SSA notes: The 2021 UK drugs strategy

The UK Government’s new 10-year drug strategy for England and Wales was published on Monday evening (6 December 2021), ending the year with some answers to the many questions raised in Dame Carol Black’s independent review. The SSA’s Rob Calder and Natalie Davies summarise the context and the implications for criminal justice, addiction treatment, the workforce, addictions research and partnership working. 

The 2021 Drug Strategy aims to “change things for the better” in three main ways:

1. Breaking drug supply chains
2. Delivering a world-class treatment and recovery system
3. Achieving a generational shift in the demand for drugs

From a birds-eye view, the 2021 strategy is very similar to the 2010 and 2017 strategies. These focused on reducing demand (now ‘achieving a generational shift in the demand for drugs), restricting supply (now ‘breaking drug supply chains’), and building recovery (now ‘delivering a world-class treatment and recovery system’).

We at the SSA will use future posts to dive into the detail, the evidence-base and the opinions relating to this strategy. For now, we will summarise the five key points that you need to know:

• Context – the Dame Carol Black review
• Drug supply and possession
• Treatment provision and centralised oversight
• Evidence-based treatments
• Research and prevention

Context – the Dame Carol Black review

There was an expectation that this new 10-year drug strategy would be a response to the independent review of drug prevention, treatment and recovery submitted to the government 5 months ago by Dame Carol Black.

In her independent review, Dame Carol Black was pretty damning of the state of the drug treatment system:

She talked about a broken treatment system and a demoralised workforce. Writing about this for the SSA website, Rob Calder said:

The strategy acknowledges the enormous task ahead, and outlines substantial new funding and structures in response. Perhaps the most recurrent theme throughout the 67 pages is that of ‘partnership working’. Government departments, education, employment, local authorities, mental health services, police, treatment services and more will be required to cooperate at international, national and local levels. Such partnerships can be incredibly effective, but funding alone is not enough to make them work. They can also be incredibly challenging to establish and maintain. Here, the evidence-base on which models of partnership working are most effective will be crucial to the success (or other) of the strategy.

Drug supply and possession

The chapter on ‘breaking drug supply chains’ outlines the international, national and local ways to disrupt drug supply. The largest emphasis in this chapter is on addressing county lines networks of drug transport and dealing. Networks that often exploit children and vulnerable adults into moving and storing drugs and money. The strategy aims to disrupt county lines using partnerships based on Project ADDER. Project ADDER (Addiction, Diversion, Disruption, Enforcement and Recovery, since you ask) encourages police and commissioners to co-produce local plans. It involves diverting people who use drugs into treatment and coordinating police efforts to address crime. The drug strategy commits to funding Project ADDER for two more years to strengthen the evidence base and inform future direction.

Most of the noise in the news and media has come from the sections on drug possession. Headlines have seized on proposals to confiscate passports or driving licences, and sure, those proposals are there. The strategy frames them as part of the levelling-up agenda and about gaining parity across the criminal justice system. These were, however, just two examples of how police could deal with drug possession. The range of options is presented as something to consider before initiating criminal justice sanctions. Only people who repeatedly offend, or who refuse to engage, will be directed to more punitive action: “Ultimately they could receive a caution or face prosecution”. The strategy also mentions substance misuse courts – albeit in pilot mode – where people will see the same judge each time they are in court. That judge will have more options available to them, including mandatory drug testing requirements.

Treatment provision and centralised oversight

There is an extra £780m of funding for addiction treatment, bringing the total spending on treatment and recovery to £2.8bn over 3 years. In 2022/23, this investment will target the 50 areas with the highest needs. In 2023/24, the next 50 areas will be targeted, with the final 50 getting their extra funding in 2024/25. So, some local authorities may have to wait a couple of years to see extra funding, but over 3 years all should benefit. The government will ring-fence these funds for addiction treatment to ensure that they are used to recruit new workers, increase capacity and skills and to fund partnership working.

The money will mean 950 more drug and alcohol and criminal justice workers and 800 more medical, mental health and other professionals. This will include doctors, nurses, psychiatrists and psychologists. By my reckoning, this means that on average, each of the 151 local authorities with responsibility for treatment provision will gain an extra 6.3 drug and alcohol and criminal justice workers and 5.3 medical health professionals. If the treatment capacity is increased by 54,000, these new staff will be accompanied by an extra 357.6 service users per local authority; around 30.9 for each new member of staff.

The strategy talks about recruiting staff to help reduce caseloads so that the workforce can attend training and ongoing professional development. Health Education England will have a key role in defining and improving the workforce’s skills.

Local authorities will be held to account by a new national commissioning quality standard. This more central approach to commissioning has echoes of the National Treatment Agency for Substance Misuse. This change, combined with the ring-fenced funding, will go some way to making services less vulnerable to budget cuts. Indeed, the strategy says “We will ensure that local areas maintain their existing investment in drug and alcohol treatment in 2022/23 and beyond.”

This means that local authorities will not be able to reduce funding for drug and alcohol provision. Considering the experiences of the past 10 years, this alone is a pretty big statement (bigger than confiscating passports anyway). There is, however, a passing mention of using incentives to support delivery, hinting that payment-by-results (1, 2) might not yet be a thing of the past.

The more centralised approach will also enable a national approach to workforce development. The government’s Joint Combating Drugs Unit will create a Centre for Addiction and guidance for workers that will include standards for caseload sizes.

Evidence-based treatments

The strategy refers to evidence-based treatments, but for the most part does not specify what these are. Inpatient detoxification, long-acting buprenorphine, naloxone, needle and syringe programmes and residential rehabilitation are all mentioned. There is a brief mention of trauma-informed care. There are, however, no references to some of the treatmets with the best evidence base including behavioural couples’ therapy, cognitive behavioural therapies, contingency management, hepatitis testing and treatment, motivational interviewing, smoking cessation, etc.

The new Centre for Addiction and Health Education England will have to consider the evidence-base when specifying the skills and abilities required for drug workers. With so much money available, there will be many opportunities to spend it on exciting new interventions. But it is important note that many well-evidenced interventions are still only partially or sub-optimally implemented, so exploring better ways of implementing existing treatments will be as important as research into new ones.

Research and prevention

The strategy pledges to “develop a world-leading evidence-base on how to tackle drug use among adults”. This will include addressing “insufficient international knowledge for how to change drug-related attitudes and behaviours at a population level”. The demand for drugs is, according to the strategy, “too high”. Hence its aim to achieve a ‘generational shift in the demand for drugs’. Within the general population, however, some groups are more vulnerable than others to using drugs and experiencing drug-related harm. The strategy also acknowledges this.

On the day the strategy was launched, the government asked the Advisory Council on the Misuse of Drugs (ACMD) to conduct a review of prevention among vulnerable groups. The Minister of State for Crime, Policing and Probation wrote to the ACMD, asking that they make this work a priority and have their initial findings ready to present at the planned Drugs Summit in spring 2022.

Overall, the strategy says it will align research into treating addiction with research on treatments for dementia, cancer, mental health and obesity, and will sit with the Life Sciences Vision. The strategy notes the importance of new medicines and digital therapies; and although no new funding for research is announced, the strategy does say that government will “exploring funding mechanisms” for those conducting research in these areas.

Next steps

There is too much in this strategy to cover in a single summary – so apologies if we missed your favourite part. As with all UK drug strategies dating back to Tackling Drug Misuse in 1985, the level of success will rely on how it is implemented. The strategy creates bold targets, new structures and large pots of funding; but it remains far from guaranteed that these will be achieved, established and well-spent. The more the sector looks to the evidence-base, however, the better those outcomes will be.

by Rob Calder and Natalie Davies

(Edited for accuracy on 10/12/21 replacing reference to 333 local authorities with reference to the 151 with responsibility for treatment provision) 

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The opinions expressed in this post reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the SSA.

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