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 WWW.DRINKANDDRUGSNEWS.COM