Services for drug users

Each local authority area in England has a Drug Action Team (DAT) or Drug and Alcohol Action Team (DAAT) whose role is to tackle drug and alcohol problems locally. These teams work with, and include representatives from, a wide range of agencies including the local authority, police, probation service, prison service, primary care trust and other NHS organisations, as well as specialist voluntary agencies. The DAT or DAAT funds (commissions) services for drug users in its local area.

Similar partnerships plan and fund services in other parts of the UK: Alcohol & Drug Partnerships (ADPs) in Scotland, Community Safety Partnerships (CSPs) in Wales and Drug & Alcohol Co-ordination Teams (DACTs) in Northern Ireland.

The National Treatment Agency for Substance Misuse (NTA) is a special health authority within the NHS which works with national, regional and local agencies in England to increase the availability and effectiveness of the treatment system. Community drug-treatment services are often provided by NHS mental health trusts and voluntary sector agencies, although other NHS bodies, private-sector clinics, local authorities and others also work with drug users. 

There are four main types of drug treatment provision (referred to as the four care ‘tiers’) – general services (tier 1), open access services (tier 2), community services (tier 3) and specialist services (tier 4). 

People using drugs will often see their GP as a first port of call. GPs can refer patients on to treatment services, as well as providing more general medical care and harm reduction advice. GPs may also work with a specialist drug service, for example to prescribe methadone. This is an arrangement known as shared care. 

Some drug services are open access, meaning that you don’t need a referral to be seen by a drug worker. This kind of service will offer advice and information for someone who is concerned about their drug use, as well as providing harm-reduction services such as the provision of clean needles for injecting drug users. Chemists may also provide harm-reduction services.

Community drug-treatment services usually offer a more structured programme and a referral is required (for example, from an open-access service or a GP). The drug user will attend regular sessions at a local centre where they may receive counselling, detoxification, substitute prescribing (e.g., methadone) and other therapies. In recent years, waiting lists for community drug treatment have come down significantly and most people are seen within three weeks.

Treatment may also be provided at a specialist service such as residential rehabilitation (rehab). Drug users will usually undergo a detoxification beforehand and will stay in rehab for weeks or months at a time. If considered appropriate for their needs, people may be referred to rehab by community services. People can access rehab services privately if they have enough money.

Not for all services. Drug users can access information and advice, drop-ins and harm-reduction services without a referral at open-access services, or they can go to their GP.

Users may need a referral from an open-access service or GP to receive care from community drug-treatment services. Access to a specialist service is usually via a referral from a community service.

Some people enter drug treatment as a result of contact with the criminal justice system, for instance following a court order or through the Drugs Intervention Programme (DIP). Committing certain offences (e.g., shoplifting or burglary) can lead to a drug test on arrest and, if they test positive, the person must undergo an assessment by a drug worker.

Services funded by the DAT (or equivalent) will require the person to be resident in the local area. Services provided by charities and residential rehabs may take people from other areas.

Open-access services, such as advice and information, drop-in and harm-reduction services, as well as more structured therapeutic interventions funded by a DAT or equivalent, are free.

If a drug user is prescribed methadone or other medication in order to help stabilise their drug use, this is treated the same as any other medicine and NHS prescription charges apply. People receiving drug treatment may receive methadone without charge, but only if they meet the exemption criteria for prescription charges.

Private treatment providers charge for their services.

If treatment is provided by a GP, the rules are the same as for other aspects of primary care (see above). When treatment is provided by an NHS hospital or hospital staff, the rules are as described in the secondary care section. The majority of open-access, community and voluntary sector services will not exclude people because of their immigration status.

The government has a duty to provide a comprehensive health service, including treatment for drug users. Doctors must not discriminate against patients or withhold treatment because they believe a patient’s lifestyle has contributed to their condition.

Drug services are increasingly recognising the importance of service-user involvement and most DATs or equivalent structures now have formal procedures to ensure service users are involved in decisions around care provision. There are also many local service-user groups – the DAT or similar structure should have contact details.