UK Government Injectable Opiates Prescribing Guidelines

Link here to the NTA (national treatment agency) UK injectable opiate prescribing guidelines

I've quoted below the most important parts... There is a lot of interesting information in the PDF so I would suggest reading through if you have an interest in the subject

This is taken from the PDF. The main message from the NTA is that the following eight principles should be adhered to when considering prescribing injectable opiates:

This link is the guidelines issued to my local NHS specialist addiction unit, it's specific to east London but the guidelines are probably applicable to most drug services nationwide.

        Principles guiding injectable maintenance prescribing

This guidance recommends that injectable maintenance prescribing should only be undertaken in line
with eight principles.

1. Drug treatment comprises a range of treatment modalities which should be woven together to
form integrated packages of care for individual patients.

2. Substitute prescribing alone does not constitute drug treatment. Substitute prescribing requires
assessment and planned care, usually with other interventions such as psycho-social
interventions. It should be seen as one element or pathway within wider packages of planned
and integrated drug treatment.

3. Within the substitute prescribing modality, a range of prescribing options are required for
heroin misusers requiring opioid maintenance. Some options may carry more inherent risks
than others (e.g. injectable versus oral options). Patients who do not respond to oral
maintenance drug treatment should be offered other options in a series of steps. This would
normally include:
• oral methadone and buprenorphine maintenance, specifically optimised higher dose
oral methadone or buprenorphine maintenance treatment, then
• injectable methadone or injectable heroin maintenance treatment (perhaps in
combination with oral preparations).

4. Injectable maintenance options should be offered in a local area that can offer optimised oral
methadone maintenance treatment including adequate doses, supervised consumption and
psycho-social interventions. This is essential to ensure oral drug treatment options have been
fully explored prior to a trial of injectable maintenance treatment and to ensure smooth
transition back to oral treatment if required.

5. Injectable and oral substitute prescribing must be supported by locally commissioned and
provided mechanisms for supervised consumption. Injectable drugs may present more risk
of overdose than oral preparations and have a greater value on illicit markets and hence may
require greater levels of supervision.

6. Injectable maintenance treatment is likely to be long-term treatment with long-term resource
implications. Clinicians should consider the move from oral to a trial of injectable preparations
carefully, including long-term implications for the patient and drug treatment systems and
involvement of services.

7. Specialist levels of clinical competence are required to prescribe injectable substitute drugs.
Heroin prescribing also requires a Home Office licence.
8. The skills of the clinician should be matched with good local systems of clinical governance,
supervised consumption and access to a range of other drug treatment modalities.



         Clinical eligibility

The expert group reached some consensus on eligibility criteria, precautions and outcome measures.
However, guidance on issues such as dose or the prescribing of combinations of oral and injectable
preparations will require further work.
The agreed criteria are set out in full and relate to factors such as:
• age and drug usage
• willingness to comply with conditions such as supervision and monitoring, engagement
in a range of care options, avoidance of some risky behaviours and of diverting prescriptions
into illicit markets
• persistence of poor outcomes within an optimised oral programme.


         Recommendations

The key recommendations are that:
• optimised oral methadone maintenance should be the maintenance treatment for
the majority of heroin users
• injectable heroin and methadone treatments should be considered only for the minority of
patients who are genuinely unresponsive to an optimised oral maintenance treatment approach
• injectable heroin and injectable methadone treatments based on this guidance should
be seen as a new drug treatment modality requiring the development of new integrated
care pathways.


         Key messages

The document has four key messages:
1. The prescribing of injectable substitute opioid drugs may be beneficial for a minority of heroin
misusers. The document makes preliminary recommendations on eligibility criteria.
2. Future maintenance prescribing of injectable heroin or methadone should only be undertaken
if it is in line with eight principles identified by the expert groups. This is essentially a new
standard of injectable drug treatment to that previously provided in England. Applying these
principles in practice, sets a high standard for delivery of this treatment intervention, in
recognition of the risks involved.
3. Services should be improving for patients already in receipt of injectable maintenance
prescriptions for heroin or methadone. Where patients are stable, maintaining this stability
is paramount.
4. Priority should be given to improving the effectiveness of oral maintenance treatment (on
methadone or buprenorphine) for the majority of patients in all drug action team areas in England.


         Clinical evidence

The following statements were agreed as consensus on ‘clinical evidence’ by the expert group based
upon many years’ experience of prescribing heroin and other injectable drugs.
Statements from the expert advisory group

1. We consider that the prescribing of injectable substitute opioid drugs, including heroin and
methadone ampoules, may be of benefit for a minority of heroin misusers. In principle this
should be part of a range of potentially available drug treatment options, provided it is set
in the context of a comprehensive drug treatment package.

2. We consider the prescribing of heroin and other injectable opiate maintenance treatment is
not a first-line treatment for dependent heroin users. Injectable opioid maintenance treatment
(including injectable heroin maintenance) is an exceptional treatment that should only be
considered for patients who have not responded to optimised conventional oral
maintenance treatment.

3. We consider that there may be greater inherent risks with injectable opioid treatment, when
compared with the better-studied oral methadone maintenance (and other treatments, such
as sublingual buprenorphine maintenance that has less risk of overdose). These include
greater risks of overdose, continued injecting harms and greater risks of diversion and abuse
of medication. Formal consideration of the risks and benefits of injectable opioid treatment
should be undertaken with all potential patients, particularly those who may be at highest risk.

4. We consider that these risks and dangers (to the individual patient and to society at large)
can be greatly reduced by adherence to practices and procedures which increase
compliance with treatment, and which reduce prescribing to inappropriate patients, erratic
use and diversion to the illicit market.

5. We consider the assessment of potentially suitable patients, and the subsequent initiation of
injectable opioid maintenance treatment, to be a task that requires considerable experience
and expertise in the addictions field, and which should consequently be undertaken by a
competent specialist doctor* working in an appropriately supported treatment setting.

6. We consider that the wider safe provision of injectable opioid maintenance treatment
requires substantial identifiable resources and facilities (as recently established in Switzerland
and the Netherlands). These are required in order to make possible the wider provision of
injectable maintenance treatment options and thereby achieve these greater potential benefits
to the patient and society whilst minimising adverse consequences.


           Cost and cost-effectiveness of injectable substitute prescribing

Injectable substitute drug treatment is a relatively expensive drug treatment option. Calculating cost
and cost-effectiveness of different types of drug treatment is complex and attempts to do so are
compounded by a lack of agreement on appropriate methodology. The NTA is engaged in further
work to provide more accurate and consistent unit costings of drug treatment modalities and options.
Strang et al (2003) estimated that injectable methadone represented 20 per cent of the methadone
prescription drug costs in 2001 for four per cent of treatments. Indeed injectable methadone and heroin
treatment has been estimated to cost between 5 to 15 times as much as oral methadone treatment,
depending on the content of treatment packages and arrangements to supervise consumption.
Surveys of clinicians indicate that the cost of injectable heroin in particular is a prohibitive factor. In
addition, it is recognised that the substitute prescribing of injectable heroin and methadone in the UK
appears to be a long-term treatment which may limit long-term cost-effectiveness.
The NTA will explore issues of cost in greater depth. However, cost factors indicate that commissioners
need to be able to ensure that the provision of injectable maintenance drug treatment does not
undermine the overall quality of care for all patients. Where adequate access to optimised oral drug
treatment options are not available to the majority of patients, it may be particularly difficult to
demonstrate this.
The potentially “high cost and low volume” nature of injectable maintenance drug treatment indicates
that it should be targeted at patients with high levels of need. These patients are, in any case, likely
to incur high levels of costs to health and social care systems.


          Inclusion criteria for injectable opioid maintenance

Clients should meet all of the following inclusion criteria in order to be eligible for injectable
opioid maintenance:
• The client should have a protracted history (> 3 years) of heroin dependence and regular
daily injecting.
• The client should be aged 18 or over.
• The client should be able to provide informed consent. This includes no active medical
or psychiatric condition impairing the patient’s capacity to provide informed consent
• The client should be willing to comply with the conditions of injectable opiate
treatment2, including:
• a treatment plan
• regular supervision and monitoring
• avoidance of persistent injecting in high risk areas (e.g. neck or groin veins)
• continuation of injectable treatment being conditional upon positive healthy response
to treatment (which includes other treatment elements in a package of planned,
co-ordinated care)
• diversion of the prescribed injectable drugs and “double scripting” being grounds
for discontinuation of injectable treatment.
• The client should first have received optimised oral maintenance treatment - an adequate
period (normally at least six months and for some this could be significantly longer) of
optimised conventional substitution maintenance treatment and associated package of care.
• There should be a persistence of poor treatment outcomes despite a current optimised oral
maintenance treatment episode. Indicators of poor outcomes may include:
• continued frequent (daily or almost daily) injecting of illicit heroin or other opioids
• patients at continuing high risk of the transmission of HIV, HBV or HCV to
themselves or others
• continuing injecting-related health problems (e.g. abscesses, cellulitis,
systemic infections), poor general health, poor psychosocial functioning and
drug-related criminality.
If the inclusion criteria are met injectable opioid maintenance treatment may then legitimately
be considered by the clinician, in consultation with the patient, key carers and the relevant
multidisciplinary team.
22

Getting Injectables Prescribed In The Uk

I'm currently in the process of helping a good friend who's having trouble with our local drug service. 

When I was using I know I could have done with someone on my side, advocating for me. So now I'm in a better position myself i thought I'd try and help.

So this is the situation, she is a long term user, around 20 years. IV heroin for most of it but speedballs, heroin and crack combined, for the last five years. Which I know from experience is a total bitch to kick. 

When I first started using, I used to hang with a guy that did both. He used to infuriate me because after hustling money, we'd go to score the heroin, I'd be chomping at the bit to use it! But this guy wouldn't do heroin without crack! Seriously, we'd have to wait around for hours sometimes for his crack dealer. He just point blank refused to do just the heroin and I just didn't get it! .... Fast forward 15 years and now I get it! I fell into the speedball trap too towards the end. It really is difficult to do just the heroin. It's just not the same. 

It's difficult to explain if you haven't experienced it, it's like toast without butter, or tea without sugar. Haha

It obviously also makes it that much harder to stop, you have a double whammy addiction!

I read somewhere about the physiological side of it. IV heroin or IV crack, alone, obviously induce a huge dopamine release, which gives the high. 

Put the two together however and the dopamine release is around 400% more!

It's an awful addiction to have, at least with just heroin, psychologically, you're on a pretty even keel. Yeah you have ups and downs, when you're sick and skint you feel crap but trust me, once you've been on speedballs you appreciate the difference. The crash after a day of using is just awful. It used to take me a week to recover from a speedball binge. Not even wanting to talk to anyone else, physically feeling awful but the psychological side of it is like nothing else. Well, maybe like an amphetamine come down,.. a bit..

When it's time to stop, you're not only battling cravings and physical symptoms of normal opiate withdrawal, you get the extra fun of cocaine cravings and withdrawal! Cocaine cravings are pretty intense on their own!

Like I said, double whammy! .... Why did you think it was a good idea to try a speedball again? ;)

So anyway, my mate is an old school addict. Been at it a long time, been in and out of rehabs and programmes. Spent the majority of her addiction on methadone, 180mg at the highest. In drug service terms anything over 60mg is classed as an 'optimised' dose. 60mg is believed to be the minimum to achieve a 'therapeutic effect', the 'optimised dose'. 

This has changed over the years, it wasn't too long ago that 60mg was considered a high dose!

Incredibly, in the United States, doses of up to 500mg daily aren't unheard of.

The most I have ever heard anyone being in here was 250mg. 

She tried subutex but didn't get on with it. Some people just don't get on with buprenorphine. It's a very different drug to methadone and heroin, pharmaceutically and subjectively. It's a semi-synthetic, partial opiate agonist/antagonist. 

It can feel quite 'chemically' to some people.  If you're used to full agonist opiates like heroin or methadone, the crossover to subs can be difficult. 

Right now she's frustrated with her treatment, she feels as though they have given up on her almost. A 'lost cause' .. It's very sad actually, this girl is an amazing person, really creative and kind. I've known her a long time, she's a little like me I guess, in that she's not really what you'd class as a 'junkie'. Having worked and supported herself, her kids and her habit most of her life. 

Like me, getting caught up in opiates using them almost like a sticking plaster, to deal with emotional pain. Opiates are great at numbing those painful memories some of us damaged people have. They were almost a natural progression for me, I'd spent most of my teens struggling with feelings and emotions that I just didn't have the tools to deal with. 

She's currently under the care of our local specialist addiction unit, at the hospital. This is where they send the people that don't respond well to traditional treatment, maintenance scripts which can be given by a key-worker at a community drugs service. 

They are, by definition, there to provide a specialist service, in my eyes you would think that that involves using a wider range of medications and psycho-social interventions like psychotherapy and family counselling. 

About a year ago, while I was still there actually, the budget was slashed.

Lots of NHS services were cut, obviously addiction services are an easy and obvious target and therefore one of the first to feel the pinch. 

The consultant that ran the unit for years was fantastic, I've written about her before I think. A really amazing, caring doctor. 

Part of the cuts included her having to incorporate the alcohol unit into the drugs unit. Splitting her time overseeing both units and pulling back on direct patient contact.  She wasn't prepared to make this compromise and ended up resigning, it was a travesty actually and makes me mad to this day. Things at the SAU really went downhill after she left. Every week I'd hear clients moaning in the waiting room, keyworkers would change from week to week, it became impossible to see a doctor and you could just tell that most of the staff couldn't really care anymore, they'd be out the door by 4.30 whereas in the past stayed til gone five.

Rather than clients seeing doctors, nowadays everyone sees a keyworker, no matter what their needs or level of priority. The keyworker is like the liaison between the client and 'the team'

The team consists of registrars, keyworkers, one psychologist (to cover every client), the consultants, the manager, nurse and various other workers. They meet weekly to discuss the clients. 

This may seem a sensible idea, and certainly streamlines things, but at what cost?

I know for me, when I was still there, I just felt a total lack of care or even interest. I had a different keyworker every appointment at one stage. They were obviously temporary agency staff, with no specialist training in the drugs field. One lady In particular was so obviously uninterested in me I played around a little and told her I was injecting benzos and that I was self harming again. To see her reaction. There was none.. She just wrote it down and moved on. I don't know what I was expecting really, maybe 'are you ok?' I guess..

Back to my mate.. She asked me to look up the government guidelines for injectable opiate prescribing. 

I have an interest in this too because I was looking into it for myself before I stopped using. 

It's a bit of a grey area, it's not a common practice, but technically it's possible to get an injectable script. The studies looking at injectable vs oral prescribing show positive outcomes, there is plenty of evidence from Europe, we all know about Zurich's incredible results with 'needle park'. They had a huge and very visible heroin problem some years ago, addicts would (infamously) stand out in the open, injecting eachother. 

They rather bravely, implemented an injectable opiates policy. Set up a clinic where addicts could go and get a legal, safe and regular supply of heroin. There were conditions attached of course, the addicts had to attend the clinic twice daily and inject in front of staff where they could be monitored to ensure they were injecting safely and to stop overdoses. Incredibly they cut their new addict numbers by around 80%. By taking the 'glamour' out of IV drugs, they essentially stopped people wanting to start using. They have similar places in Canada although these are just safe spaces to inject, with staff on hand dealing with OD's and to offer safer injecting advice. They don't prescribe here just supervise. Many many lives have been saved and local HIV and Hep C rates have dropped. 

Portugal have recently decriminalised the use of drugs, where before an addict would be punished through the courts and prison system, they started instead to offer them a place in rehab, or opiate replacement therapy. Again, they have proven the concept and cut drug related crime dramatically.

The glaringly obvious point here is that people will use drugs wether they are illegal or not, criminalising and punishing people for using DOESN'T WORK. Putting programmes and systems in place to help drug users is the only way to make a real difference. 

Although I don't personally need medical treatment anymore, it's not long ago that I did, and I feel strongly about the UK's and the rest of the western world's outdated and useless drug policies. The 'war on drugs' hasn't, and never will, work. 

I'm hopeful that things will change though, there is a small but rapidly emerging worldwide movement towards the decriminalisation of drugs. 

UK drug policy does allow for the off label prescription of injectable opiates for addiction. 

A home office licence is required to prescribe diamorphine though and there are only around 90 doctors that hold one. 

No licence is required to prescribe methadone amps though.

I feel my mate is a good candidate for injectable prescribing, after reading the NTA and NICE guidelines she fits the criteria. The only other things in the way are practical things like being able to demonstrate good injection technique and having good venous access. It's also necessary to monitor people closely who start this treatment. Especially during induction. It may not be logistically possible to prescribe at your local unit and this will have an impact on their decisions to provide injectables. 

Essentially though, the final decison rests with the prescribing doctor.  it literally is as simple as the personal prejudice, preference, experience and maybe even the whim, of the consultant. 

If you can demonstrate that you fulfil the criteria and you can show a good case for a realistic reduction in harm and improvement in illicit drug use, then there is really nothing stopping you pursuing it. 

Cost is another major factor, we all know oral methadone is cheap as chips. As low as 20p per dose. 

Currently there are around 5000 addicts receiving injectable methadone and around 450 diamorphine. Most of these people have been on it long term and were often inherited patients to the new doctor. Injectable scripts account for 80% of the total cost for methadone prescriptions.

Maybe some of you will think that I'm wrong. And that addicts shouldn't be given injectables. Maybe you're right. I just feel we should be given the option, if it works then all the better. 

As I keep saying, addiction is a complex, difficult issue, it is not a 'one size fits all' problem and treatment should be tailored to the client. Utilising all the treatment options, including medications. 

Trial results show a large amount of people either coming off opiates altogether or achieving a significant reduction of illicit drug use. That can't be a bad thing no?

If people aren't needing to commit crimes to get their drugs anymore doesn't society in general benefit?

Adulterated Heroin In Hackney

http://www.release.org.uk/heroin-warning-february-2013

Release has received reports of dangerously adulterated heroin circulating in the Hackney area. It seems to be wide spread among local 'shotters'/street dealers. It is medium dark and appears to run on foil but we have had a couple of reliable reports from users and their friends suggesting that it has an opiate-type rapid onset of action (by smoking) but within twenty minutes to half an hour observers became concerned about disorientation, confusion, loss of co-ordination and loss of memory in users. The reports also state that the initial taste is usual, but the after taste is ‘strongly chemical’.

We suspect that it may be cut with a benzodiazepine and/or possibly Gabapentin/Pregabalin. There is a chance the benzodiazepine of concern is Alprazolam, a very strong form of benzodiazepines, or a pre-operative hypnotic benzodiazepine Midazolam (where users appear to be knocked for a couple of days). Benzodiazepines and opiates are dangerous mix in general, with profound effects on the respiratory system, and these benzodiazepines are particularly strong. With regards to potential cut with Gabapentin/Pregabalin, these are again very strong drugs, used in treatment of chronic pain/epilepsy and there are reports that these in combination with opiates can cause the above effects seen in this potential new batch.

We saw similar adulteration in the heroin shortage of 2010 which caused greater problems afterwards, when there was a high risk of overdose with batches that were not cut as strongly.

I've Been Offered A Free Trip To Thailand!

Cool huh!?

There is a catch though...

I'd be going to Thamrabok monastery.
It's the one where you purge and sauna for a couple of weeks to detox.

It's a drug detox, apparently it's in the middle of nowhere and you pretty much spend the trip drinking purgative tea and throwing your guts up.

Sound appealing?

I might go actually, although I'm not technically dependant on anything, I do still have days that I really struggle with cravings.
I don't know too much about the place, I've heard a few stories though!

The people that come through the other side swear by it so it must do something right?!

Maybe going to somewhere like this will be the kick up the ass I need to keep clean and sober, looking to the future instead of dwelling on the past and shrugging off this depression and lethargy I've had for months..

There's a charity called 'East-West Detox' based here in the UK. Run by a chap called Mike that I met a couple of months ago when I was speaking at a confrence about ibogaine, recovery and addiction.
East-West cover the travel expenses to get addicts over there, quite impressive really!

-Edit- I discovered that I made a mistake, they apparently don't pay for the flights and food. You have to pay for yourself! They just facilitate the process. Sorry!

Thamrabok is another 'extreme' detox, honestly, after ibogaine I don't think I'd be shocked or anxious about doing it.
Ibogaine visions along with the total inability to control your legs and arms are pretty bloody intense. Ibogaine induced vomiting anyway, been there done that. At least with the thamrabok method your not tripping your nuts off at the same time!

It seems too good an opportunity to turn down really, I've not been out the country since my 21st birthday. I've always wanted to travel India, Thailand and Nepal.
Seeing it as a holiday probably is very far from the truth though.
I did skim read the website and your pretty much whisked from the airport to the monastery and whisked back at the end.
No 'stopping at go to collect £50'
Can you imagine how many clients they must have 'lost' over the years!?
Haha, Thailand, the land of cheap china white heroin and OTC ketamine.

I've been told to let them know if I want to go.
I also want to start my music degree this year so it would probably be best to squeeze thamrabok in first!

A New Year..

My life feels like a merry go round sometimes. Only one that never stops to let you off!
Every new year and every birthday I promise myself 'not another year, this has to stop now and yet the next year here I am again, looking back at my own reflection with another years worth of lines and the beginnings of grey hairs.
I've been doing this ritual since I was seventeen. I guess things are better, im nowhere near as bad as I have been. Since my last Iboga flood I seem to have lost that obsessing for drugs thing. That's a relief and a novelty to be frank. I'm obviously not in the small percent of people that take Iboga and detox never to touch or crave drugs again.
I have to keep telling myself, it's not perfect but it's better. This time last year I was shooting crushed MST, plus heroin and crack on top. I do none of those anymore!
Actually, shooting the MST for so long has really left me with some quite scary health problems.

I wish I was better at taking my own advice sometimes. It's like I hear the words coming out my mouth when I'm trying to help others but I'm fucked if I can actually follow it myself!

I took a break from the big Facebook group I admin over the holidays. Since the creators and co admins, Cat Asche & Chris Bava died so unexpectedly last September in that awful car crash I've been trying to hold the group together. I was the only other admin in the group. I guess I felt responsible, and to a large extent, invested in the group. I've been a member for a few years, I've made some amazing friends there too, people that I'd say I'm closer to than people in my real life. I've witnessed some incredible acts of kindness happen there. From letting people stay at others homes, gifting ibogaine, donating towards members in hardship and just general support really. I mean there have been quite a few hairy moments with in fighting and tantrums but on the whole I love them all. Since Chris & Cat died the group has been in turmoil really. People jostling for a new position in the group, a lot of 'well I know what Chris and Cat would have said/wanted/done/agreed/disagreed with' etc.. Almost like a popularity contest at times. I've struggled at times because by taking over the role I seemed to automatically make a load of enemies. People that I've never met or spoken to suddenly abusing me and slandering me. All very bizarre and quite hurtful really, it's a strange thing, being an admin in such a large group of very bold personalities. It seems people view me as 'in authority' or something. I've been accused of being egotistical and power hungry, of only being interested in telling everyone I'm gay, of hating women and wanting to turn the group into my private domicile. Chris was excellent at refereeing, when arguments arose it often only took a paragraph from Chris and everyone would settle down. Because he was so patient and endlessly compassionate, he was able to placate people and settle any disputes whilst simultaneously being fair at all times, to both parties. He was wise, he cared and he had the time to spend every day having multiple pm's with people. There's no way I could ever love up to that! I wouldn't even try. In the weeks after they passed I spent days worrying about how best to continue the group, I came to the conclusion id need co-admins to help with the workload, vetting join requests and general day to day stuff. Chris used to pm new requests just to check them out briefly, the group has a huge proportion of silent members. I did the same, this would very often end up in long conversations about ibogaine and dosing and recovery, it really is a lot of work behind the scenes. Chris very rarely censored comments or booted anyone, it took a lot for him to remove someone. The problem is that he is obviously no longer with us, it seems that the previous light handed, laid back method of adminship no longer works. People seem to now think it's ok to troll, to offend other members with name calling and get away with it. In my opinion, part of my role is to keep the group safe and a place where anyone can ask for help. I did notice a drop in the amount of these kind of posts and a rise in the obnoxious, silly ones. This is why I think I might need to discuss with the group the possibility of some new small rules about abusing other people. It's not nice and it's not fair. There was an issue a few weeks back, a member that had been in the group a long time but rarely contributed was becoming abusive to a new member. She was obviously high, it was escalating, she was offering bad advice and offending other members so I stepped in and booted her. I pm'd her to say 'I took you out for 24 hours, your welcome to come back when you've calmed down' ... Well, the abuse I got was unreal, I was a cunt and a faggot, a women hater. I mean really vile stuff. Anyway, she went on to slander me in her group but that's another story! I thought it had blown over until people kept bringing it up in my group 'Sid booted her too early, I wasn't finished with her' etc.. This was just the most recent in a long line of unfair comments aimed at me, comments I'd let go for the sake of peace, and that as an admin I felt I should be somewhat impartial. That's why I left anyway, it was the straw that broke the camels back so to speak. It was quite liberating actually, I felt free of the responsibility for a short time. People forget I think that I'm only a few months into recovery myself, I'm not the strongest person in the world and I don't have a thick skin (all necessary traits for a good admin apparently!) ... I heard the odd report of what's been going on, I was really quite shocked at the latest drama though! One of the older members had taken it upon herself to start some group polls. With the following questions posed: Should we boot out the current admins.? Another one asking: Should we all get a say in group decisions? .. Now, there is a reason the group isn't asked to vote on things like this, it would be a nightmare for one! 600 people voting Everytime a group picture was changed, or which posts are pinned. It would be silly, Chris himself said as much, 'the ISC is not a democracy, if you don't like it, leave'. I've no objection to the group having input but not to that extent. It's a closed group with admins, not an open group where everyone has equal privileges. Anyway, the polls flopped, the votes against her were 18 to 10 I believe, at which point she herself deleted them! ... The next thing we hear, she's started her own 'secret' group called 'ISC2'! With the 'about' saying 'this is the new ISC, for those jumping ship as its now falling apart' .. She then added 60 odd people without asking them, included in that list were Cat and Chris themselves and Chris's elderly mother! The whole thing is sick actually. I've no problem at all with splinter groups, nor did Chris! He in fact encouraged people to, and would join them and contribute! My issue is with the underhand and nasty way she's done this. It's so disrespectful to Chris and Cats memory, and legacy! Right now people are practically begging me to come back, I have rejoined, lets hope things get better. The ISC used to be such an amazing group and it would be very sad for the few louder members, claiming to be the majority, to destroy it.

That's all for now! I needed to vent.

Happy new year to you all!

Christmas N Stuff

Hmmm, it's that time of year again.. The time for families to guilt trip each other into spending money they haven't got and everyone sits around wishing they were at home with a pile of gear.. ;)
I usually go to my mums, unfortunately she's working this year so were staying in London. I grabbed the opportunity to go volunteer for 'crisis at Christmas' .. I did it once before years ago, in fact I was a service user one year when I was homeless.. Crisis do great work, they have day centres up and down the country and work to help people who are street homeless.
Every year they do 'Crisis At Christmas' they open day centres across London and provide Christmas dinners, I think they cooked 16000 meals last year!
Besides the food they use a huge team if volunteers to provide healthcare, dentist, addiction key workers, complimentary therapists and counsellor.
This year I've volunteered as an entertainer! I'm playing a one hour set on piano!
I got myself a new keyboard a while back, I'd love to work full time as a pianist, at a piano bar or even session musician.

Music is the only thing I ever really gave a shit about, I've had so many different jobs I've the years! I never really followed my dream if being a pianist because I could t see a career in it for me. I don't have many regrets in my life, even getting on heroin was a huge life lesson.,! I do however, regret not staying at school, I really believe if I'd concentrate more on music I could have gone to an academy or uni to study for a degree, I have my grades up to 6 I think, I play be ear really, I can read music (although I'm really rusty) if I have to, but I picked up piano and guitar by sitting for hours playing and seeing what notes sounded good together! I discovered triads pretty early on :)
Before my friend Cat died she helped me by lending me some money towards buying my keyboard. She believed in me and wanted me to follow my dreams. It's with that in my thoughts that I've contacted goldsmiths to try and get on their music degree course, starting September 2013.
What I'd really like to do is music therapy, the degree will enable me to do a therapy course or just teach, I'd have to sit my grades up to 8 and do an access course too apparently..
It would mean 5-6 years study.. I'd be nearly 40 by the time I qualify! Although I'd be a 40 year old with a degree!
I'm trying to get some direction in my life anyway, it's time to do something I actually want to do I don't think I'm the kind of person that can do a job I hate. I've had some good jobs in my time too. I was the deputy general manager of one of the biggest clubs in London for a couple of years, good money but shit hours and a lot of stress! I'd much rather be teaching someone how to play piano!
I'm doing ok otherwise, I've been quiet this last few months because I've been trying to concentrate on myself. I'm still clean, I still use ibogaine root bark most days. Let me make it clear though, I am in no way dependent on it, physically or psychologically, I ran out a while back and I ended up sitting through some of the most intense cravings I've ever had! I had a couple of using dreams too... I hate them, they're always so vivid, usually I'm running around the streets, hustling up cash, then I go score, get home, cook up, I find a vein, pull back red and do it... That's when I wake up! Expecting a nice warm rush but nothing happens! Haha.. Pure torture! I don't think people who have never gone through opiate withdrawal understand just how intense and insidious the effects of detox can be! When you can't even get a moment of relief in the few hours of sleep you manage to grab things get hard!
I'm still trying to deal with the Facebook group i sort of inherited.. Who knew that as an admin you get so much abuse! I'm taking a break from it all for a few weeks. It all got a bit much, when I gained the admin ship I lost my support group, as an admin it feels there is this unspoken expectation to hold it together and be an inspiration to others struggling with their own recovery. People seem to forget that I'm newly clean myself!
It seems whenever you do good people just can't wait to try and drag you down!.. Or back into using as the case may be.
Just by being the third admin and inheriting full responsibility I gained a bunch of ready made haters and trolls.,! I wish I had a thicker skin, it's a steel learning curve, learning to let shit roll right off your back, I'm a pretty sensitive kinda guy.. It hurts when I, being called a cunt and fag for no other reason that I'm the admin of a support group

Anyways... I hope you all have bearable Christmases!

Here's a link to my (bad) attempt at playing 'Bohemian Rhapsody' on the piano!.. Man that's a hard song to Play! let alone sing 'gallileo gallileo' at the same time! haha http://www.youtube.com/watch?v=jXSetKK5B1k&sns=em

Oh, and if you'd like to sponsor me at crisis, ie donate towards providing the food and services you can do so here...: http://uk.virginmoneygiving.com/SidSkid
Thanks to my family and friends I smashed my first goal of £100 and had to up it to £150!!