyond breaking point, surely, common sense should warn
us, that it stands to reason, all related outcomes beyond that point present imminent risk of
escalating into a quagmire of negative chaos in the social policy arena, no area untouched. The
result of which can quite clearly be seen in the current opioid crisis reaching epidemic proportions
globally, which has now begun to rear its ugly head here in the UK, with the loss of 48 lives this year
alone to Fentanyl, a figure I have no doubt is realistically higher, but undetected due to the insidious
nature of the substance and its many analogues, each one more potent than its predecessor. We are
ill prepared, severely unequipped, and far from being in a strong and stable enough position to
address this crisis. And I fear that to not see this as a reason to put more focus on improving the
avenues to care and support rather than to continue to disintegrate the model best suited to take
the impact may put this all-in perspective, at an extremely high cost, to life, primarily, but also to the
already battered emotional, mental and physical wellbeing of whole communities, overdose affects
everyone, more so when iy is preventable. 10% of all the monies that are used up in promoting and
maintaining a criminal justice approach towards controlling drug use, and drug users, would be
sufficient to implement, or simply reinstate, appropriate models of care, increasing penetration
levels, improving retention in staff and users alike, and effectively reducing the recent significant
increase in negative outcomes.
Over 100 years of rhetorical procrastination is now reaching the point where options have become
limited and all that is left is to embrace the radical proposals made by experts from all angles
throughout those years. Rhetoric is dangerous and mounts to nothing more than negligent
complacency in its approach to the health and wellbeing of an ever-growing number of people for
whom the barriers to safe, effective environments of care and support can mean the difference
between life and death.
Some of the more prominent providers are now struggling to meet the increasingly high demands
of an ever-changing community, with increasing numbers on caseloads, a growing number of
individuals whose needs are becoming more complex, widening availability of new substances
reshaping the global market creating a massive black hole of unknown territory, navigated by luck
and chance, unacceptable qualities in public health matters where quality of life and high risks of
death are primary key elements. Additionally, we can add to this the projected increase (25% by
2025) of elderly presentations adding a whole new diverse and complex range of poly health issues
and comorbid underlying conditions, it raises the question as to whether the sector is capable of
rising to the challenges that lay ahead with the limited assets they have, and what will be the
outcomes if they can’t?
For years governments have followed the iconic, utopian dream set out by the United Nations with
regards to creating a ‘Drug free world’ which is both ludicrous and unachievable, driving punitive
policies and legislation, affecting local commissioning, creating unrealistic key performance
indicators, that are creating a landscape that is more reminiscent of an Orwellian nightmare of epic
proportions. A public health crisis is looming casting a dark shadow over the global crisis we are
currently facing. It’s time to end the rhetorical questioning and complacency in due care and
attention to ‘selective’ public health matters and start actioning the solutions offered from the
frontline experts, no matter how radical they may seem, everything else has been tried and failed
abysmally. The continued resistance experienced in these matters, especially when there are still
options that have not yet, at very least been piloted, is by definition, negligent and eugenic in
practice and principle, this is reflected in the majority of related outcomes relating to the sector.

4. Even the ‘positive’ outcomes are questionable. Numbers shown relating to those accessing
treatment services for opioids is currently dropping, this translates as a ‘successful outcome’ which
is then attributed to the success of current policy. The reality is that there has been an
unprecedented increase in fatalities recording the highest ever statistical data relating to drug
related deaths since 1993, and, a significant shift in the way services are both commissioned and
delivered. An area as complex as addiction cannot be successfully managed by a blanket policy, that
is primarily designed to target between 10-20% of the user community, those deemed as
‘problematic’, the remaining 80-90% are not currently getting their needs met. In any other area
where inventory exposed such a prevalent deficit, supported by cold hard facts, there would be a
direct plan of action implemented immediately to increase effective measures and address all
aspects of negativity arising, for example; We deemed the Ebola scare as a matter of National
emergency, prioritising our ‘fears’ and subsequently ‘ring-fencing’ a significantly large pocket of
funding ‘just in case’ it broke out here in the UK, and yet, the current global opioid crisis/epidemic,
and the unacceptable increase of, for the large part, preventable deaths attributed to substance
misuse is still at the bottom of this governments priority list, only becoming a priority topic for
discussion when imposing more damaging cuts.
This harsh reality will obviously influence penetration levels, retention, and positive outcomes. How
it translates is dependent on who your nemesis is, if your priorities are politically motivated and you
seek to justify your actions, then this becomes a positive, however, if your primary concerns are the
improved health and wellbeing of your community members and the economic gains of effective
positive intervention it is most definitely a negative.
In general, the negative attitude shown towards substance users in the UK, more prominently in
England , is one that appears to favour the exclusion of drug users, whether current or historical,
from the majority of community based assets needed to help individuals create a realistic, solid
platform on which to build a secure, sustainable pathway that enables them to be of maximum
benefit to the community of which they are a part of, rather than putting up barriers specifically
designed to keep them apart from. This negative outlook and is the result imposed systematic design
allowing far too much room for discriminatory practice, stigmatising people for using substances,
and this has resulted in providing the ideal ‘scapegoat’ arena to pass the blame for all of societies
social ills. The truth of the matter, is that it is more likely to be the complete opposite in the majority
of cases. Escalating social inequalities and related negative impact of targeting the less affluent
areas, whether directly or indirectly, is fuelled by the relentless, continued disinvestment of much
needed vital, structured provider networks and availability of effective wrap around support options,
thus increasing the prevalence of negative outcomes in every single one of the key elements
highlighted as priority values in the 2010 agenda. The agenda continues to expose its own
contradictory approaches by successfully undermining its own core values, and its statement of
intent, disempowering the aims and objectives of all key points and recommendations that, in print
only, seem to support the desired outcomes but, achieved quite the opposite. All that has been
achieved is in direct contrast to all that it hoped to achieve, or at best, fraught with restrictions and
small print. Each element of the agenda, expanding over time to include a wide range of human and
civil rights violations, which , affects some of our most vulnerable community members/groups, and
effectively creates a virile, almost perfect breeding ground for all negative aspects relating to the
current approach, to not only continue, but to thrive.
The less affluent areas in UK have been subject to an increasingly dangerous level of cuts, in all
essence, these should be the areas where there is more attention given to reduce the increase of
risk and harm.

5. In essence, we must invest in, reinstall and reinforce a culture that enhances the evidence based
and scientifically proven successes of supportive measures that focus on reducing the harms, rather
than continue to waste what resources and finances we have on the continued culture of
punishment, that has never once provided any stable solid proof of being effective in any other way
other than to further marginalise, penalise, stigmatise and discriminate against some of our most
vulnerable community members, and, as the current trend shows us, is now resulting in an
unacceptable increase in deaths, for which someone must be held accountable.
Failure to act appropriately and responsibly, once aware of the consequences of your actions, is not
acceptable for those struggling on a day to day basis, with homelessness, poverty, ill-health and
other inequalities, desperately reaching out for care and support. Why should it be remotely
acceptable behaviour from those who have the power to initiate change but choose not to. In tort
law that behaviour, and similar acts of inaction are defined as negligent, in my opinion its eugenic.
Either way, actions resulting in the loss of life are unacceptable.
What I am hoping to influence in raising these concerns is the need for….
• Reinvestment in the drug and alcohol/Health sector that effectively enables providers to
offer a more comprehensive, person centred, inclusive service in their approach towards
ensuring a positive experience for all Service Users/Significant others/Family
members/Stakeholders, and others accessing, or interacting with support services, to
minimise the harms and growing risks of all potential negative outcomes, primarily fatalities,
especially in light of current global opioid crisis, by ensuring all aspects of provision are
delivered to meet the highest standard that reflects the quality and competence previously
experienced historically, in particular, during the HIV/AIDS epidemic in the early to mid-80’s.
Which significantly reduced the potential negative outcomes and placed Britain at the
forefront of its approach towards caring for its most vulnerable.
• The introduction of accredited, comprehensive and extensive quality standards, specific to,
but not exclusive to, this particular area of care. All current and future employees should be
trained to meet these quality standards during their induction/probationary period. This
period should be ‘protected’ time during which caseloads and interactions with clients
should be kept to a minimal to reduce levels of stress during the learning period and the
negative impact of incompetence and lack of appropriate specialised knowledge needed to
provide exclusive support that meets the desired standards of care designed to minimise risk
of future harms and satisfy the ever-changing elevated level of needs of the user
community. This training period should be monitored and assessed by a designated,
qualified individual within each service. And signed of in a formal interview type manner
where the interviewers consist of a service user and service user representative as well as a
member of management. This training should always be kept up to date to meet the needs
of an ever-changing landscape to ensure that staff feel confident in their role. For example:
in light of the fact that there is a global opioid epidemic that has now reached Britain,
resulting in a confirmed death toll of 48 this year alone, an understanding of the risks
associated with the Fentanyl family and other synthetic opioids should have been covered in
preparation to help minimise the devastating effects seen globally.
• In the nature of the current globalisation trend, a complete and evidence based approach
taking into account the successes, and failures, of other areas/countries is needed to ensure
that we are incorporating best practice at all levels, based on the proven successful

6. outcomes that are already evident in practice. This would also give us an advance warning
approach that could significantly reducing the negative outcomes we are currently
experiencing.
• A mandatory approach towards combatting the growing number of opioid related deaths
that expanded the availability of life saving medications such as Naloxone, and realistic
research into other opioid antagonists such as Nalmafene in light of current increased
potency of Fentanyl’s, to reduce the risk of further deaths should Naloxone not have the
desired effects in reversing the overdoses experienced in the current trend of increasingly
potent analogues of Fentanyl.
• Reintegration of effective ‘independent’ service user representation in services that respects
both the key performance targets of the provider ‘and’ the needs of the user community
rather than the apparent ‘tokenistic’ value that promote the service outcomes. This would
include forming inroads to the recovering community, but would not be set as a
requirement where a set number of recovery focused groups must be attended or clients
face being penalised, in any way shape or form. Removing the element of using a
prescription as a ‘carrot’ to ensure targets are met. This is a form of enforced recovery and
does not work. Statistics have proven this time and time again. The introduction of a
comprehensive service user representation aspect also gives the added benefit of keeping
local services in line with local needs and provides an early warning system as to trends in
the local area. Giving services the chance to prepare for the ensuing potential increase in risk
and preventable harms.
• An end to the increasingly competitive market arising from the financial restraints imposed
by the continued reduction in necessary funding that impedes the ability to provide a high
standard of care that meets the growing demand of a community that in times of austerity
(or generated false economy,) where poverty, unemployment, homelessness, etc, thrives,
has a negative impact on all areas of social policy. Replaced by the inclusive multi-
disciplinary partnership approach that enables, shared responsibility and positive interaction
of experts in all aspects of care needed to ensure a full and comprehensive care plan of the
highest standard is met with satisfactory competence by experts in their fields. The current
disinvestment has created a vacuum where the expectations imposed on staff and services
in general is causing lower retention rates due to ill health in staff attempting to meet the
needs of a community and the needs of unrealistic commissioning bodies. At times this
expectation demands interactions with clients whose needs are complex and exceed the
experience of the services such as the high priority needs of those with dual diagnoses. It is
rare that you will find generic drug workers with the additional knowledge needed to meet
the demands of an individual who has dual diagnoses, and even rarer that you will see an
effective transition of care between the relevant services to meet those needs. More often
than not there is an ensuing ‘debate’ as to who should ‘take responsibility’ as primary carer,
which has a detrimental effect on the individual seeking care and inevitably a high number
of high priority needs clients fall through the net with no care, while the specialised care
providers take the time to make the decision as to who takes responsibility, this is an
uncomfortable period for all involved and a dangerous period for the individual seeking
support. Yet another preventable high-risk scenario that is playing out under the strain of
reduced funding and the resulting unrealistic commissioning that inevitably pushes
providers into a position where they are forced to be selective in their intake process, to
secure their output statistics. This promotes the affectionately termed ‘quick win’ client,
whose needs are usually minimal, by comparison, to the needs of the more chaotic and
desperately in need of care, which all too often results in priority being wrongly

7. allocated/awarded during initial assessment on entry to treatment. This approach would be
dramatically reduced if all aspects of healthcare were treated with equality projected with
less discrimination. The importance and relevance of the need for a better universal
understanding and recognition of the need for effective partnerships, all seen as equal
strands of the finely woven blanket that covers all aspects of care in equal proportion would
have a more cost-effective affect long term, inspiring a more effective level of penetration
into an expanding community, whose needs are ever changing and ever expanding a
community who are at present, disillusioned, under-represented, undervalued in their
potential, losing faith and trust in the providers to meet their needs, and as a result
choosing to rely on luck, leaving outcomes to chance and fate, rather than access support
that has sadly become a depersonalising process that lacks empathy, understanding and
person centred values that empower and inspire positive change, with underlying enforced
directives that are designed to meet the minority of those it was initially designed to provide
care for. And the result, yet another vulnerable group of community members who are dying
at an unprecedented rate, in an unacceptable environment, that is for the most part
preventable. For the sake of promoting a false economy, that seeks to save pennies, and in
doing so merely transfers the impeding cost elsewhere in social policy
To summarise: There is a growing list of valid concerns arising as a direct result of the continued
disinvestment in the sector which inevitably reduces the availability of pooled resources, and
therefore has a negative impact on the ability of providers to provide adequate, cost effective,
comprehensive care options that inspire and promote positive change, promoting an inclusive
package of care that incorporates a full multi-disciplinary approach. This sadly translates/manifests
as incompetency within services that have been forced into a position where the competitive nature
of survival restricts effective partnership working. The multidisciplinary approach that is necessary to
achieve the desired results set out by the disconnected policy makers has been replaced by an
almost tribal battle, that has lost its focus, leaving users of services with an ever-growing list of
complex needs that are not being met. Resulting in the disintegration of an effective model of care
that significantly reduced the negative impact of HIV/AIDS and put the UK at the top of the quality
standards on an International level. We have surpassed breaking point and are now paying with our
lives, how can this be see55n as remotely acceptable in a sector designed to do exactly the opposite
and improve quality of life Far too many have paid the ultimate cost in the so-called war on drugs,
which is nothing more than a war on people that resembles a form of social cleansing that is neither
humane in content or valid in practice. The cost has by far exceeded that of financial qualities and
we are now paying with our lives. This is not acceptable in any manner of speaking and demands a
complete reformation that puts the value of human life back at the forefront of its approach and
seeks to reduce the effects of addiction in all aspects of community on a National scale. There are no
excuses for the continued negative approaches when the solutions have been made clear, we
cannot afford any more losses. We have paid enough. As have those who have lost family members,
fathers. Sons, mothers and daughters. Enough is enough. We demand action, no more deaths, lest
you are prepared to live with our blood on your hands.