Action On Addiction
Dr Max argues for a major shift in how we treat addiction
“Iremember falling and thinking, This is it, I’m going to die,” said Malcom and he paused, consumed by the memory. “It might have been easier if I had,” he added quietly. I was sitting in an outpatient clinic at the drug dependency unit where I worked. He shifted in his chair and winced as he did. Before he became a drug addict, Malcom had been an electrician. But one day, 15 years ago, he had been up a ladder fitting a burglar alarm to the outside of his house when he lost his balance and fell from his ladder on to the stone paving slabs of his drive below, breaking his back and fracturing his pelvis. At that moment, his life changed. In constant pain, he was prescribed high doses of painkillers and soon became addicted. When the GP became concerned about the number he was consuming and not knowing what else to do, he stopped the prescription. Malcom then began buying the tablets off the street and progressed to smoking heroin to satisfy his cravings. By the time I saw him, he was well and truly addicted to heroin.
While most people assume that rehab refers to a specialist residential facility where people stay for weeks or months on end in an attempt to get clean, in fact, the most common place to receive treatment is in a community-based clinic as an outpatient and it was in one of these that I met Malcom.
While I think much could be done to improve services for those addicted to illicit drugs—not least focusing more on psychological
therapies rather than simply on the physical addiction—i think it is justified to place parameters around who receives a residential placement. These are incredibly expensive programmes, costing thousands of pounds a week, and there must be assurances that those who are referred will be the ones who most benefit. But there is another aspect of drug services that truly is wanting and that receives next to no coverage or discussion. This relates to a group of people who really need help and yet there is a dearth of specialist provisions for them. People addicted to prescription medications. This group are roundly ignored by drug services. This is despite their addiction often being just as severe and debilitating as those addicted to illicit drugs.
It would be easy to blame GPS for this—after all, it is they who are providing the prescriptions. But drug addiction is a tremendously complex and time-consuming condition to tackle. Often patients conceal their addiction and broaching the subject requires skill and patience that is not compatible with a ten minute GP appointment. What is needed is specialist help within the drug services for these types of patients, yet this rarely exists.
Drug services prioritise hardcore illicit substance use because it’s this that is associated with crime and high levels of mortality, leaving those with prescription drug addiction to flounder. People are left to their own devices and have to manage with improvised assistance, mainly from GPS who have next to no training in managing addiction. It seems bizarre that you can get help for being addicted to heroin, but not if you’re addicted to painkillers containing codeine, even though they are in the same pharmacological group. I’ve seen patients addicted to painkillers that are using the equivalent of two bags of heroin a day and yet drug services are unwilling to help because they are only mandated to manage heroin addiction. As a result, GPS are placed in an impossible position—either continue prescribing the medication or, in the case of Malcom, simply stop, thereby forcing the patient to buy them off the street and pushing them into the criminal underworld.
We really need to rethink how we manage drug services in this country and this should start with opening up the criteria for who can receive specialist help. We need improved access to rehab services for all those with addiction, not just those addicted to heroin.
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GPS HAVE NEXT TO NO TRAINING IN MANAGING ADDICTION