Recently in Drugs Category

The Royal College of Psychiatrists has updated its guidelines on the assessment and treatment of people with substance misuse problems who are detained in police custody.

The guidelines recognise that the assessment and treatment of substance misusers present forensic physicians with challenges. The guidelines stress the importance of good communication, of working closely with custody officers, and of shared responsibility for the safety and care of detainees with substance misuse problems. In particular, they stress the importance of:

· the full participation of forensic physicians in all aspects and at all stages of the healthcare of detainees with substance misuse/dependence

· providing advice to custody officers and others involved with detainees with substance misuse/dependence

· comprehensive contemporaneous records

· appropriate sharing of information in accordance with the law and the General Medical Council's advice on professional confidentiality

· being aware when making all interventions that the interests of the detainee as a patient is paramount.

Professor Hamid Ghodse, chair of the working group that revised the guidance, said: "Addicted individuals should always be cared for and treated without being stigmatised - whatever their personal circumstances. Over the last couple of decades there has been a major increase in substance misuse, and a corresponding increase in the numbers of people detained in police custody who misuse substances. Most of these detainees are vulnerable people.

"It can be difficult to undertake a proper assessment of someone in police custody. However, a detained substance-dependent person who is at risk of complications is entitled to exactly the same quality of healthcare as they would receive in other locations. The overriding principle of care must be their safety, and the treatment of suffering that occurs as a result of substance intoxication or withdrawal."

photo credit: poweron

A report into the care of a Tyneside ex-soldier, who shot four members of his family, revealed failings in the mental health care he received.

Reports say David Bradley killed his aunt, uncle and two cousins in July 2006. Bradley was sentenced to a minimum term of 15 years after admitting manslaughter. Bradley had served in Bosnia and the first Gulf War.

The report concluded: "This was a complex and multifaceted case which presented difficulties both in diagnosis and in management. The essential approach to such cases is a comprehensive, coherent and well executed package of multidisciplinary care. There
were plainly deficiencies in the care package that was provided for David Bradley."

Report recommendations included:

• There should be a clear three stage approach to the question of clinical risk; first
the identification of any risk, second a detailed assessment of any such risk and
third a clear plan for the management of that risk.
• A full social circumstances assessment must take place in any case in which issues
in that area have been identified.
• Engagement with patients ought to be achieved by acknowledging their
expressed needs and developing an agreed care plan based on those needs.

The Lib Dems are set to push again at the drugs policy merry-go-round. The Guardian reports a motion will be put to the party conference to launch an independent inquiry into decriminalisation of possession of all drugs.

It seems to me that the debate on drugs policy just goes round and around in circles and little changes, ever.

Perhaps, like addicts, society first has to admit that the current policy isn't working before it can move forward.

Will this be the end of constant debate?

Image by r0bz on Flickr

Brighton MP Caroline Lucas is bidding to decriminalise drugs use across the city in a bid to tackle its serious substance misuse problem, reports The Observer.
She believes that the government's localism agenda can enable the city to experiment with a policy that would not be in place elsewhere for a trial period, and she seems to have the support (up to a point) of a senior police officer.
Brighton has the highest death rate per capita of any place in the country so there would seem to be an argument for trying a new approach there. But it seems beyond the realms of the possible for this government to allow it.

Do you know the core principles of dementia care? If not, then you should probably check-out some guidance published today by the Department of Health.

I don't often go to the trouble of praising these kinds of documents, but this one is genuinely a very good starting point for anyone new to dementia care or wanting to refresh their practice. I have to read a lot of documents in a hurry in this job and I can vouch for the fact this is one of the easiest to navigate that I've seen in a while.

Care managers should have all dementia patients' prescriptions of antipsychotics reviewed by April 2012, a consortium of charities has said.

The Dementia Action Alliance, which consists of 50 charities in the sector, is hoping the move will reduce the numbers of people on the drugs, which have been shown to shorten people's lives.

To help managers it is consulting on some best practice guidance which will highlight ways people with dementia can be cared for while avoiding the use of the drugs, which are currently prescribed to 180,000 people in the UK. Up to 144,000 are thought to be on the drugs unnecessarily.

The Alliance has also produced guidance for carers and patients to recognise inappropriate use of the drugs.

If you're of African-Caribbean background you may want to pick-up that guidance - you're more likely to need it.

A separate study, published in the British Journal of Psychiatry, has shown African-Caribbean people over 60 are more likely have dementia than their white British counterparts.

A study of over 400 people in London showed 9.6% of those who had migrated from the Caribbean or Guyana had dementia while only 6.9% of white British people of the same age did.

Some interesting stories for readers from the nationals:

1) How the British fell out of love with drugs, from The Guardian

2) Hospital bed numbers set to fall by 20,000 in a year, from the Daily Telegraph

3) Stroke victims receive 'unequal care' under NHS, from the Daily Telegraph

The second is interesting as it makes the point that simple cutting of bed numbers needs to be coordinated with services provided elsewhere and there is little evidence of this of this increase in services being provided elsewhere currently.

The latest figures for the numbers of patients experiencing delayed transfers of care have shown a rise from December to January from 3,881 to 4,640 patients.

This is also higher than November's figure of 4,492 patients.

Some of the other main findings for January 2011 were:

• There were 3,560 adult critical care beds available with 3,016 occupied in January 2011. This compares to 3,535 available and 3,088 occupied in December 2010.
• The number of urgent operations cancelled was 222 in January 2011. This compares with 322 urgent operations cancelled in December 2010.

It's obviously not possible to read anything into this currently, but it's worth noting for the time being.

The alarm bells will have to start sounding if there are rises from April onwards as that would indicate that council cuts are having an effect on patients when they are medically fit to leave hospital.

The hope is, of course, that joint working in this area will be thoroughly embedded, as Community Care showed in this feature on how Portsmouth is combating bed blocking.

The speed and extent of planned changes to the funding of treatment for drug misuse may undermine services, warns independent drug policy body the UK Drug Policy Commission (UKDPC).

In a report published today,  UKPDC warns that if introduced too quickly and without thorough evidence-led planning, this new system may not deliver the benefits expected and may even undermine service provision.

Among concerns:

•    The planned timetable for PbR may result in changes being introduced before their consequences have been fully understood and the system can be properly developed.

•    The challenge of moving to a new system will be compounded by the fact that the introduction overlaps with radical wider health service reforms, a new system of prison commissioning, the introduction of elected police commissioners, and restricted budgets for local councils.

•    In basing PbR for drug recovery on outcomes across four very different areas - crime, employment, drug use, and wellbeing - there will be enormous practical challenges for those delivering services and for the management of the system.

•    A key challenge will be to decide how the payments are triggered: there are no clear answers about what results are measured, what timescales are used, and how service users' own wishes are taken into account.

•    A significant bureaucracy may be needed to manage the new system, prevent providers from neglecting those who have the most complex problems, and ensure that people are able to access the types of care that meet their particular needs. This has the potential to create additional costs that outweigh any savings made by introducing PbR.

The government wants to extend PbR to adult social care so it would do well to heed this warning.

Why does this sound so much like the concerns being uttered over the breakneck NHS reforms, which the government appears to not be listening to?