With much anecdotal evidence that people are losing their OST of choice , a meeting was held at the DDN conference to ask , ‘ are you getting what you want ?’ The comments suggest new action points for services
OST
One size fits nobody
With much anecdotal evidence that people are losing their OST of choice , a meeting was held at the DDN conference to ask , ‘ are you getting what you want ?’ The comments suggest new action points for services
Drug-related death statistics are well documented and at their highest level since records began . Evidence also tells us that opioid substitution treatment ( OST ) is protective against opioid deaths , when given at the right dose and for the right duration . At the DDN conference we took the opportunity to run an interactive session with people in treatment , those who were thinking about it , and others who had experienced it for better or worse . In an informal group , Dr Chris Ford and Stuart Haste invited people to comment on their situation . Could this help to shed light on a lost connection between services and those whose lives – and quality of life – depended on them ?
It was clear from the outset that the dwindling state of funding was affecting each group of participants , with many people being told that choice of OST was no longer an option because of cuts : ‘ I really wanted to try buprenorphine , as I ’ d tried methadone twice before . But the worker said I couldn ’ t have it because it wasn ’ t right for me and too expensive ,’ said one member of the group .
Others were having their dose of OST reduced without their consent , leading to them becoming unstable . In John ’ s case an abstinence agenda was being used as ‘ law ’ to reduce his medication : ‘ My prescription keeps me alive , and I ’ ve been on it for a good 12 years ,’ he said . ‘ But they keep saying I need to reduce – that it ’ s the law . I know it isn ’ t , but I have to fight at each appointment . The new staff don ’ t understand , or believe in , harm reduction – but I ’ ve seen too many friends die when they stop treatment and I ’ ve got to live to bring up my kid .’
For those trying to access OST , either
‘ If you don ’ t want to listen , tell me what you want to hear .’
‘ I knew they were wrong .’
‘ I have had six key workers in the last six months .’
for the first time or after a break in treatment , new barriers had appeared .
‘ I had to jump through so many hoops to get into treatment ,’ said one participant , while another commented : ‘ I wanted to try being drug free , but felt very odd and soon relapsed . I asked to come back into treatment quickly so I wouldn ’ t lose everything but they said it ’ s not possible to do that because there are rules . I would have been dead when I overdosed if my friend hadn ’ t been there .’
CLIMATE OF MISTRUST
This lack of flexibility was cultivating a climate of mistrust . ‘ They asked me about my motivation and didn ’ t like it when I said , “ I ’ m here , isn ’ t that enough ”,’ said one person , while others had become used to feeling that services were not listening to them . ‘ If you have your own answers , don ’ t ask me for mine ,’ was Linda ’ s response to this ; while Deb commented that her reaction had been , ‘ If you don ’ t want to listen , tell me what you want to hear .’
In practical terms , services ’ unwillingness to be flexible could put an insurmount - able hurdle in front of treatment : ‘ I missed the first day of my three-day pick-up because my child was ill and I had to go back for re-titration ,’ said one mother .
Some felt that they could not risk being honest about their needs or challenge treatment provision for fear of the consequences : ‘ I feel that I can never say what ’ s going on with me or ask for something like an increased dose , because it means they will probably reduce me or put me back on daily dispensing , which is impossible as I need to live ,’ said Angela .
Alisha was confronted with stipulations when trying to access hepatitis C treatment : ‘ They told me I needed to reduce my dose before I could start hepatitis C treatment , but I knew they were wrong from going to a HCV support group ,’ she said . ‘ So I agreed to the reduction but bought some methadone to keep my dose the same . It ’ s madness that I can ’ t be honest .’
For many , the stigma of being identified as a ‘ drug user ’ permeated services and blocked the chances of a trusting and beneficial relationship with staff . Linda had
16 | drinkanddrugsnews | March 2018 www . drinkanddrugsnews . com