Can they do that????

[Jules]

Really pleased your mate got the result he wanted Anon33 - it really doesn't take much in some cases does it? 

Take care.

Jules

[usandthem]

Mark,

Google will only find you what you want to find and the research goes much deeper as anyone knows on this forum it is about user choice not what some key-worker jots down to pass up the chain to be used as statistics. I visited a DSP the other day and there was an opening day with a buffet and the local rag were there for the big story.

Turning to the gathering of big wigs and commissioners there to see the quick progress of this new service. I noticed a giant sized black board with targets and targets hit scribbled in thick marker pen. Wow, I thought is this what drug treatment has turned to. Giving feedback from user to keyworker is not as straight forward as many in the National Audit Office for Stats would like to believe it is. So this troubles me.

Of course the down side to this is a lot of data can be mis-interpreted and can end up being used as a way to update and revise the original guidelines into a more recovery orientated guide.

It is for the user to decide what works best for them and the data is nothing more than data and the new revised guidelines for recovery are just a guide and not to be interpreted out of context for how a service should or could practice itself. Prof. Rand makes it clear that recovery is either rehabilitation, maintenance, or supported abstinence i.e. reductions - are all to be looked at as equally successful no matter what medication is favoured. [The user must completely own their recovery]and the service should support the user in where the user wants their treatment to go. This is how recovery should be used as a good standard and conduct guide to all practices, care services, and centers of care and no interpretations should be made by any service that contradicts the needs of the service user.

John

[froude]

Firstly id like to add that the first link(Topix) that was put up by Mark Gilman about Bup and Methadone Maintenence,4 people were from the uk and 2 said that Methadone works and the other 2 said Bup work,and the rest were from the United States,9 in all,personally im not intrested in what  Americans have to say,as it has no bearing to me as i live in England,so i wont be in a line in Alabama waiting for my medication.IM under the impression that if used right they can both be good for treatment,and they both can be abused.Bup can be snorted and you either get a whizzy feeling or gouched out feeling,and you can use on top of Methadone.Here on the Alliance we have some one who has just come off MMT,and at the moment Angie is doing really well,im on MMT and im feeling better and healthier than i have for nearly a decade,and im sure thousands of people are aswell,same goes for the Subbies.Im really getting peeeeed off with different people saying this is better than Methadone,Methadone Maintenence works it is as simple as that ,and so does Bup.Whatever suits you as an individual that is fine,as for the other link ,in it someone said Methadone can be sold,down my way more Bup is on the blackmarket than Methadone,so it seems they (Bup)are in more demand.Instead of this massive debate on what works and what doesnt ,and over the last 6months to a year Methadone and its Maintenence have taken a hell of a slagging down cant we as users and ex-users be happy that there is more treatment available no matter what it is,if it helps thats great,and the most important thing to remember Methadone isnt for everyone,at least we have a choice, when there isnt many choices out there at the moment.It really gets me pissed off when there is so many of us out there who are suceeding on Methadone Maintenence,only for meth to be slagged off.METHADONE MAINTENENCE WORKS,AND SO DOES BUP,so whats the problem,im not bothered whats best im more intrested in what kind of medication works for me and thats Methadone Maintenence Treatment.As for the 12 STEP PROGRAME,done it in Prison and on the outside ,personally i think its a load of bollocks,Have a good day ,all the best Froude

[sapphire]

So we're using Topix as proper research???

No wonder drug treatment is in such bad shape!! 

[derek d j]

Yes, all power to Mark for stimulating this debate. I may disagree with what you say but I will defend to the etc.

It must be remembered that 'Drug Treatment' exists as expedient reaction to the shortcomings of absurd 'Drug Laws'. A citizen may change his consciousness with gin as long as he commits no crime while under the influence. The taking of opiates is a crime in itself - for Christmas merriment, read Dalrymple's attempted repudiation of JS Mill to justify drug prohibition - but a sizable minority determinedly defy the law. It's a mystery why there is such fear of heroin, probably something to do with death, but criminals dictate the economic terms, a social problem ensues and habitual offenders are granted limited exemptions 'on medical grounds'. Within these artificial limits, Treatment gurus stumble around like the boy in the bubble.

A social problem with moral overtones is always going to be vulnerable to political silliness. The tendency is not to allow the evidence to shape the agenda but to shape the evidence to fit a predetermined agenda. I'd a friend who argued in all seriousness that heroin was an perfectly sane reaction to life in the dying days of consumer capitalism. The world banking system, that great secret of which 99% of the population know nothing, is floundering and the eurozone apparently in meltdown. We hope the same masters who pollute our planet and create the mess will now solve it and hurry to catch the post-Christmas sales now in full swing. You could say we're all a little out of touch with reality.

There are certainly many separate, often interconnected problems with which our society must deal. One is the unnecessary criminalisation of over 300,000 UK citizens. Its solution is simple; a return to Rolleston. All else relates to our plethora of other problems and a crippling absence of self-understanding. But, instead of addressing the central issue, we argue about how much of which substitute may be allowed for how long until we forget quite how barmy we've become.

Sure, many addicts would dearly love to stop and appreciate any help to do so. What would help most, of course, would be to understand why they take it the first place. But that involves getting real and nobody is very good at that. It's easier to think of weak or deviant victims of evil pushers who now want only to 'get clean' and be like everyone else. In a dirty world where the corrupt prosper, you may think linking cleanliness to drug abstinence is beautifully cynical. In lieu of proper direction, we rely on our common humanity. Luckily, humane and caring people still exist in Drug Treatment despite ugly politicians, cheap moralists and rotten corporate agendas. A very happy Christmas to them all.

[Mark Gilman]

snip>
Sure, many addicts would dearly love to stop and appreciate any help to do so. What would help most, of course, would be to understand why they take it the first place.

Thanks Derek. I completely agree that we need to understand why people take it the first place in order to help those who want to stop.

[usandthem]

I completely agree that we need to understand why people take it the first place in order to help those who want to stop.

"In order to help those who want to stop" Maybe if they want to stop they will be able to do that once in substitute treatment. i.e. Methadone Maintenance. If they ask you to help them to stop - then be suspicious - as they probably mean that A. they want to be clean from heroin to please their family, or B. they have hit rock bottom, are skint and need opiate substitute maintenance to keep them from shoplifting. or C. a DTTO, court order, or DIP referral. or D. other reasons or pressures to stop heroin use.   Although this probably doesn't mean they want to be completely abstinent from substitute mediciation. This will mean they will mostly want to stay in oral treatment maintenance.

Something drove them to heroin in the first place. We must not look at helping them to stop but more of helping them to reduce their use ONLY if they wish to  "if they feel they are up to it then support them". Up their methadone dose if they want to reduce but can not. I do believe that once at the therapeutic level then this will reduce the need to use heroin. The only and best way is to give substitute medication for opioid users and to maintain them. The default in society is to first deal with heroin addiction as a stigma or something to fear.? Then to cure the sick.? Clean them of this wretched beast that has held them down for so long.? We are helping them to free themselves from this beast.? Not all heroin addicts think like this. They only go along with it because it is the DEFAULT and it helps them keeps their name on the prescription pad at their local D.S.P

As a sidenote: Sure heroin has a death rate attatched to it. But this is because when something is outlawed then it can not be clinically measured and regulated. Many overdoses happen because usually the injector is usually alone. Just out of curiosity has anyone ever died of 'chasing the dragon'? I would imagine not.

Anyway, Isn't being maintained on methadone or other opioid type meds good enough for society?!. Doesn't being maintained mean you are no longer committing crime to fund your fix?! Doesn't being maintained help families rid themselves of guilt at seeing their loved ones on the floor in agony and the only other thing to do is give them money or watch them keep returning to jail?! Does not being maintained cut crime significantly and help stop the revolving prison terms?!
Methadone or other opiate substitute maintenance is the only sure way to stop any heroin use. To take that away or make one abstinent can automatically spring board them back to full on heroin use. Stability, Support, Happiness, is key to complete the long arduous road to full-on abstinence - no matter how encouraging or supportive the key-worker is.

If you want your client or service user to be clean - as in clean from substitute meds then you are going to probably fail in the long term. You may get really lucky if you have a really DETERMINED client. If you want your client to remain clean from heroin then the best bet is opioid substitute maintenance and if that means the long term then so be it. Recovery covers all types of treatment including maintenance. Maintenance is equally as valid to the NTA as a full on reduction. So it is a myth that you should reduce once in service. They try to stimulate a user from being parked for too long. But there is no law saying you can not be maintained in the long term.

It will surely be what the Service User wants that counts here. After all it is their LIFE. That is all for now.

Anyway Spot on Derek you always give us a clear picture of how the drug treatment world really works.  

John

[sapphire]

Mark - the truth of it is, we are being marginalised even further by this abstinence based 'recovery' agenda.
What are you going to do to stop that?

[derek d j]

Thanks Derek. I completely agree that we need to understand why people take it the first place in order to help those who want to stop.

Well, yes, but.

The insistence on a need to 'help' is a fundamentally flawed creation of the help industry to justify its existence.

Under Rolleston, a slightly higher percentage of users came and stayed off than do today. They also 'kicked' slightly more quickly than they do today.

Today, users have an abundance of assistance, from the enthusiastic ministrations of 'key workers' to institutional detox centres and big business rehabs. The Rolleston era user had none of these. What they did have was the unadulterated drug and themselves. Without distractions of supply, law and lifestyle, theirs was exclusively a pharmacological problem. When they'd had enough of the drug and decided they neither needed nor wanted it any longer, they did their 'turkey' and stopped. This decision was usually made long before neurological changes entered the picture and withdrawals were within the realms of the bearable. Under Rolleston, those who came off tended to stay off. They knew what they were doing and why they were doing it.

When adults are permitted to shape their own affairs, they usually do better than when they're treated as deviant or delinquent children whose decisions must be made for them The kind of 'help' offered not by empathic family or friends but by strangers in need of 'a job' serves further to confuse the issue. Apart from the dubious sincerity and accuracy of information served up by the paid legions of helpers, we witness the phenomenon of small-habit users utterly convinced they need 'rehab' to have the slightest chance of 'getting clean'. Tell someone they're a dog often and long enough and they'll bark. Treatment can create its own mess and add to what's wrong.

The present 'encouragement to abstinence' will have as little impact on the 'drug problem' as previous 'dynamic solutions'. If Treatment offers no prescriptions, the number of users in Treatment will decline drastically; they'll go to criminals instead. Only in the world of the mad may this be touted as 'success'.

We need to see the reality of the situation. Over 300,000 UK citizens believe they have a need for opiate drugs. Many actually don't; their attraction is to the criminality, status or lifestyle. These would fall by the wayside were morphia freely and unexcitingly available from the doctor. And those who seek the actual drug, whether to solve 'personal problems' or from a more generalised angst, would find their peace and, in time, resocialisation. Far better than unspoken efforts at socio-moral engineering mistaken for medical treatment. Far better than a job creation scheme mistaken for a practical necessity. These are part of a wider malaise and should be detached from the object of the exercise.

Which is, I'm told, to minimise drug crime, drug violence, drug gangs, drug prisoners and to encourage drug addicts to lead productive lives. We achieved all this under the Rolleston system and were the envy of the civilised world. For reasons murky and undiscussed, we threw it all away and for forty years the drug problem has gone from bad to worse. If you want Drug Treatment to 'work' return the problem - and the research - to the realms of the pharmaceutical and permit adults, under medical supervision, to use whatever medication they think appropriate. The rest is as real as the fairy on top of my Christmas tree and it's time we realised it.

[Jimmy]

Mark - I'm a little suspicious of some of these Service USer groups. My service has a group, but there is only 1 current service user in it, the ret are all abstinent ex-service users

When CRI were in the process of attempting to win MK contract, relaying false promises and promoting false hope for financial gain, I made sure to attend every 'user' event on offer. Out of 5 meetings, maintenance patients were outnumbered significantly; during the last 2, there was only 1 - me. I must admit, the abstinent appeared to be against time limited treatment or coerced reduction; methadone/bupe, for some of them, had saved their lives. CRI duly expressed a desire to keep those stable in maintenance in receipt of their scripts before throwing yesterdays truths back at those who has trusted and believed them. At the time, they were an unknown quantity and SUs themselves were, from I've heard, involved in the final decision .......... or were they?

I noticed a flyer during my last visit - another SU meeting scheduled for this week which unfortunately I'm unable to attend. A bit gutted really; it would make for interesting observation, patients' perceptions 6 or so months on those blatant from false promises of hope. I wonder if more maintenance patients will appear this time around? I would imagine so. Although, will they even be welcome now? An abstinent only meeting could be disastrous for the medically assisted.

Currently I have a new key worker who actually listens and claims to understand the reasons for my decisions around MMT. He also appears unintimidated by the sadist/doctor. Here's hoping.

I would seriously advise every maintenance patient unsatisfied with their treatment to make this known, if not at a SU meeting then by some means else.

Best wishes to all

Jimmy

[froude]

Yes Derek,Mark i also agree that we have to understand why people like me and the other 299,999 people take drugs in the first place in order to help me and others who want to stop,I was under the impression that was for the D.S.P and the person who has the care plan to work out in their appointments.Coming  back to D.S.P's all they are intrested in now is getting you off your script as quickly as possible or hoodwinking you into taking a reducement.A few months ago i was in between Keyworkers,and i went to my second appointment with this Key and all he was intrested in was reducing me 10 mil as i had'nt used for a month,during those 2 appointments i never talked about WHY I got a habit or even about myself it was all about reducing ,"Hi Froude my name is Trevor ,I see in your file you havent used for a while  dont you think it would be a good idea to start reducing" ,his tunnel vision of getting me to reduce was amusing to say the least,and this is happening all over the country,many people who are'nt as up front as me or dont want to rock the boat ,have been pushed into either reducing on their script or are so worried if they say NO they will be taken off their script,Is that the way D.S.P's around the country are going to work.After nearly 8yrs on M.M.T my new Key has decided that once we deal with my past ,then i can start to move on,as i have said before its taken them nearly 8 yrs to do thius ,what does it tell you about my D.S.P,like many others, heads up their asses.

Derek has a valid point of going back to the Rolleston,it would, in the long run have a significant effect on all aspects of the drug scene,from the dealers,crime and choice of what drugs we have in treatment that are'nt readily available now.

Im just really pissed off that MMT is getting such a bum rap at the moment,and everything has to be abstinant based,the Alliance is the one forum that when you get on it you have'nt got people saying abstinant ,abstinant,or "Yeah i was on methadone and it worked and then slag it off,All the best,hope you all enjoy the Holidays  Froude.

[OP8S]

Exactlly Jimmy anybody undergoing treatment & is relatively stable should recieve the treatmentthat helps them the most, in their wel-being. Instead the UK will mot budge from meth or bupe when like sapphire says " everybody's different " & medications that are having better resultes ,may suit the user for the better, as we see in other EU countries.
Froude just make your issues from the past last as long as you want meth, yu're under a care of a cpn which means you can stretch it out forever if you want.

[froude]

Yeah OP im on that now ,nice one.Cant see me getting reduced on any of my meds next year ,still dont mean i can have a rant though ha ha ,Have a good Christmas mate ,All the best Froude&Family

[Anon33]

#off topic#
Now know why I just a fattie around my waist....all my intestines are backed up with shite.....so on all sorts of laxatives, ones tastes like liquid sugar love.....must dash....moving again     

[Anon33]

Really pleased your mate got the result he wanted Anon33 - it really doesn't take much in some cases does it? 

Take care.

Jules

Thanx.....he is well happy....x