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Wednesday, 1st May 2019

Council risking deaths and crime with proposed cuts to drugs programme

A Green councillor in Bristol has raised concerns about Council proposals to cut prescription services for vulnerable drug users, which government evidence suggests may not save money and could result in increased crime and even deaths.

Councillor Fi Hance said she was alarmed by the proposal by Bristol Council, referred to in a consultation closing on May 2nd (1). The Council’s proposal appears to suggest cutting methadone-type prescription services for drug users (Opioid Substitution Treatments), and could attempt to force users into abstinence instead.

It does not explain how the proposal could save money. Councillor Hance pointed out that cuts in the level of support could lead to significantly increased costs for the Council in other areas through the impact on vulnerable drug users and the public.

She said: “Many people dependent on opiates are not ready to stop, and withdrawing methadone will mean users revert to street heroin, risking overdose, death and health problems that put them in hospital. Some may also commit crimes to fund their use. This would be a catastrophe for individuals and Bristol as a whole, and end up costing far more than any short term saving from withdrawing patients’ prescriptions.”

The Council’s proposal goes against evidence from government bodies such as NICE (National Institute for Health and Care Excellence) and the Advisory Council on Misuse of Drugs which recommends retaining prescription drug schemes as cost effective and suggests there is little evidence to support abstinence approaches being successful or cheaper. (2)

Research shows that 73% of patients in methadone maintenance stay in treatment, compared to just 16% of those receiving therapies with no medication. (3) Public Health England (PHE) advice states the prescribing physician should “maintain the patient on a stable daily dose for as long as is clinically indicated.” (4)

PHE advice also suggests that retention on Opioid Substitution Treatment is an important driver of crime reduction, with research showing every month spent in methadone therapy, criminal convictions and cautions reduced by 1.7% with expected reductions of about 10% for every six months. (5)

Councillor Hance says she has tried asking questions to understand the thinking and get more information on the Council’s proposed cuts but had no meaningful response. She said:

“It seems the Council are proposing arbitrary targets for cuts to prescriptions. They claim this proposal will save money but have presented no evidence to support this. What the evidence does suggest is that forcing vulnerable drug users off controlled prescriptions like methadone into abstinence is a recipe for disaster. Reducing or ending a patient’s prescription of methadone should be a medical decision, not one taken by the Mayor’s office.”

“This is a badly thought out set of proposals liable to cause harm to some of the most vulnerable people in the city. The proposals are incompetent and cruel – likely to result in increased drug-related crime and deaths – and the Labour administration should rethink these plans urgently.”

The Council’s consultation closes on May 2nd and can be found at https://bristol.citizenspace.com/public-health/commissioning-intentions-2019-to-2021/

Sources:

1) https://bristol.citizenspace.com/public-health/commissioning-intentions-2019-to-2021/ 
2) Advisory Council on the Misuse of Drugs, 2015, p.22 (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/470399/ACMD_RC_OPTIMISING_OST_REPORT_231015.pdf)
3) Public Health England 2017, p.44 (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/586111/PHE_Evidence_review_of_drug_treatment_outcomes.pdf)
4) Public Health England 2017, p.44
5) Public Health England 2017, p.50

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