Keep it personal

Post-its fRom PRactice

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

MEDIA SAVVY

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
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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