IT ’ S MY SCRIPT
Steven Hatton | Dreamstime
There ’ s no automatic reason to revert to stigmatising daily pick-ups , as DDN reports
COVID has changed all our lives massively , as we know – but it ’ s affected drug users in one rather good way .’ At a EuroNPUD virtual event , Dr Christopher Hallam looked at the widespread use of take-home doses for people on methadone and buprenorphine . With restrictions in place and many drug services turning ‘ virtual ’, daily pick-ups and supervised consumption were changed to weekly or fortnightly scripts .
This ‘ light touch ’ model of treatment had been a gamechanger for many people whose lives had revolved around the pharmacy . ‘ A lot of people have found this a liberating experience ,’ said Hallam . A survey by With You in Scotland showed that 70 per cent of the clients interviewed said they did not want to return to overly frequent pick-ups , while the University of Bristol concluded that the new routine was important in reducing embarrassment and stigma . The European Monitoring Centre for Drugs and Drug Addiction ( EMCDDA ) observed ‘ good behaviour ’ throughout the pandemic , with very little diversion .
‘ Methadone and buprenorphine are the only drugs where patients are required to take their drugs in front of pharmacy staff and it can be a terrible experience ,’ said Hallam . ‘ Drug dependence is a very stigmatised condition and frequent visits to the pharmacy can enhance stigma – surely not what we want , any of us .’ Medical confidentiality – ‘ a basic human right ’ – was also very difficult to achieve in the neighbourhood pharmacy .
For some people , daily pick-up would still be essential if they were vulnerable in some way – maybe feeling suicidal , being threatened , or having their medications stolen . But if not , then we shouldn ’ t go back to the default position of expecting people to attend the pharmacy on a daily basis , said Hallam – ‘ particularly the case if you are not using on top , your life is not chaotic , and you may have a job ’. Daily visits could be counterproductive in many ways , including increasing contact with other drug users which could be a ‘ continuous trigger ’, and it could ‘ put people off engaging in drug treatment altogether ’.
While many services were being supportive , some were slow to initiate change for the long term , leaving restrictive or punitive routines in place . The first thing to do in this instance , ‘ is to speak to your drug service , at managerial level if possible , and ask for the reason you ’ re being asked to go back to daily pick-up ,’ said Hallam . He had written the EuroNPUD take home OST advocacy brief to assist with this , and it included a letter to the drug service to request this and an advocacy letter to take things
‘ Working in treatment services , it can be easy to disconnect from the law and its impact on the people who use our services .’
further if they didn ’ t respond satisfactorily .
Martin ( Cuca ) McCusker shared experience of using the advocacy brief with Lambeth Service User Council ( LSUC ), which was part of a consortium model with various treatment agencies . ‘ For years we ’ ve been badgering users if they ’ re not happy to challenge a decision , but time and again people wouldn ’ t do it – they don ’ t want to rock the boat ,’ he said .
Before handing out the brief to peers he showed it to staff so they were aware of it and had ‘ nothing but positive feedback ’. The document made clear to keyworkers that in most cases there was no need to go back to supervised consumption . ‘ It makes clear what the drug user thinks of this degrading process
– it will never be a therapeutic intervention ,’ he said .
Of four cases in which LSUC trialled the brief , three had the successful result they wanted . The fourth person had various health risks that meant the longer intervals weren ’ t suitable at the present time , but enabling them to challenge their prescribing regime in this constructive way was still positive – ‘ they came away feeling that they were heard by the worker , and the worker knows how they feel about supervised consumption .’
The initiative was being taken further in partnership with Release , explained their head of legal services , Kirstie Douse . As ‘ honest brokers ’ for people in drug treatment , Release was creating and distributing an advocacy toolkit for people who use drugs and service user representatives , to be used in situations where OST was being refused , reduced or withdrawn . With funding from the Baring Foundation , they would be delivering training to service users and peers , and providing additional advocacy and legal support around it .
‘ The creation of the toolkit needs to be informed and influenced by people using advocacy ,’ said Douse – hence the partnership with EuroNPUD . It was designed to capture good as well as bad experiences and had benefited from diverse opinions . Drafting , review and launch of the toolkit would be followed by training events in the autumn . DDN
The EuroNPUD take home OST advocacy brief is available at https :// bit . ly / 3cd5y6a
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