So, here are my thoughts on how a drug service should be run....
The service should be based around these core principles:
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:
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...
The service should be based around these core principles:
- Harm Minimisation
- Appropriate Opiate Substitution Prescribing & Maintenance
- Detoxification & Abstinence
- A Client Centred Approach
- Relapse Prevention
- 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'
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...
