Drug Treatment Failing Patients……

26 Jul

There exists a large number of patients for whom drug treatment is failing to deliver results, both in terms of achieving abstinence and reducing the harm being caused to the individual and the wider community.  The statistics published by the National Drug Treatment Monitoring System (NDTMS) are not only inherently difficult to understand due to the way in which groups are subdivided but also offer no insight into the damage caused to the individuals within certain groups by the ineffective treatment they receive.  The statistics focus mainly on the numbers of patients engaging with services and those discharged or who leave.  Little, if any, consideration is given and no solution proposed for the group who have been in treatment for extended periods of time or to the damaging effect it is having on them.  The recent reorganisation of services and the different agencies engaged to deliver them will only further complicate the reporting of the results.


The NDTMS statistics for 2010 – 2011 show a total of 39,725 patients who have engaged in treatment and been in receipt of prescribed medication for over 4 years.  This represents more than 25% of the total for whom treatment is demonstrably ineffective.


How this Failure is Affecting Those Involved…..?


The impact on individuals, their families and the community can be wide reaching and devastating for all affected.  The impact on the health of the patients can be irreversible.  Patients may be placed at risk of overdose or contracting Hepatitis C, HIV and other infections from using unsterilised equipment.  They are also at risk from the agents used by unscrupulous dealers to ‘cut’ drugs in order to increase weight and therefore profits.  Users sometimes re-use equipment through lack of access to clean ‘works’.  Many users experience weight loss as a result of having insufficient funds to maintain a healthy diet.  The general ill health of users can result in a suppressed immune system leaving them susceptible to infections.  The social impact of long term drug use can have many consequences for the patient, their families and wider society.  Maintaining stable housing can prove difficult leaving some users homeless, making access to General Practitioners difficult, which invariably leads to further deterioration in mental and physical health.  Criminality often results as users turn to crime to fund their habits and family relationships breakdown making it hard for users to maintain contact with their children.  Overall, the failure of drug and alcohol services to properly address these issues with the tools at their disposal is having a hugely detrimental effect on the physical and mental health of patients, many of who feel despondent, badly let down and in some cases suicidal.  Addiction is a disease and given the right treatment can be successfully addressed.


The Failing Model…..


The guidelines for the treatment of opiate addiction are clearly set out.  Once a patient is referred to drug and alcohol services an assessment is carried out.  The ‘first-line’ treatment is by using psycho-social intervention, usually delivered by a key worker, with the substitute prescribing of either Methadone or Buprenorphine given at an optimised dosage in an attempt to reach abstinence from the use of illicit drugs.  Statistically, this appears to work in 75% of cases.  However, in the remaining 25% of cases where the patient does not respond a more structured form of psycho-social intervention may be required, especially when co-morbidity is a factor.  Along side this, a clearly defined prescribing regime is set out in the guidelines.  This involves the prescribing of Dia-Morphine under close monitoring of the prescribing doctor.  In practice this does not happen despite the clear failing of prior interventions.  As provisions for this are clearly laid down in the guidelines, one has to ask the question why these are not followed.


Evidence Based Medicine……


In numerous peer reviewed scientific studies, the prescribing of Dia-Morphine to treatment resistant users, has proven to be between 88-94% effective.  In conclusion to one of the largest studies published in the British Medical Journal (Van Der Brink – Volume 327 – August 2008) sited by 207 doctors, Dr. Van Der Brink states “Supervised co-prescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts.”  The RIOTT trials undertaken by Professor Strang at the Institute of Psychiatry produced similar results.


Given that evidence proves the effectiveness of prescribing an alternative to Methadone or Buprenorphine and, that the guidelines allow for this course of action, one has to ask why this approach is not being used by the agencies tasked with helping people who have been unable to tackle their problems using the ‘first-line’ interventions.  It appears prima facia that a structural hierarchy does exist, contrary to the principals issued by the NTA and NICE which state that decisions regarding treatment should be taken on an individual basis.  In practice this does not happen as can be demonstrated statistically.


The Solution……


To mount an effective challenge to the structural hierarchy will take more than one individuals effort.  To do this we will be collecting questionnaires from long term treatment users who have experienced the same treatment and offered nothing other than the status quo.  The defence that the treatment is not offered on the grounds of cost does not stand up in light of the fact that length of the existing treatment can be shown to be more expensive.  As studies have shown the treatment is no more inherently dangerous than current treatment and, proves effective therein negating the mental and social damage being caused by the status quo.


We need to compile enough first hand experiences of service users to show the ineffectiveness of the treatments currently being offered and demonstrate the stonewalling of requests for other established treatments.  We will then be able to demonstrate the second rate treatment we receive and the failure of services to follow their own guidelines, through a petition to the European Court of Human Rights if necessary……


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