However, there are a number of developments that threaten this success. Newer demographics of people are starting to inject drugs and the government has made worrying comments which appear critical of opioid substitution therapy (OST).
The National AIDS Trust (NAT) has recently published a report “HIV and Injecting Drug Use” based on a roundtable which brought together experts in the drugs and blood-borne virus sectors. It found a rapid change in drug use amongst men who have sex with men in the past few years. New drugs are being used—crystal meth, mephedrone, and GHB/GBL—with the first two increasingly injected and needles shared. The drugs are also being used in the context of risky sexual behaviour.
At one key service in London, 85% of men who have sex with men now report using one or more of these three drugs compared with only 3% in 2005.
There are only a few services who understand the specific needs of men who have sex with men who have problems with drug use and its interaction with high risk sex, and these services are massively overstretched.
Feedback we received from men who have sex with men is that generic drug support services often seem uncomfortable discussing the sexual nature of men who have sex with men’s drug use and as a result their needs are not being met. This has lead to an increased HIV transmission risk, rising rates of hepatitis C infection and re-infection, poor mental health, and even deaths from overdose.
NAT is calling on the government to provide a national strategic response to this issue. At a local level, councils should ensure drugs and sexual health services work together to meet the needs of men who have sex with men.
The report also found an increase in the use of injected image and performance enhancing drugs (IPEDs) such as steroids or tanning agents.
There is a risk that these newer injectors are not being given the key health messages, for example around use of clean injecting equipment, and are therefore at risk of HIV and hepatitis. There is already evidence of elevated HIV and hepatitis rates amongst steroid injectors.
NAT’s 2010 survey of public knowledge and attitudes to HIV found only 45% of the general public knew HIV can be transmitted through sharing injecting equipment. If new communities are starting to inject drugs, there is an urgent task to ensure health promotion and harm reduction messages reach these groups. Otherwise there will be new transmissions of HIV and hepatitis B and C.
The changes in the way people inject drugs, and the types of people who are injecting drugs come at a time of great change in drugs service provision.
Local councils in England are now responsible for drugs service commissioning, and they will need guidance from Public Health England on this issue.
There were some worrying comments last year from the government which critised the maintenance of some people on OST (usually methadone). The government also offers policy and financial incentives to services to get people off OST—but pushing people off OST before they are ready risks relapse and overdose. We need to ensure that such incentives do not encourage services to apply for inappropriate pressure for treatment exit.
We strongly believe recovery can include being maintained on OST whilst avoiding ill health and building successful social, family, and working relationships.
The newly created Public Health England must re-sate an evidence based approach to OST provision, change funding mechanisms, and make it clear to local councils that maintaining people on OST can be the appropriate and successful treatment outcome.
I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.
Yusef Azad is the director of policy at the National AIDS Trust.