Drink and Drugs News DDN December 2018 - Page 18

comment Post-its from Practice Now tell me yours… Different lives require different approaches to treatment, says Dr Steve Brinksman I HAD THE PRIVILEGE of speaking at the annual RCGP/SMMGP conference at the end of November. I have been attending these for 20 years now and the knowledge I have gained, alongside the peer support, has been invaluable in my career working with people who run into problems with their alcohol and/or other drug use. I was talking about treatment optimisation. By that I don’t mean just increasing the dose of OST prescribed, but also increasing the psychosocial interventions and making sure that all aspects of treatment are in place long enough for people to make sustainable change. There has been – to my mind – a climate change over the past decade or so where increasing pressure is being applied to get people out of services and signed off as ‘treatment complete’. This prevailing paradigm has the knock-on effect that anyone who is taking OST in the longer term almost feels they should be ashamed of it. We should not feel guilty for providing good quality evidence-based treatment that protects and supports people and gives them the space to establish and manage their own recovery. Jake came to see me at the surgery for a review. He had started in treatment three years ago and his buprenorphine had been titrated up to 16mg at which point he had stopped using heroin completely. His relationship with the mother of his two sons had improved and he had started a college course with a view to becoming an electrician. About nine months after starting OST his recovery worker suggested he try reducing his dose. He managed to cut down to 10mg daily – but at that point he started using heroin again. His dose was titrated back up and he again stopped using heroin. Six months later he tried reducing again and the same thing happened. By the time he came to see me he had made four attempts at reducing and he felt he was failing in treatment. He was guilt-ridden that he lacked willpower, because as he couldn’t cope with the craving, he had to use heroin when his dose reduced. He seemed slightly surprised when I suggested to him that not only do we put his dose back up but that we leave it at that for an extended period of time. Six months on, he is well and happy and feeling confident in treatment. He has started work in a warehouse, sees his sons regularly and has them overnight every other week. He hasn’t used heroin since our last appointment. He does say he would like to come off his OST at some point in the future but feels that time isn’t now. We will discuss this whenever we meet and I will always encourage him. However, it will be up to him to make the decision when – or if – he wants to undertake this. Aneurin Bevan, one of the founders of the NHS, once said: ‘This is my truth, now tell me yours.’ I feel this encapsulates beautifully the different approaches to how we all live our lives and I think it adapts to our field. So to paraphrase, ‘This is my recovery, now tell me yours.’ Steve Brinksman is a GP in Birmingham, clinical lead for SMMGP and RCGP regional lead in substance misuse for the West Midlands 18 | drinkanddrugsnews | December/January 2019 IN It together The GPs’ conference showed the power of a united front for better treatment, says Lee Collingham AFTER A DECADE of attending the RCGP conference, I was in London for this year’s event. I’ve learnt that to get the most from the programme, it’s handy to go through the running order for the two days and see if there’s anything or anybody that I must see. Otherwise you spend your time nipping from session to session and not particularly learning anything new. With this in mind, I identified sessions which matched my own personal goals. These included reducing drug-related deaths, the testing of substances to eliminate contaminants, and inclusivity for those working in or using the treatment. Whether the goal is abstinence or the approach is focused on harm reduction, I believe it is important for us to work in partnership and together, rather than being a foghorn alone. One of the sessions that caught my eye was by Professor Roy Robertson from Edinburgh University who spoke about the recently released Scottish drug treatment strategy. Although not entirely relevant for England or Wales, it does however give us good indicators of what is and isn’t working and what the overall aim is. It was unclear whether the provision of naloxone in the community had made any difference to drug- related deaths; however it had been a success with those leaving prison. He made welcome suggestions that treatment should be person centred and lead with a multidisciplinary approach. Of personal interest to me was finally meeting Fiona Measham, who discussed the growing success of The Loop in giving festival guests and nightclub users the opportunity of having the drugs they’d purchased tested. The team was shocked to find the increase in strength of MDMA, some with over 90 per cent purity, and they also found a number drugs being missold as other things. The initiative had been a success, not just with service users who were having second thoughts about what they were taking, but also the police and organisers. They planned to do at least 18 events in 2019 and were looking at working with more nightclubs. Other than the moving tributes given to both Rob Bell and Beryl Poole, two of the many we have lost, the final highlight for me was attending a presentation on the future face of recovery from Annemarie Ward of Favor UK. She highlighted the challenges and problems service user groups and organisations often face when it comes to raising funds – particularly if we’re fighting against each other, rather than together, for the same resources. All too often, she pointed out, it’s left to a team of motivated individuals and volunteers to ensure the success of such projects, and I could identify with that. Lee Collingham is a service user activist and advocate ‘It is important for us to work in partnership rather than alone.’ www.drinkanddrugsnews.com