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Post-its
23 March 2009 |
drinkanddrugsnews
| 7
www.drinkanddrugsnews.com
Post-its from Practice
Playing safe
Don’t forget contraception when
starting treatment, says
Dr Chris Ford
Elizabeth walked into my room with a broad grin on her face
and said ‘I thought
I would help you this time!’ She went on to explain that she had decided to try
for her second child. We laughed, remembering the story of her first pregnancy.
Almost seven years ago, Elizabeth had arrived at the surgery in a terrible
mess. She was thin and drawn, had multiple new and old track marks and a large
abscess on her left arm. She was ‘Miss Angry’, and in a broad Dublin accent that I
struggled to understand, Elizabeth said that we had better help her or she would
be done for. She went on to say she was injecting two grams of heroin daily and
her source, her partner, had just been arrested, leaving her without money or
drugs. We treated the abscess and started her on methadone titration. Within six
weeks she described herself as a new woman. Elizabeth had put on about three-
quarters of a stone in weight, had stopped injecting and had settled well on
90mg of methadone.
Around this time, her partner Owen was released and also came to register,
being so impressed by the visible improvement in Elizabeth’s health. He likewise
settled into treatment and things progressed well. About three months later, one
of the receptionists casually asked me when Elizabeth’s baby was due.
I was dumbfounded – I hadn’t noticed and neither had Elizabeth! On arrival
she had been so unwell and underweight she hadn’t had a period for many years.
Then, on starting treatment, I had forgotten to offer contraception, which is a
must.
At her next attendance the pregnancy was confirmed and Elizabeth and
Owen were shocked but pleased. Charlotte was born six months later with mild
withdrawals for about ten days, but has not looked back since and is doing well
at the local school. Charlotte was meant to be and her parents are happy that
she came into their lives.
However this is not always the case. In order that women can make a choice,
they need to be advised about the return of, or increase in, their fertility and be
offered contraception at the same time as beginning treatment.
Any method of contraception is open to drug using women and over the years
women have used pills, injections, IUD and IUSs, implants and condoms. It’s good
practice for all women at the beginning of a relationship or change of partner to
use the method of their choice and condoms to help prevent sexually
transmitted infections. After the birth of Charlotte, Elizabeth had settled on an
IUD, which she now wanted removed.
I smiled as I sat and remembered the slogan from my favourite birthday card
from last year, which is still on my mantelpiece. It says ‘I’ve learnt so much from
my mistakes, I’m thinking of making a few more’!
Dr Chris Ford is a GP at Lonsdale Medical Centre and clinical director for SMMGP.
the truth is – we can! An addict on
methadone is, in the majority of cases,
unemployed and receiving job seekers’
allowance or unemployment benefit. He
is also likely to be receiving housing
support and children’s allowance, as
well as costing the community more in
policing, court time and health.
Addicts cost society billions, not only
because they cause the most accidents
at work and mug and rob old people, but
because addicts and drunks cause the
most road accidents, sell drugs to
children, increase the numbers of
prostitutes in our towns, disrupt our
schools, the education of our children
and the life of our communities,
because addicts bankrupt businesses
and destroy jobs, burgle people’s
homes, spread HIV, Aids and hepatitis
and waste our tax money and other
resources. Addicts and drunks also
commit the most crimes, and are
undoubtedly the real current threat to
our lives and to everybody’s future, and
this not only includes addicts on illegal
and licensed drugs but also those on
prescribed drugs.
With effective residential recovery
training at £97 a day for a 22-week
programme, we not only have them off
the street for five months, but
thereafter we also save billions per
year in taxpayer funded benefits.
When you add in the costs across
all government departments, you find
that less than three years’ worth of
methadone supplies and benefits will
pay for 18 to 26 weeks of effective
recovery training and a lifelong
abstinence result in over two-thirds of
cases.
In addition, a cured drug addict is a
productive citizen who is again able to
contribute to society and his family. So
I know where I’d like to see my tax
being spent – even though we know
that some addicts are bankers.
Kenneth Eckersley, CEO, Addiction
Recovery Training Services.
Dr Pharm-assist
As Dr Joss Bray is proposing to spend
even more of my taxes on supplying
provenly failed methadone to prisoners
(
DDN
, 9 March, page 9), I feel I should
remind him that when pharmacists
some 50 plus years ago persuaded
government to substitute methadone for
heroin, their main argument was that
methadone was a drug which enabled a
dose reduction programme to be
comfortably implemented in order to
bring those on a methadone script to
eventual, if not early, abstinence. In all
those years I have personally never met
a methadone addict who achieved
abstinence – not surprising now that we
know from Professor Neil McKeganey
and the NTA that less than 3 per cent of
such users ever stop. As a result we
should all rejoice that prisoners are on a
maximum dose of 40mg (and hopefully
supervised reduction) rather than on the
higher dosages proposed by this self-
styled substance misuse specialist. Or
should he adopt the more appropriate
title of: ‘tax misuse specialist’, or even
just straightforwardly: ‘drug-pusher’?
Elisabeth Reichert, school head.
Give peace a chance
I can’t help thinking that Derek Wilson
is being a little harsh on Geoffrey
McMullan and his nature awareness
therapy (
DDN
, 9 March, page 9). It’s
fair enough if he thinks there’s nothing
to nature awareness therapy – Geoffrey
McMullan is open about the fact most
people are cynical about it. But to call
the article ‘frankly insulting to those of
us who have spent many years offering
service users robust evidence-based
programmes’ seems somewhat over
the top.
It was clear that Geoffrey McMullan
was saying that nature awareness
could be used as a useful add-on for
some clients, to help them engage
more effectively in treatment. At no
point does he call it an alternative to
mainstream treatment, nor is he
asking for NTA money, as Derek Wilson
appears to be implying.
He’s helped some clients and
wanted to share his findings – where’s
the harm in that? And, as he’s the only
practitioner in the country carrying out
these interventions with this client
group, I don’t think he really poses too
much of a threat. I’d say the robust
evidence based programmes were
safe from being discarded in favour of
people pretending to be wolves for
quite a while yet.
Molly Cochrane, by email.