Sunday, 26 June 2011

Government Cuts Hit Local Drug Services - Part Two

Govenment budget cuts hit local services...


So.... A little update on the situation at the SAU (Specialist Addiction Unit)

Since my psychiatrist left the service due to funding cuts things have gone from bad to worse!

All the clients now have 'key-workers', no one actually gets to see a doctor any more.
My 'key-worker' has taken a disliking to me because I dare to challenge and question the way things are done... Like I said before, and as people have confirmed in the comments to the previous post, drug services are set up for your stereotypical 'junkie' .... Take your methadone, jump through all the hoops, tick the boxes and shut up...

Well, I'm sorry but that's just not me!...

I was so happy when I was first referred to the SAU, and met Dr Crawford,... For the first time in fifteen years of counsellors, key-workers and doctors I actually felt like this doctor gave a shit about me and my treatment.

We had a great relationship, we kept in touch by text which meant I could get in contact any time I needed, and we developed a good treatment plan.. together.. (which is really bloody important)

So often, addicts are relegated to a life on methadone or subutex and drug services seem to exist solely to keep people alive....

Dr Crawford actually listened to me, we trusted each other and she gave me chances I wouldn't have got with any other NHS psychiatrist (MST for a start, she also spent money getting me music equipment, got me into one of the best music tech colleges in London, sent me to one of the most expensive rehabs in the country and has worked with me very step of the way when it comes to medication)

I would see her every two weeks, we would chat for an hour or so, and decide where to go from there.
Most recently I came with the suggestion of trying MST and amazingly she agreed.

I had to sign a contract stating I wouldn't take any other recreational or prescription drugs (diazepam, cannabis, crack cocaine etc)

When she asked what I had been taking I was always honest and it's never been a problem, until now!

Now my key-worker keeps bringing up the contract, testing my urine for 'illicit' drugs which when positive for cannabis and benzodiazepines she reminds me that I am breaching my agreement and risking my treatment.

I saw her for all of 4 minutes last week, she literally gave me my script, asked how I was doing and fucked me out the door.

The reason I smoke the odd spliff and take a valium a couple of times a week, is because I'm not stable and can't sleep when I'm sick! 

Now I'm struggling on 200mg MST twice daily. I'm ill, it's barely keeping me well, let alone helping with cravings. I was really hoping it would.
I'm also still stuck on daily pick up at the chemist which is incredibly difficult when your trying to hold down a job!

I need an increase, I wake up every day ill, and run to the chemist.. take my morning dose and then have to try and leave it as late as possible before taking my evening dose so I'm not too ill when I wake up.

I don't see the point, when I'm barely well I want to use! I might as well not be on anything!
I need a dose increase, and I need weekly pick up at the chemist.

Now if Dr Crawford was still at the service she would sort it out on the spot.
Now I have to ask, and my key-worker 'takes it to the team' ... The weekly meeting of key-workers and doctors... I've been waiting a week already for a decision.

I want to get on with my life! I want to work, I can't when I'm ill!

I hope this post doesn't come across as sounding arrogant or self centred.. I understand there are budget cuts and things are changing.. but the treatment I'm getting at the moment is no treatment..! I might as well use and not bother going to the SAU at all...

Who is this meant to help?

I thought the idea was to work with people to get them clean.. Not trying to fuck people over at every opportunity...

I want to write to the new doctor over-seeing the SAU but am scared if I stick my neck out it will get chopped off!

We're not meant to complain and challenge the doctors, they know best, they've been to medical school and learnt about addiction.. they know best! Who am I to dare have some input to my treatment?!

I actually don't even want to go to the SAU any more, the idea was to get me stabilised on a suitable dose of MST and then refer me back to my GP. I wish they would just do it now actually... At least with my GP we have quite a good relationship.

Anyway, moan over...

Tuesday, 21 June 2011

How drugs services SHOULD be run...

So, here are my thoughts on how a drug service should be run....

        The service should be based around these core principles:

       Government Drugs strategys' should include:
  • Early Drug & Alcohol Education In Schools 
  • De-Criminalisation Of Cannabis
  • Raising The Price Of Alcohol In Supermarkets
  • Regulation Of Advertising Of Alco-pops
  • Working Towards De-Glamorising 'Hard Drugs'
  • Early Intervention Where Drug Use Is Suspected In Teens (Education In Schools)
  • Reducing 'Binge Drinking'

      The most important of these is 'client centred' - By this I mean, working with the client to define and attain sensible and achievable goals.

    For some reason this government has gone backwards! Drug services are being told to push clients towards detox and abstinence, long term maintenance is being phased out..

    Forcing addicts to detox WILL NOT WORK! 

    I believe the best approach to drug treatment would be...

    It should be decided with the client what his/her expectations of treatment are and then:
    • Re-assessing current dosing guidelines (30mls methadone is not enough to keep an average addict well), to stabilise the client (this means a dose that 'holds' the client as well as attenuates cravings, over 60mls in most cases)
    •  Prescribing suitable opiates for the individual client based on history of use, age etc. whether this be methadone, subutex, MST or diamorphine, the full range of medication available should be employed as required.
    •  Working with injectable opiates for injecting users.
    •  Working with smokeable forms for smoking users.
    • Not punishing the client for topping up with street drugs whilst titrating substitute.
    • Establishing whether the client wants to detox or maintain.
    • Allowing clients to maintain for as long as required.
    • Providing intensive support for clients wishing to detox.
    • Providing regular 'key-work' and counselling sessions.
    • Providing access to a nurse.
    • Providing proven 'alternative' aids to detox (auricular acupuncture, meditation, CBT, NLP, Hypnosis)
    • Providing 'shooting rooms' for clients, providing on-site medical support for injectors including workshops on safer injecting techniques.
    • Providing support for clients wishing to detox at home, home visits, detox plan, adequate medication (benzodiazepines, quinnine, immodium, vitamins, clonidine etc)
    • Post detox medication. Provision of Naltrexlone implants and tablets
    • Support groups for abstinent clients

    Now, the way I see it, the above really isn't that far from reality, and isn't anything totally out there or unachievable.

    Most of these have been used either in the past in the UK or are currently being used around the world in other countries.

    Appropriate prescribing of diamorphine to heroin addicts is a controversial subject and one that inevitably raises concerns. In every trial that has ever been done, diamorphine vs methadone has better results in terms of attenuating illicit drug use, clients getting on with they're lives, finding jobs and contributing to society etc.
    Yet the government for some reason will not roll it out nationwide.

    (You can sign the petition to the government here by the way)

    The same old arguments come up every time... 'why should we give them heroin', 'the diamorphine will be diverted to the street', it's too expensive'.

    Let me tell you now, the lucky few on diamorphine prescriptions do not 'divert' they're scripts, why would they!? And why should we give nicotine patches to smokers?
    Prescribing pharmaceutical heroin to addicts is the right thing to do, injecting street heroin carries so much risk, not least collapsing veins and DVT's, the spread of viruses like HIV/HCV through sharing of injecting equipment, risk of overdose with constantly changing batches of heroin of varying strength and purity etc..

    MP's always say diamorphine maintenance would be prohibitively expensive and apparently there is a worldwide shortage.
    It is only expensive because in the UK we use freeze dried preparations. A powder in an ampule to which sterile water is added.
    The extra step of freeze-drying is unnecessary and as far as I know only done to prolong the shelf life.

    The cost of producing diamorphine would come down as demand increased and would level out at around the same price as methadone.
    (On a side note, I along with most addicts would happily pay the cost of the medication)

    Post detox, providing naltrexlone implants on the NHS is a must. Currently there are only a handful of private clinics in the UK that carry out the procedure and it's very expensive.

    The crux of the issue is about working with the client and not re-hashing old treatment models that don't work.
    Listening to the hopes and wishes of the client and providing the support for them to achieve them.

    It doesn't seem like too much to ask, and as I say it's not exactly groundbreaking stuff I'm talking about.
    It could all be done with a few minor changes to protocol with the existing network of local drug services and agencies.

    Stand up for your rights, stop laying back and letting Cameron and Klegg fuck you up the ass just because you found opiates relieved whatever issues or pain you can't cope with in your lives.
    Seek help. challenge existing ways of working, post comments in your DDU's' suggestions box.
    Start a local users forum, sign the petition, write to your MP...

    Just because your an addict does not make you a bad person, you are human and deserve equal treatment to anyone else...

    Peace out...