September2 2020 - Page 19

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 WWW.DRINKANDDRUGSNEWS.COM SEPTEMBER 2020 • DRINK AND DRUGS NEWS • 19