INVOLUNTARY CESSATION OF PRESCRIBING

[Alan J]

Dear All,

An issue that frequantly features in my case work is the 'involuntary cessation of prescribing'. In short service users having their treatment /script withdrawn for
a wide and geographicaly variable number of reasons.

Is it reasonable to stop a patients script because they present with urine or oral swab tests that are positive for non prescribed medication? Eg heroin on top, benzo's, alcohol, crack, cocaine. etc?

What about threatening or voilent behaviour? What are the limits? And what should happen to those who have treatment stopped, should specialist services be able to manage 'difficult behaviour', or should the saftey and well being of other patients and staff come first?

Should a patient risk exclusion for exhibiting anger, perhaps, swearing, due to treatment problems?

What about Patients who are unable to confirm to a 'treatment plan' agreed under different conditions, or in circumstances where the patient felt disempowered and would agree to anything in order to secure a script. I have done it in the past and I am sure I am not alone in this.

What are the experiences of contributers who have had their treatment / script stopped for 'punitive reasons', clinical reasons, or for other purposes.

How did it impact on you, your life, work, health, home, family, stability, use, etc.
Did anyone find it of help? How many found it really sent them spiralling into chaos.

I welcome your views, experiences, and comments.

Best, Alan J.

[daveywales]

Hi Alan, I remember when I first arrived in Wales, 'to start my new drug free life' I had weaned myself down to around 30ml of methadone. Amazingly I got a script the same day I walked into the local CDT with a letter from a G.P. I was picking the script up weekly, the year was 1996 and I happily selling the Big Issue on the streets of Newport.
Then one awful day I was summoned to see the consultant who showed me that I had tested negative for methadone!!!!! I knew it had to be a mistake but straight away my word counted for nothing I started to shout my innocence through fear and panic of losing the script. The doctor then went into the automatic mode of if you don't stop shouting I will call the police and I had done NOTHING wrong.
Eventually after convincing her how futile it would be for me to sell such a small amount of methadone, plus my newly appointed social worker could see I was gaining confidence selling the Issue and I had no track marks etc. Also the hostel I was in was staffed and all medication had to be handed in, so that really clinched it for me.
But if it was not for the hostel confirming I was given 30 ml every morning, I would have had to go on daily pick up, which would of mean't losing my job selling the Issue as the CDT was an hour bus ride there and back. So by the time I got to the Issue's office all the pitches would have been taken. My new fragile world would have been turned upside down due to a mistake at the hospital's Toxology dept.
Since then I have lived in fear of drug tests.
So Alan, just by sharing my experience shows that our scripts can be taken away from us at the whim of a doctor and suddenly we find ourselves disempowered, in a cold clinical system.
O.K things have changed round here if you are found with other chemicals in you urine, but if you test negative for methadone that is still another story. David

[Tony.B.]

Hi Alan,

I have to say that the last time this happened to me it certainly did send me spiralling into self destruction and a sense of hopelesness which ended in me presenting at local hospital a week from death, as i was informed.

This was the days of 12 week treatment+that's your lot m8.I was holding down a job and generally doing not too bad but just settling in, as evidence based practice later gives us at least 3 months to 'settle in'.Anyway i was being forced from methadone onto Ibupr. without stabilising on the Methadone.

Came the day for switch+i tested positive for Heroin hence i could not switch+my meth was to stop.After much pleading i was given one more day.Of course i still came up positive next day+given 3 days meth+ 3 days/nights nitraz, i must say i knew what was to follow+ to my chagrin i begged that worker not to throw me off.To no avail.

So i hope that is the sort of stuff you were referring Alan.

Dave got your email add from mutual friend.Something i would like to discuss r.e.your good work over there.i know Canton + a particular hostile there, behind snooker club?

That' me
cheers
Tony.B.

[stavros]

HELLO PEEPS ,
 Although i fortunately have not had a prescription stopped , i have found that a thrice weekly pickup heightens the risk of my covert medicine activities being discovered by a vast number of our small community , since b4 our doctors became paranoid about the dangers of large pickups , i would pickup once aweek , which went on for months , our chem is verybusy and so each visit normally lasts 20 mins approx , i dont want this , the chem could certainly do without me hangin round 3 times aweek , i am trying to hold down a job and have just been appointed a workmate which has added pressure also ,
 i have asked for this to be changed but so far i cat get past my key worker
 any ideas

[simon]

I think it's like all things you need a balance and it's not out of the realms of possibility that a patient may use now and again. I would personally advise them whatever drug it was. Look at the doses of prescribed drugs i.e. is it enough do they need more. Have they got a habit of something else e.g. benzo's in some cases a prescription  for this can help if there is instability due to this.
I think also if someone is acting in a professional capacity well maybe it could be that they need some training in de-escalation techniques. However I don't see any need for violence of aggression, then I don't think someone should stop a script without good cause and a couple of positive tests is not good cause and will just give a relationship of hide and seek rather than open and honest self reporting.

[Alan J]

Dear Simon,

Many thanks for your post?

I would like to thanck you all for your additional support,and hope we can achieve s
at outcomes we need..

Best, Alan J

[simon]

Alan,
I guess the reasons for stopping scripts is very subjective, bad language doesn't bother me too much, but for some for whatever reason this is not tolerable.
I don't like contracts but prefer a treatment agreement something that sounds a bit more cosy and  less threatening.
Both parties to an agreement have obligations and not one of us is perfect.