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
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