Tag Archives: drugs

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!

Ketamine

Now most people who read this blog will be well aware that I work for a drug treatment agency as a social worker. The majority of the work that I do is around prescribing alternative medication for those people who are opiate dependent drugs users. For example, dishing out methadone, Subutex, or more latterly Suboxone to heroin addicts. I also work with crack cocaine users with multiple problems and have a special interest in working with pregnant women who use drugs and alcohol.

Anyway, this week has kind of been fascinating, and exhausting in equal measures. Not only have we had three staff members off sick, but we have also been very busy, but I have also received a couple of really interesting referrals. The majority of our referrals are quite straightforward, with a large proportion of clients having additional problems such as homelessness, physical and mental health problems and child protection and/or childcare issues. However, in the last two weeks we have received two referrals for young men in their early twenties who are using vast quantities of ketamine. They were both well educated, in fact one had just completed a degree in chemistry with strong family support and yet they were both using this vile drug.

Ketamine is a dissociative anaesthetic and is generally used in veterinary operations, but occasionally in human surgery too. It is a brilliant pain-reliever but in large quantities sends people into something called a K-hole which is when they feel like they are having an out-of-the-body experience. It is really unusual for us to see ketamine users, let alone ones that are still quite young and very few people come to us with it as their primary drug of choice.

Anyway, I am not really going anywhere with this other than to so DON’T EVER TRY IT! The dissociative effect along with the anaelgesic effect can mean that you can injure yourself and not know about it until sometime later. Grim… grim and grim again.

Interesting what people will use though isn’t it?

Coroner’s court

Today I was summoned to appear at Coroner’s Court regarding the death of one of my clients. Death seems to be one of the hazards of working with clients who misuse drugs and alcohol and yet this case was especially sad as I had worked with him for over 4 years and he was one of my favourite clients. Also I found him dead at home which was hard.

I was absolutely bricking it at having to attend court today, but it actually turned out to be a surprisingly good experience. For a start the coroner was intent on establishing an accurate cause of death, and so we went through all the evidence. I was called first as a witness and I was surprised to be asked about my relationship with the client, what he was like as a person. It all seemed so personal and I was able to explain to work that I did, but more to the point the fact that I really cared about what happened to my client. Anyway, it all turned out as well as could be expected and the coroner determined that the death was due to natural causes.

One of the hardest bits though was facing the family who I know quite well. I was really aware that this was an important procedure for them, and I desperately wanted it to be as positive as possible to ensure that they were able to move on. In the end it seems that this is a possibility for them and I was pleased with the outcome. It was also reassuring to have the coroner call my work ‘exemplary’ and for him to credit me me on both my compassion and my professionalism. Whilst I don’t do this job for the credit or the thanks, it is wonderful to receive praise in such difficult circumstances.

Drug Strategy frustrations

Today I have been at a conference about the new Drug Strategy 2008. Today I have been blinded with science and statistics and I have come away thinking that every single one of the people who were up the front speaking wouldn’t know a drug user if they robbed their handbag.

Now, here is the thing that has really frustrated me. The new strategy talks a lot about reducing harm to families and to children and young people, whether they be using drugs and/or alcohol themselves or whether a family member is a user. However, as part of a treatment service we are forced to engage in a ridiculous game known as National Treatment Agency Targets. Every single one of these targets is about waiting times and retention. Not one of them is about client care, outcomes or family and systemic work. So, the fact that about 80% of the work that I do is with families, pregnant women and more general work around psycho-social interventions does not count. Not one minute of this work goes towards the so-called targets that I am meant to meet.

What really, really hacks me off is that we know that merely prescribing a pharmaceutical intervention to someone is not enough. If they are homeless, have no benefits and are therefore offending to fund their habit, lonely, dirty, poorly and have children in and out of the care system, how on earth is giving them methadone or Subutex actually going to make a big difference to their lives? They need someone to help them through the issues, to give them the confidence and ability to rebuild their shattered lives and support them to make positive sustained change.

But no. None of this makes a difference and none of this counts as it does not fit into the aforementioned bastard targets.

I dream that one day the policy makers would come and sit in a client session with me. That they would look into the eyes of the individual sitting in front of them and see the years of pain and abuse that clients go through until they end up in my counselling room. Then, just maybe, we would start to make progress. Then we might have policies and targets that mean something, both to the clients and the workers. Until then however, I am a paper-pusher who has to get in at 7.30am just to do my paperwork and statistics so that my client work isn’t affected by it all.

No wonder I am so knackered.

Crystal meth

I have had a very interesting day. I have been on a course about methamphetamine and amphetamine (or methamfetamine/amfetamine if you are being picky).

It was full of information that I didn’t know before and I learnt lots of useful things, like how to manufacture crystal meth, how to use it, how much I should be selling it for and the ways I might die from using it. Nice.