Substance Misuse Guidance for Supported Housing

Contents

1. Executive Summary
2. Use of Illicit Drugs
3. Risk to other residents
4. Possession of prescribed illicit drugs
5.Suspicion or actual supply or intent to supply illicit substances
6. Repossessing property/room
7. Supplying by a visitor
8.Discovery of illicit substances in service
9. Destruction and Disposal of Drugs
10. Storage of drugs
11. Record keeping
12. Training and use of specialist services.
13. Working with the Police
14. Public Health alerts

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1. Executive Summary

1.1 This document must be used in conjunction with the Providers current Drug Policy.

1.2 Gateshead Council neither approves of nor condones the use of illicit drugs on any premises used as part of a contract with a Provider of supported accommodation. However, Gateshead Council do recognise that some of our service users may have needs related to and a history of illicit drug use.

1.3 Gateshead Council therefore aims to work proactively and constructively with Providers to work with those currently using illicit drugs, with a view to managing this and in accessing the necessary support and advice, rather than excluding people or and forcing them into more covert or unsafe use.

1.4 Taking into consideration all service users' safety this guidance distinguishes between discreet use and public use.

1.5 Gateshead Council must not tolerate the use of drugs where this impacts on others including in communal spaces, which threatens to affect the safety of other service users or support staff. Where staff become aware of such use, they must work with people to address the behaviour. If such efforts do not succeed, further action could be taken which may result in repossession of the accommodation. Providers must refer to advice and support guidance within the Sustainment Protocol.

1.6 The supplying of drugs must also be taken extremely seriously, and police must be notified if anyone is suspected of supplying drugs.

2. Use of Illicit Drugs

Support and Safety of People who use Illicit Substances

2.1 A Provider is expected to adhere to Section 8 of the misuse of drugs act 1971. A Provider is under no legal obligation to exclude service users who use illicit drugs on the premises but must work with the Police and the Councils ASB Team, if there is an investigation and consider work to limit the impact on other Service Users.

2.2 A Provider must consider the provision of discreet sharps bins within individual rooms, on a case-by-case basis, based on an individual service user needs and where appropriate, to encourage safe disposal, and to ensure that duty of care is fulfilled to other service users.  This would need to be led by an individual service user and form part of their harm reduction plan.

2.3 The safety of the staff and other service users always needs to be a primary consideration. Where support to the resident to manage drug paraphernalia has not been successful the Provider must take steps to ensure the safety of the accommodation.  This may include giving notice to the resident and work must be undertaken by the Provider in their accommodation, including needle picks.

Use of Substances in Shared Public Areas

2.4 This document distinguishes between public use (for example in communal areas or shared sitting rooms) and discreet use.

2.5 Where public use is evident, the support worker and a member of the support team must speak with the individual concerned when assessed as appropriate at the meeting staff must consider:

• Explaining the Providers policy on the use of drugs.
• Give the service user advice, information, and support, including referral to specialist agencies where appropriate.
• Whether appropriate sanction must be issued. This could be a warning, or, where appropriate, a notice or the equivalent.
• Any plans must be monitored and reviewed with feedback provided to the Service User at monthly support reviews.

2.6  In the event of further public use additional actions must be considered, which may include steps further investigation by Police and/or the Councils ASB Team and in accordance with The Sustainment Protocol.

Private use of using substances

2.7  If staff are aware that a service user is using drugs privately in their occupied tenancy, away from other service users, this must be treated as discreet drug use. If this is apparent staff must:

• Ensure that the service users' key workers are aware, and the appropriate harm reduction plan is in place. Service user must be supported to engage with specialist services where appropriate.
• Provide advice and information on specialist providers of advice and support.
• Explain the Providers legal obligations and position as a landlord.
• Positively encourage and support the service user to access further help.

Fire Hazards include information on risk and mitigation

2.8 There may be situations where there is a related fire risk, such as instances where the Service Users is under the influence and smoking in bed and we would expect Providers to undertake a risk assessment and work with the Fire Service and any Service User to undertake any relevant actions to reduce the risk.

Disclosure of Drug Use on an Application for Accommodation

2.9 Gateshead Council works with a considerable number of service users who have a history of drug use. When the Council have received information about current illicit drug use prior to an applicant's arrival, this must not necessarily automatically exclude that applicant from accessing supported accommodation, service users must be placed in the most appropriate service available with a supporting care/ harm reduction plan to ensure safety and support, where overdose awareness and the dangers of using substances alone.

2.10  In such cases, the Providers Drugs Policy must be clearly explained to the service user.

3. Risk to other residents

3.1 In some situations, a service users' possession of illicitly held or prescribed illicit drugs may represent a risk or hazard to other service users or staff. For example, where drugs are being openly displayed or are left unsupervised or unattended, or where staff believe there is intent to supply. In such situations staff need to act to reduce the risk to other service users. They must take the following steps:

• The service user must be educated on the risks around others being in possession of substances that are not prescribed to themselves. Service users must be encouraged to obtain specialist drug storage equipment from specialist services.
• Should the problem continue, further steps must be taken. In the case of prescribed illicit drugs, the service user must be instructed to simply put the drug away.
• If the drugs are illegally held illicit drugs, this is a criminal offence and must be reported to police.

4. Possession of prescribed illicit drugs

4.1 Service users who are using prescribed illicit drugs, e.g., methadone, buprenorphine (Opiate replacement therapy) must be encouraged to inform staff prior to their admission, for the safety of staff and other service users. Drugs must always be kept either on the service user's own person, or another secure place under the service user's control.

4.2 They must be kept in their original packaging and with labels intact showing the name of the person they have been prescribed to, so that staff know who owns them. They must not be given to other people to take or to look after. Service Users must have access to safe storage boxes as part of their harm reduction plan.

5. Suspicious or actual supply or intent to supply illicit substances

What Constitutes Supply

5.1 Supply includes the sharing, swapping, or giving of illicit substances and the Police must be notified.

5.2 If a service user is seen to inject another drug user, e.g., with heroin, this may appear to be consensual, but in fact counts as supply and the Police must be notified immediately.

Staff Responsibility

5.3 There is an obligation to act to prevent the supply taking place and if it was deemed likely that the offence would continue to take place. Managers are responsible for ensuring that staff act vigorously and effectively in all cases where the supply of illicit substances is known or suspected, no matter how minor the incident may be.

5.4 If staff consider that it is likely that the prohibited action must continue unless further steps are taken, then they must take those further steps.

5.5 Police must be informed as soon as a service user is found to be or assumed to be supplying drugs. Staff must call 999 if it's an emergency. If not an emergency, then staff must report by telephoning 101 or via the website.

Witnessed Supplying of Drugs

5.6 Where staff have witnessed the supplying of drugs by a service user, they must report the incident to the police immediately.

5.7 Where a service user or service users report that they have witnessed another service user or service users supplying drugs, the Provider must fully investigate the alleged incident.

Suspected Supplying of Drugs

5.8  In many cases, staff must have suspicions that a service user is involved in supplying but must have insufficient proof of this. Any suspicions must be investigated and if found necessary following the evidence gained then appropriate action must be taken.

5.9 However, the Provider needs to act upon information or suspicion that a service user is involved in supplying:

• If staff have suspicions that a service user is supplying because his or her behaviour could indicate this, notes must be made on the service user's file detailing why the service user's behaviour is considered "suspicious" and where and when such behaviour took place. Care must be taken to ensure that such notes are factual and accurate.
• If staff are informed by other service users that an individual is supplying, the reasons for their suspicion must be recorded. Any further information on where and when supplying is alleged to have taken place must also be recorded. In the majority of cases, service users providing information must not wish to be named, but this must be checked with the individual(s) concerned. This must be recorded in the "Confidential" section of the individual's file.
• A support worker and a member of the schemes management team must together interview the service user who is alleged to be involved in supplying drugs. They must clearly outline the issue and the basis for suspicion and explain the Providers policy on the supplying and use of drugs, making it clear that the meeting has been called to discuss the issue and to enable the individual to put his or her point of view.
• Formal notes of the meeting must be kept and placed on the individual's file.
• The situation must then be monitored carefully. If no further suspicious action is noted, this must be recorded on the file and no further action taken.
• Any suspicions may be reported to the police via the intelligence systems available as part of a harm reduction approach.

If suspicious behaviour continues, formal and detailed notes of each incident must be taken. The Councils Sustainment Protocol must be followed.

6. Repossessing property/room

Proven Supplying of Drugs

6.1 Where a criminal conviction has been secured for the supplying of drugs or the intention to supply drugs, action may be taken to repossess the property or room.

Assumed Supplying of Drugs

6.2 Where a criminal conviction has not been secured, but the Provider is certain that supply has taken place, all necessary action must be taken to stop the supply of drugs. This must initially involve a full investigation of the incident, and warnings, etc, as appropriate. This may include the assistance of police, probation, and specialist services where appropriate.

6.3 As a general guideline, a one-off, small-scale supply, where the Provider is certain has been stopped through use of the Providers warnings procedure, must not result in action to repossess the property.

6.4  However, a second offence or a single large-scale offence of a more serious nature must usually result in commencement of action to repossess the property or room. The decision on the action to be taken in each case must be made by the relevant member of staff from the Provider in consultation with the Sustainment Protocol.

Recording the Supply of Drugs

6.5 Providers must ensure that they keep abreast of all relevant documents. On each and every occasion where staff have factual knowledge that supply has taken place, they must act and ensure that:

• The incident and the subsequent response is logged accurately
• Minutes of meetings and discussions are accurate
• Where such minutes are inaccurate, they are corrected at subsequent meetings
• Other sources of information such as daily logbooks are accurately maintained

When staff have received information that the supply of drugs has taken place, they act, and that the action taken is accurately recorded.

7. Supplying by a visitor

Support Accommodation with Communal Areas

7.1 Where it is known or suspected that a visitor of a service user is engaged in supplying drugs. The Police and the Councils ASB Team must be informed of this, so that support can be provided to restrict access by visitors.

7.2 Service users must be further advised that they are responsible for the behaviour of their visitors. If they permit visitors to cause anti-social or engage in illegal behaviour, then they may place their own occupancy in jeopardy.

Self-Contained Accommodation

7.3 In the case of self-contained accommodation, service users must be informed that they are responsible for the behaviour of visitors. If they permit anti-social behaviour to be caused, then the Provider must consider seeking possession.

7.4 Where supplying is suspected in self-contained accommodation, the Police must be informed.

7.5 If a non-service user is convicted of supplying in a Providers property, an investigation as to the circumstances should be carried out. Following this investigation, this could result in additional support to the service user, through to enforcement action under the terms of the tenancy.  Any follow up actions should be carried out within the terms of the Sustainment protocol.

8. Discovery of illicit substances in service

Drugs Found in Communal Areas

8.1 Drugs that are left unattended are a risk to others, even if they are prescribed medicines. If drugs are found in a place where others would be at risk (e.g. a shared bathroom) then there would be an obligation to act under the duty of care that the Provider bears towards service users.

8.2 If staff find any substances unattended in communal or shared areas, they must remove them. Where the identity of the person who left them is not known, all service users must be reminded of the Providers drug policy on this area.

• If illegally held illicit drugs are found in communal areas, they must never be returned to the service user, this could be deemed as supply of drugs by staff. The drugs must not be disposed of without prior contact with/ permission from the police. If the service user's health is in danger from illicit substance withdrawal of the drug, the relevant professional must also be contacted e.g., GP, Substance Misuse Officer or emergency services if required. Pharmacy staff must be made aware if this belongs to another named person.
• If prescribed illicit drugs are found, these must be handed in to a pharmacy. If it is known which service user the drugs belong to, the service user must be approached and encouraged to take more care of their medication.
• If prescribed medications are found in their original packaging and with the service user's name on it, they must be returned to the service user. The service user must be warned that their actions were unsafe, and better care must be taken to look after their medications. If a name is not on the medications, they must be taken back to pharmacy to be destroyed. In any event, they must be removed from the communal area. The drugs must be returned to a pharmacy for disposal and a written record kept of this action. The member of staff must contact the pharmacist before setting off.

Drugs Found in Private Areas

8.3  Even where staff are legally entitled to enter service users' rooms, for example for health and safety checks, or for cleaning, there is no expectation that staff must search service users' rooms or possessions for illicit drugs. If illicit drugs are in the service users own room it is the service user who commits the offence of possession, and not the Provider, which is under no legal obligation to dispose of substances found in such circumstances.

8.4  If illegal drugs or related equipment are clearly visible by staff when entering the premises and the service user has moved out, staff must act as if the drug were in a communal area, as described above. Otherwise, the following guidance must be used:

Identifying Prescribed Illicit Drugs and Illegal Drugs for Personal Use

8.5  In some situations, such as on finding a small amount of cannabis, it may be clear to the worker that the person is in illegal possession of an illicit drug. In other situations, this may be less clear cut. A bag of pills could be Valium bought on the street, or could be prescribed drugs, no longer in their original packaging.

Possession of Illegal Drugs for Personal Use

8.6  If the quantity of drugs is enough to be considered "for personal use" the service user must be interviewed by the support worker and a member of the management team. They must explain the Providers policy on drugs and must offer support, information, and advice. This must include referral to a specialist agency if appropriate.

8.7  A suitable sanction must be placed on the service user as appropriate to ensure that no further occurrences of possession take place.  This must involve issuing a warning. If the service user gives staff no further reason to believe that drug use is continuing or embarks on an official drug detoxification or rehabilitation programme (which may include a Methadone script), no further action must be taken.

8.8  If the service user continues to use illicit drugs, if further drugs are discovered or if the support programme is abandoned and use of drugs continues, further sanctions must be issued. This may include further warnings or eventual repossession of the property.

9. Destruction and Disposal of Drugs

Protection of Staff

9.1 Once the decision has been made to take possession of a suspected illicit drug, it is important that the safety of staff is paramount, both from prosecution and from accusations of wrongdoing. Where a decision is made to take drugs to the police for destruction rather than destroying 'in-house' the police must be informed that a worker is coming to the police station prior to setting off.

Methods of Destruction and Disposal

9.2 The person finding the drug must not pass it on to another worker they must take it directly to a Police station themselves or store it securely before being handed directly over to a Police Constable. A record must be kept of the incident.

10. Storage of drugs

Storage of Prescribed Illicit Drugs

10.1 Prescribed illicit drugs can only be stored by a Provider in a scheme registered with the CQC. In the scheme, storage is subject to detailed administration, Safe storage lock boxes can be obtained from local specialist drug service.

10.2 Staff in other projects must not take possession of controlled or another illicit drug to store it for a service user. It is likely that they would be committing an offence by doing so.

10.3 The MDA makes it an offence to be in possession of an illicit drug unless you have legal authority to be in possession of it. Staff in a scheme do not hold this legal authority to possess illicit drugs. The only circumstances in which a member of staff could legitimately take possession of an illicit drug would be:

• "For the purpose of delivering it into the custody of a person lawfully entitled to take custody of it and that as soon as possible after taking possession of it he took all such steps as were reasonably open to him to deliver it into the custody of such a person." [MDA 1971 s. 5(4)(b)]
• Or if they were: "a person engaged in conveying the drug to a person authorised by these regulations to have it in his possession." [Misuse of Drugs Regulations 1973 6(f)].

10.4  Staff must encourage users to disclose that they are bringing prescribed methadone or other prescribed illicit drugs into the building. Service users must ensure that such drugs prescribed are safely and securely stored. If service users are prescribed other medication, they must be encouraged to discuss this with staff.

Storage of Other Illicit Drugs

10.5 Staff would be committing an offence of possession and possibly intent to supply if they took possession of an illicit drug for any reason other than to pass it on to someone lawfully entitled to have it.

11. Record keeping

11.1 A 'Drugs Incident Book' must be maintained by each project/scheme or service. This book must record all drug-related incidents. The book must be a bound book, not a loose-leaf file. On each drug-related incident, including episodes of suspicion and third-party information, the incident must be recorded in the Incident Book.

11.2 This information must only be copied into the confidential section of the

service user's personal file and must not be disclosed to the service user. This is a permitted exemption under the General Data Protection Regulation 2018 because to disclose the information to the service user might prejudice the detection or prevention of crime. Staff must endeavour to record information as soon as possible after the incident. Information in the incident book must include the following:

• The date and time of the incident.
• The name or service user-code of the service user(s) involved.
• A reference to the service user's personal file.
• The initials of the worker dealing with the incident.
• Full details of the incident and action taken must be recorded only in the confidential section of the service user's personal file.
•  Information must be recorded in an accurate and professional manner.
• Records relating to people who are banned must record the identity of the person, the duration of their ban, and a date of re-admittance.
• All other information must be recorded in the service user's personal file. All drug-related incidents, and responses to them, must be accurately recorded.

12. Training and use of specialist services

12.1  All housing and care staff must have available up to date information on local and national services. Such information must also be displayed in communal areas.

12.2 Projects/schemes must encourage and support all staff to develop a wider knowledge around drug issues. Full training must be provided by specialist treatment services for all staff including the training of naloxone. Providers can consult the Council for information on how to access suitable services and any additional advice and support i.e., storage facilities.

12.3 Housing and care staff must receive training, advice and information on drugs and drug use, including recognising drugs and symptoms of use, and the legal position, etc.

12.4 All staff must be fully conversant with this policy and procedure, which must be clearly explained during induction. They must receive regular and effective supervision to ensure that they are fulfilling their duties under this policy.

12.5 Managers must ensure that action is taken on any occasion when staff do not fully discharge their responsibility in line with the law and this policy. The manager must also fully document all steps taken regarding staff supervision, training, coaching, guidance, and disciplinary activities undertaken in respect of this policy.

13. Working with police

13.1 In all cases, staff must co-operate fully with the Police and ensure that no information on drugs is withheld from the Police if requested by them. This could include working with them to organise searches, if appropriate, where drug supplying is suspected. The Police would expect co-operation from staff, if they reported anything the Police would expect them to give a statement if required.

13.2 All suspicions of drug supplying must be acted upon fully in accordance with this policy. All contact with the Police including notification of any suspicious activity concerning drugs, must be recorded in the Drugs Incident Book (see above).

13.3  Any Confidentiality Policy must not be used as a barrier to giving Police information on suspected drug dealing, etc. Information must be given to a third party without the person's consent in exceptional circumstances.

14. Public Health alerts

14. Related Public Health alerts will be shared with Supported Accommodation Providers.