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was available to both groups of patients.
We ‘accidentally’ kill ourselves because
we are homeless, hungry, so lonely and
depressed and cannot see a reason to
live. Researchers need to be empowered
to take a more detailed analysis of what
those increased drug-related deaths are
really about instead of simply blaming
doctors who are trying to reduce
people's pain in this very dark time.
On behalf of www.usersvoice.org
I was happy to see a strapline on last month’s
DDN that promotes the rebirth of harm
reduction activism... And then I turn the
page and read the ‘Post-its from practice’.
What has happened to us in terms of truly
understanding what harm reduction is?
I was happy to see a strapline on last
month’s DDN that promotes the rebirth
of harm reduction activism, though who
knows where the money will come from
for that. And then I turn the page and
read the ‘Post-its from practice’. What
has happened to us in terms of truly
understanding what harm reduction is?
It is not only clean needles and medically
assisted therapies, with the possibility of
more low threshold services like safe
injecting rooms and increased
supervised heroin/morphine prescribing.
How many people in recovery (from
addiction and mental health issues),
especially the ageing cohorts, need
modest doses of different mood-altering
substance to live reasonable and
functional lives? Think codeine, selective
serotonin reuptake inhibitors (SSRIs) and
so on. Without these meds prescribed
responsibly by our GPs, many people
would be forced back to the streets
again to medicate pain or depressions,
which is what many daily street-
opiaphiles (and others) were doing in the
first place – self medicating.
Steve Brinksman’s comment about
the thorny issue of de-prescribing is
really dangerous for a lot of people who
have finally found stability in their lives
because a few GPs are willing to
14 | drinkanddrugsnews | October 2019
prescribe for pain.
What do I mean? 1) It is a publicly
accessible comment that can be read by
a) people who know little about any of
the above but generally are abstinence
aficionados and have the power to
prescribe or not. b) It is given respect in
a magazine read by thousands.
2) In an era when harm reduction
services have suffered annihilation by a
government that largely doesn't give a
damn where drug users or chronic pain
patients and the mentally ill live or die –
many NHS patients in fact – I think we
need to be extremely careful what is
published in DDN.
Allowing a respected GP to advocate
de-prescribing in DDN is also so mixed-
messaging. On the one hand we should
be willing to prescribe more to
vulnerable addicts/drug users. On the
other hand, we should be pushing
chronic pain patients off drugs.
While I understand the need to not
over-prescribe to pain patients, I think
the idea of starting to coerce any of the
above patients off of drugs using the
increase of drug-related deaths as an
excuse is highly questionable.
We do not accidentally kill ourselves
because of access to drugs, otherwise
tons more of us would have died during
the period when increased prescribing
Evidence-based treatment should always
encompass a range of interventions
designed to match a range of individual
treatment goals (DDN, September, page
6). The problems that I have observed
have often come about by expert-
derived guidelines in the form of the
‘Orange Book’, together with advice
from ACMD whose statutory remit is to
advise governments on drug policy
based on effectiveness evidence who are
ignored by some politicians for
perceived political expediency.
Sadly, I remember having this exact
debate when the UK 2010 drug
strategy was released, with abstinence-
based recovery being apparently the
only treatment goal allowed. Person-
centred care anyone?
I don’t suppose I was alone in
forecasting the tragic increase in drug-
related deaths, some of which could be
said to be the direct result of this
policy. Whilst I wasn’t alone, I was
certainly in a very small minority at the
service I worked at in 2010.
There needs to be a range of
interventions for different goals that
individuals will have at different times
in their lives – ranging from harm
reduction, opiate maintenance, to
abstinence-based recovery. They should
all be universally available, none should
take precedence, they are all equally
The sad state of affairs is, I feel,
illustrated by my observation that the
publication of a new UK government
drug strategy is greeted by a degree of
enthusiasm by managers rushing to
read it that sadly doesn’t always seem
to be matched by the same enthusiasm
to read and study Orange Book
guidelines, let alone the research
referenced in the guidelines. Another
beneficial change might be to move
responsibility for drug control from the
Home Office to Department of Health.
Paul Almond, via DDN website
MOVING ON: Danny Kushlick has announced that
he’s leaving Transform after 25 years.
‘I founded the organisation when I was 32, in 1994, to campaign for an
end to global drug prohibition, and to replace it with an effective, just
and humane system of regulation and control,’ he said on the
organisation’s blog. ‘It’s been an extraordinary trip.’
Drug policy reform has now moved from an ‘NGO ghetto’ to the
mainstream, he said. ‘I’m proud that Transform’s work has helped turn
legal regulation from fantasy into reality.’