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The Audit Commission's publication Changing Habits reports on a study of the commissioning and management of community drug services carried out in 2001. The report says that drug treatment services work, but effort is wasted through poor co‐ordination. Commissioners and treatment providers need a better understanding of the most effective approaches for clients.

This paper examines the social and institutional context of barriers to drug service throughcare and aftercare for prisoners in England and Wales, including those that specifically affect Black and minority ethnic prisoners. A research project in 2004 reviewed relevant literature and statistical data, mapped prison drug services, and sought the perspectives of relevant stakeholders: in total, 334 individuals were recruited to the study. The methodology facilitates analysis of the structure of services and the agency prisoner in accessing them. Recommendations are made for changes to the structure and delivery of prison drug services.

In this paper, academics and managers of specialist services reflect on the shifting policy and funding landscapes that shape service provision for drug‐using sex workers in England and Ireland. The paper outlines the harm reduction and holistic principles that underpinned much original service provision concerned with public health in the face of an HIV epidemic and the limitations of services that equate drug use minimisation with sex work minimisation. It concludes that an ‘exiting’ and victim discourse dovetails with the well‐funded crime and disorder agenda, and that lobbyists on these issues are proving to be natural allies against harm reduction.

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

The purpose of this paper is to illustrate how local drug services use their senior staff to respond to emerging ethnic groups presenting to treatment using flexible thinking and innovative processes.

The methodology was a case study design that used a semi-structured questionnaire that looked at two drug services and their staff’s influence on service delivery in different boroughs of east London.

The research found very innovative findings from the two boroughs. The boroughs had different racial mixes and therefore differing populations presenting to their local drug services. However, they used flexible approaches to structure their services to engage with emerging ethnic minority populations in drug treatment. From the findings, these different approaches and structures of providing drug treatment were very important. Approaches, for example, of clinical staff offering a “rapid assessment” are particularly important in engaging and retaining ethnic minority populations. Also, using flexible thinking within the staff team enables drug services to adapt treatments to be flexible in responding to emerging ethnic populations.

This paper shows that thinking in designing approaches to drug treatment shows that ethnic minority populations can be successfully engaged in drug treatment. This has implications for drug treatment nationally and across Europe where there are “emerging” ethnic populations presenting for drug treatment.

This paper shows that drug services can adapt and change to their different ethnic minority populations if they can able to be flexible in their clinical approach to service provision.

In response to Scottish Government assertions that an ageing cohort explained increases in drug-related death (DRD), the previous research by the authors established that socio-economic inequalities were additional risk factors explaining the significant increases in DRD in Scotland. This paper aims to subject the drug policy narratives provided by Scottish Government in relation to the governance of drug and alcohol services to critical scrutiny and reveal the social consequences of the funding formula used to direct funding to services via NHS Scotland Boards, and Alcohol and Drug Partnerships (ADP).

The paper provides a narrative review in the context of the AUDIT Scotland reports “Drug and Alcohol Services in Scotland” from 2009 and follow-up report published in 2019. The authors refer to the recommendations made in the 2009 report on effectiveness of drug and alcohol services and subject Scottish Government funding processes, and governance of drug and alcohol services to critical scrutiny.

This analysis provides robust evidence that Scottish Government funding processes and governance of drug and alcohol services increased risk to vulnerable drug users and document evidence that link these risk factors to increased DRD.

The authors have focused on Scottish drug policy and drug services funding. Alcohol services funding is not subject to critical analysis due to limitations of time and resources.

This case study investigates AUDIT Scotland’s recommendations in 2009 to Scottish Government to provide researchers, government policy advisors and media with robust critical analysis that links drug policy decisions to increased DRD.

Drug policy governance by the Scottish Government and NHS Scotland since 2009 have disproportionately affected communities of interest and communities of place already experiencing stark inequalities. These budget decisions have resulted in widening inequalities, and increased DRD within communities in Scotland. The authors conclude that in diverging politically and ideologically from Public Health England, and the Westminster Parliament, Scottish Government drug policy and financial governance of drugs services contributes to increased risk factors explaining DRD within deprived communities.

The 2009 AUDIT Scotland recommendations to Scottish Government subject their governance of drug services to critical scrutiny. This analysis provides a counterpoint to the explanations that rising DRD are unconnected to drug policy and drug services governance.

This paper aims to examine policy innovation among street-level bureaucrats at low-threshold services to people who use drugs during the COVID-19 pandemic in Denmark.

This paper builds on two research projects conducted during the first pandemic lockdown in Denmark. The first is a case study of how COVID-19 impacted on people who use drugs (PWUD) and services for PWUD at the open drug scene in the neighborhood of Vesterbro in Copenhagen. The second is an ethnographic study of how users of services at the intersection of drug use and homelessness were impacted by lockdown.

Drawing on Kingdon’s “multiple policy streams” approach, this study shows how lockdown opened a “policy window” for innovating services to people who use drugs. This paper further shows how the pandemic crisis afforded street-level bureaucrats new possibilities for acting as “policy entrepreneurs” in a context where vertical bureaucratic barriers and horizontal cross-sectoral silos temporarily collapsed. Finally, the authors show how this had more lasting effects through the initiation of outreach opioid substitution treatment.

In Denmark, the emergence of a “policy window” for street-level bureaucrats to act as street-level “entrepreneurs” occurred in a context of rapid government response to the pandemic. For crises to act as “policy windows” for innovation depends on strong, preexisting institutional landscapes.

This paper adds to existing literature on policy innovation during COVID-19 in two ways: methodologically by contributing an ethnographically grounded approach to studying policy innovation and theoretically by examining the conditions that allowed policy innovation to occur.

It is unclear how consumer participation (CP) can be optimised to transform drug and alcohol treatment services and improve health outcomes. The purpose of this paper is to present the findings of a systematic review examining the types and benefits of activities, and the factors that facilitate CP in drug treatment services.

A structured search of four databases was undertaken to identify peer reviewed primary research literature in English. Screened articles were appraised. A content analysis was applied to examine the types and outcomes of CP and the associated factors affecting the process. In total, 16 articles were included for review.

A range of CP activities were identified, and benefits included increased consumer satisfaction, and improved health service delivery. Factors that facilitated the process of CP included positive attitudes of both consumers and providers and employment of people with a lived experience of drug use. However, the lack of consumer and organisational capacity, negative attitudes of providers and power imbalances between consumers and providers constrained CP efforts.

To maximise the benefits of CP in drug and alcohol treatment services, negative attitudes about CP and power dynamics between consumers and health providers need to be addressed. This can be achieved by the strategic use of strengths-based interventions and consumer led education to enhance social capital.

This is the first known review to examine the benefits and facilitators of CP in drug treatment services.

Problematic drug use in prison remains a pervasive and increasing concern throughout the European Union (EU) in terms of costs to the individual, community and the state. Drug‐related problems in prison seem to be more prominent among female prisoners, as a high proportion of them are problematic drug users whose use continues in prison. Assuming that women’s drug use is an indication of need for treatment and health care, it becomes increasingly interesting how the European penal institutions differ in their response to this need. For this reason, a survey of the prison drug services for adult female drug users has been carried out among the Ministries of Justice of all 25 EU member states. The main purpose of the survey was to gain comprehensive and systematic information on the prevalence of female problematic drug users in European prisons and the availability of treatment and healthcare services. Altogether, 27 European countries and autonomous regions completed the questionnaire developed for this survey. The results of the data analyses indicate that there is poor availability and quality of data relating to the extent of problematic drug use in women’s prisons and, where it is available, it seems to underestimate the proportion of female problematic drug users in prisons. However, most of the European countries provide a range of different harm‐reduction and drug treatment services to respond to the reported health and rehabilitation problems of female problematic drug users. At the same time, however, it is evident that there is a need for further action in some countries, due to their low provision of prison drug treatment and healthcare services for this group. This article is based upon the European research project ‘Female drug users in European prisons’, which was conducted between 2003 and 2004 and funded by the AGIS Programme, Directorate General Justice and Home Affairs, of the European Commission.

The purpose of this paper is to examine the implications for drug and alcohol treatment of radical policy changes being implemented by the government, particularly the proposed transition of responsibility for treatment from the National Treatment Agency to a new public health service from 2013.

It is argued that this is a critical moment in the development of substance misuse services in England, particularly given the impact of health service reform. Concerns are raised about the lack of reference to drug and alcohol treatment in key policy documents, such as the Department of Health's White Paper Healthy Lives, Healthy People. The removal of the “ring fence” from the pooled treatment budget may result in national disinvestment at a time when public spending cuts are likely to reduce local authority spending on drug and alcohol treatment. It will be challenging to deliver on the vision of recovery in the “Drug strategy 2010”.

The new public health structures and the commitment to recovery create new opportunities to improve services too – for example, the potential for joint working through Health and Wellbeing Boards. It is also positive that Healthy Lives, Healthy People stated that the NHS Constitution will apply to the public health service.

While these changes could provide a platform for improving outcomes, there is a genuine risk that substantial disinvestment in drug and alcohol services will be witnessed.