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...


    John said...

    I agree with some of your strategies Sid but am not too sure about naltrexone. I have experience with them, the implants and tablets (orally). I felt they stopped my endorphins and just made me sick for months until I got rid of the impant or stopped taking the 50mg tab orally. The nal may very well stop you from using but the downside is you feel shit and depressed, my experiences with nal havent been positive by any stetch of the imagination. Anyway I thought your ibogaine deal was kusthi, what happend? sorry I havent had time to check on blogs or read down below. Ill do that now mate.


    Sid said...

    Hi John,

    Yeah I keep hearing horror stories with people taking Nal, two friends just took it after 5 days clean (as advised by the stapleford clinic) and both ended up in hospital for a week!

    I just meant it should be more freely available on the NHS, not just for people that can afford it.

    Iv'e been offered it in oral form for when I come off the MST, but I think I will probably intergrate it with some Ibogaine to completely reset and empty my receptors before taking it. I think you have to be absoloutely squeaky clean before taking it.

    And yeah, the months of depression and low grade PAWS people talk about when on it are worrying.. but is this actually caused by the nal or would the PAWS be there anyway?

    I just think people should have more choice and more input when it comes to their treatment really!

    Re Ibogaine.. I tried it.. it works for acute wd's great, but like most people, after a few days and the initial high of being clean wears off the PAWS kick in and seem to go on for weeks.. theres only so much you can take, you know what I mean..!

    Anonymous said...

    Sid didnt you consume boosters of ibogaine for PAWS? i was planning this route in the near future but now am having second thoughts, i keep reading horror stories of iboga messing up the body and brain which makes PAWS come back, am worried now. My problem is PAWS. I can get by the acute withdrawals believe it or not, with the help of short actig opiates. But i genuinely thought micro doses help paws? or you didnt hve enough money for that? i thought you only need 2 weeks worth of boosters to speed up the recovery time and eliminate paws?

    Gledwood said...

    Do they really give doses of 30mg to established addicts? How fucking ridiculous.

    You know something I noticed (time and again) ~ they don't seem to factor in whether people smoke or inject. A lot of the crackheads coming into these methadone clinics are incinerating their heroin on the end of a bottle. Most of the heroin is burned up before it ever reaches their lungs and a good deal is exhaled before it ever hits the bloodstream. I used to live in a house with crackheads who smoked gear in this way and none of them EVER looked intoxicated. I remember one who was "dying sick" putting about £1.50 worth on the pipe, then raving about how OK he was afterwards! And yet the clinic were giving this couple 80mg each!!!!

    While my group injected gear heavily and barely touched crack and the clinic couldn't understand why they could't stick to their juice.

    Also when I still had a baby habit, I could switch from a gram of gear IV to 20mg methadone mixture within 5 days relatively painlessly (but outside London). There is just no way 20 mg would hold me now. They don't take into account how methadone becomes considerably less of a substitute the longer you've been using gear. There's no question this is true. When I'd been smoking about a £10 bag a day for a few months I could still hold myself on less than 10mg of methadone a day. 5mg most days. How many methadone clinics would believe this?

    But it's TRUE. Soon as I got into taking gear every day I was on it constantly and teeny tiny methadone doses used to hold me.

    Someone wants to do some research on this because it's definitely true that methadone just becomes ineffectual over the course of years, whether you rely on gear or methadone.

    Also: most smackheads take massively varying doses each day, yet only once in ten years did I ever go sick after taking street gear that just wasn't strong enough. So it stands to reason you could reduce pretty steeply on diamorphine and feel nothing. I never did. Yet people seem to have terrible problems reducing methadone... why is this? It pisses me off when people level the accusation that it's "all psychological". I know when I'm sick and not sick and I've gone sick on methadone loads of times. Yet strangely not on gear. Which says a fuck of a lot about how pathetically weak methadone is.

    They seem to "worry" about (ie try and cover their arses against) people overdosing on methadone... AS IF! I calculated your bladder would EXPLODE before you ever managed to OD on methadone 1mg/1ml!