Drink and Drugs News DDN December 2019 - Page 24

LETTERS AND COMMENT ‘We must provide appropriate interventions to reduce harm to people wherever they are on this spectrum and not where we think they should be. Harm reduction is... a set of principles and a movement for social justice.’ CALL FOR COMPASSION I fully agree with the letter ‘Thorny Issues’ written by Users Voice (DDN, October, page 14). This followed up Nick Wilson’s great article ‘Agents of Change’ (DDN, September, page 6) that we need a rebirth of harm reduction and harm reduction activism. I feel compelled to add further comments about harm reduction. It is exactly what it says it is, whether for those people who continue to use drugs in the most chaotic way or for those who want complete abstinence. We must provide appropriate interventions to reduce harm to people wherever they are on this spectrum and not where we think they should be. Harm reduction is not just a list of practical strategies like NSP and DCRs, essential as they are, but it is a set of principles and a movement for social justice. There are many but here are a few that I feel should be adhered to: • Treat all people who use drugs with the same care and compassion as anyone else. • Never judge people just because they use drugs. • With people who use drugs being the primary agents of reducing the harms caused by their drug use they must be allowed a real voice in their own treatment and proper input into the development of treatment services. • Give real recognition to the reality that poverty, class, racism, social isolation, past trauma, gender-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm. Are we adhering to these principles? In a word, no. This is not to say many are not trying, but with what has taken place over the last decade – including dramatically reduced funding, 24 • DRINK AND DRUGS NEWS • DEC 2019-JAN 2020 reduced training and politics leading treatment rather than evidence – it has become very difficult. A few examples: 1. Jane who was caring very well for both her child and disabled partner, was very stable on 120mg methadone. She asked me to speak to her drug worker because he was insisting that she reduce her dose by 10mg a fortnight simply because he said she had to. When I spoke to Justin, the worker, he had no understanding of the evidence for OST and didn’t know what harm reduction was – and thought a quick road to abstinence was the only option. Thankfully, this story turned out well in that Jane is now back on her 120mg and Justin has enrolled on RCGP Part 1 Certificate in Drug Dependence. 2. Kieron requested an increase in his buprenorphine from 8mg to 10mg. The doctor agreed but on attending the pharmacist he found he had been changed from weekly pick-up to supervised consumption, without any discussion. This was impossible for Kieron as he worked and dropped the kids at school most mornings. 3. Jim, who was in his 70s, had health problems of his own and cared for his disabled wife. He found using opioids, originally started for arthritis, and diazepam, helped him through the day. As the Users Voice letter says some people, (especially older ones, ones who have mental health issues and other previous health conditions) ‘require modest doses of mood-altering substances to live reasonable and functional lives’. His GP explained about dependency and wanted him to come off his opioids. Understanding the evidence, Jim wanted to remain on them. How many stories like these are being played out around the country? We need to fight for change and regain our care and compassion. Chris Ford, clinical director, IDHDP PERSONAL PLAN In response to the comment (DDN, October, page 14) on my Post It from Practice (DDN, September, page 11), I am, and always have been, a strong believer in harm reduction and believe it should be taken literally – ie that each individual I see needs a plan that reduces the risks to them. For some this involves continuing long-term medication and so I have patients that I have prescribed opioid substitution medication to for over 20 years. However for others, a risk is in continuing high-dose medication where no benefit is shown. The patient mentioned in this Post It has no history of using illicit opioids and I do not feel he is likely to start doing so if we proceed – with caution – in reducing his medication load. There is no intention of completely stopping his prescribed medication, but the fact remains that he is at significant risk due to the dose he is on and after discussion with him he was willing to try reducing his overall opioid dose. The word ‘deprescribing’ is used increasingly in primary care. Put simply, its definition is to approve outcomes for patients for whom their prescribed medication is having a negative effect on their health. Working in primary care allows for a long-term individualised approach to each patient to be taken, and it is this that I was aiming to convey, within the constraints of the column word count. Dr Steve Brinksman, clinical director, SMMGP DDN welcomes your letters Please email the editor, [email protected], or post them to DDN, CJ Wellings Ltd, Romney House, School Road, Ashford, Kent TN27 0LT. Letters may be edited for space or clarity. /ddnmagazine @ddnmagazine www.drinkanddrugsnews.com WWW.DRINKANDDRUGSNEWS.COM