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than one option of medication … the information was very clear and detailed and I was made aware of what to expect during my treatment,’ he says. Regular reviews and clear communication left him feeling supported and involved:‘ One of the most crucial aspects was that I was made to feel that I was no longer alone in my attempts to become drug-free, and that I had an enormous amount of support and encouragement.’
LIMITED CHOICES However, not everyone was offered that level of engagement.
Several contributors describe being given only one treatment option, typically methadone, with little discussion of possible alternatives. Louise, who entered treatment in 2004, says simply‘ no’ when asked if she was offered more than one option. Before arriving at rehab she had a methadone script, which she‘ either sold, or used on its own or with heroin’. Her reception in treatment was not a two-way conversation back then –‘ the more heroin
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While some described compassionate, collaborative care, others recalled feeling excluded from decisions, under-informed, or judged.
you said you took, the more methadone they gave you, so it was ripe for abuse.’ Was she reviewed and titrated?‘ Not really,’ she says. The chemist offered little by way of further encouragement. While the methadone‘ definitely took the edge of and stopped the rattle’, the chemist‘ used to say it was worse that heroin in some respects and always said it was best to get off it,’ she says.‘ It was very sugary then, and rotted teeth,’ she adds.
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Fifteen years later Cathy from Liverpool was among many others who were still missing out on a partnership approach to treatment:‘ I was only given one option of treatment and that was methadone,’ she says.‘ The information I was given was only brief and I was told I would be put on a low dose.’ However, she was reviewed frequently – the start of something more positive – and she found the medication really started to help, so she was only using heroin‘ once every few months’. While she felt that she was treated‘ fairly well’ she stumbled with the lack of consistency:‘ changing key workers made it very uncomfortable to open up … I’ d just got used to the keyworkers, then was told I was being moved to another service.’ She finally detoxed at home during COVID and is now heroin and methadone free, but remains grateful to the drug and alcohol services, as‘ without methadone I probably wouldn’ t be alive today’ |
Lack of clarity – the missing conversations that should take place – is a common part of the experience. Fraser Parry hears of many such situations in his role as drugs advocacy and support advisor at Release, and says it’ s‘ not at all uncommon’ for people to feel excluded from decisions about their treatment.‘ Often people do not have different medications properly explained to them,’ he says.‘ For example, they may not understand that if they choose buprenorphine they could move away from daily supervision more quickly; or that opiates detected in a UDS [ urine drug screen ] doesn’ t mean that a methadone script will be stopped or reduced.’ First impressions are important, and he sees the consequences of many lost opportunities to engage. When practitioners don’ t ask the right questions during those first interactions, the cues are missed.‘ One individual I spoke with had – after taking a long time to build up the courage – booked in for his |
My first experience wasn’ t great. I attended my partner’ s appointment with him to see his keyworker, to get his methadone script. I was full of shame and guilt and hadn’ t admitted to anyone – except my partner – that I was using heroin and had a habit. Up until this point I’ d been sharing his supervised script that he was collecting daily. He was drinking it in the chemist and saving some in his mouth to pass to me waiting outside. As our heroin consumption increased, the script was no longer holding us both, and at this appointment he was going to ask for it to be increased. What actually happened at the appointment was that he told his keyworker I was pregnant – another thing along with the heroin addiction
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that I was in complete denial about. I was 22 years old, had been taking heroin and crack for the last four years and told no one. I had a five-year-old little boy and was five months pregnant.
The reason I didn’ t seek support before is that I was CONVINCED they would take my child from me. The guilt and shame I felt and how harshly I judged myself – and knew how others would judge – stopped me from reaching out to get any harm reduction or treatment support.
At that appointment they did what I knew they would do. They told me they would need to contact social services and that I would need a specialised midwife to take on my care for my unborn child and my OST prescribing. It reinforced my belief that I was a terrible
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person and mother.
I was put on a methadone script and increased quite quickly to 60ml – a pretty high dose as I’ d been taking unprescribed methadone – using on top of that, and was pregnant. My dose was given to me daily
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