Rosanna O’Connor Director of Delivery National Treatment Agency

1. Rosanna O’Connor Director of Delivery National Treatment Agency

2. The National Treatment Agency for Substance Misuse • Special Health Authority established in 2001 to improve the availability, capacity and effectiveness of drug treatment in England • NTA works in partnership with national, regional and local agencies to: • Ensure efficient use of public funds • Promote evidence based practice • Improve performance • Monitor and develop treatment effectiveness • NTA has led the successful delivery of DH targets to • Double the number in treatment • Increase percentage successfully completing treatment

3. Overview • The problem • Link between drugs and crime • The evidence • How do we know that drug treatment can make a difference? • What’s been achieved? • Community based treatment • Where do prisons fit in? • Prison based drug treatment finally comes in from the cold • Where do we go from here? • What threats and opportunities does the future hold

4. Percentage of different crimes motivated by drug use While shoplifting is the most common drug motivated crime it accounts for a relatively small share of the total cost of drug related crime Drug motivated crime accounts for around half of all crime Drug use is responsible for the great majority of some types of crime - but tends to be skewed towards property crime rather than high victim trauma crimes Source: The economic and social costs of Class A drug use in England and Wales, 2003/4 in Measuring different aspects of problem drug use: methodological developments, Home Office Online Report 16/06; BCS 2007

5. Drug motivated crime accounts for around half of all crime Drug users are estimated to commit between a third to a half of all acquisitive crime Some users will have been offenders before taking high harm drugs but once addicted, funding a serious habit is expensive and can increase offending Source: The economic and social costs of Class A drug use in England and Wales, 2003/4 in Measuring different aspects of problem drug use: methodological developments, Home Office Online Report 16/06; BCS 2007

6. Why it’s everybody’s problem? • If you are a taxpayer you will pick up part of the annual £15.4bn bill for the crime and health costs generated by people buying and using Class A drugs such as heroin and crack • If you are a victim of crime there is a strong chance it will be drug-related. Estimates suggest that between a third and a half of all acquisitive crime (shoplifting, burglary, vehicle crime, robbery, etc) is drug-related. Around three-quarters of heroin and crack users say they commit crime to fund their habit • The community you live in can be badly affected in a number of ways, from the antisocial behaviour associated with drug dealing, the activities of those under the influence of drugs (including discarded needles), the violence associated with organised crime, and prostitution.

7. Treatment effectiveness • The National Treatment Outcome Research Study (NTORS) followed more than 1,000 problem drug users through treatment It recorded significant reductions in offending, with rates of acquisitive crime falling by half at the one-year point. These improvements were maintained at various follow-up points. • National Institute for Health and Clinical Excellence (NICE) suggests the health and crime cost of each injecting drug user is £480,000 over a lifetime. • DTORS estimated a cost benefit ratio for all drug treatment of around 2.5:1 as the mean benefit per drug user in treatment • Source: Drug Treatment Outcomes Research Study: December 2009 • http://www.homeoffice.gov.uk/rds/pdfs09/horr23.pdf

8. Evidence of effectiveness of CJ interventions • Arrest Referral Schemes 1 and the Drug Treatment and Testing Orders (DTTO)2 which showed that the average amount pent on drugs fell from £400 per week at the start of the intervention to £25 per week at the follow up stage • Acquisitive crime – to which drug-related crime makes a substantial contribution - has fallen by almost a third since the Drug Interventions Programme started in 2003 • More than1 in 4 of those starting a new episode of treatment in England are referred by staff working in the criminal justice system. • 1 http://www.kcl.ac.uk/depsta/law/research/icpr/publications/Doing%20Justice%20to%20Treatment.%20DPAS2.pdf • 2 http://www.homeoffice.gov.uk/rds/pdfs/hors212.pdf

9. Stop press…… • http://www.homeoffice.gov.uk/rds/pdfs06/r275.pdf • This study matches data from the Police National Computer (PNC) with the NTA’s National Drug Treatment Monitoring System (NDTMS) database on a sample of opiate and crack users who had recently offended but had not been jailed and had started treatment in the community. The number of offences committed almost halved following the start of treatment and the results were very much in line with the studies that had been based on self report information

11. Drug Interventions Programme (DIP) Criminal Justice Integrated Teams (CJITs) Testing on arrest Required assessments Restrictions on bail Rapid access to treatment Drug Rehabilitation Requirements (DRRs) Every week, over 1,000 drug-misusing offenders are engaged in treatment via DIP HO research followed group of 7,727 DIP clients and found that half showed a 79% reduction in offending over a 6 month period Overall volume of offending was 26% lower following DIP identification Number of DRRs increased from 4,854 in 2001/02 to 16,607 in 2007/08. Completion rates improved from 28% to 43% in the same period What’s been achieved in the community?

13. some numbers… • On average, 55% of all prisoners are problematic drug misusers • 45% of men and 65% arrive drug dependent – of these 40% report injecting drug use within 28 days • Problematic drug use can be as high as 75%-80% in some local prisons • 75,000 PDUs per year will enter the prison system • 16% of all problem drug-users in prison at any one time

14. The good news… Massive increase in funding (from £7.2m in 1997 to over £100m in 2010) Improving range of treatment options including clinical, CARATs and structured programmes The bad news… High profile class actions by ex prisoners citing clinical negligence result in out of court settlements Inconsistent approach, variable quality and lack of join up between clinical and psychosocial provision Continuity of care arrangements remain fragile Prison based drug treatment….

15. IDTS • Better treatment for offenders, with a range of effective needs based treatment and realistic treatment opportunities, including to become drug free • Improved clinical management including opioid stabilisation and maintenance prescriptions where appropriate • Intensive psychosocial support for all patients • Greater integration with an emphasis on clinicians and drug workers working as multi-disciplinary teams • Better targeting of interventions to match individual need • Strengthening links to community services including Primary Care Trusts, Criminal Justice Integrated Teams (CJITs), Drug Treatment providers etc.

16. What’s been achieved in prisons? • £40m per year of DH investment to support IDTS • IDTS now implemented in the majority of English prisons and full coverage will be achieved by April 2011 • Arrangements in place to begin recording prison based drug treatment on National Drug Treatment Monitoring System (NDTMS)

18. A work in progress – more to be done • Implementing the DIP review • IDTS – finishing the job and getting the balance right • The Prison Drug Treatment Strategy Review Group chaired by Lord Patel is charged with taking forward the recommendations of PWC review and producing a unified prison drug strategy • System Change Pilots – more joined up, more efficient, more effective • Integrated Offender Management – addressing the reintegration agenda and delivering case management

19. http://www.nta.nhs.uk/uploads/nta_criminaljustice_0809.pdf