TREATMENT
SHIFTING
SANDS
The increasing numbers
of GPs caring for opioid
users through the
’90s and providing
oral methadone – and
later buprenorphine
– had the effect of encouraging
NHS specialist clinics to either
further entrench their personal view
of treatment, or to embrace the
opportunity to work with GPs. And,
increasingly, specialist support was
being provided by consultants and
their teams. I could cite examples of
entrenched non-prescribing clinics
by name, but it’s not my intention
to recriminate about things done
in years gone by. I don’t, however,
extend that same tolerance to
today’s treatment policy in England,
because we clearly have yet to learn
the lesson that all valid treatments
must be available.
In the third part of ‘Doctor Wars’, Bill Nelles
looks at the advent of the NTA – and what
came after
As we moved towards 2000,
these shafts of progressive light
coincided with the interest in
patient advocacy being shown by
Whitehall. Ostensibly a patient
advice liaison service (PALS) was
to be set up in hospitals and other
NHS services to help patients
negotiate the system, and even
make complaints. The initiative
started with John Major but
was made more powerful by the
incoming Labour government
under Tony Blair. Some of us
couldn’t see how such PALS services
could assist drug users, but we
were also fortunate to have Mike
Trace as deputy drug tsar – he
would advance the goal of patient
support and advocacy for ‘service
users’, as we came to be called.
Many doctors and consultants
were particularly helpful to us. Dr
Clare Gerada was the medical lead
for drug treatment in the late ’90s
at the Department of Health. She
was instrumental in the birth of the
Methadone Alliance, authorising
our first grant of £9,000 to start our
helpline. Professor John Strang also
listened to our case and supported
us, and Dr Chris Ford, one of the
first ‘GPwSIs’ (a GP with a special
interest in treating drug users)
joined our board because we took
being an alliance between people
in treatment and their treatment
providers very seriously.
The next big change was the
advent of the National Treatment
Agency for Substance Misuse
(NTA), with a feisty and pragmatic
chief executive, Paul Hayes. Mike
Trace, Annette Dale-Perera, and
Dr Emily Finch also joined the NTA
– not everything was perfect but
they ensured that the care being
provided increasingly followed
what was now being called
‘evidence-based medicine’.
There was criticism of the NTA
for its crime prevention approach
and I wasn’t enthused to begin
with, but I preferred people getting
treatment rather than prison. But 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.
For the first time there were
clear quality standards, more
flexible clinical guidelines and good
practice protocols for the treatment
field. The NTA was not just about
methadone and prescribing
approaches – it spent much time
and energy encouraging and
highlighting residential services as
well as focusing on family support
and abstinence groups for people
moving off medication.
In case you feel that I only
bang on about medical
treatments, let me say
that I am particularly
supportive of high-quality
residential treatment,
especially when one’s life is in a
real mess, as mine was in 1981.
Phoenix House in South London
provided me with enormous
help, support, and housing. But
therapy on its own wasn’t enough
for me, and I described in my last
article the reason why I returned
to methadone and found my own
pathway to stability and self-worth.
But entry must be governed by
patient choice, and a safety net
must exist to provide a swift return
to prescribing approaches so that
people do not return to using the
poison increasingly dominating
our streets. Ensuring close
communication between such
services would certainly deserve
‘payment by results’. We all know
there is no magic treatment that
works for everyone, and that all the
evidence-based treatments should
be quickly available in every locality.
NTA CHAMPIONS, from the left:
Mike Trace, Dr Clare Gerada,
Professor John Strang, Dr Chris
Ford, Paul Hayes, Annette Dale-
Perera, Dr Emily Finch
cocoparisienne/pixabay
18 • DRINK AND DRUGS NEWS • SEPTEMBER 2020
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