Tuesday, 25 June 2013

The Future


So I'm applying to do a music degree at goldsmiths next year. 
It's a BMus, they do music or popular music. For the music course they want more things like GCSE's and a grade eight on your main instrument. Well, I didn't hang around at school long enough to get GCSE's, I sat my music one incidentally and got an A. Technically I hold up to grade six on piano but again I dropped out at about seventeen. So the popular music course is a little easier to get on, no qualifications necessary, just a talent and passion for music. I had a quick chat with one of the tutors and, reading between the lines, I have a pretty good chance of getting on the course. She told me they have to get 400 plus applicants down to 200 for interviews, they then get that down to just 50! Funnily enough I never even knew that university picks you, not the other way around! Haha. So she told me that a lot will come down to the personal statement, she recommended I start playing more live and to get some tracks recorded. I have just over a year to prepare anyway, pretty excited about it!
I might, in the interim year, go back to college and complete the final year of my counselling and psychotherapy diploma. I'd technically be able to practise as a counsellor then, which is a scary proposition! Haha
It would though go towards my final goal of being a music therapist, after three years getting a music degree I'd then go on to do some kind of therapist/counselling course. I think goldsmiths actually had a specific music therapy course. They have a pretty decent social sciences department anyway. 

Music is really the only thing I get passionate about, it was my solace after I was abused aged eleven. We had a baby grand in the house we were renting at the time, which sounds terribly posh but believe me it weren't. I'd spend hours and hours lost in my own world. Literally working out how to play a triad chord, I learnt how to play by ear, listening to a song I liked on a loop, pressing keys until I found which ones sounded right. Stabbing out the melody and pressing base notes to match. I taught myself 'Eternal Flame' like this, 'Let it be' and 'Imagine'. It was around the time meatloaf had 'I would do anything for love' out and I remember playing it full blast and hammering it out on the piano, imagining I was on stage playing it live.. Mum noticed I was good and somehow found the money to pay a little old lady down the road to give me lessons. I had to suddenly learn these really basic classical pieces and read sheet music. I thought this was boring and would go home and play some twelve bar blues! To this day I hate playing from a lead sheet, once I know the chord progression for the song ill play it how I want to. 
I took cello and trombone lessons at school, randomly.. Initially I wanted to play the bassoon but only because it looked like the coolest instrument in the orchestra! I taught myself guitar and by 14 I was busking Bob Dylan songs on the streets of Brighton with a harmonica around my neck. Not to sound like I'm bragging but I can pretty much pick up an instrument and work out how to play it in a few hours, ok, maybe we can strike the saxophone and oboe off that list! I taught myself piano accordion a few years ago. It was a 120 key piano accordion that I found in a skip! Seriously I have no clue how they play those things! I'm pretty musical anyway, I'd love to work with music somehow so therapy sounds great!

I should have a degree by the time I'm 36 and be fully qualified by 40! Haha.. I probably should have done it a few years ago but hey, never too late :) 

Getting funded to do all this is a whole other issue though, I have no idea if I can get a student loan for this, especially the full three years. 
It's £9,000 per year just for the tuition. I'd have to look into grants for living and housing costs. I guess they do those?
I read that you don't start to pay the tuition fees back until you're earning £26,000 annually. And then it works out about £5 per week which isn't too bad I think. 
At least it's possible to get the damn things. In other countries you pay for your learning, most American families start saving for college from youngsters. 

I can see why students are pissed off about fees increasing, by the time these kids graduate they're often £30k or more in debt!
It's a pretty hefty wedge of money to be stuck with before you even start to earn. Maybe I'm lucky being a mature student, the tutor I spoke with was saying it goes in my favour, my age, life experience etc make me a good candidate, I guess they like to mix it up a bit when it comes to new students. It would be pretty boring having just school leavers. 

I'm really looking forward to it all anyway, I just have to pull my finger out before September and get some stuff recorded. I can do that easy :) 

I did record my version of 'Bohemian Rhapsody' a while back. It's on YouTube 

Monday, 24 June 2013

Complaining To Your Drugs Service & Injectable Script Progress

East London NHS's Stance On Injectable Opiate Prescribing

So, this post is about my experiences dealing with the SAU, or, 'Specialist Addiction Unit' at our local hospital, Homerton (Hackney East London), a run down of the various letters sent back and forth on behalf of my friend and the unit's addiction consultant psychiatrist,manager and the clinical director...

The issues I raised and the hospitals responses are quite generic and I would have thought other drug services around the UK operate similarly, if you were looking into other treatment options for yourself. 
I guess I've been acting as an advocate on her behalf, having someone fighting your corner, who also incidentally knows and understands how it all works, can work wonders for your self esteem and seems to have a positive effect on how well the professionals involved with your care behave ;)

This post may well piss people off, I know that a large percent of the general public probably view drug users and heroin addicts especially, as a problem for society, I'd go as far as to say sub-human, undeserving of love, compassion and tax payer money.
Sadly, the average citizen views heroin addicts as scumbags that would sell their own mother for a hit.
This isn't helped by the media, on the whole, if a news story concerns a heroin addict it will revolve around a mugging of an old lady for the £5 in her purse. The stereotypical dirty junkie.
This is also, probably the only time the public are told about heroin addicts, most don't know one or have any kind of contact with one. The message is clear, beware the scummy junkie, he'll mug you and won't think twice about it as he has no conscience or care for you.
Now, the reality...
There are an estimated 300,000 heroin addicts in the UK, that's just the ones that are registered for treatment and in receipt of maintenance scripts.
300,000 is a conservative estimate, for every addict in treatment there is a mother with kids too scared to access treatment for fear of social services getting involved, for every one in treatment there is one working in an office, holding down a good job, terrified of going to his/her GP for fear of being judged or losing their job. For every one in treatment there is another that can afford private healthcare, being prescribed MST from a private doctor or clinic..
My point is there is a huge amount of opiate addicts that slip under the radar, working, paying taxes, getting on with it! The 'functioning addict' I guess I'm one of them, I've always worked and supported myself and my drug use, I've always believed if one wants to use drugs then one must also support oneself and not expect others to pay for or support my habit.
Maybe people like me are in the minority, I don't know, I get the feeling there are lots of us though.
Now of course there are also your 'car crash, live to die' junkies.
These are the ones that commit crimes to pay for their drugs, most are in treatment, on scripts which for all it's negatives, gives you the option to use, being on methadone takes away the requirement to find money every day.
Sure, there are plenty that will steal, rob, lie, blag, do whatever it takes to get high.
In a society that criminalizes drug users and doesn't provide adequate prescribing of inject-able opiates, there are, unfortunately, those that will commit awful crimes.
I don't believe, in my heart, that the ones that mug old ladies actually want to do so, no-one gets off on stuff like that, it comes from a desperate place. I know they will have that on their conscience forever and so they should, I'm not condoning it in the slightest, I think it's disgusting, but I think simply punishing the person without any kind of constructive treatment is unhelpful and pointless.
It pisses me off that all addicts get bunched in with those that go that low.
Iv'e never in my life mugged anyone, Iv'e never stolen from my family, if anything I kept well away from my family when I was at my worst. I'm not trying to make out I'm mr goody two shoes but I am saying that despite the drug addiction, we still have a conscience, we are still human beings, we are your brother, sister, mother, father...
At my worst I spent a couple of years living on the streets in Brighton, I slept in car parks with a few other addicts. We would get up early and go begging or sell the big issue, I used to have to keep everything I owned in my sleeping bag, I'd make sure I had a hit made up ready from the night before for the morning.
Waking up sick in the freezing cold it's the only thing that keeps you going.
They were bad times but still I never mugged anyone, I begged for change and shoplifted occasionally. Only ever food though, I wasn't very good at shoplifting bigger goods and frankly couldn't be bothered.

So, my point is this.. Drug addicts are people too, people that have lost their way for whatever reason, usually some kind of abuse as kids. We're fellow human beings with feelings and dreams, don't judge us too harshly or quickly, this world needs more compassion and love not judgment and hatred.

So, onto the letter.. :P

So, a little background, if I maybe haven't covered it in previous posts...

She is a little younger than me, 30, with a long history of IV drug use, ten years plus. 
More recently (the last few years) she's been injecting 'speedballs' so crack cocaine along with the heroin. 
She has limited peripheral venous access having used the veins in her arms and legs for many years meaning the usual areas like arms and legs are thrombosed and the veins collapsed. 
She is therefore a femoral/groin injector. She's been injecting in her groin for about three years too. 

She has been in and out of treatment for around 15 years, various attempts at rehab (9-10 times?) methadone and subutex maintenance (small and large/optimised doses, the maximum being 130mg), DIY/home detox, 'community' detox (Home detox under the advice/support/comfort medications of GP), dihydrocodiene, morphine... Etc

In total in the entire length of using illicit drugs, the longest she ever managed to stay 'clean' was about a year, in 2004. 
She is currently prescribed 60mg oral methadone, on daily supervised pick up.
She still uses heroin and crack cocaine on top 3-4 times a week, an average 'hit' for her is three bags of heroin and one crack-or about 0.6 grams heroin plus 0.2 grams crack. She will usually inject this amount three or four times in a day, costing around £30 per shot. She struggles daily with drug cravings and withdrawal symptoms. She doesn't feel her current treatment of 60mg methadone 'works' or is even keeping her out of physical withdrawal. 
Traditional treatment has had little effect in the long term and she wants to try something new. 

Ok, so in my opinion my mate is a perfect damn candidate for IV opiates, ideally heroin (diamorphine), although IV methadone would also be an option. She feels that her addiction is as much to do with the physical act of injecting as it is to anything else. 
In her words she has, and always has had, a 'needle fetish' in other words, using IV drugs is almost a ritual, similar to rolling a joint or mixing a drink I guess. Some users become almost obsessive about how and where they prepare/cook and use. The act of tying off, finding a vein, pulling back and shooting becomes so ingrained, if you think about it from a CBT point of view, the reward is the hit. It's usually preceded by hours of hustling, shoplifting, sex work, whatever... Obtaining cash then obtaining the actual drug/s is all part of the addiction. This reward system is particularly strong when the user is in withdrawal, or has had to work extra hard to get the cash.... I can totally relate to and empathise with her, I was very similar..
I know for me at least, I was hooked on the whole process, running round scoring and finding a quiet corner or public toilet to shoot up in was all part of the attraction for me, maybe it's the knowing what you're doing is illegal/bad for you/dodgy.. Whatever, I got off on shooting a speedball in a public loo as much as the hit itself... Yeah.. Go figure mr psychologist ;)

Anyway.. As no other treatment has ever really worked, and she continues to inject illicit drugs on a near daily basis, with all the associated risks, I see injectables as a good option, it would be a method of harm reduction, she believes she can exchange her speedballs for a single, clean methadone or diamorphine shot. Cutting out the crack altogether. Pharmaceutical grade opiates are obviously also much less damaging to inject than adulterated street drugs.

After reviewing the NICE (National Institute Of Clinical Excellence) and NTA (National Treatment Agency) guidelines, she fits all the eligibility criteria so technically there is no reason she should be refused. 

I put all this, in writing, to her consultant, the unit manager and the clinical director ..Who, by the way, holds the requisite home office diamorphine/dipipanone license. 

Recently my friend has had a string of seemingly ever changing and frankly, bloody useless 'key-workers', I've been telling her to ask to see an actual doctor for months but apparently it's near impossible up there,.. at the 'SPECIALIST addiction unit' (Yeah, I'm annoyed, it was no better when I was there). They seem to specialise in doing as little work as possible, you might get asked to do the health assessment, otherwise it's just a case of handing out a blue script every two weeks and off you go. 

We talked about the lack of specialty care at the unit, along with the high staff turnover and the de facto issue of confidentiality and continuity of care. We asked for an actual doctor to assess her for possible injectable prescribing and told them that we felt the unit was no longer even providing a basic duty of care to its clients any more. (Managerial talk for 'oh dear, duty of care is rather important')

Strangely enough, this seemed to get quite the reaction!
She was telephoned days later and informed that as her complaint was rather serious it was being referred directly to the trusts' complaint department. 

She was asked to attend an appointment with a consultant from the neighbouring boroughs drug service to clarify the points she had raised. 
She duly went along, as did I. 

I have to say, we were pretty impressed with how the complaint was dealt with, the doctor asked her exactly what she was unhappy about and we discussed the possibility of injectables. 
He told us that he'd be carrying out a thorough investigation of our SAU and the staff involved, and that he'd look into the injectables issue. 

Fast forward two weeks...

She's called back again to see this consultant. 
He agreed with her issue around not being able to see a doctor when requested and said he'd be hopefully putting a system in place with a time limit when a request is made.. He assuaged her other minor issues and moved into the IV script..

Long story short..

Yes, she fits most of the eligibility criteria, 
yes on paper she would probably benefit from this intervention,
yes he agrees that studies from IV prescribing show very positive results, 
yes yes yes pretty much..!

Oh, wait though.. We can't do it because we don't have the facilities/staff/money/home office licence/lives in the wrong part of London/worries she will inject in her neck/groin which rules out treatment..

Blah blah..

My take on it?

He thinks it's a good idea but his hands are tied with beaurocratic   nonsense red tape and government guidelines. 
Apparently, starting someone on any IV script (methadone or diamorphine) is a big deal. Most people with IV scripts are long term, inherited patients. Initiating new scripts is rare as hens teeth. These 'grandfathered in' patients are pretty much regarded as long termers that the doctors would rather not have to deal with. 
The NTA guidelines state that the client must be observed for an initial period of time when initiating IV treatment, demonstrating safe and correct injection technique. (Not in the groin or neck, which is a whole other issue and personal gripe of mine, by the time a service user may be suitable for IV prescribing they usually have very limited venuous access anymore). 
To do this means the unit needs a specialist nurse and a room. 
See, to me that ain't really a big deal, but apparently it is. 
The client would need to attend the unit and be observed twice daily for at least three months. They would get one take home a week for the Sunday and would need to return the empty ampoule, proving they weren't diverting their script (Again, really? why on earth would they 'divert' the drug they want and have fought tooth and nail for?!) 
The prescribing doctor would require a home office licence, they would also want to be experienced and comfortable providing the script. (Funnily enough, there are barely any with the experience and confidence to do this) 
Apparently it's quite a big thing to take on and the vast majority of doctors would simply rather not get involved. 

I think, that really, it's just the fact that the government have made it so bloody difficult to provide this kind of treatment that no doctor wants to do it!

There was an outside chance of a referral to the maudsley hospital in south London. This is where the drug unit that did the RIOTT trials is based.  
IF, and I mean IF, she managed to get a referral and was accepted, she would be under the same rigorous and thorough regime. 
Having to travel halfway across London twice a day to inject in front of a nurse..and seriously..you'd need to be pretty bloody desperate to do that!

Currently we're waiting for the investigating consultants report. 
It should be completed any day now, I'll update you all as we know more. 

What came out of this all is the following;

-It is technically possible to get an IV opiate script
-There are only around 300 doctors in the UK with the necessary licence, these are not evenly distributed throughout the country. 
-You're very unlikely to get injectables prescribed, particularly if you live outside the main cities
(Brighton and London both have provisions although they're near impossible to access)
-Be prepared to face a lot of hostility and red tape, whether its right or wrong, a lot will come down to the individual doctors personal beliefs/ethics/experience/preferences/prejudices etc
-Even if you manage to find a doctor willing to work with you, there's no guarantee the PCT will fund it, in comparison to traditional oral alternatives, ampoules are very expensive 
-Our current Tory governments drug strategy is to go against all the evidence and previous experience and focus on abstinence based treatment. Ie: getting you off your methadone script as fast as possible (Yes, I'll be posting about this issue soon)
-Get some advocacy, it can really make a difference! Look up the methadone alliance, RELEASE and local users groups
-Do your homework, presenting a well researched, sensible and concise case will make a big difference

As I was saying before, the reputation and stigma attached to heroin/crack cocaine addicts is one I have to battle with on a near daily basis. Sadly this prejudice can often carry through to the very people that are meant to help us, doctors, nurses, drugs workers even. 

Don't just lay back and accept the status quo, being ambivalent and passive with regards to the treatment you receive is what's expected of you. 
Drug treatment strategies in the UK rarely change and are nearly always led by politicians that certainly don't have your best interests at heart. Drug treatment is a controversial area and MP's make decisions based on public opinion. Not on evidence based and patient centred choices. 

Advocate for yourself and others, join your local drug users group, if there isn't one, start one!

As I've said many times before, addiction is not a 'one size fits all' problem. 
There are many factors that contribute to a person becoming addicted to drugs and alcohol.
Addiction crosses all social boundaries and classes. 

Ill leave you with this;

The consultant we saw told us he was very impressed we had written a letter of complaint. He told us it was a real novelty, to meet someone who wanted to bring attention to issues with their treatment. 
He told us that most complaints come in the form of kicking off and shouting in the waiting room, the client storming off when he'd got what he wanted. End of story..
To get some real feedback and the chance to make the patient experience better was something he was more than happy to do! 

So... Get writing :)



Saturday, 8 June 2013

Nearly Six Months, PAWS And Stopping Smoking!

I've not been too good at writing posts recently, my only excuse is that when I cleaned up, life kinda took over!

It's coming up on six months now since my last Iboga flood. 
Apart from a couple of minor slips, ie: one or two small shots, months ago, I haven't slipped back into a full time opiate habit, nor am I on any maintenance meds anymore! :)

As ever when coming off long term opiates, it takes quite some time for the body to heal and adjust. Often longer than you expect, actually when I got clean back in '06, I tapered myself off a 120mg a day methadone habit. 
It took about 18 months of dropping 1-2mg each 4-5 days. 
It was slow and arduous but it worked, I got three years opiate free after that too!
I'd never heard of Ibogaine at that stage, if I ever had to do a slow meth taper again I'd microdose with rootbark without a doubt. 

Funny too, I'd not heard of the dreaded PAWS back then either, I think if I had I'd have probably talked myself out of the detox, or at a minimum suffered a lot more. 

Looking back now, knowing more, I did struggle with it. From 120mg down to about 12mg was easy in comparison to that last 12mg!

I got so worked up convincing myself that the last drop, from 1mg to 0 I'd go into hellish cold turkey that I nearly talked myself out of it altogether! I started to do the addict thing of coming up with justifications why I should just stay on 12mg forever! Haha

As it happened, I actually swapped over onto subutex for the final bit. It wasn't easy, the transition is difficult and I got pretty sick. I was really pissed that I ended up needing a full 32mg to hold me, I thought I'd be ok at 16mg max! 
It took about a week of pretty shitty withdrawal symptoms to stabilise, I then stayed at the 32 for a couple of weeks then started tapering. 
It was much easier to taper with, I set myself a three month limit for taking subs, much longer and I've noticed people start to struggle getting off. 
I got right down to 0.02mg, shaving the pills with a razor. 
When I finally stopped altogether, I remember sitting at home that day waiting for the ct to hit me, I had subs on hand if it did... It never did!

Yeah, I was amazed.. But it just goes to show, if you have the discipline and willpower to taper it is possible..

Anyway. I'm getting off track..

I wanted to talk about PAWS, or Post Acute Withdrawal Symptoms/Syndrome, like I said, I'd never even heard of it, so I didn't really know what to expect in the way of symptoms when I finally stopped. 

Physically I had minor sweats and chills, goosebumps and sneezes that went on for maybe another week or two, my main problems were insomnia and depression. 
For about a year after I stopped I was battling severe depression, I researched medications and antidepressants that were good post opiate addiction and the SNRI Venlaflaxine/Effexor came up. I asked my doctor and was prescribed Effexor. I can't say I felt on top of the world but if lifted me out of the suicidal zone. 

It seems to take about a year to fully recover from long term opiate abuse, after that time I felt pretty much 'normal' and happy and had forgotten all about my past life really. 

Why am I talking about this? 

I guess because its kind of where I'm at again now, feeling sad and suffering a lot of anxiety. 
Iboga rootbark helps me loads, I take about a gram whenever I feel I need it, which is usually about every two weeks. It seems to stop any drug cravings I'm having dead in their tracks and lifts my mood. 

I actually even stopped smoking about six weeks ago too. Which is just crazy for me, I've always loved smoking and never had much intention to stop. 

I bought one of those E-cigs from the pharmacy and never looked back, haven't smoked since! :)

Can't recommend them enough

That's all for now anyhow