Outrage in Cambridge!

[Lelee]

The following is taken from the Dept of Health 'Drug misuse and dependence UK guideliines on clinical management.'

A8.2.3 Patients already receiving unsupervised injectable opioid treatment

There are a small but significant number of patients who are already in receipt of injectable maintenance prescriptions, on an unsupervised basis. The number who receive such treatment is steadily dwindling, having been about 10% of prescribing to this group in the mid-1990s, it now represents about 2% of all maintenance prescribing (Strang, Sheridan et al., 1996; Strang, Manning et al., 2007).

Patients usually receive a prescription regularly and pick up sometimes very large doses of medicines from community pharmacists. There is some evidence that quality of care planning and treatment for many of these patients is variable and often poor (Metrebian et al., 2006). Many have long-term chronic health problems.
The quality of care for such patients is often in need of renewed attention and should be reviewed regularly. Where there is clear evidence of benefit, then treatment should continue and be improved for these patients.
117
Annexes
There may be some difficulty for service providers in continuing to provide for such ‘old system’ patients while, within another part of local development, the service is moving to supervised-only IOT for new patients. ‘Old system’ patients should not have their treatment withdrawn but should be reviewed to consider whether their current treatment optimally meets their needs.

Linda

[derek d j]

many thanx2pheyseptomaton,skunkworks,wastedyouth,mcdermott,jimmy,leelee and all off-site4yr msgs of support.  Simon-nobody disputes methadone linctus is appropriate treatment for the majority,to insist it works on everyone,that its just a matter of metabolic rates or dosage, denies the experiences of many of the 29&a whole heap of empirical evidence..sorry, but the argument that they'll be "ok" if given enough syrup isn't that far removed from that once used for the coldbathing, electro-convulsing or lobotomisation of mental patients.
Meanwhile, as we debate, the 29, esp those refusing linctus, are living with sleeplessness&anxiety as their prescriptions are reduced.  One or two are already perilously close to clinical depression.  Remember, many are in their 50s and 60s.  How on earth can we justify forcing men&women who've led blameless lives for years off the very medication that allowed them to turn those lives around?   Is throwing the weakest overboard going to be the way a lilting SS G.B. tries to straighten its course?   The "they'll be all right and, if not, who cares, they're only junkies" mindset has worrying historical precedent; there are obvious implications for other 'easy target' groups if it is allowed to grow.
The 29 face returning to the desperate junkie existences they longago left behind(&which methadone linctus did not arrest)or an impossible 'kick'.  You don't need a genius iq to work what's happening in Cambridge now wll be coming your way soon.  So, please, unless you want the future of drug treatment to be a straight alternative between methadone linctus and criminalisation, speak out while you still can, and add your voice to the growing campaiign to challenge this dreadfully shortsighted decision.

[skunkworks]

Seems to me that SS Great Britain has been one of the biggest causes of Opiate addiction looking back historically.

Now I know Chinese society 150 years ago bears little resemblance to the UK in 2010 but it’s relevant nonetheless.
The middle eighteen-hundreds saw Britain all but forcing thousands upon thousands of tonnes of Opium on the Chinese. Some estimates say anywhere between 2 to 5 M.I.L.L.I.O.N Chinese citizens were hooked on opiates at the hands of the British Government. And China has never beaten about the bush when it comes to its policy on opiate addiction – leave the poppy alone RIGHT NOW or face the death penalty.

So excuse my lack of respect when any government this country has had starts lecturing its people on the rights and wrongs of opiate addiction.
Whitehall, Parliament, the Commons, all of them can take a collective kiss of my arse on the whole subject of opiate addiction

Whether it is the British Opium Wars, Air America [CIA] running Heroin out of Laos to help fund  the Vietnam War addicting its own soldiers in the process, ‘Officials’ in Afghanistan flooding the world  heroin market, Government owned banks allowing many billions of Drug-Dollars to be cleaned, Mexican Narco-traffickers buying up entire police forces/Armies & huge sections of it’s government, drug Squad Police worldwide miraculously ‘losing’ tonnes and tonnes of seized Hash & Charlie by the  time the court trial date comes up, it all boils down to the same hypocritical bollocks…..
   
It is any wonder that folks affected by all this are entirely fed up being preached to by these vacuous, sanctimonious and morally bankrupt arseheads ……

[mcdermott]

In addition to what Linda said, here's a link to a summary of the the NTA's expert guidance on injectables:

http://www.nta.nhs.uk/uploads/nta_injectable_heroin_and_methadone_2003_summary.pdf

And here's the full document:

http://www.nta.nhs.uk/uploads/nta_injectable_heroin_and_methadone_2003_fullguide.pdf

[afcjimwomble]

All 29 users on injecteabl presciriptions in Cambridge were told late April that their prescriptions were to be 'individually reviewed'; now they are all in the process of being switched, individually, to methadone linctus.
 Cambridge has no history of cavalier prescribing.  All those concerned were given their prescriptions only after all else had failed.  The group includes eight on diamorphine maintenance; all but one of these are in their late fifties and sixties and have had their prescriptions for an average of 17 years.  Between them they accumulated 45 criminal convictions for drug-related crime; since they've been on diamorphine, none.  Some have now gone decades without recourse to the black market; all live settled existences that, they believe, would not have been possible without their prescriptions, nor if their precriptions are removed.  Unsurprisingly, they share a costant sense of dread.  The statistics are not avialable for the 21 users on methadone ampoules but, broadly, their experiences appear to tell a similar story.
 The change, those affected were told, was ' on cost gorunds '.  Users note wrly that extra counsellors are being employed to help them ' structure their days' and similar gobbledegook innapropriate and insulting to grandparents approaching pension age.  They also comment on the costs of repeated and extensive outsourced 'drug testing', increased monitoring, ill-attended classes and beaucratic excesses since Addaction took over as dsp for Cambridgeshire two years ago.  Those on diamorphine also query why diamorphine linctus is not on offer as an alternative for those who experienced unhappy reactions to methadone.
 They are inclined to think a truer motive may be that their histories manifestly contradict the ' recovery equals abstinence' and ' one model fits all' approach to drug treatment. " It seems that if you're not a tabloid gutter junkie they're going to make you into one," said one user bitterly.
 Whatever the rights and wrongs of injectable or maintenance prescription for new users, it is an entirely different proposition for those already with a long history of succesful maintenance.  There is, for example, no recorded instance of anybody successfully conquering a diamorphine addicion aged over 55; for the sp to expect eight so to do indicates either an ingenuous or callously indifferent attitude to the fates of these individuals.  Their protests that physical, mental and spiritual realities are simply being ignored are met with a  glib' you'll thank us when you're on linctus',  It beggars belief but it's happening now in Cambridge; recoveries of decades duration are already beginning to unravel as users grapple with the stress and disruption of 10% monthly cuts.  But, hey what's the lives of a few ageing addicts when you've a masterplan?
 Addaction took over the contract here in 2009.  Is there any field other than that of drug treatment where an organisation can grow so big without challenge or investigation?  Since they arrived here, nodified addict numbers are down-no new scripts save for supervised syrup for the persistent&thickskinned-while, in the real world, dealers offer a free 'bag' if the customer waits more than 20 mins for delivery and a red light area has sprung up to accomodate poor women addicts.   It seems the only people to benefit since Addaction's arrival here have been unemployed social workers and corporate middle managers, black market dealers and, possibly, those wanting to come off and needing an instiutional support structure.  In time, the effects of what is arguably a simplistic,cosmetic approach to the complex problem of addiction will become apparent to the wider population; hopefully, it will then be discredited.(cold comfort for the 29)  But, as history teaches, people will swallow what they're told where ' drugs' are concerned. 
 So tell themthe truth-now, before they swallow the Maddaxtion fantasy and addicts everywhere swallow methadone syrup... in sleepy Canbridge, lives long mended by a judicious application of a programme of injectable mainenance are presently being ripped apart, and decent human beings treated like experimental  laborary animals.  Those of you who've done a kick know how long it took to regain anything like your natural energy and feel on top of things again; now, iimagine coming off in your sixties from a 20 year habit and figure  when you'd be right again.  Enuf said?i
  Let me be clear.  Longterm injectable maintenance is not for everyone; , just that very few who find it impossible to stop their using behaviour,whatever the cost, and on whom it produces a marked, and defineable improvement.  People like the Cambridge 29,  in fact.   Are they to be condemnded to an uncertain futurre. wth icriminilisation and disnintegration among the likelier outcomes, in order to "prove" that recovery means abstinence?  Unless somebody speaks out, and speaks out soon, it seems quite probable.  The 29 need your help and support and now.  Any ideas out there?

Is this  Human Rights issue?..Sounds like discrimination against the disabled to me. Why is it that addicts suffer the most dicrimination because of our illness?

[wastedyouth]

I have become to think that we as addicts allow people to treat us like this because we feel a huge abundance of guilt for the past and because of course we are easy to pick on being that we are a minority there are no PC ways to talk about a junkie they get away with saying anything they want and we dont fight back because a part of us feel there right, well there not we as addict have a problem/disease i dont really know what to call it but we all know we have no power over it, you cant say anything not PC about other minority groups but you can ours and once one person does they all join in.  To them we are the route of all evil.

[Jimmy]

To Derick d j, or anyone else who knows

The Cambridge 29  - how have they been coping with what has happened to them?

[Flip]

I have become to think that we as addicts allow people to treat us like this because we feel a huge abundance of guilt for the past and because of course we are easy to pick on being that we are a minority there are no PC ways to talk about a junkie they get away with saying anything they want and we dont fight back because a part of us feel there right, well there not we as addict have a problem/disease i dont really know what to call it but we all know we have no power over it, you cant say anything not PC about other minority groups but you can ours and once one person does they all join in.  To them we are the route of all evil.

I think there's a fair bit of truth in what you say WY. As a whole addicts could certainly use an image update! I also think a large part of the problem is that there is almost no organisation of addicts who don't come into contact with services (or have yet to do so).  I know when you are in active addiction you don't have much time or perhaps inclination for politics but it really seems like the addict population are only ever really represented by ex users and those currently in treatment. I know there are street based service groups etc but there doesn't seem much communication between them and there's nothing resembling  a unified front or policy direction  for addicts, especially active ones, at least as far as I am aware.

Flip

[derek d j]

To Derick d j, or anyone else who knows

The Cambridge 29  - how have they been coping with what has happened to them?

with gr8 difficulty.
its tough2wake up2a realisation yr sp is actually a bunch of junkies..esp4addicts already working their own 'recovery' programme.
one thing we've learned is that in corporate speak words can be used2mean the opposite of their dictionary definitions
--'recovery','reintegration','care','suppport', the list is endless.
an accusation often levelled at users is that 'junkies can justify anything'. oh yes.
what we're doing now is trying to protest the decision. we were told our only recourse was to 'make a complaint' in house, a court where the respondent sits as judge, but with alliance and other assistance we're learning.  now the ball's starting2roll at last..more as it happens,all support&suggestions appreciated,thanks
those refusing methadone slush or street drugs - to be corrupted2get'clean'-&others r suffering a bit but good things r happening2..we're looking after one another-the sp wont-and turning 2 our 'love'4 the answers..sounds a bit hippytrippyish but where drug treatment like mental health services are run on principles more suited to operating a bank or sales business -ever tried getting hold of a keyworker out of working hours?-and has become more problem than solution 'love' is, to use the corny old cohen line,our only engine4big society survival. 
in short we're all thinking.  hope ur2.  Is it maybe time we stopped cringing and whingeing and stood tall to ask out front why this drug war madness cant be laid to rest for ever.  40 years ago the 'british system' for addiction treatment atood as a model 4 the civilised world.  Is there any real reason it cant be again?

 

[campanula]

as one of the Cambridge 29 (embarrassed titter) I feel compelled to chime in in support of those of us who are not receiving diamorphine but getting physeptone amps. This is a tricky situation since we cannot honestly claim that methadone per se is not working for us as it clearly is (with reservations since we are making the best of a bad job) but I feel put in the invidious position of having to defend my 'needle habit'. Well yes, I am going to make no bones about it - the psychological aspect should, in no way, be diminished in favour of physiological needs. More than ever, because ampoules have minimal euphoric value, my dependance has been transferred to the injection. Now I would argue that, if we had the choice of methadone or diamorphine, we would change over in a flash - the linctus is vile and has to be taken in tiny gagging sips over several hours before I can guarantee keeping it down and so far, we are refusing adding more methadone linctus to our prescription. Tellingly, Addaction actually offered us an exchange rate of 15mls linctus for each 10ml ampoule.
Essentially, after a stable prescription of over 15 years (this time....my addictions started after dexedrine was prescribed for me as a 12 year old in foster care!, 42 years ago), we have been informed that these scripts are being removed at a rate of 15% each month. We are already down by a third and, as we are refusing linctus, we are not doing well. I guess we had gotten complacent since we really have been stable for such a long time, in reasonably good health (apart from HepC and an utterly compromised endorphin system) that we had begun to think we could 'ride it out' - our consultant (ahem) is fond of telling us how 'mature and sensible' we are (no thanks to Addaction whatsoever since the standard interventions on offer from them are along the lines of a chance to do origami in the 'creative' group and a meeting with a keyworker every couple of months who witters on endlessly about HER problems with her GP and her tiny pension!! When the consultant said we were recieving 'psychosocial therapy, we nearly fell off our chairs with disbelieving laughter.
But hey, I can see many of you going through some really grim times so I am not going to bore on endlessly but I do fear, in this age of corporate charities as opposed to the old 'not for profit' organisations of past times, we are going to be seeing a whole lot more amateur services along the lines of Addaction who will resort to the simplest, cheapest and most superficial attempts at socail engineering, requiring only the most minimal credibility (ie.one paid up actual doctor, usually a psychiatrist) who are more than happy to quote company policy in order to keep their job contracts.  It irks me that these people should have such utter control over life and death decisions (much like many consultants on the NHS feel about managerial interventions based on 'efficiency', ie.cost. This is the age of the new capitalist - the social entrepeneur - no doubt heavily supported by the Cameron/Clegg cohort.

[campanula]

Well, it's  September here in Cambridge and I am just updating you all on the latest results from the ongoing battle with our SP. Essentially, thanks to Alliance intervention and a torrid letter writing campaign, we are now at the point where future reductions have been suspended, pending a second opinion (from an agreed clinical authority separate frm our sp). A group of 9 users challenged the rationale and methods of Addaction or a group within Addaction but I honestly believe that, without the advocacy of the Alliance,i.e someone organised 'they' can't ignore our words, no matter how heartfelt and eloquent, would have fallen on deaf ears. Even now, the situation is far from clear but, more of us have joined in the group protest and the response of public health sector to user voices was encouraging.It just showed what a one sided view they'd previously been given.  There were surprising differences between what they saw and what they'd been told.. So, although we have some way to go, it has been a battle worth having - quite apart from the individual grief caused by what is beginning to look like a woeful misunderstanding along with wilful denial of some undeniable facts (finances, risk assessments, clinical propriety), we have prised open a tiny chink in drug treatment orthodoxy, and as such, we are going to seize upon this chance to actually have a truthful and meaningful dialogue as opposed to the usual dance of fear, power relations and ideology.  So speak out, all of you out there instead os simmering about worse accepting shitty treatment-if you're worth anything, so's your voice.  Use it!

[Fluoro]

simon, if i have understood you correctly,you said earlier in this thread that eventually gp's will be responsible for the costs of providing addiction medication,whether that be meth or whatever. If that is the case, what will happen to ddu's/cdt's?.

[OP8S]

I agree with campanula totally, it's time to stand up & be counted! I've phoned my local rag to see if they will allow me to be interviewed on the subject of succesfull methadone maintainence treatment, though I am encountering a bit of a negative response ( surprise! ) The editor has a problem with me wanting to be kept anonamous, though the journalist doesn't seem to. It's a small community that I live in & if I were to put my name to it it would be quite possible that I would lose my job which is a responsible one in the healthcare industry. Surely thats the point though? That's my arguement to the editor which I am trying to get across, my biggest worry would be the possible victomisation of my family though. If I can't do it anonamously then I can't let them take the flak for my actions. In the words of an old song...the problems that we suffer from are the problems that we make, the shit we have to go through is the shit we choose to take. If you don't like the life you lead change it now, it's yours. Nothing has effect if you don't recognise the cause!

[wastedyouth]

Well done 60DEGREESNORTH if only there were more success stories willing to remember where they came from, it seems as if alot of people get clean move on and try to forget(which i can totally understand, imagine what my kids at school would get if i suddenly done a piece for the paper).  I understand why you cant put your name to it, stigma and loss of job i suppose.  We peronnaly know of success stories but the public, the same ones that hear every piece of bed information flying about dont hear about the succesful ones i it changed just one persons perspective of methadone and the people that take it then it will be worth it.

Well done great idea
Maybe you could post it on the alliance so we could also have a read, but i would also understand i you wished it to stay private, but i know that i would be interested in reading it.
At least you are doing something for people like me, Thanks  WY

[simon]

simon, if i have understood you correctly,you said earlier in this thread that eventually gp's will be responsible for the costs of providing addiction medication,whether that be meth or whatever. If that is the case, what will happen to ddu's/cdt's?.

GP's will be responsible for commissioning services it will be a massive task and it's not that clear to me how well it will work. I'm guessing CDT's will have to provide a cheap and effective service or the GP's won't buy it. They may buy from other GP practices rather than secondary care.
It's not clear to me whether drug action teams will still be around either as the PCT's will be decommissioned and the local councils have to save so much money.
GP practices will sell the skills they have to other practices a local example is vasectomies one of the GP's does them and it's much cheaper than going to Hospital to do them. GP's have lots of underutilised skills that are wasted because they are tied to the QOF means of earning money and it restricts a lot of practice.
This is my interpretation and may not be correct as it's early days with this yet, time will tell but for me working for a GP practice it could make services much more responsive. GP's will not be reckless with money though.