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LONDON Britain on the brink of new heroin epidemic
LONDON
Britain on the brink of new heroin epidemic
A
new drug-control strategy, unveiled by the government last week coincided with warnings from a senior researcher that Britain was on the brink of a second heroin epidemic. The new strategy aims to cut young people’s misuse of heroin and cocaine by 50% by 2008, to wean addicts away from their criminal lifestyles, and to double the number of treatment places. There will be much more emphasis in the £1·5 billion service on treatment rather than prison sentences, and an expansion of anti-drugs education programmes. But the announcement coincided with the news that although drug seizures had increased tenfold, there had been no effect on drug supplies. Indeed, customs and excise officials told MPs that illegal imports had produced a reduction in street prices. Howard Parker, director of the drugs research centre at Manchester University’s social policy department, made a bleak epidemiological forecast that the traditionally separate recreational and problem drugs arenas were beginning to overlap. Parker was also responsible for first mapping out the new outbreaks of teenage heroin abuse for the government He explained in a report for The Guardian newspaper that despite having the largest recreational-drugs scene in Europe through out the 1990s, the UK has not had the most problematic. During the first half of the 1990s heroin use and crack use had climbed fairly slowly but the picture had become more bleak: “Britain (not Northern Ireland) is in the early stages of a second heroin epidemic involving very young users which is particularly affecting Scotland, and TEL AVIV
north and south west England. The new heroin users are in small cities and towns with no heroin history and therefore no services.” Metropolitan areas—London, Manchester, and Liverpool—which had had the most serious heroin outbreaks in the 1980s were not currently affected, although they were seeing an increase in cocaine use. He went on: “This is a worrying scenario—a high demand for treatment services for heroin in the regions with few services and high levels of stimulant and crack use in the metropolitan areas, which are traditionally geared to prescribing methadone. We don’t have a cocaine substitute to prescribe.”
“The drug agencies welcomed the new emphasis on treatment” Jack Cunningham, the minister responsible for tackling drug misuse, paid tribute to the work of Keith Hellawell, the drug czar, for his work in coordinating the various anti-drug agencies. “For the first time departments and agencies, nationally and locally, are being brought together to work in partnership towards joint performance targets. The focus is on results.” The minister set out a series of detailed targets including a 20% reduction in the misuse of serious drugs by 11–16-year-olds by 2002; a 25% reduction in the use of heroin and cocaine by under 25-year-olds by 2005; and a 50% reduction in repeat offending by drug addicts by 2008. But doubts were raised over the reliability of the targets when so little is
known about current misuse. Challenged by reporters to reveal current numbers misusing drugs, Cunningham conceded there was “a regrettable shortage of reliable information”. He promised an extra £6 million over the next 3 years to establish accurate baselines. In his first report, Hellawell said the government were committed to redirecting existing resources away from processing drug-related offenders to programmes that enable offenders to tackle their drug problems. The drug agencies welcomed the new emphasis on treatment but expressed concern about whether services would be able to cope. Currently, about 30 000 people are being treated out of an estimated 200 000 in need of treatment. Roger Howard, chief executive of the Standing Conference on Drug Abuse, said he was “concerned that drug services on the ground will find themselves under substantial pressure to meet such ambitious targets”. Parker believes Britain needs to improve the monitoring of its drug services, which involve 111 local-drug action teams as well as several Whitehall departments. The treatment sector is funded by an odd mix of local authority community-care money, Health Department funds, the European social fund, and the National Lottery. But there are no routine audits or a proper system of inspection. Extraordinarily there is still no formal education and training route into the service. He forecast that: “This neglect will, unless rectified, lead to a crisis particularly in treatment delivery.” Malcolm Dean
Private medicine blossoms in Israel
T
he demand for private medicine in Israel is increasing —especially for chronic care, mainly geriatric, and elective surgery, mainly cosmetic. Head of the Israeli Health Ministry’s medical administration department, Yitzhak Berlowich, explains that linked with the advent of National Health Insurance “Israelis . . . have been seeking more private health care to get what is not always possible in the public sector”. This includes being able to choose a specialist or hospi tal where the treatment will be done, adds Berlowich.
THE LANCET • Vol 353 • June 5, 1999
Only 5% of acute care beds are private, yet almost every specialist is involved in some private activity including an unestimated number working in the “black market”, which illegally uses public facilities. Just what is public versus private is the single most important issue, says secretary-general of the Israel Medical Association Leah Wapner. Israel’s 12 private general hospi tals produce more income than the equivalent 500 beds in public hospi tals. This “pure private enterprise” has been driven over the past 15 years by patient demand for “pri vate quality care with discretion
and unyielding expertise”, nurtured recently by more private insurance plans and greater income, says plastic surgeon Michael Sheflan who pioneered pri vate practice in Israel 20 years ago. On May 20 and for the first time in Israel, a monthly health-services price guide, Kavim Labriute, was published. The guide, aimed at medical consumers, compares costs of public and private services, though how publishing prices will effect the ultimate prices charged is an experiment in progress. Rachelle HB Fishman
1947
Britain on the brink of new heroin epidemic
A
new drug-control strategy, unveiled by the government last week coincided with warnings from a senior researcher that Britain was on the brink of a second heroin epidemic. The new strategy aims to cut young people’s misuse of heroin and cocaine by 50% by 2008, to wean addicts away from their criminal lifestyles, and to double the number of treatment places. There will be much more emphasis in the £1·5 billion service on treatment rather than prison sentences, and an expansion of anti-drugs education programmes. But the announcement coincided with the news that although drug seizures had increased tenfold, there had been no effect on drug supplies. Indeed, customs and excise officials told MPs that illegal imports had produced a reduction in street prices. Howard Parker, director of the drugs research centre at Manchester University’s social policy department, made a bleak epidemiological forecast that the traditionally separate recreational and problem drugs arenas were beginning to overlap. Parker was also responsible for first mapping out the new outbreaks of teenage heroin abuse for the government He explained in a report for The Guardian newspaper that despite having the largest recreational-drugs scene in Europe through out the 1990s, the UK has not had the most problematic. During the first half of the 1990s heroin use and crack use had climbed fairly slowly but the picture had become more bleak: “Britain (not Northern Ireland) is in the early stages of a second heroin epidemic involving very young users which is particularly affecting Scotland, and TEL AVIV
north and south west England. The new heroin users are in small cities and towns with no heroin history and therefore no services.” Metropolitan areas—London, Manchester, and Liverpool—which had had the most serious heroin outbreaks in the 1980s were not currently affected, although they were seeing an increase in cocaine use. He went on: “This is a worrying scenario—a high demand for treatment services for heroin in the regions with few services and high levels of stimulant and crack use in the metropolitan areas, which are traditionally geared to prescribing methadone. We don’t have a cocaine substitute to prescribe.”
“The drug agencies welcomed the new emphasis on treatment” Jack Cunningham, the minister responsible for tackling drug misuse, paid tribute to the work of Keith Hellawell, the drug czar, for his work in coordinating the various anti-drug agencies. “For the first time departments and agencies, nationally and locally, are being brought together to work in partnership towards joint performance targets. The focus is on results.” The minister set out a series of detailed targets including a 20% reduction in the misuse of serious drugs by 11–16-year-olds by 2002; a 25% reduction in the use of heroin and cocaine by under 25-year-olds by 2005; and a 50% reduction in repeat offending by drug addicts by 2008. But doubts were raised over the reliability of the targets when so little is
known about current misuse. Challenged by reporters to reveal current numbers misusing drugs, Cunningham conceded there was “a regrettable shortage of reliable information”. He promised an extra £6 million over the next 3 years to establish accurate baselines. In his first report, Hellawell said the government were committed to redirecting existing resources away from processing drug-related offenders to programmes that enable offenders to tackle their drug problems. The drug agencies welcomed the new emphasis on treatment but expressed concern about whether services would be able to cope. Currently, about 30 000 people are being treated out of an estimated 200 000 in need of treatment. Roger Howard, chief executive of the Standing Conference on Drug Abuse, said he was “concerned that drug services on the ground will find themselves under substantial pressure to meet such ambitious targets”. Parker believes Britain needs to improve the monitoring of its drug services, which involve 111 local-drug action teams as well as several Whitehall departments. The treatment sector is funded by an odd mix of local authority community-care money, Health Department funds, the European social fund, and the National Lottery. But there are no routine audits or a proper system of inspection. Extraordinarily there is still no formal education and training route into the service. He forecast that: “This neglect will, unless rectified, lead to a crisis particularly in treatment delivery.” Malcolm Dean
Private medicine blossoms in Israel
T
he demand for private medicine in Israel is increasing —especially for chronic care, mainly geriatric, and elective surgery, mainly cosmetic. Head of the Israeli Health Ministry’s medical administration department, Yitzhak Berlowich, explains that linked with the advent of National Health Insurance “Israelis . . . have been seeking more private health care to get what is not always possible in the public sector”. This includes being able to choose a specialist or hospi tal where the treatment will be done, adds Berlowich.
THE LANCET • Vol 353 • June 5, 1999
Only 5% of acute care beds are private, yet almost every specialist is involved in some private activity including an unestimated number working in the “black market”, which illegally uses public facilities. Just what is public versus private is the single most important issue, says secretary-general of the Israel Medical Association Leah Wapner. Israel’s 12 private general hospi tals produce more income than the equivalent 500 beds in public hospi tals. This “pure private enterprise” has been driven over the past 15 years by patient demand for “pri vate quality care with discretion
and unyielding expertise”, nurtured recently by more private insurance plans and greater income, says plastic surgeon Michael Sheflan who pioneered pri vate practice in Israel 20 years ago. On May 20 and for the first time in Israel, a monthly health-services price guide, Kavim Labriute, was published. The guide, aimed at medical consumers, compares costs of public and private services, though how publishing prices will effect the ultimate prices charged is an experiment in progress. Rachelle HB Fishman
1947