In 2019 Dame Carol Black was appointed by UK government to lead a major review examining: the ways that drugs fuel serious violence; treatment, recovery and prevention. The report emphasised that research in the field is lacking, underdeveloped and under-resourced with a lack of research infrastructure in local authority and third sector settings despite 80% of treatment and support being delivered there.
In 2021, government published their 10 Year drug strategy “From Harm to Hope”. The aim was “to cut crime and save lives by reducing the supply and demand for drugs and delivering a high quality treatment system.” Harm to Hope announced the Addiction Healthcare Goals (AHG) initiative, based in the Office for Life Sciences, which aims to tackle increasing rates of drug related deaths and other harms faced by people using drugs and alcohol.
The AHG initiative sponsored a James Lind Alliance research priority setting exercise for addiction which generated a top ten list of research questions covering topics such as reducing deaths, treatment for trauma, reducing stigma, improving harm reduction, treating mental health, supporting children, individualised care, psychological therapies, preventing relapse.
In spite of these various initiatives, drug-related deaths in England and Wales have continued to rise, from 5000 in 2022 to 5565 in 2024. The highest rates are seen in the Northeast of England, whereas East of England has the lowest (less than half that of Northeast). Broadly, regions in the South of England (East, Southeast and London) have lower rates of drug-related deaths than the North (Northeast, Northwest, Yorkshire and Humber). Wales has very high rates, which continue to rise. In Essex, in line with trends in the South East, deaths are low relative to the North (e.g. 6.6 per 100,000 in Essex versus 32.4 in Blackpool).
Whilst national research priorities are a helpful guide, localised research priorities may be more useful to address the general upward trend in deaths and morbidity. Local innovation, both in Essex and throughout the country, has often been led by local communities including those with lived and living experience. Local knowledge is an important resource: it can help identify what is changing on the ground, what is working, and what gaps remain. Irrespective of regional trends, there are inequalities in access and rates of death within regions and increasing demands for local services. We wanted to co-produce research priorities relevant to the local context so that future research can help to strengthen the local treatment system.
To support this process, we worked with a filmmaker to produce a short film reflecting views of local practitioners and people with lived and living experience. The film, “Our Voices, Our services: building a research agenda for compassionate communities” was premiered at an art gallery in Colchester at the start of a full day of participatory work with 80 people including practitioners, commissioners and people with lived and living experience. Preparing for the event, we worked with Mat Southwell of Coact and Essex Recovery Foundation to help facilitate activities; ensure we had involvement from both local recovery and active drug use communities; and to run a pre-event workshop to prepare people with lived and living experience to be able to contribute and work together on the day.
After screening the film, we held facilitated group discussions about identifying local strengths and challenges; improvements needed; and how to use research to advocate for change. Each discussion began with contributions from experts, advocates or policymakers sharing experiences from Scotland, Northern Ireland, Wales, and England including work such as building the Scotland Charter of Rights for People Affected by Substance Use; establishing safe consumption rooms; and research-led approaches to countering stigma and discrimination.
Participants identified strengths of the local treatment system such as good access to clean needles and naloxone; pre‑release support for people leaving prison helping people reconnect quickly with GP services, benefits, and housing. It was felt that Essex has a good treatment system with committed staff, effective partnerships, and promising harm reduction practices. However, participants felt that underfunding, workforce strain, siloed systems, and persistent stigma limit the ability of services to meet the needs of a growing and increasingly complex population.
Five overarching priority themes emerged:
- Integrated, person-centred systems: the need for shared records, joint commissioning, and consistent service standards.
- Workforce development and retention: calls for fair pay, training, caseload balance and wellbeing support.
- Lived experience leadership: a need for more meaningful involvement.
- Modernised harm reduction: such as stimulant support, same-day prescribing, evidence-based models.
- Anti-stigma, trauma-informed, rights-based practice: needed across NHS, housing, justice, and community services.
Participants stressed the need for services to reach out into the community, not wait for people to walk through the door. Staff wanted to be supported, fairly paid, and trained in trauma, mental health, and harm reduction. It was agreed that stigma stops people from seeking help and makes life harder for those already struggling. Housing was identified as a major issue, with many people needing support being homeless or living in HMOs, struggling to access housing because of digital or paperwork barriers. It was also highlighted that some groups are not getting the help they need. For example,people who use stimulants (like crack or amphetamines) have fewer tailored options and people with both mental health issues and substance use needs fall between services.
We collated emerging research topics and used “dot democracy” to identify which of these were felt to be the highest priority on the day. These were:
- Outreach and flexibility (32 votes)
- Mental health (29 votes)
- Workforce (17 votes)
- Psychosocial interventions (13 votes)
- Women’s services (6 votes)
- Support for young people (5 votes)
- Alcohol (8 votes)
- Joined up services (6 votes)
“Mental health” and “psychosocial interventions” overlap with the James Lind Alliance national top ten but other topics are different or take a different angle. This suggests that national research priorities may not always reflect local challenges albeit our methodology might be seen as less rigorous relative to JLA methodology. Moving forward, we will gather further input from the wider local community and work with services, commissioners and people with lived and living experience to design specific research projects that may help improve local services.
About the Authors: Susan McPherson is a regular contributor to the blog. Katie Peterson is a Clinical Psychologist and Research Fellow in the Institute of Public Health and Wellbeing at the University of Essex. She works in collaboration with the Essex County Council drug and alcohol commission team to support research into psychosocial interventions for drug and alcohol use. Julie Hannah is a Lecturer in the School of Law at the University of Essex and isDirector of the International Centre on Human Rights and Drug Policy based at the Human Rights Centre, and co-founder of the Centre for Mental Health, Human Rights, and Social Justice, a global research consortium
