Drug services need big changes, says report

Overly-rigid treatment and centres working ‘over capacity’ are all highlighted in summary

The city’s drug treatment service is in need of radical overhaul, a “damning” report by the Dundee Drugs Commission has recommended.

Buildings used by the Integrated Substance Misuse Service (ISMS) on Constitution Road have been dubbed “not fit for purpose”, while a lack of leadership in a number of the city’s drug services and partnerships has been highlighted.

Drug treatment centres are operating “over-capacity and in silos” and third sector organisations working with addicts are afraid to speak out for fear of losing funding.

The findings were contained in the commission’s report into the state of the drugs crisis in the city, published yesterday.

Sixty-six people died from drugrelated harm in 2018.

Treatment takes up almost 80% of the total drug and alcohol budget spend in Dundee, with prevention services receiving an average of 7.5% of the money and recovery programmes, around 3.5% on average.

The Dundee “system” for treatment, the commission discovered, is driven by a national direction to “get individuals into treatment”, which focuses on “funnelling” individuals into the prescribing service, rather than having a prevention-based philosophy.

This results in drug-addicted people struggling to be seen and treated by specialists and then, in turn, struggling with the “rigidity” of the opioid substitution therapy (OST) practice the service is “narrowly” delivering.

They then, in turn, drop out of the service.

The ISMS experienced 452 unplanned discharges last year, compared to the 22 which were planned.

In its report, the commission said: “The reports we have heard are dominated by accounts of how the service treats so many people that they struggle to deal with the people with the most complex circumstances – the people that they should fundamentally be dealing with.

“At times (they are) not working with them until they have managed their drug use to a certain degree.

“It is a scenario where specialist treatment almost becomes the only option in Dundee for those who use drugs and who desire help.

“Many of the stories we have heard were of people struggling to access opioid substitution therapy (such as methadone) and then struggling with the rigidity of the programme, with numerous reports that if you do not meet the established service criteria or expectations at any one point of the system, no matter how small, then that apparent failure is used as a reason to put somebody back to the start of the process for receiving treatment.”

The commission noted staff involved in the ISMS had “little access” to share their views with the study.

It added: “There are passionate, skilled and experienced professionals in all services who are often working over capacity but who are constantly battling the ‘system’ to be able to do their jobs to the best of their ability.

“We have, however, heard many reports from staff that they are often ‘unable to see the wood for the trees’ because of the high numbers of individuals they are having to work with and because of the systems that require a whole range of procedures to be followed – some of which are perceived as being unnecessary and risk-averse.

“Staff at ISMS have had little access to allow them to feed in their views directly to the commission.

“This has led to the perception that the commission is a threat to the service, rather than an opportunity to engage with a process to improve the situation in Dundee for the benefit of everyone.”

The commission found the areas of treatment and support “dominated” the time they spent evidence gathering.

This had a knock-on effect for further investigation into other matters, including the impact of childhood sexual abuse and those who use drugs to “cope”, the role of criminal justice services and law enforcement’s role in keeping drugs out of the city.