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drinkanddrugsnews
| December 2013
www.drinkanddrugsnews.com
LETTERS
LOSING THE PLOT
• ‘Personally I don’t think you should be
on methadone – it’s legal smack!’
• ‘Safer injecting information is just
enabling.’
Quotations from right-wing press or
substance misuse workers? Recovery
is a word that is used a lot, a word that
can inspire hope and positive change,
but increasingly it appears to be a word
that is losing its meaning. One certain
aspect of recovery is that one person’s
version may differ from another’s.
I’m witnessing an increasing amount
of evangelical approaches in frontline
working, which is capable of being mean
spirited and lacking in compassion or
understanding. Telling someone what
they ‘need to’, ‘have to’ or have ‘got to’
do is not person-centred. Sadder still is
that many adopting this style of working
are ex-users themselves.
I have been labelled ‘anti-recovery’
in the past; I’m not, but I am pro-
choice. Some might argue that addicts
do not have the capability to make
choices of their own, not good ones
anyway. I’m not sure – and I’m also not
sure if there is anything entirely ‘wrong’
with making the ‘wrong choice’. Surely
we have the capacity to learn from our
errors and are empowered by doing so.
Having previously felt like some sort
of pariah when airing my concerns, it
often makes me wonder how it feels
for our most marginalised service
users who just ‘don’t get it’ when it
comes to embracing recovery. I doubt
being told what to do adds much value
to their often-damaged existence.
The recovery agenda has been
penned by a government that does not
care about vulnerable and marginalised
people and it is naive to think
otherwise. If recovery is a journey, then
we must not lose sight of where
someone is on their journey and what it
means to them, if anything at all.
A Hindu swami once told me that
there are hundreds of ways to reach
the summit of a mountain; each path
will let us admire the view. We may
stumble along the way, we may stop on
a ledge for some time and build a fire
for warmth and comfort. These ledges
may indeed be a summit enough for
some. We were not discussing recovery
but I think his words can still apply.
Jesse Fayle, DIP practitioner
CLEAR EVIDENCE
Malcolm Clayton responded to my
Soapbox article in October’s
DDN
on
whether the drug laws are having an
adverse impact on recovery by wondering
where ‘the faith in the criminal justice
system to reduce the availability and
accessibility comes from.’ (
DDN
,
November, page 10).
In a recent review of recovery in the
Annual Review of Clinical Psychology
(
‘Quitting drugs: quantitative and
qualitative features’
, 2013), G Heyman
found that while drug dependency is
often characterised as a chronic
relapsing condition, in fact recovery was
commonplace. In one of the reviewed
studies, for example, Lopez-Quintero et al
(
‘Probability and predictors of remission
from life-time nicotine, alcohol, cannabis
or cocaine dependence’
,
Addiction
, 2011)
found that of those addicted to cocaine,
27 per cent had stopped using the drug
after two years, 51 per cent had stopped
after four years, and 76 per cent had
stopped after nine years.
According to Heyman, ‘The strongest
correlate of remission was legal status.
For instance, the half-life of alcohol
dependence was about four times longer
than the half-life of cocaine dependence
(16 and four years, respectively). The
simplest explanation of this difference is
that alcohol is legal and therefore more
available.’
Within the addictions field we often
prefer our personal views and experiences
over the evidence. In this case however,
the evidence does appear to show that
there is a beneficial impact upon recovery
from the fact that some drugs are illegal.
Neil McKeganey Ph.D, director, Centre
for Drug Misuse Research
NOT SO SMART
I run Alcohol Support Project East
Yorkshire (ASPrEY) and we have two
groups, one in Bridlington and one in
Beverley. We use the SMART Recovery
process – I have completed their
facilitator course and our meetings are
published on their website. We engage
with the NHS who advise their patients
when they finish the Hull and East
Yorkshire Alcohol withdrawal programme
to get in touch with us for ongoing
support.
The local authority (East Riding of
Yorkshire Council), which is now respon-
Every step
We have a duty of care – from the
recovery position to the recovery journey,
says
Dr Steve Brinksman
If you have read this column before
, you
will know that I am always keen to
promote recovery, defined by the
individual in respect of their own journey
and not from a political or ideological
concept. That said I am reasonably long in
the tooth and, having worked with people
who use heroin for 20 years, I am well
versed in the concepts of harm
minimisation. The truism ‘dead people
don’t recover’ springs to mind. Harm
reduction is the solid foundation on which
we can build future recovery.
With this in mind, the treatment system I operate within in
Birmingham has now started actively encouraging service users to
undergo training in the administration of naloxone for the treatment of
suspected opioid overdose, alongside placing the person in the recovery
position and calling an ambulance. I have been told that ‘people in
treatment shouldn’t need prescriptions for naloxone’, yet I have come
across people in treatment who have used naloxone to reverse overdose
in people outside of the treatment system, and I am sure we would all
accept that, despite people’s best intentions, use on top of a script
occurs. There have been enough uses of naloxone in Birmingham for me
to be confident that there are people alive today who would not have
been were it not for the availability of naloxone.
To back this up there is growing evidence from around the world that
it is not only clinically effective, but that it can be safely administered by
peers and reduce overdose deaths. Our service users have embraced this,
but in a system with a large number of GPs operating in a community
setting, it is proving more of a stumbling block to get these clinicians
involved, a vital step if prescriptions are to be issued. Talking to
colleagues around the UK shows that we are not alone in this.
There are a number of ways to try and address this. The National
Treatment Agency [NTA] supported a number of pilot sites and in 2011
produced a report recommending it –
The NTA overdose and naloxone
training programme for families and carers
,
http://bit.ly/1cz0r99
The Medicines and Healthcare products Regulatory Agency (MHRA)
has just announced a consultation on a proposal to allow wider access
to naloxone for the purpose of saving life in an emergency. The
consultation runs until 7 February 2014 and is available online at
http://bit.ly/1aRGS9b
At SMMGP we recognise that lack of knowledge and training are
significant factors that hold clinicians back from adopting new
treatment approaches, and so we have committed to developing a free
to access e-module that will cover the rationale behind naloxone
prescribing as well as the practical aspects.
We also need those of you who work with clinicians, those who
commission services and those who provide education to recommend
the prescribing of naloxone. Drug-related deaths from overdose remain
a significant problem and I believe a widespread roll-out of naloxone
could significantly reduce this. We have as much a duty of care to people
who use, as we do to those at any stage of their recovery.
Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP.
www.smmgp.org.uk. He is also the RCGP regional lead in substance
misuse for the West Midlands
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