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Drugs Don’t Kill People – Policies Do……

19 Dec

‘I was waiting in the reception area of the local Addaction clinic and thumbed through some of their leaflets to kill some time and noticed  advice given out only confirms the case for alternative approaches to treatment.’

 

The Leaflet in Question……

The leaflet was titled ‘Heroin – Essential Information about Heroin, What it is, how it is used and its Effects’.  It gives basic information about what Heroin is derived from, how and why people use it, details about how addictive it can be, health hazards, withdrawal and getting help……

A Couple of Pieces of Information Caught my Attention……

First:  Health Hazards – This is verbatim what the leaflet states:

‘Frequent injecting [of Heroin] can lead to a variety of problems; such as Thrombosis and blocked veins.  If you share or borrow injecting equipment (including needles, syringes and spoons), you run the risk of becoming infected with a number of blood borne viruses, such as Hepatitis C or HIV.

It is easy to overdose on Heroin, such as when the drug being used is unusually pure – or when it is being used with other drugs.  Most overdoses occur when the user has been abstinent for some time, and then injected their ‘usual’ dose.  Because it is often mixed with other substances, it is difficult for a user to know how much Heroin they are taking and, therefore, the risk of them overdosing is increased.

The substances mixed into the Heroin can cause health problems themselves, for example; powdered baby milk can thicken in your veins which, in turn, can lead to circulatory problems and even loss of limbs.  Others can cause Heart diseases, blood poisoning and lung disorders.’

Second:  Getting Help – Again, this is verbatim what the leaflet states:

‘If you want to stop you don’t have to do it on your own.  Asking for help from a drug worker is the first positive step you can take.

Addaction’s services are completely free and confidential.  We can help you find substitute medication (such as Methadone or Subutex) and work with you in managing your withdrawal.  Many of our services also have needle exchanges where you can get sterile injecting equipment, and return used equipment.’

Health Hazards……

There is nothing within the information offered which is untrue.  However, they highlight the very issues which an alternative approach to treatment could greatly reduce harm and the very same issues which have been addresses in the numerous consultations undertaken by Professor David Nutt, the former chairman of the Government’s Advisory Council on the Misuse of Drugs, and Professor John Strang the head of the National Treatment Agency at Kings College, London.  Both have advocated the use of Dia-Morphine in the treatment of Heroin addiction and which have been demonstrated to be more effective for compliance, negating the dangers highlighted in Addaction’s literature……

Getting Help……

There is nothing inherently incorrect in the ‘Getting Help’ section.  The services are indeed free and confidential to a point.  With regard to confidentiality, service users are asked to complete a Treatment Outcomes Profile sheet.  In my experience, anecdotally, service users are not aware of the purpose of this form.  It asks a variety of questions regarding a patient’s mood, the amount they have used and even if they have committed any crimes to fund their usage.  However, this form has no bearing on any future treatment nor is it used to evaluate the current treatment.  It is used to collate statistics by the Government.  If a patient was told with whom this information would be shared, they may reconsider their answers and even their willingness to fill in the form.

Another statement which is somewhat disingenuous is that an alternative medication can be found ‘such as Methadone or Subutex’.  Although there are many different medications which can be used, Methadone and Subutex are the only choices offered, even though the clinical guidelines allow for other substitutes; the same substitutes recommended by Professor Nutt, Professor Strang and cited in many other peer reviewed scientific trials……

The Aims of Drug and Alcohol Services……

The aims of drug and alcohol services are to reduce the harm caused to users and attempt to help them achieve abstinence.  The peer reviewed scientific studies referred to above demonstrate that there are much more effective ways of achieving these goals.  However, as I wrote about in ‘The War on Drugs’, it is the political stonewalling of the advice they contain which is causing the most harm to those involved in the war on drugs……

‘I was waiting in the reception area of the local Addaction clinic and thumbed through some of their leaflets to kill some time and noticed  advice given out only confirms the case for alternative approaches to treatment.’

 

The Leaflet in Question……

The leaflet was titled ‘Heroin – Essential Information about Heroin, What it is, how it is used and its Effects’.  It gives basic information about what Heroin is derived from, how and why people use it, details about how addictive it can be, health hazards, withdrawal and getting help……

A Couple of Pieces of Information Caught my Attention……

First:  Health Hazards – This is verbatim what the leaflet states:

‘Frequent injecting [of Heroin] can lead to a variety of problems; such as Thrombosis and blocked veins.  If you share or borrow injecting equipment (including needles, syringes and spoons), you run the risk of becoming infected with a number of blood borne viruses, such as Hepatitis C or HIV.

It is easy to overdose on Heroin, such as when the drug being used is unusually pure – or when it is being used with other drugs.  Most overdoses occur when the user has been abstinent for some time, and then injected their ‘usual’ dose.  Because it is often mixed with other substances, it is difficult for a user to know how much Heroin they are taking and, therefore, the risk of them overdosing is increased.

The substances mixed into the Heroin can cause health problems themselves, for example; powdered baby milk can thicken in your veins which, in turn, can lead to circulatory problems and even loss of limbs.  Others can cause Heart diseases, blood poisoning and lung disorders.’

Second:  Getting Help – Again, this is verbatim what the leaflet states:

‘If you want to stop you don’t have to do it on your own.  Asking for help from a drug worker is the first positive step you can take.

Addaction’s services are completely free and confidential.  We can help you find substitute medication (such as Methadone or Subutex) and work with you in managing your withdrawal.  Many of our services also have needle exchanges where you can get sterile injecting equipment, and return used equipment.’

Health Hazards……

There is nothing within the information offered which is untrue.  However, they highlight the very issues which an alternative approach to treatment could greatly reduce harm and the very same issues which have been addresses in the numerous consultations undertaken by Professor David Nutt, the former chairman of the Government’s Advisory Council on the Misuse of Drugs, and Professor John Strang the head of the National Treatment Agency at Kings College, London.  Both have advocated the use of Dia-Morphine in the treatment of Heroin addiction and which have been demonstrated to be more effective for compliance, negating the dangers highlighted in Addaction’s literature……

Getting Help……

There is nothing inherently incorrect in the ‘Getting Help’ section.  The services are indeed free and confidential to a point.  With regard to confidentiality, service users are asked to complete a Treatment Outcomes Profile sheet.  In my experience, anecdotally, service users are not aware of the purpose of this form.  It asks a variety of questions regarding a patient’s mood, the amount they have used and even if they have committed any crimes to fund their usage.  However, this form has no bearing on any future treatment nor is it used to evaluate the current treatment.  It is used to collate statistics by the Government.  If a patient was told with whom this information would be shared, they may reconsider their answers and even their willingness to fill in the form.

Another statement which is somewhat disingenuous is that an alternative medication can be found ‘such as Methadone or Subutex’.  Although there are many different medications which can be used, Methadone and Subutex are the only choices offered, even though the clinical guidelines allow for other substitutes; the same substitutes recommended by Professor Nutt, Professor Strang and cited in many other peer reviewed scientific trials……

The Aims of Drug and Alcohol Services……

The aims of drug and alcohol services are to reduce the harm caused to users and attempt to help them achieve abstinence.  The peer reviewed scientific studies referred to above demonstrate that there are much more effective ways of achieving these goals.  However, as I wrote about in ‘The War on Drugs’, it is the political stonewalling of the advice they contain which is causing the most harm to those involved in the war on drugs……

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The War on Drugs……

18 Dec

‘As the subject of tackling substance misuse and addiction has been raised again within the hallowed walls of Westminster, I felt now was a good time to look again at the issues which affect us all as citizens and tax payers’

 

Fighting a Loosing Battle……

 

As a society we are loosing the ‘war on drugs’.  We have been consistently loosing the ‘war on drugs’ since the 1960’s.  The affect on drug users, their families, the criminal justice system, the National Health Service and society in general is measurably damaging.  But, we are not loosing the war due to lack of ‘ammunition’ as it were, rather, the policies and approaches to dealing with the problem, which despite the advice given to government by the professionals specialising in addiction, have remained largely the unchained……Drugs and drug paraphernalia

 

Statistics in Isolation…….

 

The statistical data pertaining to drug misuse and the affects on society as a whole is disjointed and taken in isolation.  The criminal justice system can offer statistics relating to the number of crimes linked to drug use.  The commercial sector can provide figures for theft of goods and increased security costs.  The NHS can provide statistics for the costs of secondary treatment provided as a result of damage to health caused as a result of drug misuse.  What is not available are statistics of the causal effects of how one is linked to any of the others……

 

The Origins of Democracy …..

 

The word democracy is derived from ancient Greek:  ‘Demos’ meaning ‘the people’ and ‘Kratos’ meaning ‘power’.  The literal interpretation of ‘Democracy’ is the power of the people.  In ancient Greece this was seen as the fundamental way in which parliament operated; upon the power of the people……

 

Democracy in Practice……

 

Our democracy is far cry from its original meaning but it shouldn’t be.  The power, or opinions of the people, should still be exercised by governments they elect.  Furthermore, as it would be impossible to canvas the people on all issues of policy, we entrust the ‘will of the people’ to acknowledged experts in their fields and cross party select committees.  One only has to look at the House of Lords which, for all of its shortcomings, have some highly respected specialists chosen to add an unbiased and independent voice to political debates.  For example, Lord Robert Winston was chosen for his intimate knowledge on Embryonic Stem Cell research and reproductive medical issues.

 

There are however, some notable exceptions.  We have recently seen the complete disregard for the recommendations made by Lord Justice Leveson into the future regulation of the press.

 

Another hot potato is that of the recommendations made by those specialist charged advising the Government on substance misuse and addiction.  Professor David Nut is a specialist in Psychiatry, Neuropsychopharmacology and

Professor David Nutt

Professor David Nutt

addiction.  Professor Nutt was the Government’s chief drug advisor until he submitted advice which was not dissimilar to hundreds of other peer reviewed scientific studies into the treatment of substance misuse and addiction, recommending a radical change into the way in which services are delivered.  As Professor Nutt’s recommendations were diametrically opposed to the current legislative framework the Home Secretary asked for his resignation as the chair of the Advisory Council on the Misuse of Drugs.  The Home Secretary then appointed a chairperson who agreed wholeheartedly with current doctrine.  The potential benefits to all of society were stopped in their tracks by ‘democracy’……

 

‘In future blogs I will set out the ‘radical’ proposals put forward by Professor Nutt and site the numerous peer reviewed scientific studies which demonstrate a much more effective approach to dealing with substance misuse issues to the benefit to all parties affected.  Surprisingly, none of these suggestions require and change to legislation and are in fact laid down in the guidelines as the recommended course of action.’

 

 

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……