British policy against drug abuse is failing because of a misguided drive to achieve abstinence, leading public health doctors say today.
Professor John Middleton, president of the Faculty of Public Health, and other doctors call for "hard lessons" to be learnt from the policies of the last six years.
Between 2012 and 2015 the number of drug-related deaths increased by 65% and those related to opioids by 107% in England and Wales.
Writing in The BMJ, the doctors say a Public Health England report is "silent" on a number of factors.
The report says increased death rates may be a result of rising age, increased physical frailty of users and variations in the street purity of opiates.
But Professor Middleton says there has also been a significant change in policy, switching from a focus on harm reduction to abstinence.
The Public Health Outcomes Framework says that achieving abstinence at the time of discharge from treatment programmes is a key measure of success.
Professor Middleton says that research shows that users who get pharmacological and psychosocial interventions have a 50% reduced risk of death compared with those seeking abstinence.
He calls for "substantial use" of naloxone together with investment in safe injecting advice and access to clean equipment – together with immunisation programmes.
There should also be new guidelines on opiate substitution therapies and the use of drug consumption rooms.
He writes: “The lessons of a failing national policy need to be learnt."
BMJ 18 October 2016 [abstract]
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