SERVICES
‘The NTA
negotiated and
invested large
funding increases
that improved
treatment services
– by 2008 they
had doubled
the number of
people receiving
treatment services
to 2m.’
The first five years of the Alliance
saw our team effectively intervene
in three hundred or so requests
for help, collaborate with the Royal
College of General Practitioners in
training our advocates alongside
GPs for the same qualification,
and organise the annual national
drug treatment conferences in
partnership with Exchange Supplies.
When I left for Canada in 2004 I felt
we had made our point and I didn’t
expect that anyone could or would
want to change the treatment
system back to the extremes of
strict abstinence warring with harm
reduction initiatives. I certainly
didn’t expect being likened to a car
stuck in a parking lot.
How wrong can one be? By 2007
The Royal Society for the Arts (RSA)
(not exactly an authority on drug
treatment) had a go, and the BBC
(ditto) also weighed in on the issue,
reporting – with no clear evidence
– that only 3 per cent of drug users
entering treatment had completed
it and emerged ‘drug free’. I don’t
believe these figures. I don’t believe
that even the direst treatment
provider has such a low success rate,
especially in this case with the bar
set at the highest level – becoming
drug free (not usually an immediate
goal for long-term opiate users). But
the damage was done – methadone
and approaches like it were again
labelled ‘problems’ instead of
‘effective ways to reduce injecting
poisonous street drugs’.
Then came the coalition
government, the Conservatives and
the Centre for Social Justice, and the
campaigns to denigrate methadone
started back up. Well known
authorities such as Professor John
Strang and other advocates have
continually beaten back attempts
to end the provision of opiate
maintenance and they need your
continued support to do so.
By the end of June 2012 an
expert group convened to bring
‘stakeholders’ together produced
their final report. It concluded that
opioid substitution treatment
would remain as ‘a key tool within
a recovery orientated system…
underpinned by a full range of
treatment interventions’. Talk about
slippery wording.
It’s depressing to see
England mess things up so
badly. Reductions in funding
and the hiring of those
opposed to prescribing
approaches have already
made themselves felt. A former
colleague and friend, now in his
mid-60s, wrote to me last week
saying that he is finding it hard to
obtain a maintenance script for
25mg of oral methadone a day!
Anyone wishing for a more
comprehensive history should read
Substitution treatment in the era of
‘recovery’: An analysis of stakeholder
roles and policy windows in Britain
by Karen Duke, Rachel Herring,
Anthony Thickett and Betsy Thom,
a well written commentary on
these changes.
There have been times when
doctors based their actions not on
clinical evidence gathered together,
but on subjective viewpoints.
But I hope I’ve also shown that,
particularly in times of medical crisis
for users, caring means providing
all the interventions that we know
reduce harm. This is not the time to
allow politicians undue influence to
limit clinical judgements.
Making the case that providing
opioids to people doesn’t do
anything to move them forward just
isn’t true, especially when people
also get active support and services.
I am still alive and heathy after
nearly 40 years on MMT. Without it I
would be as dead as all the people I
left behind in Canada in 1977.
Bill Nelles is an advocate and
activist, now in Canada. He founded
the (Methadone) Alliance in the UK
OVERDOSE
AWARENESS
Both our prison and community
substance misuse teams are doing
fantastic work to support people
who are at risk of an overdose. Here
are just two examples of recent
initiatives:
IN PRISON: HMP ELMLEY
Prisoners are at particular risk of
overdosing because illicit substances
were in limited supply throughout
lockdown. While this is positive,
our concern was that as restrictions
eased there would be a sudden
influx of substances – dangerous for
people whose tolerance levels have
dropped dramatically.
‘Now restrictions are starting
to ease, a member of the team is
prioritising residents who are most
at risk or who appear to have used
recently, offering brief interventions
and reviews,’ Nichola Bennett,
Forward team leader at Elmley, told
us. ‘Whilst we’re limited in some
of the things we’d normally do
because of social distancing, our
team has created a COVID-specific
harm minimisation leaflet about
the dangers of using after lockdown,
which has been rolled out to all our
prisons.’
As soon as the team can deliver
harm minimisation workshops
again, they’ll be the priority,
alongside recruiting more peer
workers to increase their presence on
wings and availability to residents.
Commemorating Overdose
Awareness Day, James Parker
looks at how Forward Trust are
supporting those most at risk
IN THE COMMUNITY:
ASHFORD, KENT
All frontline staff are trained in
the use of naloxone to mitigate
the life-threatening effects of
an overdose. Staff at Forward’s
Ashford hub put their naloxone
training into practice last month
when one of our clients came to
use their needle exchange service.
‘A client came in and told
us he’d overdosed,’ explains
Tarnya Hurcombe, team leader
at the Ashford hub. ‘We called an
ambulance, but before it arrived
he got agitated and tried to leave.
Then he collapsed outside the
building. We donned full PPE and
brought naloxone kits to where
he was lying. Routine first aid was
performed but the client remained
unresponsive. We knew that
naloxone was the next step.’
Abbie, one of our drug and
alcohol practitioners, administered
the naloxone and the client came
to moments later, just as the
ambulance arrived.
‘Abbie and the whole team
were amazing,’ says Tarnya,
adding: ‘It just goes to show the
importance of naloxone training.’
We offer naloxone and training to
every opiate client that attends
one of our hubs, as well as to
service users’ loved ones.
James Parker is head of services
at Forward Trust
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SEPTEMBER 2020 • DRINK AND DRUGS NEWS • 19