Post-its from Practice
Now tell me yours…
Different lives require
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
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
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
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
for us to