Drink and Drugs News June 2020 ISSN 1755-6236

STAYING ALERT What might the ‘new normal’ mean for services? ZOOM BOOM Making the most of enforced online working

ESCAPING THE BENZO TRAP LET’S IMPROVE OUR UNDERSTANDING OF BENZODIAZEPINES TO SAVE LIVES THE 2020 RECOVERY STREET FILM FESTIVAL HAS MOVED ONLINE

This year we are inviting anyone who is directly or indirectly affected by addiction (individuals, family members, friends, professionals) to make a 60 second film on the theme of ‘Isolation’.

For more information and details of how to enter: www.rsff.co.uk UPFRONT

IN THIS ISSUE Drink and Drugs News is published by CJ Wellings Ltd, REGULARS Romney House, School Road, Ashford, Kent TN27 0LT 4 NEWS t: 0845 299 3429 Chance to end Editor: Claire Brown rough sleeping e: [email protected] 8 PARLIAMENT Advertising manager: Ian Ralph Cross-party group e: [email protected] takes to Zoom Reporter: David Gilliver 6 e: [email protected] 10 LETTERS Designer: Jez Tucker Thoughts on e: [email protected] solidarity and Subscriptions: dealing with stress e: [email protected] website: www.drinkanddrugsnews.com Bill Nelles on how ON THE COVER: The benzo trap doctors shaped Website support by 16 wiredupwales.com drug treatment Printed on environmentally Gender friendly paper by the Manson inequality in All in it together Group Ltd lockdown – the power of Cover by: Suretha Rous / Alamy 9 partnership COVID-19, what CJ Wellings Ltd does not accept happens next? responsibility for the accuracy of statements made by contributors or advertisers. The contents of this magazine 17 are the copyright of CJ Wellings Ltd, but do not necessarily 14 represent its views, or those of its partner organisations.

STAYING STRONG IN PARTNERSHIP ‘We need to be proactive Find the resources to stay ahead of and responsive’ coronavirus from the DDN partners INNOVATIVE DEVELOPMENTS and impressive collaboration and community at have characterised our sector’s response to the crisis (page 8). But what we also need to keep up with are the changes in the www.drinkanddrugsnews.com drugs market and regional trends that could tip the drug-related We are especially grateful to our network of deaths crisis into further catastrophe. One of the trends identified partners at this difficult time and thank each by Release’s new drug monitoring network is increased use of and every one of them for their loyal support. benzodiazepines, so our cover story looks at how we can respond to this by developing urgent new pathways and treatment protocols. It’s essential that we remain proactive and responsive at the same DDN is a self-funded independent publication. Our bespoke partnership packages provide time as making so many other adjustments to routine. an opportunity to work closely with the magazine. Please get in touch to find out more. Commissioners have been thinking along the same lines and there’s an invitation to join a new national forum on page 11. As we’re all particularly concerned about diminishing resources and the threat of services being decommissioned, it’s the right time to create a space for clear strategy and a representative commissioner voice. Collective Voice are working hard for the treatment sector and invite your involvement in rising to important challenges (p14). When we emerge from this crisis let’s not forget the many gains we’ve discovered from working more closely together.

Claire Brown, editor Keep in touch at www.drinkanddrugsnews.com and @DDNmagazine

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 3 NEWS ROUND-UP

Don’t squander chance to end rough sleeping, urge parliamentarians

The government needs to work for anyone to leave temporary quickly to put in place a housing- accommodation and end up back based exit strategy and a dedicated on the streets. This isn't just about funding stream to support it, the protecting vulnerable people from committee urges. The government COVID-19. It is not safe to live on the recently denied press reports that streets in any circumstances, and it it was about to stop funding the is not acceptable to allow it to return scheme to provide emergency once the health crisis abates. For accommodation for rough sleepers the first time in over a decade rough in hotels, with the Ministry of sleepers have been comprehensively Housing, Communities and Local taken off the streets and given Government (MHCLG) stating that it accommodation. This must become would ‘work with partners to ensure the new norm.’ rough sleepers can move into long- Meanwhile, St Mungo’s has term, safe accommodation once the launched a campaign, No going immediate crisis is over’. However back, which is calling for funding to London mayor Sadiq Khan has be put in place for local authorities warned that funding to house rough to ensure that no one is made to he government needs London, May 2020: Homeless people sleepers in hotels in the capital leave emergency accommodation to establish a £100m erect tents on Tottenham Court will run out in mid June, telling without being offered suitable housing support fund Road. Credit: Monica Wells/Alamy the Guardian that without new alternative housing, as well as to avoid losing a ‘golden government money there would for more housing and support for opportunity’ to put an be a ‘surge’ in homeless people people with complex needs. ‘If Tend to rough sleeping, says a report sleeping in England for once and for returning to the streets. the government takes action now from the Housing, Communities and all’, says the committee. It wants to ‘We must praise the efforts of thousands of people can be helped Local Government Committee. see at least £100m a year dedicated all those who have done so much to off the streets permanently,’ it says. Around 90 per cent of rough to long-term housing support to avoid help take people of the streets during Protecting rough sleepers and sleepers – approximately 5,400 people the thousands of people in temporary the current health emergency, but renters at https://publications. – have been housed in temporary accommodation ending up back on what happens next is crucial,’ said parliament.uk/pa/cm5801/cmselect/ accommodation in response to the streets, and warns of a ‘looming Housing, Communities and Local cmcomloc/309/30902.htm COVID-19, providing a ‘unique homelessness crisis’ as the three- Government Committee chair Clive No going back campaign at www. opportunity to eradicate rough month ban on evictions expires. Betts. ‘It is simply not good enough mungos.org Scottish Government widens COVID-19 reducing availability of naloxone drug supplies

THE SCOTTISH GOVERNMENT has widened the availability HEROIN SHORTAGES have been reported in Europe, of naloxone as part of a package of support for people North America and South West Asia, according to affected by drug use during the COVID-19 pandemic. It would ‘not a UNODC report on COVID-19 and drug supply, Other measures include £1.9m to support people on increasing the risk that people may switch to fentanyl OST while in prison to switch to prolonged-release be in the public or its derivatives. Afghanistan’s poppy harvest is being buprenorphine injections, and an ‘enhanced offer of affected by the pandemic, as is cocaine production in residential rehab’ for people leaving prison during the interest’ to Colombia, which has been hit by gasoline shortages. outbreak in order to reduce pressure on local services. prosecute anyone Disruption of air and land routes because of COVID-19 Under current UK regulations, only drug treatment has also had a major impact on drug supply. ‘In the services are allowed to supply take-home naloxone working for a long run, the economic downturn caused by the kits. However, Scotland’s lord advocate has confirmed COVID-19 pandemic has the potential to lead to a that it would ‘not be in the public interest’ to prosecute service registered lasting and profound transformation of the drug anyone working for a service registered with the markets,’ says the agency. ‘The economic difficulties Scottish Government – for example, a homelessness with the Scottish caused by COVID-19 may affect people who are organisation – who supplies naloxone for use in an Government. already in position of socioeconomic disadvantage emergency during the crisis. Non-drug treatment harder than others.’ services will need to register with the Scottish COVID-19 and the drug supply chain: from production Government to become a naloxone provider. and trafficking to use available at www.unodc.org

4 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM News DDN EVERY DAY All the news, updated daily www.drinkanddrugsnews.com

Local News Women were three times more likely than men to cite practical barriers like time, cost or location as reasons for not

Sergey Nazarov/iStock Sergey accessing treatment NEW HORIZONS per cent of respondents said other Change UK is Half of people with people had also been affected by their inviting applications for gambling. GambleAware is calling for its New Horizons grants services tailored to the needs of groups programme, which will fund gambling disorder have less likely to access services, as well as ‘fresh, innovative’ research campaigns to increase awareness and projects on the theme of not accessed support reduce stigma. ‘groups, communities ‘This research has shown that there and alcohol harm’ with ust under half of people admit having a problem and lack is a clear need to further strengthen awards up to £65,000. with a gambling disorder of awareness of available services. and improve the existing treatment Contact NewHorizons@ have not accessed Perceived stigma or shame was cited and support on offer, to develop routes alcoholchange.org.uk for treatment or support, as a reason for not accessing support into treatment and to reduce barriers more information. according to a study by by 27 per cent of problem gamblers. to accessing help,’ said GambleAware JGambleAware. Of those scoring In particular, women and people chief executive Marc Etches. above eight on the Problem from BAME communities and lower ‘Services have to be flexible to meet Gambling Severity Index (PGSI) – socio-economic backgrounds may the needs of individuals and easy to considered ‘high risk’ – 46 per cent ‘not be having their treatment and access. Working with those with lived had not accessed support. support needs adequately met’, says experiences is essential in designing The research, which included GambleAware. Just under a fifth of and promoting access to services, as a YouGov survey, found that up to gamblers from lower socio-economic well as helping to prevent relapse. It 61 per cent of the population had backgrounds were ‘likely to report is important to engage community gambled in the last 12 months. that nothing would motivate them to institutions including faith groups, to Overall, 17 per cent of gamblers seek support’, researchers said, while help make more people aware of the SPECIAL DELIVERY experiencing harm at any level had women were three times more likely options available to them and ensure WDP is partnering with accessed support over the last year, than men to cite practical barriers like no one feels excluded from services.’ delivery company Hermes to with barriers to seeking treatment time, cost or location as reasons for Treatment needs and gap analysis in make sure its Capital Card including stigma, reluctance to not accessing treatment. Around 7 Great Britain at gambleaware.org users can receive essential items such as toiletries during the pandemic. ‘Our Capital Card team are doing ‘ tag’ scheme rolled One-stop shop everything they can to find new and innovative ways to out nationwide THE SOCIAL INTEREST GROUP (SIG) support our service users,’ has launched a new ‘faster, easier said WDP chair Yasmin THE GOVERNMENT is rolling out related harm. ‘Smart technologies to navigate and more user-friendly’ Batliwala. its ‘sobriety tag’ programme for like sobriety tags not only punish website containing all the information offenders across England and offenders but can help turn their on SIG and its subsidiary organisations BUDDY UP Wales, following pilots in London, lives around,’ said crime minister Equinox Care and Penrose Options in The Kaleidoscope Project’s Humberside, Lincolnshire and Kit Malthouse. one place. The site includes careers Birchwood residential North Yorkshire. The ankle tags pages, service user stories and staff detox centre community in monitor an offender’s sweat blogs, as well as integrated social Birkenhead has developed around the clock to determine media links. ‘I am pleased that we have a ‘sobriety buddy’ initiative whether alcohol has been Courts will be able achieved this in the time that we have,’ to provide support and consumed, with courts able to said group chief executive Gill Arukpe. share experiences. ‘We order people to wear them for to order people ‘It is particularly exciting that instead were becoming acutely up to 120 days. The programme of three disparate websites of differing aware that extra support will aid rehabilitation by making to wear ankle tag quality, look and feel, there is now one was needed during the people ‘address the causes of monitors for up to single site where visitors can find out COVID-19 restrictions,’ said their behaviour’, the government about the wonderful work we do to manager Jo Moore. states, and so reduce alcohol- 120 days. support our service users.’

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 5 EDUCATION THE BENZO TRAP

Improving our understanding of benzodiazepines would save many lives, says Kevin Flemen

on-medical use of type drugs will show up on urine In the meantime, some will find benzodiazepines screens, possibly because the benzos and start to self-medicate. creates big stronger ones produce effect When and if the young person Initial benzo challenges at very low doses – producing does access mental health services for treatment lower levels of metabolites there is a good chance – in classic dependency was services. There below the detection threshold. ‘dual diagnosis ping pong’ – that need to be significant changes in And some of the drugs, such as they will be told they have a largely driven Nhow we respond if we are to reduce etizolam, are thienodiazepines not primary presenting drug problem by massive over- dependency and fatalities related benzodiazepines, so won’t produce and therefore should be referred to this family of drugs. metabolites that show up on a to a drug service. In turn, when and long-term The extent of non-prescribed standard screen. they present to the drug service benzo use is poorly understood. they may well find a paucity of prescribing, The Crime Survey for England and YOUNG PEOPLE treatment options to assist with Wales (CSEW) reports a drop in use, Young people’s benzo use appears their benzo dependency. something but anecdotal information from to have increased. Some of this is that has been drug services, including young recreational, influenced by popular THE BENZO BACKLASH people’s services, suggests the culture, including a new generation The increase in the use of Xanax addressed but opposite is true. of rappers whose image and lyrics may have started among young The CSEW data is highly have popularised Xanax. For others, people, but the wider pattern of remains an issue. suspect in relation to benzos, and use may be self-medicating for non-prescribed benzo use has been this may be because it misses trauma, anxiety or other negative an ongoing issue and has morphed key using populations. Questions mental health conditions. over time. Initial benzo dependency reduced the extent of benzos to identify benzo use need to be The trap here is the slow access was largely driven by massive being prescribed in the UK. But carefully framed too – would young that too many young people over-prescribing and long-term without measures to address the people taking ‘Xans’ automatically encounter when seeking help from prescribing, something that has been underlying reasons why people feel know that this is alprazolam, a child and adolescent mental health addressed but remains an issue. they need tranquillisers, people benzodiazepine? If not, standard services (CAMHS). Long waiting lists The path to hell is, however, ended up seeking these drugs first screening questions such as ‘have or failure to meet the threshold to paved with good intentions. from online pharmacies, then via you used benzodiazepines in the access services mean young people The ongoing guidance to GPs to the NPS market off the dark web past six months?’ are liable to may be waiting months for access carefully consider the need for and, ultimately, off the streets. under-count actual use. to CAMHS, if they can access the benzo prescribing and review This has allowed people to build Further, not all our benzo- service at all. existing patients has certainly up tolerance to novel benzos at

6 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM THE BENZO TRAP

having an arbitrary maximum dose UNKNOWN TABLETS no certainty can be derived from of 30ml methadone and saying to Efforts to accurately substitute testing a single pill. heroin users they should reduce prescribe for illicitly acquired benzo This uncertainty about drug, themselves off street heroin until habits are further confounded by dose and strength makes it they get to this level. our uncertainty as to the specific impossible to accurately assess: This situation also assumes that drug and specific dose that the • what level of substitute the person has continued access to person is actually taking. prescribing is required illicit benzos that they can taper off. A significant amount of the • how fast or slow a taper should If a person has been purchasing off tablets sold as Xanax could contain be applied – some novel benzos a dark web site which is then shut one or more other compounds. have a very long duration of down, they could be left without Alprazolam may or may not be effect (100-200 hours) and so any access to drugs, withdrawing present – weaker or stronger slower tapers may be required. off a high dose with no access to benzos could be present, and these legal substitutes. This brings with it could be shorter or longer acting In lieu of accurate and rapid pill huge risks, including psychosis and than alprazolam. Dose may be testing, the only practical way of life-threatening convulsions. higher or lower than the claimed substitute prescribing and tapering strength, and there may be other is to prescribe symptomatically, ASHTON MANUAL psychoactive compounds present increasing dose and slowing Many professionals and people such as quetiapine. withdrawal where there are clinical seeking help online will find the While drug testing websites indicators of unmanageable Ashton Manual, a guide to benzo such as WEDINOS are invaluable withdrawal symptoms combined reduction and withdrawal by in highlighting trends in pill with careful assessment of the far higher doses than they would Professor C Heather Ashton. A composition they are less helpful patient’s self-reported symptoms. have obtained on the NHS. These helpful resource for many, the when considering tapers and Kevin Flemen runs the drugs same patients, when presenting to manual and related resources withdrawal protocols – even if pills education and training initiative KFx GPs for treatment, may encounter create two key challenges. First, for held by the client are submitted for – www.kfx.org.uk the same reluctance to prescribe some people, reading the manual analysis. The analysis doesn’t show Workshops have moved online benzos that pushed them to the could reinforce fear and anxiety the amount of each psychoactive during the current lockdown. street market in the first place. of withdrawal symptoms. There compound in a pill, and without Email [email protected] for joining is a risk that people will anticipate testing several pills from a batch, instructions. PRESCRIBING TRAP and expect symptoms and could The NICE BNF guidance on benzos therefore experience a wider range of for the treatment of anxiety allows symptoms and with greater severity. for doses up to 30mg a day. For Second, the withdrawal Escaping the trap someone who has a significant schedules suggested by Ashton Services need to urgently develop new pathways and street-acquired strong benzo habit, typically reflect people reducing off treatment protocols for people using benzodiazepines the BNF upper limit may be well NHS-prescribed dose ranges. Where outside of clinical and prescribed settings. These need to below that person’s current dose. people have built up dependency The dose equivalence for someone on stronger novel benzos, and built include: using four 2mg alprazolam a up high tolerance on street drugs, • screening tools to assess for patterns and nature of day (8mg x 20) would be 160mg following the sort of slow tapers benzo use diazepam – more than five times the proposed by Ashton could take one BNF upper limit for treating anxiety. to two years or longer to complete. • research into the extent of non-prescribed benzo use Where services do have a While on the one hand very slow in the UK benzo-prescribing pathway it tapers as described by Ashton • protocols to test clients’ pills for content and potency typically requires a person to minimise risks of unpleasant reduce themselves off their own or dangerous symptoms, they • appropriate levels of substitute prescribing with tapers illicit benzos to a level where can prove prohibitively and • rapid access for children experiencing anxiety to drug services or GPs could take unnecessarily slow for people who CAMHS to reduce self-medicating with benzos over prescribing. This approach have been using at high doses. effectively directs a person to Minute dose reductions can lead to • staff training and training for GPs about addressing continue purchasing off the illicit people fixating on each reduction, the use of prescribed benzos without driving people market, with all the risks that and losing motivation over a

towards illicit markets. ajt/iStockPhoto: this entails. It is the equivalent of protracted reduction programme.

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 7 PARLIAMENTARY GROUP

to replace other drugs. Meanwhile patterns of policing ‘were not proportionate in lockdown’, she said, IN THE PICTURE with an increase in stop and search for low level offences. The parliamentary group discussion moved to Zoom for its Dr Richard Piper, chief executive of Alcohol Change UK, gave a first meeting since the crisis hit services, asDDN reports snapshot of the effect on . A national survey on lockdown drinking had tested the he issue around needles and other essential harm hypothesis that people would deprivation and reduction equipment. But there was be drinking more, but findings inequality is going also an increase in mental health contradicted this. While 21 per cent to come out really issues from the boredom, loneliness of people were drinking a greater strongly.’ Speaking and a situation that ‘has been really volume of alcohol (‘binge drinkers’ ‘Tat the Drugs, Alcohol and Justice tough for everybody’. continuing to binge), many (35 per Cross-Party Parliamentary Group’s ‘We’ve had to put our thinking cent) were found to be drinking less first Zoom meeting, Karen Tyrell, caps on,’ said WDP’s chair Yasmin (DDN, May, page 5). executive director of Humankind, Batliwala. Collaboration and ‘Some have decided to protect was the first of the treatment communication – between staff, their immunity, take care of providers to give an update on the service users, commissioners and themselves and only drink when situation since COVID-19 had turned other services – had been key to out,’ he said, adding that the ways of working upside down. carrying on, including more training disruption had enabled people With two-thirds of clients falling through webinars. ‘We’re speaking Issues around to break drinking routines. There into the ‘vulnerable’ category, more to each other than we ever were five times as many people the organisation was pleased did,’ she said. The crisis had shown deprivation and coming to Alcohol Change UK’s with the way many had switched that there were opportunities to do website looking for information readily to online support. Staff and more online in the longer term. inequality are and five times as many searches commissioning teams had risen to Beyond the immediate crisis around on the challenge, but one of the main all the organisations were deeply going to come out Google, suggesting that people worries was the drop-off in people worried about funding, redirection really strongly. were receptive to the opportunity to coming into treatment – Humankind of resources and the threat of make healthier choices. had seen a third fewer people services being decommissioned. KAREN TYRELL Participating in the group entering services, and exits were also The vital need for sector funding discussion, most felt that there were down as the organisation was trying was underlined by Niamh Eastwood, lessons for working smarter after to keep people in treatment during executive director of Release, which Xanax, especially among young the crisis, particularly around more this unpredictable time. had set up a monitoring network people, increased use of psychedelics, intelligent prescribing options, tech Laura Bunt, deputy chief to hear about changes in the drugs and a reduction in MDMA use (‘not a solutions and web-based support. executive at We Are With you echoed market. drug for physical distancing’). But there was also a note of that the move to remote working ‘We’ve already had a public Diversion was not happening, caution about moving to a world of overnight had been ‘astonishing’, health crisis with drug-related as ‘people are holding onto their teleconferences and losing face to but that many people who weren’t deaths,’ she said. ‘If fentanyl arrives meds’ (mainly methadone) during face contact. accessing support were deterred by it will be a catastrophe.’ The network the crisis. The move to longer-term ‘The recovery community has fear of putting pressure on the NHS had been identifying regional issues, prescribing had been helpful in responded very strongly with as well as contracting COVID. There such as fluctuations in heroin purity making people ‘feel more in control some great web-based support,’ had been impressive collaboration in the north and north east of of their treatment’. commented Dr Ed Day. ‘But it is no within the sector, and some England and reports of ‘really poor’ A reduction in opportunities for replacement for real face-to-face innovative developments including quality ketamine. shoplifting and begging had led to contact and some people must be trialling a ‘click and collect’ model for There was increased use of increased use of benzodiazepines falling through the cracks.’ DDN

8 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM RESEARCH GENDER IMBALANCE The lockdown may be having a disproportionate effect on female service users, warns Gordon Hay

Changes in the clients’ alcohol, drug or tobacco use were explored. Although it cannot be assumed that any changes are increases or decreases, 15 per cent of female clients reported a change compared to 6 per cent of male clients. While all of these differences are seen to be statistically significant, the starkest gender difference occurred when considering mental health, with 23 per cent of female clients reporting that their mental health had been affected by the current environment, compared to 10 per cent of male clients. Research typically shows that women who use drugs face additional challenges, for example Tetiana Shyshkina Tetiana the European Monitoring Centre for Drugs and Drug Addiction he coronavirus alcohol services across Merseyside (EMCDDA) suggests that women pandemic and the and Cheshire. Just as the UK entered are particularly likely to experience subsequent lockdown lockdown, six additional questions ‘Changes in the stigma and social disadvantage and impacts on all society, were added to the monitoring to have less social support. They and is likely to be system to enable services and clients’ alcohol, may be likely to come from families Timpacting more on groups such commissioners to identify additional with substance use problems and as those in contact with drug or issues facing their clients. drug or tobacco use have a substance-using partner, alcohol services. Research studies As services were not mandated were explored... have faced Adverse Childhood are being launched to explore how to ask the additional questions, Experiences (ACEs) and may have COVID-19 and lockdown impact on the numbers are relatively small 15 per cent of co-occurring mental disorders. people who use drugs, and there is but large enough to highlight the The emerging information a wider discussion about how levels impact of gender. Two months female clients from this monitoring system is not of alcohol use within the general from lockdown, emerging findings a replacement for more detailed population have changed over the from 1,435 contacts with services reported a change research, as we can only highlight last few months (DDN, May, page 5) involving 468 clients suggest that compared to 6 per that there are differences and would and issues such as the relationship female clients are impacted more only be able to speculate on why between domestic abuse and than males. Overall, very few cent of male clients.’ these differences are occurring, and alcohol use during the current crisis. clients (about 1 per cent) report research is needed to examine why While new research studies are concerns about having symptoms females are experiencing lockdown being set up, existing monitoring of coronavirus. Interestingly, only More clients report difficulties differently to males. Those working and surveillance systems can quickly a similarly small amount reported in social distancing and accessing in drug and alcohol services, and be augmented to highlight emerging problems accessing medicines, basic needs such as food. While commissioners of these and similar issues facing those in contact with healthcare or harm-reduction social distancing was reported as services, should be alert to any drug or alcohol services. supplies – however this finding an issue for 22 per cent of female additional difficulties faced by The Public Health Institute at is unlikely to be representative of clients, only about 10 per cent of female clients and seek to explore Liverpool John Moores University all people who use drugs or have male clients reported difficulties. them in more detail during contacts has, since 2013, hosted the problems with alcohol, as the For accessing basic needs, 6 per with female clients. Integrated Monitoring System (IMS) monitoring is being undertaken cent of female clients as opposed Gordon Hay is a reader at the which records activity at a range of in healthcare, particularly harm- to 2 per cent of male clients Public Health Institute, Liverpool primarily low-threshold drug and reduction, settings. reported issues. John Moores University

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 9 LETTERS AND COMMENT HAVE YOUR SAY Write to the editor and get it off your chest [email protected]

make a relapse more likely, shoes and the family and friends especially in the early stages of those with an addiction. The of sobriety. When our coping blog can be found here at: www. skills are tried, we often revert drink-n-drugs.com or on Facebook back to behaviours that are not and Twitter ‘Drink ‘n’ Drugs’. I necessarily serving us. hope it helps others as writing it We offer people this service helps me! before they arrive for their detox. Dave Richens, by email During their first telephone consultation with our office we ask if they would like a sobriety buddy to support them. Their buddy will then text first to introduce themselves, and they can move onto talking daily if any easier, either. I remember that support is wanted. There asking a colleague how they coped is no better way to learn than ‘It’s not something with it early on in my career and from someone who has been being light-heartedly assured there and is happy to share that necessarily that I’d soon ‘toughen up’ – the their experience; we are able implication being that if I didn’t to guide people on how to deal gets any easier... then I’d probably be better off in with difficult life events without some other line of work. Obviously resorting to past behaviours and I remember asking things have moved on since then, it’s been getting great results. IN MEMORY OF a colleague how but this is still an under-discussed It’s already been such a KEVIN KNOTT issue and it’s good to see it getting success we are going to continue It is with great sadness that they coped with some attention. running this after lockdown as Bradford Drug Services report Name and address supplied the support people have received the passing of our colleague it early on in my has made all the difference. Kevin Knott after a short Jo Moore, manager at Birchwood illness. Kevin was a drug career and being BEST BUDDIES (a Kaleidoscope Project facility), worker in the Bradford and light-heartedly I read with interest the article Birkenhead Airedale district. Kevin was a about Lancashire’s Recovery big supporter of service user assured that I’d communities working together influence and involvement and during COVID-19 (DDN, May, IN SOLIDARITY he frequently attended the soon “toughen up”.’ page 8) and thought you may be When I was at school I always DDN service user conferences. interested in our ‘sobriety buddy’ thought that I’d make something Kevin was a great guy who initiative. of my life, do something exciting was very popular and loved SERIOUS STRESS For members of any detox and follow my dream of helping by all – such an inspirational, I was pleased to read Victoria community meetings are a others. However, it turned out I’d funny, caring and genuine Hancock’s article about secondary cornerstone of recovery, but this end up on a different path. individual, fantastic at his job traumatic stress (DDN, May, page is just not an option for anyone I joined the ambulance service and able to instil confidence 14), especially her call for this to leaving a detox facility right now. the day after my 18th birthday in anyone he met. He was a be taken more seriously by senior So at our Birchwood residential and worked for them for over ten proper character who loved a management. I must confess detox centre community in years as a paramedic. Six years laugh and was a true legend. that although it’s an issue that’s Birkenhead we’ve created a new ago I developed a brain problem It was such a pleasure to have concerned me for a long time, I initiative – each member can and ended up needing multiple known him over the years wasn’t even aware that it had an have their own personal ‘sobriety surgeries over the following two and his legacy and treasured official name. buddy’ (see news, page 5). The years and during this time I was memories will last forever. I’ve worked in this sector – and idea is to provide support for prescribed Oramorph. It turned Gerard Smyth and all his associated fields like homelessness people while they undertake out that I’d become addicted to colleagues in Bradford and mental health – for close to a detox programme, so that it and I never thought I’d end two decades, and some of the support can continue when they up becoming one of the people I stories I’ve heard from clients have return home too. previously cared for. I then began DDN welcomes your letters been truly horrific. Hearing about We realised extra support is injecting the Oramorph when Please email the editor, this kind of trauma and abuse, needed under current conditions, taking it orally wasn’t working [email protected], or post and witnessing its often still-raw and so we set about finding quickly enough. When my them to DDN, CJ Wellings Ltd, effects on clients, is something volunteers to help service users prescription was abruptly cut off I Romney House, School Road, that can be extremely difficult to in this difficult time and be went into withdrawals and ended Ashford, Kent TN27 0LT. Letters switch off from or forget – and I’m that person on the other end of up swapping to injecting heroin may be edited for space or clarity. not sure what it would say about the telephone with some good and crack cocaine. me if I was easily able to do that. sobriety time under their belt. After getting myself clean I /ddnmagazine In my experience it’s not Research shows that coping decided to start a blog to help @ddnmagazine something that necessarily gets with stress and isolation can those who are in my previous www.drinkanddrugsnews.com

10 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM SERVICES COMMISSIONING QUALITY

The new national substance misuse commissioner forum will play a vital role in responding to future challenges, say Chris Lee and Prof Jim McManus

ven through these currently accessing treatment, unprecedented times, while the success rates of drug councils are absolutely services vary five-fold from place to Key objectives committed to ensuring place. What’s more, new threats are To support the development of good practice and effective that people seeking emerging all the time – one only commissioning approaches Ehelp with substance misuse get needs to look at the drug-related the right treatment and support, as death statistics to see that. We To enable commissioners to share information, intelligence, part of their public health and other must not be complacent. Councils challenges, ideas, and to support problem-solving wider responsibilities. This includes know more needs to be done in To represent commissioner views on relevant current and helping vulnerable people being close collaboration with local emerging policy and strategy given another chance to find work, partners to ensure everyone gets To influence legislation and policy at a local, regional and rebuild relationships, improve their the support they need wherever national level physical and mental health and find possible. safe and secure accommodation. The COVID-19 emergency comes To enable national representation of substance misuse But more must be done. Only after a lengthy period of financial commissioners in relation to other sector organisations. a fifth of dependent drinkers are and policy upheaval for the drug and alcohol sector. For example, those of us in local government opportunity adding structure and we develop the best possible have long argued that reductions to support around the alcohol and services and best commissioning ‘Only a fifth councils’ public health grant – used drug agenda in England. It will practices. This is just one plank of to fund drug and alcohol prevention provide a dedicated space to address ensuring we have a response to of dependent and treatment services – is a false the issues and concerns of those drug and alcohol issues and the economy that will only compound commissioning substance misuse need of our populations. But it is an drinkers are acute pressures for criminal justice, related services and the opportunity important plank.’ NHS and social care services further to share ideas and experience or With physical meetings unlikely currently down the line. even just support colleagues. to happen for the foreseeable The Local Government ‘The new national network future, the intention is to initially accessing Association (LGA) and the comes at an important time,’ develop an online forum to Association of Directors of Public said director of public health at bring people together and use treatment.... Health (ADPH) have jointly agreed Hertfordshire County Council, Knowledge Hub as a central Councils know to support the establishment of Prof Jim McManus. ‘Bringing platform – it’s hoped we can a national forum for substance commissioners together to learn physically bring people together at more needs to misuse commissioners in England. and share good practice is core to a future date! While there are strong regional the improvement ethos of local Chris Lee is a public health be done in close support networks across England, government known as sector-led specialist at Lancashire County coordinated by Public Health improvement, and will seek to bring Council collaboration with England regional teams, the some structured support to an area Prof Jim McManus is director purpose of this new forum is to which has been neglected in recent of public health at Hertfordshire local partners to provide a strategic national space years. Part of this will be ensuring County Council ensure everyone in which to bring together those with commissioning responsibility gets the support in local government, and enable a While planning is at an early stage, we would welcome representative commissioner voice. expressions of interest to join this emerging forum. If you they need With many people currently have any ideas to support this development or wish to register finding new ways to work, this interest in joining, please contact: [email protected] wherever possible.’ development will be a timely

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 11 SERVICES

They gave me every opportunity. I saw a judge every two weeks, had appointments to see how I was doing, and they tried getting me on MOVING ON a methadone script. I suppose I had gone through so much trauma that it didn’t go that way.’ Liam Ward talks to former Phoenix Arrangements were made for Jo’s son to be cared for by his Futures resident Jo, about rebuilding her grandmother. ‘A month before he was born, I signed a document to life and her relationship with with her son say my mum could look after him on a special guardianship order. He went as soon as he was born…’ arlier this year I spoke her peers, and the process she went rehab, Jo had also taken the first Jo paused. ‘My son wasn’t my with Jo, a graduate from through in being able to understand steps in repairing her relationship first thought, it was myself and our Sheffield Residential the reasoning behind this. ‘At first with her three-year-old son. She my habit. When you’re on drugs service. We talked at I didn’t think I was doing anything explained the circumstances that you don’t care about anyone but length about her past, wrong,’ she said. ‘You’re going to had led to their separation. ‘I was yourself, you’re so selfish.’ Eher journey towards recovery and have your defences up, but if you still using heroin and crack when I I asked Jo what had changed, her aspirations for the future. listen and relate it to the work you’re was pregnant. I was still involved and when she felt as though she Central to this was the rebuilding doing it all fits together.’ in crime to support my habit,’ she had become his mother again. of her relationship with her son and During her time in prison and said. ‘Social services got involved. ‘Where it started properly was when her own mother. I left rehab. Learning what he likes Despite the adversity Jo faced in to eat, what he likes to play with, her early years, she retained a fierce going out to parks, taking him to desire to reclaim ownership of her nursery.’ Jo left rehab in November life. In late 2018, Jo was serving a ‘In late 2018, Jo was 2019, moving on to Phoenix short prison sentence. This was not Futures’ supported housing. In the her first, but she was determined it serving a short following months she saw her son would be her last. It was here that prison sentence. more frequently and began making her journey to recovery would begin. plans around her future. This was ‘While I was in prison I didn’t This was not her interrupted in March 2020 as the engage with drugs. I reduced coronavirus outbreak saw lockdown my methadone and was clean. I first, but she was measures imposed. asked for help. I had to do groups Despite this, Jo has retained on relapse prevention. I did it all. determined it an optimistic outlook and feels I proved myself. I thought it was would be her last. her pathway from prison into a best to do this somewhere where I structured therapeutic community couldn’t run away.’ It was here that her and finally into supported housing After successfully detoxing and has prepared her well for living a making progress during her time journey to recovery life with a certain set of restrictions in prison, Jo was released in May for her own wellbeing. ‘I’m finding 2019. ‘I was picked up at the gate would begin.’ it easier than most people are. I by my worker and went straight suppose coming from prison then to Phoenix in Sheffield. This was going to Phoenix, it feels like a carry my first time in rehab. At first I on. You’ve got to be peaceful and intimidated people quite a lot in grateful for where you are today. It’s the way I presented myself. I was a massive transformation for me.’ walking around like I was still on I asked Jo if this had affected the wing, acting like I had to defend her future plans. ‘I’m backwards myself from everybody. But if I and forwards in my mind. I don’t didn’t act in that way, I wouldn’t want to rush into anything. Some have known I needed to change.’ days I feel like I’m ready to move Jo reflected on her response to out of here and have my son come her behaviour being challenged by live with me. It’s good to have a chance to slow down and reflect,’ Jo continued. ‘Every day I’m still in Jo took part in Phoenix Future’s recovery. Every day I’m still learning Voyage of Recovery, where about myself.’ participants learned to sail a boat Liam Ward is residential while gaining skills to support marketing manager at Phoenix their long-term physical and Futures. To read Jo’s full story visit mental health. www.phoenix-futures.org.uk

12 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM TECHNOLOGY Chris Montgomery ZOOMING IN Technology is helping to make sure that recovery workers and clients stay connected. While it can never take the place of face-to-face working we should retain the best parts of the ‘Zoom boom’, says Charlotte Hadaway

he lockdown has reflect on what’s working, and keep meetings have kept clients in changed my working each other going. contact with each other. It’s often day. As an outreach just talking about the little things ‘I know that just worker in Devon I can GETTING STARTED that makes people feel they’re part travel up to 60 miles When we started setting up Zoom of something. Just knowing they’re getting to an Ta day to see my clients. We’re meetings we didn’t know how tech being heard is really important. a very rural county, so I work savvy people were, but I was really appointment can from a number of Together/EDP surprised that clients jumped at the MORE CHOICE hubs as well as GP surgeries and chance of joining an online group. What will happen beyond lockdown be quite stressful community locations. They really wanted to see each other is hard to tell, but I would like to for some people, Before lockdown, technology and know how they were getting on offer an evening virtual meeting enabled me to do simple things like in their recovery. It’s never quite the going forward. It will be easier for so these digital keep an online diary so everyone same as being in the same room, but some clients who experience high knew where I was and who I was it’s a great alternative. I don’t think anxiety or who are trying to work solutions are a great seeing, or write up my notes on you can beat human contact because full-time and manage their recovery. the hoof using Wi-Fi and phone you see people’s expressions, you I know that just getting to an way for people to tethering. When lockdown hit, all this see their movements, you can look appointment can be quite stressful have more choice in changed. We had to adapt quickly into people’s eyes and you can see for some people, so these digital to be able to offer a safe and secure behaviours better up close. You can solutions are a great way for people treatment.’ service, and I have to say Together/ still see that on Zoom, but it’s not as to have more choice in treatment. EDP have been brilliant at supporting powerful as face-to-face. I’ve also learnt that it is important to us during the changes. We have daily be patient while clients are setting friendship and fellowship all rolled virtual meetings with managers and KEEP IT CLEAR up Zoom accounts, as tech can be into one. But to meet online is the team members, we’re kept really We are very clear about our daunting for those not used to it. next best thing, and I’m looking well informed of developments and meeting rules with Zoom, especially It’s fair to say that most agree forward to keeping the best bits as what we need to do to keep everyone around respecting each other and there is a new place for virtual we move forward and offer more safe, and we’ve been encouraged confidentiality. I find that when groups post-lockdown. Of course, choice and variety to our clients. to use virtual groups utilising people do share their feelings, nothing beats face-to-face group Charlotte Hadaway is an Microsoft Teams, WhatsApp, Zoom others still connect well with them work. The interaction between outreach recovery worker at and other technologies. I think it’s – they are very respectful, they are clients can mean everything, Together, part of EDP Drug & fair to say that we’ve adapted well listening to that person and that especially in early recovery. A hug, Alcohol Services. and changed the way we work – we person feels held by everybody a conversation over a cup of tea, EDP is a subsidiary of the continuously share the experience, in the virtual group. The online a chat in the break – it’s bonding, Humankind charity

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 13 POLICY STAYING ALERT

questions of ‘what do we keep?’ The sector has risen and ‘what do we lose?’ The sector admirably to the has always been a champion of ‘As we look to innovation and flexibility when it challenges of COVID-19. comes to designing services around how services will people’s needs, and this flexibility has operate in the “new But it needs to remain been crucial in recent months. It has allowed us to keep people supplied normal”, there are vigilant when it comes to what with life-saving OST medication and food, helped us create safe spaces for a number of issues happens next, says Peter Keeling women and children fleeing abuse and violence and, almost overnight, that are already allowed the sector to shift to digital f the current emergency has Over the past few months, ways of working so frontline staff can causing concern.’ demonstrated anything, it’s Collective Voice has been working maintain crucial relationships with the importance of having a hard to bring together people their clients and support them in robust healthcare system. and organisations from across their recovery. Avon and Wiltshire Mental Health Drug and alcohol treatment the sector, so we can identify key The crisis has also highlighted Partnership NHS Trust is working and recovery services form challenges and find solutions our sector’s ability to collaborate; with drug and alcohol partners and an absolutely essential part of this, that work for everybody. We’ve not just at national policy level, the local public health team so that Ibut like so many others our sector seen unprecedented levels but also at local levels. Because council delivery drivers can provide is facing incredible challenges of collaboration across third it’s at these levels that drug and vulnerable service users with OST because of COVID-19. sector providers, NHS trusts and alcohol services have established medications. Across the country, The fact that services from commissioners, who have all themselves as key partners in cross- there are many other examples of community treatment to brought their expertise to bear on sector initiatives that support some such collaboration. residential rehab have been able to what is possible when it comes of the most vulnerable people These local and national find solutions is testament to both to provision of OST, face-to-face in society. The London Homeless relationships have helped the sector the sector’s innovative strength and interventions, supported housing, Hotels Drug and Alcohol Support support itself during an extremely the dedication of its key workers. and many other areas of our work. Service (HDAS), brought together to turbulent period where quick And it’s these qualities that are It’s far too early to assess the provide treatment for people living decisions have had to be made keeping people safe. But now we longer-term impacts of changes in hotels under the government’s to keep people safe. Areas that need to ask ourselves about the to these core aspects of treatment rough sleeping initiative, is a perfect already had strong relationships next steps for drug and alcohol and recovery. But even at this early example of the kind of innovative, across sectors tell us they’ve been treatment, and what lies ahead for stage it’s clear that many in our collaborative response the sector well placed to respond quickly, and

Illustration: erhui1979/iStock Illustration: the people who rely on our support. field are asking themselves the hard is capable of. Similarly in Dorset, councils which already had good

14 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM COVID-19 emergency has, in been kept as safe as possible. But many ways, been a success since the funding lacks protection, story. It has taken enormous we are concerned that some public energy across different systems health services – including drug and from local authority workers to alcohol treatment – will not benefit homelessness, mental health and from its distribution. This funding drug and alcohol workers, but as is needed by a sector that has the COVID-19 emergency enters its been forced to take on unexpected second phase, the contracts with emergency costs around PPE hotels to accommodate people procurement, and payment of previously sleeping rough will end. locum and bank staff to cover staff This leaves our sector, and the sickness. many other connected parts of the system, with a significant challenge 4. UNFORESEEN to continue providing support. But CONSEQUENCES OF SERVICE it is also an important (possibly ADAPTATION never-before-seen) opportunity for Services have mobilised quickly services to create pathways into and effectively to adapt, while both long-term meaningful support managing risk and maintaining for people who have historically effective support. But there will soon sometimes been difficult to be a need for the sector to properly engage (see news, page 4). Ensuring assess the consequences of these continued accommodation changes and their effects on service obviously needs to be at the heart users’ treatment and recovery. The of the planning for this group, but remote (and particularly digital) it will be a wasted effort for many delivery of assessment, key working people if the building blocks of and more structured interventions wider support are not also put in has undoubtedly made services place – especially access to drug more accessible for some people, and alcohol treatment. and the forced changes to OST relationships with the voluntary could create a potential new provision are likely to provide sector have stated how critical cohort of people seeking treatment 3. LOCAL GOVERNMENT benefits going forward. But there these relationships have been when as they begin to recognise their FUNDING will still be people in desperate mobilising the local response. consumption has changed for the We welcome the £3.2bn need of treatment for whom online worse. If there is an increase how commitment by the Ministry services will not be appropriate, he sector has proven will it be paid for? None of us have of Housing, Communities and and it is vital that these changes itself entirely capable a crystal ball but it seems fair to Local Government to support are seen as a welcome addition to of meeting the say there may well be questions people in the most vulnerable the range of available services, not immediate challenges over the level of public spending of circumstances during this as a replacement. At a time when of COVID-19, but the country can afford and we unprecedented crisis. Local investment in drug and alcohol what comes next? know that people with drug or authorities have already distributed services may become challenging, Because as we look to how services alcohol problems are a frequently some of this funding to fortify and where digital services could be Twill operate in the ‘new normal’, discriminated-against group. services that support people seen to be a cost-saving exercise, there are a number of issues that experiencing multiple disadvantage, the sector must be vigilant as to are already causing concern. 2. ROUGH SLEEPING particularly around rough sleeping, the effects of service adaptation EXIT STRATEGY and it is testament to the strength and ensure an appropriate balance 1. INCREASED ALCOHOL The move to swiftly house people of collaboration between local is found. CONSUMPTION in hotels and other temporary government and treatment Peter Keeling is campaigns officer The effects of social isolation accommodation during the providers that our service users have at Collective Voice during the COVID-19 lockdown appear to be having a noticeable effect on the country’s alcohol consumption. Recent research Finally... We want to pay tribute to the thousands of workers across the country from Alcohol Change UK, while providing essential treatment and support to people with drug and alcohol problems. highlighting some positive COVID-19 has shone a light on the extreme vulnerability of many of our citizens, from indications of a segment of the population who are actually rough sleeping to domestic violence, and we will continue to push for our sector, and its drinking less during lockdown, many unsung heroes, to receive the same level of recognition. But we can only do this with nonetheless showed that around one in five drinkers are drinking your help and expertise, which is why we’ve launched some new ways to communicate more frequently (DDN, May, page with the field, including a weekly bulletin and an open source Slack community (all details 5). The longer-terms effect of at www.collectivevoice.org.uk). We want to hear from you about how we can best such a substantial portion of the population negatively changing support the sector, so please do get in touch: [email protected] their relationship with alcohol

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 15 TREATMENT

dependency units were taken over by psychiatrists, not medical doctors. With some notable exceptions, their goals were DOCTOR WARS abstinence through withdrawal and therapy. All these psychiatrists who held the new licences needed to prescribe heroin hardly used them, with a few notable exceptions. People were moved onto oral methadone or nothing if your particular clinician wouldn’t prescribe, or you only had access to a non-medical community drug team – tea and sympathy (of little use) if you were ‘lucky’, but confrontation if you weren’t. The fights at the monthly meetings held at the Home Office Drugs Branch during the ’70s to mid ’80s brought together psychiatrists who hated romeocane1/iStock prescribing, some of the private doctors who could still prescribe some opiates and opioids (but not heroin or cocaine), and the very The running battles between substance few doctors who did still prescribe injectables to the few. They were misuse clinicians in the ’70s and ’80s often vicious and sometimes helped to shape today’s treatment very personal – some moderating influence came from the presence landscape, says Bill Nelles and later letters and testimony of dear Bing Spear, head of the Home Office Drugs Branch the until the hat to do about housing that we know are essential early ’70s. He was replaced by a opiate use and to settling down to a life of quality warrior who did his best to shut users has been without the poisons on our streets. ‘It wasn’t until down even oral methadone. discussed, Having all these is what saved By 1983 even getting argued, and me for nearly 40 years. All were the late ’60s that methadone for more than a short Wshouted about for more than a necessary for me and there should serious period became very rare in the NHS century now to relatively little be widespread shame at the lack of clinics and unheard of in Scotland. positive change. It’s like the opening this joined-up care today. started in the UK... One of the heads of the Royal song in The Sound of Music – ‘how It wasn’t until the late ’60s that College of Psychiatrists held that do you solve a problem like Maria?’ serious prohibition started in the Some changes were ‘no one needs more than 40mg Only no one ever does solve the UK – largely because young people, of methadone a day’ – which was problem of Maria (although I think not elderly users and dependent understandable a big reason so many people had it has something to do with finding doctors, were now using heroin as the system was such poor outcomes and used love and, of course, climbing every and getting it from doctors famous on top. Most were expected to mountain – a familiar metaphor for for their unusual prescribing anarchic and largely and that’s why their methadone any users). locales like coffee bars and street was kept so low. There were no The same seems true for opiate corners. Some changes were unregulated.’ objective medical tests or practices users. We dutifully sing the songs understandable as the system was used in the UK to ensure patients asking for help, but too often anarchic and largely unregulated. had adequate doses to minimise leave disappointed. There are still But the ‘classic’ NHS clinics This was in direct contrast fluctuation of methadone levels. hundreds and even thousands of born around 1969 all had differing to Dr Vincent Dole and Marie Prescribing anything opiate-like opiate-dependent users in the UK attitudes with little agreement on Nyswander’s approach in New through the NHS to those dependent and around the world who want what to do within the teams formed York that saw opiate use as a had almost completely stopped by and deserve a safe supply of that to run them. Thus the era of the physically mediated condition that 1983. But events were about to take medicine under medical oversight, ‘doctor wars’ broke out – psychiatry was treatable but not curable, an unprecedented shift, and that and finally some are getting it. And I came to dominate treatment in and not always responsive to changed how everything would be use the word oversight for a reason. the UK, leading to psychotherapy psychotherapy. Opiate receptors done. I’ll explore this further in the It should mean ensuring services are becoming the approach, and in were identified soon afterwards, next edition. providing empathic access to a safe London high quality Chinese heroin and real research started Bill Nelles is an advocate and supply with all the social support, replaced the state gear. So people uncovering just what was going on. activist, now in Canada. He founded trauma therapies and help with voted with their veins. But the UK’s NHS drug The (Methadone) Alliance in the UK

16 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM PRACTICE

ALL IN IT TOGETHER

and others. Healthcare checks were The lockdown is reinforcing provided and naloxone given out the power of partnership, where necessary, as well as housing ‘Since the outbreak advice, COVID-19 leaflets, hand my role has collaboration and innovation, sanitiser, wet wipes, clean clothes and food packs and drinks two to fundamentally says Helen Thompson three times per day. Part of my role was to look at changed. I’ve how we could increase provision of he coronavirus I do, but since the outbreak my food supplies and hygiene products been drafted in pandemic has caused role has fundamentally changed. with limited budgets and an massive social upheaval I’ve been drafted in to support ongoing need. It was our intention to support teams but communities teams who are helping those who that if we could show additional who are helping across the country are considered most vulnerable, care and compassion to those in Thave joined forces, stepping up to adapting to meet the needs of the hotels by involving the wider those who are volunteer, organise, and strategise individuals and services. community this would encourage how to help those who need it My first stop was with the street people to stay inside until it is considered most most. During these times of fear outreach team in Leeds. The closure safer to leave. We sourced hygiene and uncertainty, the very best or reduced hours of soup kitchens, packs with support from the local vulnerable, elements of human nature have food banks, drop-in centres and community and through fundraising adapting to meet prevailed, demonstrating the power feeding services – as well as – items such as toothpaste, of displaying care and kindness to the limits on movement – were shampoos and soaps were the needs of those less fortunate. having a huge impact, as was the purchased and given out, as were My role at Change Grow Live need to support those who were cleaning products to help people be individuals and is all about communities, groups rough sleeping into temporary proud of their surroundings.

and people – I’m a connecting accommodation. We provided snack bags to the services.’ sv_sunny/iStock Illustration: communities regional lead and The closures of cafes, shopping hotels where people are staying I support services sitting within centres and restaurants meant with the support of the local food safeguarded from the streets, Yorkshire, Humberside, the North limited opportunities for people to aid network, while local cafes and supported into hotels, hostels and East and Scotland to create a range of wash their hands, nor were they businesses that were closing during temporary accommodation and innovative and creative opportunities in a position to be involved in the lockdown shared the contents provided with the best possible for those who access our services – panic buying of hand-sanitising gels of their fridges and shelves with holistic support. expanding experiences, networks or pain relief. Many street groups local soup kitchens. The positive We were trying to keep our best and long-term connections to stopped coordinating activities and relationships between partners at faces on – the brave face, the happy support healthier lifestyles. If people, we were strongly encouraged to all levels meant that the homeless face, the supportive face, just trying ask what I do my response is I try to provide outreach in pairs, keeping community received the best service to keep everybody’s morale up. To make recovery fun! a two-metre distance apart at all possible – there have been many support in this endeavour, I took my No two days are the same – one times – difficult when providing positive success stories, with some dog Pablo Escobark with me to work day I could be running a ‘human sometimes essential interventions residents who are entrenched rough – everyone came to recognise him as library’, the next day I could be for people across the city. sleepers engaging with services for a support dog and the smiling faces organising a pride float, an art Each day, seven days per the first time or after a long break. followed. He even received a virtual exhibition or supporting someone week, we were out on the streets Partnership working and award in the city as a virtual hero! to share their story on a video or alongside housing workers, mental collaboration were no longer Helen Thompson is connecting podcast with a view to inspire and physical health workers, aspirational goals – they were a communities regional lead at others. I’m so lucky to do the job complex case workers, volunteers necessity. Over 120 people were Change Grow Live

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 17 WELLBEING

GROW A LITTLE KINDNESS

and were ready to start randomly mention on the BBC East Twitter live Samantha Smith shares the Roots placing the lettuces across Luton. update and the team was invited project’s successful campaign for They went to bus stops, parks and to talk about the campaign on BBC green spaces, doorsteps and various Three Counties Radio. Mental Health Awareness Week residential streets. All carried the We will be following up with message: #lettucebekind – perhaps other campaigns over the coming the roots to kindness can start with months. It was a huge effort by the IG Penrose Roots is a the Luton area, with service users yourself. Be kind to this lettuce and it whole team and helped to get the garden-based community and local partners, to discuss the will repay your kindness. message of kindness out there as a recovery project that important topic of mental health in a The campaign was a huge gentle reminder that in these days provides a therapeutic more relaxed and open way. success and had many tweets and of supposed disconnection we have growing space for service This year the pandemic meant messages from excited community never been more connected. Susers, members, volunteers and the this could not happen and we had members who had found one of the Samantha Smith is Roots project wider community. Through work to come up with another plan. The lettuces. The campaign also got a co-ordinator in the garden, we equip people 2020 theme is kindness, which is with new skills, help reduce social very close to the heart of all who isolation, and promote positive attend our various projects. So mental, emotional and physical I thought about how we could wellbeing. make a campaign with the theme After weeks working from home of kindness to tie in with what we in lockdown, while the Roots staff currently do at our community are busy supporting the community, garden – and the ‘Lettuce be kind’ my mind started to turn to what we campaign was born. would have been doing if life was The team of staff and volunteers still ‘normal’. For the past four years got to work planting 50 lettuce seeds we have put on our annual Walk and to grow and nurture into something Talk (adding cycling in 2019) to mark that we could give out to the Mental Health Awareness Week. We community. By 18 May, the team had would go for a leisurely walk around grown the lettuces, made care labels

about what should be put in their who are able to cut down or stop place. Protecting these vulnerable drinking safely, there is a pressing They said what..? populations only when doing need for public health education. so protects the rest of us can’t Over the past two months, an Spotlight on the national media fit many people’s definition of a increasing number of older people civilised society. have been self-isolating. As health BEFORE COVID-19, only one in five Laura Spinney, Guardian, 3 May professionals, we should continue harmful and dependent drinkers to advocate for psychosocial got the help they need; the ‘We cannot claim THERE IS NO WIDER SHORTAGE prescribing to keep their spirits up. proportion will be even lower now. OF CASH in public health. The But now, perhaps this should be We cannot claim to be a nation to be a nation amount of money spent on with an extra pinch of brief advice recovering from COVID-19 if we do tenuous, policy-driven research about alcohol consumption. Their not adequately support the most recovering from alone is staggering. Public health lives may very well depend on it. vulnerable among us… Tackling COVID-19 if we academics were recently given Tony Rao, BMJ, 20 May alcohol harms is an integral part £400,000 to study the drinking of the nation’s recovery. do not adequately habits of football fans. You can LIKE CORONAVIRUS, the drugs BMJ editorial, 20 May buy a lot of face masks with that issue is a public health crisis. support the kind of money. Since the pandemic is making us ATTEMPTS TO MODEL the Christopher Snowdon, Spectator, reconsider a lot of things, from our pandemic in England’s homeless most vulnerable 7 May lifestyles to government spending, population have suggested among us...’ I’d like to propose we reconsider that, without any intervention, OLDER RELATIVES AND FRIENDS our drug policy… Across the world, up to three-quarters of them may now be spending their weeks times are changing: while Priti could become infected... As in holding a glass of wine rather Patel, the home secretary, keenly so many other areas of life, the naive to assume any temporary than the hand of a loved one… reassured the public that despite pandemic is prompting action solutions will be extended beyond Cutting down may be a problem the pandemic, she’s as committed on social problems where there the end of this crisis, but they if there is already evidence of as ever to fighting the drug war. was inertia before. It would be may at least stimulate debate alcohol addiction, but for those Niko Vorobyov, Independent, 18 May

18 • DRINK AND DRUGS NEWS • JUNE 2020 WWW.DRINKANDDRUGSNEWS.COM To advertise in DDN contact [email protected]

We have 8 rooms immediately available in our CQC registered Aspinden Wood rebuild your life Centre for People with long term alcohol during detox not just a er addiction

Male & Female rooms available, Flexible lengths of stay. Health & Wellbeing support, Personal Care (if required). Aspinden Wood follows a Harm Reduction Model regarding Alcohol Consumption Onsite. detox that doesn’t hold you back Delphi oer a range of private alcohol detox treatments that keep you moving forward Call us on 01524 39375 Email us on [email protected] To find out more.please contact: [email protected] DDN need to talk? DIARY DATES We know times are tough for Webinars, podcasts, everyone right now. online support, We’re working hard and adapting how we work to make sure every person we training, events support, or could support, gets the help and care they need.

and more... Our online chat service is there for anyone concerned about their drug or alcohol use or mental health, or that of a loved one, in these unprecedented times. See what’s on when at wearewithyou.org.uk www.drinkanddrugsnews.com/diary-dates

WWW.DRINKANDDRUGSNEWS.COM JUNE 2020 • DRINK AND DRUGS NEWS • 19 Be a different kind of Nurse, be a Delphi Nurse

VISIT US on social media and join the conversation

@DelphiMedical To view our vacancies visit: @ddnmagazine DelphiMedical delphi-medical delphimedical.co.uk /ddnmagazine

Are you interested in changing people’s lives and supporting lasting recovery? Are you in recovery yourself with lived experience? We are interested to hear from people who want to make a difference to people’s lives, people who may or may not have lived experience Recruiting experienced in recovery, or as a family member of someone in recovery. Nurses and Clinical Professionals We are currently recruiting for: We offer: – Psychotherapists – Competitive salary Work within our Substance Misuse sectors in: – Drug and Alcohol Practitioners – Simplyhealth cover Wakefield, Wiltshire and Somerset – Team Leaders – Childcare vouchers – Recovery workers – Therapy allowance – Substance Misuse Nurses – Career development – Apprentices & Volunteers – Up to 30 days annual leave

View our current vacancies at For more information please contact [email protected] or visit www.forwardtrust.org.uk/work-for-us/ https://careers.turning-point.co.uk