This quality standard covers the treatment of adults (18 years or over) who misuse opioids, cannabis, stimulants or other drugs in all settings in which care is received, in particular inpatient and specialist residential and community-based treatment settings. This includes related organisations such as prison services and the interface with other services, for example those provided by the voluntary sector. For more information see the scope for this quality standard.
Drug use disorders are defined as intoxication by, dependence on, or regular, excessive consumption of psychoactive substances leading to social, psychological, physical or legal problems. Opioid misuse is often characterised as a long-term chronic condition with periods of remission and relapse. Patterns of cannabis and stimulant misuse vary considerably and are less well understood.
Patterns of drug misuse vary in England and Wales. Among people aged between 16 and 59 years, the most commonly used psychoactive substance is cannabis, followed by cocaine and ecstasy. Opioids are used less commonly, but present the most significant health problems.
People with drug use disorders may have a range of health and social care problems. Drug misuse is more prevalent in areas characterised by social deprivation, which in turn is associated with poorer health. Many people with drug use disorders have lifestyles that are not conducive to good health. Injecting drug users are particularly vulnerable to contracting blood-borne viruses and other infections. A long-term study of people with an addiction to heroin showed they had a mortality risk 12 times greater than the general population. The aim of drug treatment is to reduce such inequalities by helping people overcome their addiction and improve their quality of life.
This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with drug use disorders in the following ways:
Preventing people from dying prematurely.
Enhancing quality of life for people with long-term conditions.
Helping people to recover from episodes of ill health or following injury.
Ensuring that people have a positive experience of care.
Treating and caring for people in a safe environment and protecting them from avoidable harm.
These overarching outcomes are from The NHS Outcomes Framework 2012 to 13.
The quality standard is also expected to contribute to the following overarching outcomes from the Public Health Outcomes Framework 2013 to 2016:
Improving the wider determinants of health.
Healthcare public health and preventing premature mortality.
The quality standard is also expected to contribute to the following overarching indicators from the 2011/12 Adult Social Care Framework:
Enhancing quality of life for people with care and support needs.
Ensuring that people have a positive experience of care and support.
Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm.
The quality standard for drug use disorders requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole drug use disorder care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to adults with drug use disorders.
Under the Health and Social Care Act 2012, the commissioning of substance misuse treatment services will be transferred to local authorities in April 2013. NICE will produce a local government briefing in the first quarter of 2013/14, drawing together resources for local authorities on drug services, including this quality standard and related NICE guidance.
The quality standard should be read in the context of national and local guidelines on training and competencies, for example competencies set out in the Drugs and Alcohol National Occupational Standards (DANOS). Implementation of this quality standard is dependent on all healthcare professionals involved in the assessment, care and treatment of adults with drug use disorders being appropriately trained, competent and supervised to deliver the actions and interventions described in the quality standard.
 Home Office (2011) Drug misuse declared: Findings from the 2010/11 British Crime Survey England and Wales
 Department of Health (2007) Drug misuse and dependence: UK guidelines on clinical management