There’s no automatic reason to revert to stigmatising daily pick-ups, as DDN reports.
‘COVID has changed all our lives massively, as we know – but it’s affected drug users in one rather good way.’ At a EuroNPUD virtual event, Dr Christopher Hallam looked at the widespread use of take-home doses for people on methadone and buprenorphine. With restrictions in place and many drug services turning ‘virtual’, daily pick-ups and supervised consumption were changed to weekly or fortnightly scripts.
This ‘light touch’ model of treatment had been a game-changer for many people whose lives had revolved around the pharmacy. ‘A lot of people have found this a liberating experience,’ said Hallam. A survey by With You in Scotland showed that 70 per cent of the clients interviewed said they did not want to return to overly frequent pick-ups, while the University of Bristol concluded that the new routine was important in reducing embarrassment and stigma. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) observed ‘good behaviour’ throughout the pandemic, with very little diversion.
‘Methadone and buprenorphine are the only drugs where patients are required to take their drugs in front of pharmacy staff and it can be a terrible experience,’ said Hallam. ‘Drug dependence is a very stigmatised condition and frequent visits to the pharmacy can enhance stigma – surely not what we want, any of us.’ Medical confidentiality – ‘a basic human right’ – was also very difficult to achieve in the neighbourhood pharmacy.
For some people, daily pick-up would still be essential if they were vulnerable in some way – maybe feeling suicidal, being threatened, or having their medications stolen. But if not, then we shouldn’t go back to the default position of expecting people to attend the pharmacy on a daily basis, said Hallam – ‘particularly the case if you are not using on top, your life is not chaotic, and you may have a job’. Daily visits could be counterproductive in many ways, including increasing contact with other drug users which could be a ‘continuous trigger’, and it could ‘put people off engaging in drug treatment altogether’.
While many services were being supportive, some were slow to initiate change for the long term, leaving restrictive or punitive routines in place. The first thing to do in this instance, ‘is to speak to your drug service, at managerial level if possible, and ask for the reason you’re being asked to go back to daily pick-up,’ said Hallam. He had written the EuroNPUD take home OST advocacy brief to assist with this, and it included a letter to the drug service to request this and an advocacy letter to take things further if they didn’t respond satisfactorily.
Martin (Cuca) McCusker shared experience of using the advocacy brief with Lambeth Service User Council (LSUC), which was part of a consortium model with various treatment agencies. ‘For years we’ve been badgering users if they’re not happy to challenge a decision, but time and again people wouldn’t do it – they don’t want to rock the boat,’ he said.
Before handing out the brief to peers he showed it to staff so they were aware of it and had ‘nothing but positive feedback’. The document made clear to keyworkers that in most cases there was no need to go back to supervised consumption. ‘It makes clear what the drug user thinks of this degrading process – it will never be a therapeutic intervention,’ he said.
Of four cases in which LSUC trialled the brief, three had the successful result they wanted. The fourth person had various health risks that meant the longer intervals weren’t suitable at the present time, but enabling them to challenge their prescribing regime in this constructive way was still positive – ‘they came away feeling that they were heard by the worker, and the worker knows how they feel about supervised consumption.’
The initiative was being taken further in partnership with Release, explained their head of legal services, Kirstie Douse. As ‘honest brokers’ for people in drug treatment, Release was creating and distributing an advocacy toolkit for people who use drugs and service user representatives, to be used in situations where OST was being refused, reduced or withdrawn. With funding from the Baring Foundation, they would be delivering training to service users and peers, and providing additional advocacy and legal support around it.
‘The creation of the toolkit needs to be informed and influenced by people using advocacy,’ said Douse – hence the partnership with EuroNPUD. It was designed to capture good as well as bad experiences and had benefited from diverse opinions. Drafting, review and launch of the toolkit would be followed by training events in the autumn.
The EuroNPUD take home OST advocacy brief is available at https://bit.ly/3cd5y6a