September2 2020 - Page 18

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 WWW.DRINKANDDRUGSNEWS.COM