Several of those working at the IDPC secretariat, despite their expertise in policy issues, are less familiar with how drug treatment or harm reduction services operate on the ground. We therefore decided to arrange a visit to two services in inner London to take a look at frontline provision. Those of us having previous knowledge of drug treatment and harm reduction services were a little apprehensive prior to these visits, in view of recent changes in UK government policy, which now involves a muscular rhetorical focus on the achievement of abstinence for all.
The first service we visited dealt largely with 'problematic' clients dependent on heroin and crack cocaine, a population often heavily stigmatised and subsisting in the social and economic margins of British society. A very busy but friendly lady showed us around the facilities, which, despite the cramped building, managed to maintain a wide range of services for its clients. From the reception worker to the consultant psychiatrist, the dedication, resourcefulness and compassion of the staff was obvious and impressive; perhaps most encouraging was the manner in which the government's recovery agenda was being interpreted. Evidence of the recovery focus was apparent in strategically placed posters and pamphlets, and our host explained that the ultimate objective of achieving abstinence was regularly discussed with service users. However, the oppressive potentials of what could easily degenerate into a programme of enforced abstinence were consistently avoided; a realism born of experience ensured that recovery also had to be about recognising the reality of the clients' lives. This meant assisting them with problems ranging from injecting techniques to housing benefit claims, and providing life-saving OST to those who needed it.
The second service we visited was more varied in its function, and included a drop-in centre and diverse clientele. We did not get the full tour, but in the little-used needle exchange (this function is provided chiefly by local pharmacies) we shared a discussion with several staff members. Here the uncertainty of the changes faced by drug treatment services and the UK's healthcare system more generally were clearly evident. While there are currently no plans for a time-limit on the provision of OST, a proposed system of 'payment by results' could effectively mean the same thing. Amongst some of these workers, whose collective experience goes back decades, there are anxieties about what the abstinence-driven recovery agenda could mean for clients in the future. We hope that the government listens to these voices before going further down the road to its recovery utopia.
As we left, the autumn air was cold; a young woman hurried in from the busy street, the beginnings of withdrawal etched into her face. For the moment, at least, the service retains its capacity to offer her something more tangible than moral exhortations.
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