Tuesday, 9 Aug 2022  |  Reading time:  16 mins  | Read online

Addiction

This week, we’re putting the spotlight on the global addiction crisis and the ways local government can intervene.

Addiction is a neuropsychological disorder that results in the uncontrolled use of substances or displays of behaviours, despite the harmful consequences.

Worldwide, it affects about one in five people over the age of 14 and there are three main categories: behavioural, substance and impulse. It is an avid contributor to several major societal problems, such as homelessness, crime, unemployment and poor public health, contributing to burdens on communities and local government as a result. Nicotine and alcohol are the most common and deadly sources, with the latter killing more than 8 million people per year.

What can local government do? Local government has a significant role to play in organising, funding and facilitating addiction treatment, but just like any other mental health issue, there are distinct challenges for each area alongside several uniting ones – namely funding and tackling stigma.

Addiction is a lifelong disorder even for those who are in recovery, and yet the treatment services on offer are often short-lived. Once dominated by abstinence methods, improved understanding in this field has thankfully led to an expansion in options. This includes approaches like medicated assisted treatments, harm reduction treatments (e.g. needle exchange) and specialist cognitive behavioural therapy. However, this expansion has also led to a struggle for local government to fully fund and provide the wide variety of needed options.

As a result, many health departments are starting to find that they are better equipped to act as a ‘treatment coordination hub’ by partnering with specialist community providers to ensure the right services are available and accessible to those in need. They are also well placed to conduct need assessments and community surveillance, so they are ready to spearhead effective responses to rising addiction rates, as and when they develop.

As coordinators, local government can facilitate all the pillars of addiction recovery, from prevention to treatment, and from recovery support (such as housing, employment and counselling) to public safety – all of which carry the challenge of establishing strong partnerships with different bodies and organisations. However, when successful, making use of better expertise and resources can help ensure that the addiction treatment needs of the community are being met comprehensively and long-term.

In light of recent record-breaking overdoses across the globe, there is also more impetus for local government to not only simplify access but also address the system’s reliance on individuals having to seek out help in the first place. Examples of how this is being tackled include interventions and outreach approaches, such as backpack walks through neighbourhoods, providing recovery housing and hosting community recovery events.

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This week's featured content

The legacy of ​​the Iceland model and its transformation of teen substance use

By Danielle Henry, LGIU Associate

During the 1990s, Icelandic teenagers drank more heavily than most other European teens. By 1998, 42% of 15 and 16-year-olds reported having been drunk in the last month, 17% smoked marijuana regularly, and 23% of them smoked cigarettes daily.

Further analysis revealed clear differences between the lives of children who took up drinking, smoking and other drugs, and those who didn’t. A few factors emerged as strongly protective: participation in organised activities (especially sport) three or four times a week; total time spent with parents during the week, feeling cared about at school; and not being outdoors in the late evenings. As a result, in 1999, the Mayor of Reykjavik and local psychologists formed a national plan known as Youth in Iceland which included the following extensive changes:

  1. Laws – the legal age for tobacco and alcohol purchases changed to 18 and 20 respectively. In addition, all tobacco and alcohol advertising products were banned nationwide. Furthermore, it became illegal for children aged between 13 and 16 to be outside after 10pm in the winter and midnight in the summer. All but the advertising (and only to a certain degree) are still in effect today.
  2. Parents – every school in Iceland had to establish parent organisations and create a school council with parental representatives. In addition, a national organisation called ‘Home and School’ was formed which focused on encouraging parents to spend more frequent time with their children, talk to them about their lives and keep them indoors at night.
  3. Funding – government funding increased for sports, music, art, dance, and other such clubs, to give children alternative ways to feel part of a group and to make them feel good. Low-income families were given the chance to participate in such activities as well through funding schemes. 
  4. Surveys – school surveys have continued annually since the inception of Youth in Iceland and almost every child in Iceland completes one. This means up-to-date, reliable data is always available.

Through this somewhat controversial method, Iceland has radically reduced rates of teenage smoking, drinking and drug use over the past 20+ years and the method continues to inspire addiction intervention programs across the globe to this day.

Get into the details of how Youth in Iceland was created and has since been adapted and transformed in the full briefing. 

LGIU Global Local Highlights

 

Illicit drug use and homelessness: how Canada and the UK are dealing with a growing crisis?

In 2016, Canada declared a national opioid crisis due to the dramatic rise in drug-related deaths over the past decade. This briefing investigates the intertwining nature of drug use and homelessness and compares the situation to the UK, before discussing whether the approaches taken in Canada could also be effective elsewhere. Click here to read this briefing.

Drug and alcohol-related deaths in Scotland and the wider UK: a national shame

During the height of the Covid-19 pandemic, 2020 saw the largest number of drug-related deaths in the UK since records began in the 1990s – and sadly, the UK was far from the only country to see these record-high rises. Perhaps it is time that drug reform policy follows the examples from abroad by moving away from the criminal justice lens to address the topic as a public health issue instead. Click here to read this briefing.

Innovation & Inspiration

Curated case studies and news from around the globe

USA: Ohio city halves opioid deaths with overdose action team

In 2017, Dayton, Ohio was facing one of the highest per capita accidental overdose death rates in the nation, with 577 deaths recorded, overwhelming police, emergency rooms and morgues. In response, city authorities created the Community Overdose Action Team, promoting a “help not handcuffs” response. Health officials devised needle exchange programs, using them to contact the city’s 4,000 drug users, while police teams were equipped with Narcan, an overdose revival kit, and offered visits of help to users after they overdose instead of routinely arresting them. Instead, illegally operating pharmacists were imprisoned, while public money was directed to treatment and recovery facilities. The move saw drug overdose deaths drop 65 per cent in Dayton’s Montgomery county from January-June 2018 and emergency department visits dropped 73%.
The New York Times

Italy: “Capital of gambling” curbs slot machine crisis

The City of Pavia was identified as Italy’s gambling capital in 2013, with a slot or video gambling machine for every 104 residents and the highest per capita spend on gambling in the country, at €1,600 a year. In response, SenzaSlot, a local grassroots movement was formed. SenzaSlot first mapped and highlighted the city’s few venues without slot machines, and now runs events to inform residents about gambling harm and offers legal support to venue owners who want to remove the machines – who could face an €8,000 per machine penalty from operators. The movement caught the attention of the City Council, who cut the operating times of the machines to just eight hours and banned the opening of new machines within 500 metres of a school, church or retirement home. Machines are also prohibited from council premises, and slot-free venues are offered longer opening hours on public holidays to incentivise the change. The policies have seen results, with per capita spending falling 25% to €1,200 and gaming machine numbers falling from 642 to 547.
The Guardian

Australia: Melbourne sees success with safe injecting rooms despite backlash

Since 2015, Melbourne has seen a heroin-related overdose almost every week within a four-intersection radius in the CBD. To tackle this, the Victorian Government opened its first medically supervised injecting facility in the city’s North Richmond area in 2018. While the site has faced strong opposition, an independent review of the injecting room found it had been used 119,000 times in its first 18 months, treating 217 serious overdoses and saving at least 21 lives. No evidence was found of the argued “honeypot effect”, where drug users are attracted to an area around a facility. Based on the review, the Victorian government has extended the trial for three more years and plans to open a second facility in Melbourne’s CBD.
The Guardian

USA: North Carolina city turns to robotics to deliver real-time opioid updates

Despite routinely ranking as one of the safest cities in the country, the Town of Cary, North Carolina, like most of the USA saw a dramatic jump in the number of fatal and non-fatal overdoses stemming from the opioid epidemic. In response, the council partnered with an NC startup to pilot a wastewater monitoring program that could generate opioid consumption data by measuring concentrations of drug metabolites in sewage, a national first. Portable robots were deployed at strategic points in the town’s sewers, with each able to monitor waste from up 15,000 residents. This near-real-time data is used to identify which communities are using which specific opioids and in what quantity and helps local officials respond faster and more effectively to drug use spikes. 
PBS

Policy & Resources

Framework: Planet Youth 
Planet Youth was developed from the Icelandic Prevention Model highlighted in the briefing above. The method has been utilised to support hundreds of communities around the world and is designed to strengthen protective factors, mitigate risk factors, and build healthy community environments for positive youth development. The model holds a key focus on local school and community intervention alongside evaluating the role of family, peer group and leisure activities in reducing youth substance use. 

Network: World Forum Against Drugs
This global network welcomes all who are working to prevent drug abuse at a grass-roots level, on a voluntary basis, professionally or as policy makers. The global forum encourages participation from every stakeholder, including NGOs, self-help groups, treatment centres, scholars, local, regional and national authorities, politicians and other decision-makers, along with anyone else who shares in their goal to showcase best practices, ideas and experiences while working together to tackle the impact of illicit drugs on communities. 

Case study: Using zoning as a public health tool to reduce alcohol outlet oversaturation, promote compliance, and guide future enforcement: a preliminary analysis of Transform Baltimore
Alcohol outlet oversaturation can exacerbate negative public health outcomes, including addiction rates. As a result, Baltimore City recently passed an extensive zoning rewrite (‘TransForm Baltimore’) which sought to give local government and residents a tool to reduce alcohol outlet oversaturation through land use regulation. As demonstrated in this case study, zoning legislation can be used effectively to not only limit alcohol outlet density but also regulate their proximity to other places where people live, work, play, worship, or attend school. Significantly, the study also outlines the potential public zoning holds to increase health equity in vulnerable and marginalised neighbourhoods.  

Resources: Monitoring drug use in the digital age: studies in web survey
This selection of academic papers showcase the significant role that web surveys can play in drug data collection. The research comes from a wide range of global experts who have conducted web surveys across local, national and international remits to develop a deeper understanding of drug-related issues. The researchers also show how the findings and analyses from these surveys have supported policy-making and the actual development of novel online harm reduction tools and resources.

Podcast recommendation: Local government’s response to the opioid epidemic – Is it enough (Sort Of)

This insightful interview with Cecil County Health Department's Deputy Director, Division of Addiction Services, Mike Massuli is an excellent listen. The podcast hosts are not afraid to dig deep with their questioning and the results are a really informative exploration into the ongoing addiction service work within Cecil County.

Massuli also highlights the core philosophy of harm reduction in the field of addiction treatment and doesn't shy away from the challenges that come with establishing these types of treatments.

Thanks for reading!

Next week, we’ll be looking at the responsibility of local government to provide accessible housing which truly benefits the disabled community.

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