Author: Daniel Mogford, Medical Director UK and Ireland, Camurus

Since the publication of one of the most comprehensive reviews into the UK illicit drug landscape, the Dame Carol Black Review in 2021, and the following 10-year drug strategy, From Harm to Hope, we still find ourselves grappling with many of the familiar struggles in drug treatment and recovery services.⁽ⁱ⁾ Years of underinvestment at a national level, workforce challenges, as well as slow adoption of innovation have left services ill-equipped to deliver the individualised care that people with drug dependence deserve. To deliver on the promise to individuals, their communities and society more broadly, the treatment and recovery system needs to retain those already in treatment for as long as the need exists and must also be attractive to those out of treatment. In England, it is estimated that only about 47% of the opioid dependent population are in treatment.⁽ⁱⁱ⁾ For this population, treatment is protective. Those outside the treatment and recovery system are at an elevated risk of death.⁽ⁱⁱⁱ⁾

Recent data from the Office for Health Improvement and Disparities (OHID) showed that just over half of people who exited the system in 2023/24 had not achieved successful treatment completion, free of dependence.^(iv) There is a pressing need for broad, low threshold access to high quality treatment, regardless of geography or social circumstances. With systematic issues and financial pressures, all those involved in the treatment and recovery system need to be advocates for the individuals and communities they serve, and for the social value that investment into the sector brings. This advocacy should extend to building compassionate involvement from a range of stakeholders, including primary care, the criminal justice system and community organisations.

Opioids remain the main substance used by adults seeking drug dependence treatment, accounting for 44% of all individuals in 2023/24.^(v) People in treatment for opioid treatment rely heavily on prescribing interventions.^(vi) This is also the group with the lowest rate of successful treatment completion. Addressing challenges in the medical treatment of opioids has the potential to bring significant system benefits and improve patient outcomes.^(vii)

Innovation as a catalyst for change 

Providing holistic and individualised care for people living with drug dependence requires a multidisciplinary and integrated approach, involving a combination of medical management, behavioural therapy and social support.^(viii) Today, this is largely provided by specialist drug and alcohol services where patients access support from psychiatrists, medical and non-medical prescribers, nurses, and recovery workers. General community services such as pharmacies, and other community organisations also play an important role in treatment delivery. 

Currently, prescribing interventions are dominated by daily medication.^(ix) Prescribed by specialist services, this medication is largely dispensed at local pharmacies with a requirement for frequent collections and variable degrees of supervised consumption. Frequency will depend on stability in treatment and the prescribing practice of individual clinicians. Due to the rigid nature of the treatment schedule, this can impose barriers on the patient, meaning time away from work or education or making it difficult to balance the daily demands of life.

The emergence of treatment options that bypass the need for daily dosing, gives patients, where appropriate, an alternative way to stabilise their lives and build toward recovery.^(x) They can eliminate the need to plan around regular medication collection or supervision, offering patients greater personal freedom to find employment or engage in other purposeful activities.

By reducing the time spent on administering and negotiating prescriptions, healthcare professionals could redeploy their time toward providing more holistic care that addresses the patient’s health and psychosocial needs, in addition to their medication requirement.  Reducing the frequency that patients need to attend medication ‘pick-ups’, may also help them disassociate from harmful networks, such as drug dealers that specifically target areas close to pharmacies.^(xi)

Innovation provides the opportunity to review and potentially rethink existing models of care to better meet the complex needs of people who use drugs. Alternative treatment pathways that take patients out of specialist services and into the care of General Practitioners are an example of other innovations that could deliver tangible benefits for patients and potentially broaden access to drug users not currently in treatment.

Empowering the workforce 

Rethinking our drug and alcohol services to ensure that patients get the best available care also means better supporting the workforce to ensure they have the tools, training and guidance they need to deliver best practice care. This is particularly important given that experiences of dependence and treatment are not uniform and can be complex.

Camurus is actively seeking to support healthcare professionals in developing their knowledge and skills in relation to opioid dependence by providing educational resources and supporting opportunities for healthcare professionals to share their experiences on how to achieve optimal patient outcomes. For example, we have established a dedicated Nurse Advisor team who use their in-depth knowledge and frontline clinical experience to help services improve patient care and treatment retention through disease area knowledge and product-specific training. 

Keyworkers also play a vital role in a patient’s treatment journey, but do not necessarily have the knowledge and experience of their professionally qualified colleagues. As a response, Camurus has developed a Keyworker Training Programme, where participants can access free online training resources and attend in-person educational workshops, focused on practical skill development.^(xii)

We strongly believe there are steps the healthcare community and decision-makers can take to improve drug treatment and recovery services in the short term, while minimising the impact on the system. We believe that embracing innovations in medical management and providing further training opportunities to empower the workforce represent key initial steps that services can take. By listening and adapting to the experiences of patients without judgement or preconceptions, alongside adequate training opportunities, we can improve the treatment pathway experience for patients, while reducing strains on capacity within the health system. 

This article has been funded by Camurus.

References

(i) Black, C. 2021. Review of Drugs part two: prevention, treatment and recovery: annexes. https://assets.publishing.service.gov.uk/media/60eef5588fa8f50c768386fd/independent-review-of-drugs-part-2-annexes.pdf

(ii) Department of Health and Social Care. 2024. Oral methadone and buprenorphine: recommendations. Guidance. https://www.gov.uk/government/publications/medicine-choices-in-opioid-substitution-treatment/oral-methadone-and-buprenorphine-recommendations

(iii) Public Health England. 2017. Health Matters: preventing drug misuse deaths. https://www.gov.uk/government/publications/health-matters-preventing-drug-misuse-deaths/health-matters-preventing-drug-misuse-deaths.

(iv) Office for Health Improvement & Disparities. 2024. Adult Substance Misuse Statistics 2023 to 2024: report. https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report.

(v) Office for Health Improvement & Disparities. 2024. Adult Substance Misuse Statistics 2023 to 2024: report https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report.

(vi) Office for Health Improvement & Disparities. 2024. Adult Substance Misuse Statistics 2023 to 2024: report. https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report.

(vii) Office for Health Improvement & Disparities. 2024. Adult Substance Misuse Statistics 2023 to 2024: report. https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report

(viii) GOV UK. 2017. Drug misuse and dependence: UK guidelines on clinical management. https://assets.publishing.service.gov.uk/media/5a821e3340f0b62305b92945/clinical_guidelines_2017.pdf

(ix) National Institute of Health and Care Excellence. Methadone hydrochloride. https://bnf.nice.org.uk/drugs/methadone-hydrochloride/.

(x) National Institute on Drug Abuse. 2021. What are the treatments for heroin use disorder? National Institutes of Health. https://nida.nih.gov/publications/research-reports/heroin/what-are-treatments-heroin-use-disorder.

(xi) Strang, J., Volkow, N. D., Degenhardt, L., Hickman, M., Johnson, K., Koob, G. F., Marshall, B. D., Tyndall, M., & Walsh, S. L. 2020. Opioid use disorder. Nature Reviews Disease Primers, 6(1). https://www.nature.com/articles/s41572-019-0137-5.

(xii) Data on File.

UK-NPR-2500015 Feb 2025