Amps-What is the deal Neil

[Anon33]

Amps....again......so maybe I am going to answer my own question.....under CRI-NO chance

A guy, has previous private script of amps...mum cany afford it or travel to Staplford centre anymore so local CDT prescribes for last few years anyway.....CRI have just taken over all treatment provision and given 1 more script for 2 weeks, after that NO more...he didn't agree to it...doesn't want it....apparently he was taken out of shared care by CRI and now is getting forced off......
any ideas....any one

[physeptomaton]

The guidelines all allow for injectable prescribing, so there is no basis for this apparent Purple Ribbon Brigade policy of getting people off physeptone amps who have been stable on them for years (I am assuming it's phy you are talking about).

Could he get a 2nd opinion like the Cambridge injectors did?

[OP8S]

These CRI cowboys are really becoming the scourge of the nation. Your mate should ask for a 2nd opinion as the Cambridge i/v users did & immeadiately start writing letters of complaint to everybody & anybody that is in a position to question CRI's authority to do this before his script runs out.

[derek d j]

Here, DAAT Commissioners, under NTA guidance, ordered a review of the local situation after the provider reported an inordinate number 'parked' and in a bad way on huge scripts. It was all a load of rot, of course; the largest Cambridge diamorphine script, for example, was of 300 mg daily, or just under 3/4 of the European average, and the judicious injectable maintenance policy followed here had been unusually successful. An opiophobe in his first consultancy teamed up with a business manager anxious to save a buck and decided simply to do what suited them and impose their will on this group of unfeeling addiction objects. We were told 'reductions'  to zero were compulsory and we had no right of appeal. Simultaneously, the DAAT were informed we were 'very happy' to be rid of our cursed prescriptions. Had we all been a little younger and been able to do what they asked, they would have probably got away with it.

The important part for your case is that, while we were told everyone was 'under orders', this was just one of of a number of dissemblance tactics and, in reality, Addaction were probably guilty of no more than an excessive loyalty to their staff. Local dsps and consultants in general enjoy considerable autonomy. You must familiarise yourself with treatment structures and ask a few questions.

Did CRI inform your DAAT of an intention to remove 'injectable' scripts prior to their winning the contract?  Are there are good clinical reasons - not justifications - for the removal of your script? Is yours an isolated case or are all injectable users being targeted, either en masse or to be picked off one by one? Have the guidelines been contravened? If, as has been suggested, all CRI consultants act in this manner, there would seem an urgent need for investigation and clarification of the policy.

In these days of a uniform conformist mediocrity, it's easy to forget the whole thing is supposed to work according to reason. Doctors may not follow a private agenda and nor may providers. If, in all honesty, you feel it's not right, it probably isn't. Persevere until you find someone who responds properly. The DAAT, PALS, the PCT, local and national NTA - it can be a little like letters in a bottle but, if you're in the right, eventually someone will hear you. If there are others in your position, you all need to get together. Yes, it's a hustle. But if you don't pursue it, you lose your script with whatever consequences that entails. And the opiophobes will march on and trample on other lives for lack of any contrary voice. Were your consultant handing out injectable scripts, the opiophobes would scrutinise his affairs with a fine comb to find grounds for complaint and what's good for the goose should apply to the gander as well. Good luck to you.

[Jim]

worth bearing in mind though that according to the guidelines new sripts for injectables have to be delivered under RIOTT trial conditions i.e in supervised injecting clinics which very few providers or commissioners can afford.

[physeptomaton]

worth bearing in mind though that according to the guidelines new sripts for injectables have to be delivered under RIOTT trial conditions i.e in supervised injecting clinics which very few providers or commissioners can afford.

it's a script he has been on for years.

[Lelee]

The following is taken from the Dept of Health 'Drug misuse and dependence UK guidelines 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.

Your friend can use the above to challenge the CDT as they are the clinical guidelines that all prescribers should adhere to.  What reasons have been given for the cessation of his injectable medication? To who's benefit is this? Has he had a clinical review? Got a care plan?  Has he made a formal complaint? Contacted the Drug Action Team who commission the services?

I wish I could do more as I advocated for the Cambridge cases. To be clear, I'm just responding as a forum friend.
All the best.

Linda

[derek d j]

But what can you do when your consultant is determined to ignore the guidelines which do not suit his own interest, leelee?

You remember what happened here. The '2nd opinion' reversal of 12 of 13 of his decisions haven't altered his beliefs one iota. He does not like injectable prescriptions and feels it unfair he should have to sign them. He assumes what suits him will suit we addiction objects and, as you found, you can't tell him it's unreasonable or counter-productive. What he does now, consciously or not, is chip away wherever he can at those of us with reasonably together lives in the hope, I at times fear, we slip up or leave town. Their consultant is a powerful figure in user lives and a hostile one can damage them in ways a non-user cannot imagine. Although our scripts remain, in slightly reduced form, such 'treatment' takes its toll.

And, of course, as hayz's mate doubtless finds, if you try to tell an opiophobe any of this, you're just a whining junkie. I honestly believe they think we lack feeling altogether and, as there's no hope until we're off, anything is justified if it serves that end.  If there's any way at all you can do without your script , you will simply to get the hell away from them. As long as consultants like this enjoy their considerable local autonomy and unaccountability, and find support from providers like CRI, users will  continue to suffer for their fantasies.  

[Lelee]

There's a lot you can do Derek as you know. It took ten months of advocacy, pursuing many avenues and fighting for your rights but in the end we got there.  A hostile consultant in any modality who puts his own ideologies and personal preferences before clinical guidance will damage those he provides treatment for. It's the imbalance of power being used in a discriminatory manner and the last thing to expect from someone who has taken the Hippocratic oath.

I would say that Anon33's mate puts a formal, written complaint in asap to the CDT and copies it to the manager of local Drug Action Team and the Regional Manager of the National Treatment Agency. He should ask for a second opinion and for his prescription to continue and nothing change until until his complaint is investigated. If there are no relevant clinical reasons given for the cessation of his injectable medication then he has a good case. They have a duty of care.

Nothing should change until he has a proper medical review consisting of:

A full medical history and physical exam.
Supervised injecting during review.
Examination of injecting sites.
Standard dose tolerance test and observation for the next 25 minutes.
Urine test carried out periodically.

This is just common good practice and they have a duty of care.

In the meantime he could call the Equalities and Human Rights  Commission, 0845 604 6610 (think that number is still current.) He could give a brief account of his situation and the benefits of injectable medication and how it was essential to his well being.  State that the reason for stopping his treatment is not based on any clinical reasons but based on an imposed blanket policy (if this is the case.)

He could ask if this breached Human Rights Article 3.24 ‘failing to provide or withdrawing proper medical help to a person with a serious illness.’ From previous calls in a similar situation I was told it may breach the HRA based on those principles and he then went on to explain that the EHRC don’t usually represent stand alone human rights issues but those that were also linked with equality.  I then went on to tell him that people who are dependent on substances, for whatever reason, are stigmatized and certainly not treated as equals in society. I said they are even discriminated against in the Disability Discrimination Act and excluded from the criteria of being disabled. He agreed and said people dependent on substances can sometimes be included because of an associated disability, eg, mental health. 

I'm not familiar with the details of this case so just giving  general information. There are Community Care solicitors who might take the case on a legal aid basis and there could be a case for a judicial review but it has to take place within three months of the decision to stop his injectable medication.

There is lots that can be done but the ball needs to start rolling with a formal written complaint. Time is of the essence here because he needs to do it while still functioning on a script.

Linda

[OP8S]

Could the same apply to people with mental health issues that are being pressured or forced to reduce to the point of abstinence that are currently recieving oral medications ?
I'm on maintenance myself, but it might be worth knowing as I know several people who'd rather stay maintained but are being ground down by ambitious keys etc.
Knowledge is power & users in treatment need to arm themselves with such knowledge in these uncertain times.

[Lelee]

Absolutely OPBS. In fact there's even more reason to keep someone with mental health problems (dual diagnosis) maintained on oral medication if that is their wish. It may be the only thing keeping them stable. I had several run in's about this with my son's psychiatrist who had no knowledge of drug treatment. When my son chose to reduce at a time he felt he wanted to it was a different matter although I had misgivings. It's about personal choice and that determines and inflences motivation. If something is working why mess with it?     

DH guidleines:

'There is clear evidence that coerced detoxification against a patient’s express will is likely to lead to relapse and increased risks of harms such as overdose and blood-borne viruses.'

'Co-morbidity is associated with negative and often complex factors including higher rates of relapse, increased hospitalisation, higher rates of completed suicide, housing, instability, poorer levels of social functioning, such as poverty, violence, criminality and marginalisation, less compliance with treatment,
greater service utilisation and higher costs to services.'

Hope that helps.

Linda

[simon]

I've known patients with mental health problems function better on methadone than with antipsychotics. We did have a poster on here can't remember who but he was fine on methadone but without it was bi-polar.

[Lelee]

Yes, that's right Simon,  there's that added dimension too.

Linda

[simon]

It's hard to demonstrate such things when patients are treated with suspicion and are believed to be scheming drug seekers. If you treated any other patients punitively guess what would happen.

[Lelee]

I agree. Whe my son was severely unwell mentally his psychiatrist told him 'all you drug users are the same. You all use mental health as an excuse to take drugs.' .....yes, I made several official complaints.

When my son's anxiety felt unmanagable and he requested benzos he was just seen as 'drug seeking.'  Such is the discrimination.

Linda