Cameron and drugs

The Guardian newspaper at the weekend produced an article entitled “David Cameron shifts drug addicts treatment to live-in schemes” which stated that the Prime Minister has requested a revised drug policy to be in place by the end of the year.

They report that in PM Direct debate this week David Cameron stated…

“The last government became too target obsessed. It was all about how many addicts are in touch with treatment agencies, and this, in too many cases, really meant the addict was talking to someone and maybe getting some methadone, which is a government authorised form of opium, rather than heroin. It did not really address the problem – that [the addict] had a drug habit.

“I would like to … try to provide – difficult though it will be given the shortage of money we have been left – more residential treatment programmes. In the end, the way you get drug addicts clean is by getting them off drugs altogether, challenging their addiction rather than just replacing one opiate with another.”

I thoroughly agree with Mr Cameron that the last government was totally target obsessed, something that I have blogged about in the past, but I cannot agree with the idea that we need to promote residential rehabilitation over substitute prescribing. We also aren’t very good about moving people through the treatment system and pursuing abstinence. However, it is not quite as straightforward as Mr Cameron would like it to seem.

Dealing with addicts is a tricky business at times. They are often very opinionated about the type of treatment they would like to have, they can be difficult to engage and they are often very resilient. As individuals they can be extremely challenging, which in a weird way is one of the joys of working with them.

There are several difficulties with promoting residential rehabilitation as the primary form of treatment.

1) The cost. A stay in residential rehabilitation will cost approximately £8000 – £12000 for a 6 month stay, and that is a conservative costing. In 2008 the National Treatment Outcome Research Study estimated that methadone would cost on average £55 per person per week. A cost of £2,860 per person per year. Whilst we may not always like it, substitute prescribing is far cheaper than residential treatment.

2) The readiness of the client. When I used to send people to residential rehab I had to do loads of preparation work with them. We had to consider whether they were suitable for inpatient treatment and what might be the right resource for them. We expected them to be stable in treatment and engaging in group work in the community. In reality, not every client is ready to go to rehab. They need to find the point when they are prepared, physically and emotionally, to enter ongoing long term treatment. For some people this will never happen.

3) Maintenance treatment reduces crime. People who are maintained on methadone need to engage in less (ideally no) criminal activity to fund their habit. This benefits the wider community.

4) Maintenance treatment improves healthcare in patients. If individuals no longer have to engage in unsafe injecting practices they are less likely to be hospitalised with major illnesses and injuries caused by illicit drugs use. This could be anything from overdose to DVT’s to falling off a bridge whilst under the influence etc.

These are just a few issues related to the maintenance in the community vs. residential rehabilitation debate. However, I feel I should add a caveat to this. My comments here might lead some people to think that I would rather see people opiate dependent than becoming drug-free. This is categorically untrue. One of the biggest pleasures I had was seeing people progress through rehab and become drug free. Those people undoubtedly had the best chance of achieving lifelong, sustainable change and being able to be a fully functioning member of society. However, I also had to recognise that some people just were not in the place to be able to make those changes. They hadn’t reached the stage in their lives where they were able to consider a life without drugs.

To quote David Cameron again when he said

“It was all about how many addicts are in touch with treatment agencies, and this, in too many cases, really meant the addict was talking to someone and maybe getting some methadone, which is a government authorised form of opium, rather than heroin. It did not really address the problem – that [the addict] had a drug habit.”

If the government want to invest in making positive changes to drug treatment then they should be providing the funding for services to be able to train their drug and alcohol workers to make them highly professional and specialised workers. It is almost impossible to underestimate what a difference a really fantastic worker can make to the client. That therapeutic relationship can really lead to change, whether it be motivational work in order to help people progress onto more intensive treatment, or whether they are discussing harm minimisation practices. A good drug worker is part of the journey, they are not just “someone to talk to”; they are treatment in and of themselves.

Anyway, I don’t know what I am ranting about this. They are going to reduce investment in drug treatment in 2012 so there will probably be no changes anyway!

2 thoughts on “Cameron and drugs

  1. I would have to disagree with you on several points, Auntie.

    It seems that you are insinuating that those on methadone are somehow prevented from living as a “fully functioning member of society” and are somehow dangling around the fringes unable to quite let go of their crutch, so to speak.

    Would you feel similarly about diabetics who continue with insulin use instead of becoming “drug free”? What about schizophrenics, depressives, or bipolar patients who take ongoing daily meds?

    Opioid addiction often results in permanent chemical changes to the brain. In many cases, the brain is no longer able to produce natural opiates (endorphins). This means that, when they become abstinent, the patient experiences severe depression, anhedonia (inability to feel pleasure or happiness), extreme irritability, physical exhaustion, and anxiety. Most patients can not bear this extreme misery very long, and this lies behind many of the cases of repeated relapse that we see in this population.

    No amount of counseling, therapy, meetings, etc can correct this–it MUST be addressed medically. This is where methadone comes in. Methadone replaces NOT the drug of abuse, as so many believe, but the missing endorphins no longer being made by the brain. It works in the same way that insulin replaces the insulin no longer being made by the diabetic pancreas. It also works in the same way that anti depressants, anti psychotics, and mood stabilizers work for other patients with disorders of the brain chemistry. It serves to adjust the brain chemistry to a state more close to normal, so that the patient can FEEL normal and can be a functioning and productive member of society.

    Methadone does NOT cause any high or euphoria in stable patients. They merely feel normal.

    As with other medications taken for chronic, incurable diseases of the mind and body, methadone does not cure the illness–it merely controls the symptoms, allowing them to resume their lives. We don’t urge and encourage them to stop their medication, because we know that if we do, the chances are enormous that their active disease will return. Yet with methadone, patients are constantly beset with family, friends, politicians, employers, law enforcement, and even medical workers urging them to discontinue this highly effective treatment.

    When MMT is properly administered, in adequate doses (a big problem in the UK where the average dose is less than half of the minimum dose required by most patients), patients can be restored to a VERY highly functional life.

    You made this statement:

    ” One of the biggest pleasures I had was seeing people progress through rehab and become drug free. Those people undoubtedly had the best chance of achieving lifelong, sustainable change and being able to be a fully functioning member of society.”

    But this is NOT the case. In fact, those people LEAVING MMT stood the best chance of relapsing into active addiction, at a rate of 90% within the first year. ANd those who go through standard, abstinence based rehab instead of MMT have an abysmal success rate as well–around 10% for those with chronic opioid addiction, and perhaps around 30% for those with other addictions.

    Methadone is not, as even some who approve of Harm Reduction seem to feel, a lure to get patients into “real” treatment (i.e., counseling) to discover the “roots” of their addiction. In fact, many people become addicted to opioids simply because they are trying to self medicate a natural deficiency of endorphins. If you ask opioid addicts, you will often hear them say that they felt “normal” for the first time in their lives when they took an opiate–that it gave them energy, that they felt patient, tolerant, more interested in their lives and surroundings, more “open”, etc–while most normal people will simply say that it made them feel a bit drowsy and maybe nauseated and that’s about it.

    So, when these folks are properly treated for their brain chemistry disorder, many of them will simply return to the life they were raised to live without need of extended counseling or therapy. Others may require assistance to get their lives back in order.

    In closing, I want to say that I am a methadone patient. I am also a college graduate, I have a degree in professional nursing. I have a full time, white collar job in another field. I am married, own my home, and have three children. I do a lot of volunteer work, help out at school and church, and sit on several boards. I run two websites for MMT patients. I have been on MMT for 6 years and I plan to remain on it.

    I spent twenty years being addicted to Rx opiates and bouncing from rehab to rehab–13 in all–without success. Only when I found MMT did my life turn around. I don’t feel that my recovery is in any way “less than” that of someone who is abstinent from medication–and that’s what methadone should be thought of as–not a “drug”, but a prescription medication that treats both pain and endorphin deficiency caused by opioid abuse–a medication that saves lives.

  2. Zenith, thank you for taking the time to send such a helpful comment. I agree with you, in many different ways, but I am not sure I have time this morning to respond to all your points before I go to work.

    I certainly think that long-term methadone has it’s place, for some people, but for others it is simply another form of abuse and ‘topping up’ illicit drugs with licit. I would still rather we had the option of methadone maintenance therapy (MMT) than we didn’t. I don’t particularly have an issues with people who are on long-term therapeutic doses, if they are able to function in other areas of their lives and be productive, work, have a family etc etc.

    The clients that I work with aren’t stable. The majority are on methadone doses of 80mls plus and the need to engage the in treatment is crucial. They are not in your situation of being stable and being able to work. The majority of them are not even housed.

    Let’s me quite clear tho. It is possible that I haven’t put myself across clearly. David Cameron wishes to reduce access to MMT.. in particular long-term therapeutic dosing. This blog post was not so much about rehab, but more about the fact that we actually need choices in treatment whether they be residential or community based treatment.

    Treatment without any choice is doomed to be unsuccessful.

Comments are closed.