Drink and Drugs News DDN November 2019 (1) | Page 10

SUBSTITUTE PRESCRIBING
BREAKING TIES
When prescribing regimes are preventing service users from moving
on, should we be looking at new options? DDN reports
‘W
hat makes me angry is that they’re treating
every drug user as potentially stupid and can’t
look after their own welfare, or potentially as
a criminal because you’re going to divert your
tablets.’
Marcus is talking about the frustrations
of being back on supervised consumption. After giving a ‘clean’ sample
at the drug service he was put straight onto a weekly pick-up of 6mg of
buprenorphine, ‘which was brilliant’. But he ‘started to have a wobble’
about three months ago and began using a couple of times a week. He
went back to the drug service and was honest with them: ‘I said this is
happening, can I increase my dose?’
The answer was yes, but it was only when he reached the chemist
that he realised he had been put back on supervised consumption,
having to travel some distance each day to collect his buprenorphine. ‘I
accept part of the blame for this – I should have read the script,’ he says.
‘But she should have gone through it with me, she didn’t say a word.
‘I feel as though I’m being punished for using and being honest,’ he
says. ‘She’s saying it’s for my own safety. I said, “I’m a 48-year-old man, I
can look after my own safety and I’ve never given anyone any reason to
believe I’m diverting tablets”. But no, their policy is, “start using again
and you’re back on supervised until you can give two clean samples”, and
that’s it.’
It makes it very difficult for him to move out of the area, he explains,
and going back to the same place brings pitfalls that he had been able
to avoid. He sees the same people every day, people ‘sorting deals out’
at the drug service and the chemist. It’s very hard to get away from. ‘I’m
seeing people all the time – I know it sounds pathetic, but you only need
the tiniest trigger with heroin.’
So what’s going wrong when a highly articulate person feels like they
can’t communicate with their drug service? ‘I don’t know whether they
have hard and fast rules or guidelines, but if they’re rules then they’re
wrong, and if they’re guidelines they should be flexible,’ says Marcus. ‘I
don’t feel like I’m invested in my own treatment at all. They are treating
me, and that’s it.’
We talk constantly about the stabilising effect of prescribing in
10 • DRINK AND DRUGS NEWS • NOVEMBER 2019
helping service users to get back
into work, but are we thinking
enough about cases where it’s
having exactly the opposite effect?
Rebecca (not her real name)
has been ‘using a bit’ on top of
her script, but she can’t tell her
drug service the truth about this
because they’ll put her back on
supervised consumption – and if
this happens, she’ll lose her job
and her family’s only source of
income.
‘They’re putting you in a position where you can’t work,’ she says. ‘I’ve
had people say to me in services, when I’ve gone in for treatment, “you
need to think what your priorities are”. I’ve said I can’t come to a group
every morning, I work full-time. My priorities? Well, a roof over my head
to be perfectly honest with you.
‘So you’re pushed out of treatment from day one. It makes life doubly
difficult. They don’t expect you to be working and they make very few
concessions for you.’
‘Rebecca’ can’t tell
her drug service
the truth or she’ll
lose her job and her
family’s only source
of income
I
t was these issues among their own service users that made WDP
look at flexible dosing regimes – they have just become the first
state-funded treatment provider to offer a prolonged-release
version of buprenorphine in England and Wales.
According to a study by Haight, Learned, Laffont et al, published
in The Lancet (February 2019) taking buprenorphine through an
injection every four weeks can offer a viable treatment option for those
who find it difficult to attend treatment or keep to a regular daily dose
– and will also be a good option for when there are children in the home
who might be at risk of taking stored medication.
Findings comments on this study that ‘extended-release injections
would seem to have their greatest potential among less stable patients –
those unlikely to take daily doses and perhaps even less likely to regularly
attend a pharmacy or clinic for consumption to be supervised.’ They also
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