Great article about addiction

Drug use is common, drug addiction is rare. About one adult in three will use an illegal drug in their lifetime and just under 3m people will do so this year in England and Wales alone. Most will suffer no long-term harm.

There are immediate risks from overdose and intoxication, and longer-term health risks associated with heavy or prolonged use; damage to lungs from smoking cannabis or the bladder from ketamine for example. However most people will either pass unscathed through a short period of experimentation or learn to accommodate their drug use into their lifestyle, adjusting patterns of use to their social and domestic circumstances, as they do with alcohol.

Compared to the 3m currently using illegal drugs there are around 300,000 heroin and/or crack addicts while around 30,000 were successfully treated for dependency on drugs in England in 2011-12, typically cannabis, or powder cocaine.

A powerful cultural narrative focusing on the power of illegal drugs to disrupt otherwise stable, happy lives dominates our media and political discourse, and shapes policy responses. Drug use is deemed to “spiral out of control”, destroying an individual’s ability to earn their living or care for their children, transforming honest productive citizens into welfare dependent, criminal “families from hell”.

This is a key component of the Broken Britaincritique of welfare and social policy advanced by the Centre for Social Justice and pursued in government by the CSJ’s founder Iain Duncan Smith in his role as secretary of state for work and pensions. However, the narrative has resonance far beyond the political arena and underpins most media coverage of drug addiction and the drug storylines of popular culture.

Most drug users are ..?

In reality the likelihood of individuals without pre-existing vulnerabilities succumbing to long-term addiction is slim. Heroin and crack addicts are not a random sub set of England’s 3m current drug users.

Addiction, unlike use, is heavily concentrated in our poorest communities – and within those communities it is the individuals who struggle most with life who will succumb. Compared to the rest of the population, heroin and crack addicts are: male, working-class, offenders, have poor educational records, little or no history of employment, experience of the care system, a vulnerability to mental illness and increasingly are over 40 with declining physical health.

The usual message. Imagens Evangelicas, CC BY

Problem cannabis use is less concentrated among the poor, but is closely associated with indicators of social stress and a vulnerability to developing mental health conditions.

Most drug users are intelligent resourceful people with good life skills, supportive networks and loving families. These assets enable them to manage the risks associated with their drug use, avoiding the most dangerous drugs and managing their frequency and scale of use to reduce harm and maximise pleasure. Crucially they will have access to support from family and friends should they begin to develop problems, and a realistic prospect of a job, a house and a stake in society to focus and sustain their motivation to get back on track.

In contrast the most vulnerable individuals in our poorest communities lack life skills and have networks that entrench their problems rather than offering solutions. Their decision making will tend to prioritise immediate benefit rather than long-term consequences. The multiplicity of overlapping challenges they face gives them little incentive to avoid high risk behaviours.

Together these factors make it more likely that, instead of carefully calibrating their drug use to minimise risk, they will be prepared to use the most dangerous drugs in the most dangerous ways. And once addicted, motivation to recover and the likelihood of success is weakened by an absence of family support, poor prospects of employment, insecure housing and social isolation.

In short what determines whether or not drug use escalates into addiction, and the prognosis once it has, is less to do with the power of the drug and more to do with the social, personal and economic circumstances of the user.

Heads in the sand

Unfortunately the strong relationship between social distress and addiction is ignored by politicians and media commentators in favour of an assumption that addiction is a random risk driven by the power of the drug.

It does happen. But the atypical experience of the relatively small number of drug users from stable backgrounds who stumble into addiction and can legitimately attribute the chaos of their subsequent lives to this one event drowns out the experience of the overwhelming majority of addicts for whom social isolation, economic exclusion, criminality and fragile mental health preceded their drug use rather than being caused by it.

Viewing addiction through the distorting lens of the minority causes policy makers to misunderstand the flow of causality and pushes them towards interventions focused on changing individual drug-using behaviour and away from addressing the structural inequality in which the vulnerabilities to addiction can flourish.

Until we re-frame our understanding of drug addiction as more often the consequence of social evils than their root cause, then we are doomed to misdirect our energy and resources towards blaming the outcasts and the vulnerable for their plight rather than recasting our economic and social structures to give them access to the sources of resilience that protect the rest of us.

Richard Branson Calls On The UK Government To Repeal The 1971 Drugs Act

Yes, I'm surprised as you probably are! 

Richard Branson, of Virgin Ltd, has recently posted a blog that urges the government to look again at our failing 'war on drugs' and urging that we look at other ways to deal with drug addiction, addicts, associated crime and social problems.

He includes a link to this petition, started by an MP from the Green Party in Brighton, which urges an immediate enquiry and investigation.

This is from the petition page:

Drug related harms and the costs to society remain high in Britain, with a growing consensus that the current enforcement led approach is not working. In recent months the independent UK Drugs Policy Commission has highlighted the fact that Government is spending around £3 billion a year on a policy that is often self-defeating; and the Home Affairs Select Committee has concluded Government action is needed "now, more than ever" to consider all the alternatives to our failing drug laws and learn from countries that have adopted a more evidence based approach. We are concerned that, in this age of austerity, nobody is checking whether Britain's current approach is value for money - or money wasted. We therefore call on the Government to commission an authoritative and independent cost-benefit analysis and impact assessment of the Misuse of Drugs Act 1971 within the next 12 months, in order to provide the evidence for Parliament to pursue a more effective drugs policy in the future.

This is positive news and I suggest you all sign and share it!

It seems the issue of our outdated and unfit for purpose drug policies here in the UK seem to be being talked about more often in the news recently. I hope and pray this is the start of the tide turning here.

As Portugal and holland have proven, the decriminalisation of drugs and the treating of addicts as people that need help, as opposed to criminals and lost causes, works!

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

Government Cuts Hit Local Drug Services - Part Two

Govenment budget cuts hit local services...

More..

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...

Government Cuts Hit Local Drug Services

Government Cuts Hit Local Drug Services

We all know the state of the country's finances..!

Greedy politicians have systematically fucked the UK up the ass since time immemorial, but over the last few years things have gotten worse.

There are cases going through court now, politicians claiming 'expenses' they are not entitled too.. evidently £80,000 a year isn't enough!

A politician went to prison just today for claiming expenses for a house he didn't even live in!

Add this to the bankers loaning and mortgaging the public with money that doesn't exist, and the government borrowing money that doesn't exist, the UK national debt now stands at a trillion pounds!

We are paying £120,000,000 (that's 120 million pounds) a day just in interest!

Long and short of it, we're fucked!

local authorities are having they're budgets cut drastically and the services being hit the hardest are grass roots and community organisations, hospitals, charities, police and fire services and DRUG SERVICES!

Unemployment has hit record levels, people are loosing they're properties and assets yet they're cutting funding to essential services that help people in desperate situations like the citizens advice bureau.

Personally, I can't find a job, no matter how many interviews I go to, and we are struggling!

Recently my psychiatrist that I've seen for years, and had a great relationship with, told me she's leaving work.

She was the consultant at my local Specialist Addiction Unit.

Budget cuts meant the hospital had decided to merge the alcohol and drugs units, and they wanted her to take a new role overseeing the whole department. No longer seeing patients and basically managing everything.

She decided it wasn't for her, and gave notice.

At my last appointment with her we were discussing upping my MST dose, and she had no problem with it, we decided I would try another week at 180mg twice daily and if I couldn't manage we would increase the dose.

When I went for my next appointment I discovered that I no longer get to see a real doctor, I now have a 'key worker'..

Basically someone with no qualifications and little experience in the addiction field who has power over me and my treatment.. I was getting flashbacks of the incredible incompetence I experienced at 'Addaction/lifeline' - our local Drug Dependency Unit..  (The name changes every year when the contracts are issued... the only thing that changes is the name, and a lick of paint)

I left Addaction years ago, sick of the endless stream of useless 'key workers' and demanded a referral to the hospitals SAU, but that's a whole other story!

Anyway, basically, my 'key worker' (hell, I'm probably more qualified to do her job than her with my NVQ3 counselling diploma and drugs awareness certificates), has absolutely no power to make a decision regarding my medication and treatment so now has to take it to the team... (a weekly meeting of doctors and key workers)

I've been waiting nearly three weeks now for a decision, I ended up having to meet with the new consultant to get it a 20mg increase!

I was hoping the MST would help with cravings as well as withdrawals but the dose im on barely keeps me well...

Now I understand I'm just another junkie, and most people probably don't see addiction services as the highest priority when it comes to hospital budgets, but we are people too, and we deserve equal treatment..

I have and always will fight for my rights as a patient, it seems sometimes these 'drug services' go out of they're way to stop you getting on with your life, it's difficult to hold a job down when your on daily pick up at the chemist or have to go to a counsellor every two weeks, then see your GP just to get a methadone script!

These services are set up for your average 'junky' - Im talking about the ones that shoplift and mug old ladies for they're drug money.
If you decide you want to provide for yourself, hold down a job and contribute to society it seems they will put as many barriers in the way they possibly can.

Bloody Snow!

So I've been waiting two weeks now for my Ibogaine to arrive in the post..

There's no bloody flights into and out of the UK so obviously that includes post planes...

What annoys me the most is that I paid £40 for courier delivery which normally takes 4-5 days, I may as well have paid the £6 snail mail option!

I really bloody need it, I'm really struggling with not relapsing, there's only so much PAWS one person can take!
It's unbearable, every day, constant physical pain, the minutes feel like hours and it feels like it's never gonna end!

Stupid UK, everything grinds to a halt when it snows here! Other countries with year round snow cope with it!
It's embarrassing, it snows a bit and there's no flights in or out of the UK for days, the roads are closed off, the buses empty they're passengers and the trains all stop..

Ridiculous...

If anyone in London wants a sitter...

I really struggled finding a UK provider, so I ended up doing it at home with my partner as a sitter...

Providing you pass the medical questions and obtain the Ibogaine yourself im happy to sit for you..

Im no expert but after having gone through it twice and researching it for years I know a fair bit about using it.


So.. apply within, or ask a question :)

UK Heroin Drought Drags On!

And the drought continues!

I've never known it this bad in fifteen odd years!

A Europe-wide heroin drought is affecting thousands of junkies everywhere!

I, along with the rest of the UK have struggled to find anything for the past month or so.

Is this a good thing? Well no if you have a habit! I've read stories of people giving opiate negative urine tests!
People are in effect withdrawing and cleaning up without knowing it!

Although it's shit, this may actually be the kick up the ass some people need to clean up!
Obviously having the choice taken away isn't nice, but it means addicts up and down the country are finding themselves without tolerance/habits!

The drug services and GP surgeries must be over-run with people trying to get scripted..
Unfortunately there's no standard way of doing things here (in the UK), last time I got a methadone script from a DDU, I had to jump through so many bloody hoops I almost gave up!....

See this counsellor, see your GP with the counsellors letter, your only allowed 30mls and will titrate over a few weeks if your sick (which obviously you are)

I mean im not complaining, if we think we have it hard, try being a junkie in America! Not only do you have to provide clean samples and see counsellors you have to pay for it, AND everything's recorded, so once youv'e recieved any kind of narcotic your forever marked as an addict!

Back in the 80s here all addicts were 'home office registered', and although they now say your personal details aren't used for anything here they obviously are!

On another note, in my experience,  addicts are some of the most sensitive, screwed up, self deprecating individuals you would ever meet, I know I internalise all my shit, and always have, I was sexually abused at a young age and never really dealt with it.. I ended up falling into drugs and by seventeen was determined to get myself a habit.. I mean, wow.. what an amazing feeling heroin gives you, I wasn't depressed for the first time in my life!

How could I not use this drug to hide from the crap in my head!?

Why can the government not give me the dignity of a regular supply of clean, safe, opiates?

I've seen it from both sides, when I cleaned up the first time properly, at 26, I took a degree in counselling and psychotherapy, I had to give it up though as I relapsed and couldn't justify working as a drug counsellor while using! (although many in serious denial do)

Anyway, signing off for the night, some useful/interesting links below



http://gledwood2.blogspot.com/2010/11/heroin-drought-uk-2010-life-goes-on.html

http://www.bluelight.ru/vb/showthread.php?t=538306

http://www.guardian.co.uk/society/2010/nov/21/heroin-shortage-uk-overdose-users