What did the ACMD find out about meeting the needs of heroin users in drug treatment?

The UK government’s advisers on drugs, the ACMD (Advisory Council on the Misuse of Drugs), last week published a report looking at how opioid substitution therapy (and drug treatment and recovery systems) could be optimised to maximise recovery outcomes for service users.

The report pushes back against the view that some seem to have that opioid substitution therapy [OST] is incompatible with a recovery agenda, and makes a number of important recommendations on how drug treatment services should respond to the needs of this part of their client group.

However, I’d like to highlight their findings on how service users see the quality of the support they get from treatment, and other services that are tied to their recovery.

The report includes a survey carried out with current and recent users of treatment who have been prescribed OST as part of their treatment.

To the left are some of the results giving the views of those currently getting OST. (There is a small difference with this group and the wider sample — mainly suggesting that current service users marginally perceive things as worse than the wider group).

Mental health care is the only domain where a narrow majority (54%) view services as poor or bad. But there are challenges for other services too, with substantial minorities suggesting that help with housing (46%), psychosocial support (41%) and finding positive activities (36%) could be better for this group.

On access to mental health the ACMD say:

The ACMD is concerned that the lack of access to mental health treatment may be a barrier to service users coming off OST medication and achieving recovery outcomes — as a level of well-being may be critical to enable people to acquire assets such as employment and new positive relationships.

On housing support they say:

From the evidence heard by the ACMD RC [recovery committee], housing that supports recovery is problematic — particularly in some parts of the country including London.

And on psychosocial support they say:

The ACMD wishes to re-iterate that evidence-based psychosocial interventions should be provided systematically to service users in OST, based on need. It is concerned about the lack of implementation of techniques with the ‘best evidence’ (contingency management including drug testing, BCT and family therapy) and recommends that this situation should be rectified. The ACMD welcomes the spread of mutual aid and recommends facilitated access and more access for those in medication-assisted recovery. It also notes the important role of CBT to treat mental health problems in this group. Together with cessation of illicit heroin use (ideally within six months), a critical focus in OST appears to require helping people to build positive relationships and establish ‘meaningful daily activity’ and reintegrate into the community.

On a more positive note service users seem (by 2.3 to 1) to be positive about their dose of OST, and clearly the links between drug treatment and the wider recovery system (as represented by mutual aid) seem strong.