Drink and Drugs News DDN October 2018 | Page 8


Valuing the future

Post-its from Practice
Guiding people towards hepatitis C treatment can be a matter of self-esteem , says Dr Steve Brinksman
ONE OF THE SERVICES I WORK WITH has been looking at setting up a hepatitis C treatment programme in conjunction with the local hospital trust , based in the prescribing centre . This is obviously a good idea and is a model of treatment that needs to be replicated across the country if we are to make serious in roads into eliminating hepatitis C – which given the efficacy of modern treatment , could be achievable .
Speaking to the hospital consultant , it transpired they have the provision to treat far more people than are currently on their waiting list . And as they struggle with engaging active service users , due to high drop-out rates , it is envisaged that more readily accessible treatment will help reduce this .
This prompted me to think about why people in drug treatment who know they have hepatitis C don ’ t engage with a treatment that is highly effective and , these days , relatively low in severe side effects ? I couldn ’ t imagine not having treatment , if it was me who was affected .
I spoke to Andy – a patient at my practice who has had hepatitis C treatment and who is now virus free – about my puzzlement . He told me that he put off treatment for a long time because although aware there were significant health consequences to having hepatitis C , something that might harm him in ten to 20 years didn ’ t seem a big issue when he knew he risked overdose every time he injected , had nowhere stable to live , and was being regularly arrested .
He also knew treatment was expensive – and quite frankly , he didn ’ t think he was worth it . It was only some time into treatment for his drug use , and after he began attending a peer support group and started to develop self-esteem , that he felt

‘ It is a simple mistake to think that others think as we do and place value on the same things we do .’

he could make a commitment to his long-term health and other health issues .
It is a simple mistake to think that others think as we do and place value on the same things we do . If we continue with that paradigm , I fear large numbers of people will remain with untreated hepatitis C and we will keep scratching our heads and wondering why .
I fully support the enhanced provision of hepatitis treatment and welcome the move to provide it in a geographically accessible way to service users . However , I think we also need to realise that difficulty getting to a treatment centre isn ’ t the sole reason people don ’ t engage in anti-viral treatment .
Alongside making treatment accessible , we need to work at improving our services to develop our service users ' selfesteem , ensuring that they value themselves and their future in the way we might value our own .
Steve Brinksman is a GP in Birmingham , clinical lead for SMMGP and RCGP regional lead in substance misuse for the West Midlands


The news , and the skews , in the national media
SCOTLAND IS A SMALL COUNTRY with some big problems . For too long we ’ ve accepted drug and alcohol problems as part of our society and culture . If we can look beyond these shores we will see brave people who have found creative solutions to their unique circumstances . It is time for us to be brave . Andrew Horne , Herald , 4 September
IN WALES AND SCOTLAND minimum unit pricing is on the table or enacted . The government ’ s failure in England to act on price seems to disregard the weight of expert and empirical evidence . Such is the reality of having a tax funded , politically accountable NHS while public policy relating to wider determinants of health rests with other government departments , Treasury included . … My concern is that however switched on our health service and public health leaders may be , the funding and the wider social policy to make their ambitions a reality rely on ministers , government communications teams , and Treasury officials . These parties are late to the party . David Oliver , BMJ , 11 September
WE CAN ’ T SIMPLY TELL YOUNG PEOPLE to ‘ say no to drugs ’ at festivals . It hasn ’ t worked for half a century and it won ’ t work now . Instead , we need a mitigating factor – and that ’ s what pill testing is . It ’ s not a silver bullet . But it is backed by international evidence . Shelley Smith , Guardian , 17 September
TO THE RELIEF OF ANYONE who for medical or cultural reasons isn ’ t getting sloshed and doesn ’ t feel like constantly explaining why , the stigma of not drinking may be wearing off . Personally , I ’ ve got no intention of going on the wagon . But a world where people are neither slut-shamed out of drinking , nor bullied into it ? I ’ ll raise a glass to that . Gaby Hinsliff , Guardian , 27 September
THE CULTURAL PULL OF TOBACCO , its hardiness in the face of hostility , may
be weaker than it once was – those who would have smoked until they dropped are mostly now fogged in clouds of vape – but its survival instincts are those of a cockroach in the aftermath of an atomic strike . Eleven years ago , I watched as pubs erected smoking shelters for the incoming smoking ban ; I don ’ t see them pulling them down in the near future . Stuart Evers , Guardian , 24 September
REOFFENDING RATES ARE FAR TOO HIGH , few alternatives to custodial sentences are pursued – because of populist political pressure – and the result is more recidivism , more violence , more burglary , more crime generally and more emotional and financial costs loaded onto peaceful citizens when offenders are released . It is a classic example of a false economy . Independent editorial , 20 September
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