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A responsive approach is as important as the right medicine, says Dr Steve Brinksman

Iwas recently involved in training shared-care GPs in Worcestershire. They wanted me to cover addiction to medicines, which fitted in with me having recently seen a young man at our practice with a dependency on overthe-counter medication.

Craig is 32, has a stressful job in IT and also has inflammatory bowel disease, which has been difficult to control and frequently flares up. He had been to the practice on three occasions in the past two months, complaining of low mood and stress and had been started on antidepressants. I was reviewing him about this and he told me he didn’ t think they were working and his bowel disease was much worse. As we started to explore this, he broke down and told me he had been buying painkillers from the pharmacy and over the internet, and was taking many more than the recommended dose.

He hadn’ t told anyone this, not even his wife, and he felt it had become a significant factor in his low mood and anxiety. He had started buying Nurofen Plus to deal with the pain from his bowels, but had soon found they helped him feel less stressed and so he carried on taking them even after his bowels settled. At the time I saw him he was taking 24 a day – he felt unwell if he stopped them and was very keen to try and do a managed withdrawal. After discussing the options he decided he wanted to use codeine [ the opioid in Nurofen Plus ] to gradually reduce, as he felt the use of methadone or buprenorphine would stigmatise him as a drug user to the pharmacist.

Things went well for the first few weeks and we reduced

‘ our job is to facilitate treat- ment not impose it... we can build the effective thera peutic relationships necessary to engender long term change.’

his dose by about a third, but then he started buying additional medication again. Acknowledging his desire not to feel stigmatised, I explained how it can be difficult to reduce using the drug that causes the dependency, as he had already developed a response to stress by using more. He agreed we should try and stabilise him on OST, then do a managed withdrawal, so a buprenorphine prescription was initiated and he stabilised on a 6mg dose. He agreed to contact our local IAPT [ improving access to psychological treatment ] service and over three months we were able to reduce, then finally stop, his medication.

Craig is doing well, however his bowel disease still causes flare-ups and he remains concerned that he could relapse. I have told him that we can review him regularly and if he does have a further problem, we want to engage with him as soon as possible.

Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP, www. smmgp. org. uk

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The news, and the skews, in the national media

WHAT WAS GOING THROUGH SALMAN ABEDI’ S MIND when he made that journey to Manchester Arena on Monday night?... Was he a psychopath? Was he evil? I do not know the answer but I do know, as the Mail reports today, that according to his friends Abedi was	a frequent and heavy cannabis smoker … For too long, we have ignored the terrible toll of this drug. Too many people have dismissed cannabis as harmless – something to help you relax and chill – and that an individual should be free to buy and use as they choose. Now, more than ever, we need to wake up to a pernicious substance that ruins not just the lives of those that take it, but countless others around them in ways we might never have imagined. Max Pemberton, Mail, 24 May MAY’ S FANATICAL AVERSION TO DRUG REFORM typifies the‘ nasty’ side of her state, an authoritarian nation, illiberal and ruled by alien hobgoblins and pre-	judic es. In the past decade the 1971 Act has criminalised almost a million young Britons, ruining their chances in life. It has crammed prisons with drug-related offences, more than ever before, and slashed the community treatment that is the norm across Europe. For what? So populist politi cians can posture against reason and common sense? Simon Jenkins, Guardian, 11 May DRUG LAWS GROW LAXER, in practice, every year. Personally, I think this is a grave mistake, just as the evidence comes pouring in that use of supposed- ly‘ soft’ cannabis is correlated with mental illness. But if we are to debate this matter seriously, those who call for weaker drug laws really must stop pre- tend ing the problems we have result from severe and stern enforcement, and the government must stop	pretending it is standing firm. The opposite is true. Our society is drenched in dangerous drug use because we no longer enforce our own laws. Peter Hitchens, Mail on Sunday, 7 May WE ARE WOEFULLY UNPREPARED to meet the needs of older people strugg- l ing with substance misuse. So what will happen in 2030, when members of Generation X – the twentysomethings who popped pills at warehouse raves in the 1990s – start to turn 65? Addiction in older age is not a problem that’ s going to go away. By 2030, nearly a quarter of the population in England will be over 65. That’ s around 12m people. We’ re sitting on a ticking time bomb, waiting for the inevitable fallout of each generation overindulging in its substance of choice. Tony Rao, Guardian, 6 May
www. drinkanddrugsnews. com			June 2017 \| drinkanddrugsnews \| 11

DDN June 2017 DDN July2017 | Page 11

Keep it personal

Iwas recently involved in training shared-care GPs in Worcestershire. They wanted me to cover addiction to medicines, which fitted in with me having recently seen a young man at our practice with a dependency on overthe-counter medication.

‘ our job is to facilitate treat- ment not impose it... we can build the effective thera peutic relationships necessary to engender long term change.’

MEDIA SAVVY