21st Century Detox

[daveywales]

At last I have made a difference in the way people are detoxed in Wales. I was on 250 ml and without my input to my detox plan I would be back on black market methadone. However I have been part of the team-my nurse, consultant and myself. They gave me total control on how fast I reduced, which could be changed by a phone call to the CDT. I was told by my consultant I had 80 ml of Valium per day to use to make it as comfortable as possible for me. So I choose how I wanted my Valium and to the dismay of the prejudiced nurses were amazed that the only time I used the full amount in 4 months was 3 times. I have documented my detox which will be on the website Wired and hopefully in Drink and Drug News. Common sense if you are in charge of your detox you will design it for you and therefore sucess is garanteed. David Wright

[jaseybabe]

Good for you,wish my bunch were living in the 21st century,rather than the 19th!Control and empowerment make it guaranteed.

[Jimi]

Yeah, bet that surprised em  plenty, look forward to reading a more detailed account, fair play Davie.

jimi of hug

[simon]

Davey,
Would be interested to see this. There is much evidence of high doses of benzo's with opiates causing respiratory depression (Sometimes fatal) Is there any evidence base that you are aware of for these high doses ?
I worry it would make sleeping even more difficult for me if I had patients on doses like this.
I've also seen patients having terrible problems coming of benzo's, some having to shave the tablets when getting to the very last bits.
It will be interesting to hear your article

regards

Simon

[daveywales]

Just a quick reply Simon as you will have a detailed account when it gets on the web or/and in print. I have a very high tolerance to benzo's and my consultant knows this. This detox was designed with that in mind and remember I have not been using my full PRN. Saying that 4-5 years ago I was getting my Valium weekly of my doctor. 210ml for the week. Sometimes(and I do not advocate this in any way) I would take the weeks dose in one go, then go and do my shopping, popping in the pub for a couple of pints, feeling sedated but know way near losing control. Yet I have seen heroin users have one 10ml tab and it wipe them out. Horses for courses. Now I treat myself with alot more respect so I would never do anything so irresponsible nowadays and I say that to all that read this.David

[simon]

David,
Will be interesting to read. This method may be suitable for you as you are now, but not as you were then.
I find a lot of people are not responsible with benzo's. I see many people buying the fake stuff from off the streets and it's an ever increasing problem, people don't know what they are buying.   Some patients have told me they've taken 100 of these fake 'Blues' with little efffect and it could lead people to thinking they have a high tolerance, to then take the same amount of the real preparation either off the streets or prescribed...........
Digressing slightly there, anyway i'm open to any new evidenced based treatments and I had a Student Nurse with me yesterday (General Nursing student), and like a good student looked in the BNF and said 'Is this all you have to treat substance misuse?'
I think she has a very valid point !

[daveywales]

Simon, I have found from previous detox's (in the days when I was still using heroin, this time I have not used heroin for 5 years and work in a drug clinic. Anyway my previous detox's I have had my methadone either reduced so fast that i go into withdrwals almost immediately or I have one dose of methadone and thats it. The drug Lofexedine(SP) was used in these two detox's to stop the noradrenalin storm, which opiate users get when they have their opiates suddenly stopped. The noradrenalin storm is horrendous-you can't keep still, extreme aggitation, not a chance of sleep etc etc. Well methadone is such a strong chemical that the Lofexedine holds of the noradrenalin storm for 3-4 days but then the methadone adrenalin storm breaks through. So basically it is another drug for opiate detox but has failed me and everyone else who have tried that form of detox-hate the expression substance misuse by the way. We do not refer to diabetics with type two as cream cake misusers. My personel point is Valium is an excellent drug to use in a SLOW reduction detox as it is a long acting benzo then Nitrazipam for sleep as again it is a long acting hypnotic and I feel there ios too much fuss about benzo's IN a hospital situation and in general. You have to roll the dice otherwise people will be walking out of their detox's. Which makes the whole thing a farce. David

[simon]

David,

I'm aware of Lofexidine and the 'Noradrenaline storm'
You may think there is a lot of fuss about benzo's and with good reason they are terribly addictive and very difficult to come off. I know from my own practice these drugs have suppressed people some for decades. I remember patients who had been prescribed them for bereavements and never grieved, but when they decided to come off them found they were grieving for someone who had died 30 years previously. I have read much evidence to say they should not be prescribed long term however, for some people nothing else seems to work. I think they should be used cautiously and with the patients being fully informed about the addictive nature of these pills.
As regards your comment about cream cake misusers we do have patients who are classed as 'Morbidly obese' that is not a term that is easy to stomach. A type 2 diabetic may not be in anyway a person who misuses cakes some people's pancreas just stops making enough insulin. It does tend to run in families and people who are overweight are more prone to it so are Afican, asian and Afro-Caribbean people. I think it's hard to 'label' someone, which is why i always term people who see me as patients, it has been around so long and I don't see any negative aspect to it. The names for types of conditions change and no longer do we have people who are feeble minded, imbeciles or idiots, we no longer have lunatics, pauper lunatics, morons or cretins.  I will always use the term patient it gives nothing away about the reason for treatment  or for presenting oneself for a consultation.

[bp]

At last I have made a difference in the way people are detoxed in Wales. I was on 250 ml and without my input to my detox plan I would be back on black market methadone. However I have been part of the team-my nurse, consultant and myself. They gave me total control on how fast I reduced, which could be changed by a phone call to the CDT. I was told by my consultant I had 80 ml of Valium per day to use to make it as comfortable as possible for me. So I choose how I wanted my Valium and to the dismay of the prejudiced nurses were amazed that the only time I used the full amount in 4 months was 3 times. I have documented my detox which will be on the website Wired and hopefully in Drink and Drug News. Common sense if you are in charge of your detox you will design it for you and therefore sucess is garanteed. David Wright

Mmm, you may have had the detox of your choice but I'm not too sure that you "have made a difference in the way people are detoxed in Wales, you are just one person David; I'd worry if everyone had a detox such as yours. I too would be very interested in reading about your detox but would prefer if you write about it in about six months times. Many of us have experienced that initial euphoria of 'coming off' but that's just half the battle; staying off is winning the war.

I hope we meet up again before too long and I do wish you all the very best. You know me, cynic to the last and never more cynical or self deprecating as I am to myself.

Beryl x

[daveywales]

Yes Beryl the detox is only half the battle and I agree with you Ihave not made a difference to detox's in Wales what I mean't to say is we as in advocates. I was on weekend leave when I wrote it, weekend leave from 4 months of living with tormented people in an acute psychaitric ward. Please forgive me for my excitement of having a say in my detox plan to the point of saying I instead of us.. Yes the battle is not even halfway over, as I have halved my methadone now I will try and reduce down to 40 ml as an outpatient. If all goes well I will go back into hospital to prepare to be transferred to subutex then hopefully do the final reduction to zero.
Thanks for helping get my feet back on the ground. You are a treasure and I have the upmost respect for you. Davidx
S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    

[simon]

David,
I worry that this is not a '21st Century Detox' and maybe just reducing Methadone and increasing Benzo's.
I will wait and see what happens and those 'Prejudiced' Nurses maye well have a valid opinion.
Fingers crossed and I wish you well
Simon

[daveywales]

Simon I have reduced from 250ml of methadone to 120ml by using 60ml of benzo's per day. I am now in the intermediate stage of my detox plan where I am an out-patient and am still reducing my methadone but at a slower rate. I am on 30 ml of diazipam and for the first time in 6 years I am sleeping without sleeping pills. In hospital I was being given 10ml of Nitrazipam. Nothing bad happened to me when the Nitrazipam stopped. Simon the consultants are responsible people and if it needs 100 ml of valium per day to detox someone off methadone successfully then surely that is better than them being undermedicated walking out of the detox to inject street heroin. Consultants are responsible people and the detox includes reduction of the benzo's at the end as it is part of the whole picture. I really believe that the your fears of giving somone a benzo habit in a detox senario is unfounded because at the end you are reduced of them like it or not. This is agreed at the start of the detox. Simon I feel it is like saying don't give someone on a methadone script opiate painkillers because the will get an opiate habit., which does happen and people are left in terrible pain because of this. If I did not have the the amount of benzo's in hospital that I did I could not of dropped 130 ml in 3 months and I have not swapped or are going to swap my methadone for benzo's. David

[simon]

David,
As before I wish you well.
There are a few points that i'd like to mention you say you are sleeping well for the first time in six years without sleeping tablets, err well haven't you already mentioned you are on Diazepam ?
You further mention that the consultants are responsible people, I never said otherwise.  I would question what you say about if it needs 100mg of Diazepam a day to detox someone off Methadone then surely that is better than someone being undermedicated, well undermedicated on what ?
Whatever you feel, I have not said anything that would suggest not treating people with opiate analgesics if they take Methadone. Please don't feel you have to preach to the converted.
I have had many patients who have been on benzo's and the withdrawal is not easy.
Continue with the battle
regards
Simon

[daveywales]

Simon, I thank you for letting me sharpen my advocate sword with our verbal jousts. I was mentally rusty and needed to exercise the brain cells. At first I thought you were the sterotype doctor type who will not prescribe nothing to a 'drug addict' but old Mrs Jones would get what she asked for. Now I know different. My main point(and I know I did not stick to it) was having the patient's input in there treatment from start to finish is a massive forward movement in medicine, instead of finding out what you have been prescribed for you detox is when you face the staff nurse behind the meds trolley.
Hope to meet you some day, ill buy you a beer, David

[simon]

No you won't, you'll buy me two!
I hope i'm not a sterotype anything, neither am I a Doctor, i'm a Nurse. Keep the Sword sharp!