14 |
drinkanddrugsnews
| June 2016
LethaL LabeL
Difficult though the challenge of the
emergence of new substances is
proving, and whether or not you agree
with the recent legislation, I feel that an
opportunity has been missed to rename
these substances.
They should perhaps be known as
potential lethal substances (PLS) –
certainly not the very misleading legal
high/new psychoactive substance
nonsense that they are currently
referred to by professionals who frankly
should know better.
From the current user to the young,
naïve future user of these substances,
using worlds such as legal, high, new
and psychoactive is no deterrent – on
the contrary it can be appealing.
However, potential lethal substance is
unequivocal; take it and you may die.
As the new legislation proves, there
are so many (an infinite amount of)
chemical combinations that
classification is impossible, likewise
enforcement.
Would you drink bleach? No. If
consumed it is simply a potential lethal
substance (PLS). No classification
necessary. Let’s start now – PLS – trips
off the tongue doesn’t it?
Do
DDN
and the many associated
agencies and contributors fancy leading
the way? It will soon catch on, in so
doing giving the honest description
that the substances deserve.
Pete Young, Andover, Hampshire
cutting corners
Against the background of shrinking
availability of residential rehabilitation
services, it is an unfortunate but true
condemnation of the UK addiction
recovery sector that the eminent
Professor Neil McKeganey found it
necessary to point out the mainly
unqualified status of a majority of
workers (and some execs) in this vital
field. And his observations are mainly
backed up by the other contributors in
your excellent article, ‘False Economies’
(
DDN
, May, page 10).
The real problems are of course the
differences of opinion on what
constitutes ‘professional qualifications’
and ‘specialist knowledge’, along with
the government’s ever-increasing desire
to see every service delivered as cheaply
as possible.
Kenneth Eckersley, CEO, Addiction
Recovery Training Services (ARTS)
Letters and Comment
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Great article in this month's @DDNMagazine about the recent UNGASS meeting.
Will things ever change?? #drugpolicyreform #HarmReduction
@westernbaye2e
@johnbirdswords on #bbctw reminds me of his incredible passionate and utterly
compelling (and rambling) talk at @DDNMagazine conference
@LadbrookInsure
Get real. #AnyonesChild campaign reduces me to tears of both pain and passion.
Amazing message drinkanddrugsnews.com/get-real-marthas-accidental-overdose
via@DDNMagazine
@drugactivist
Damp squib? cjwellings.com/ddn/May2016/#6 Excellent coverage in new
@DDNMagazine on disappointing #UNGASS2016
@russwebt
Yes... most people in recovery want to give something back, to celebrate their
recovery. Services are abusing this goodwill getting people in recovery to work free
for them – using people who are very vulnerable.
Alan Heselden, via Facebook
I’ve seen McDermott’s
Guide to Do-it-yourself Detox
in reception at drug services
as recently as three years ago. There was some good advice with a comical
element!
Neil Angus, via Facebook
I worked for Lifeline as a young person’s practitioner and prescribing lead for nine
years and I have always loved these publications! They are so impactful and
accessible, they simply WORKED!! Which in that field was very rare! Michael
Linnell and Russell Newcombe are inspiring people and I have been lucky enough
to meet them both several times throughout my career.
Jay Ratcliffe, via Facebook
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POST-ITS FROM PRACTICE
Most of us don’t like to think about dying
and we are probably
even worse at talking about it. Yet as the average age of those in
opiate treatment is increasing alongside co-morbid physical
health problems, I am seeing more and more people who are at
the end of their life. It has often been said that regular drug users
– and this applies to alcohol and cigarettes as well – are
physiologically ten to 15 years older than their chronological age.
So the likely cause of death for those in treatment has moved
from overdose to chronic illness, with COPD, cancers and end-
stage liver disease from hepatitis C now commonly listed on
death certificates.
I am as keen as anyone to promote recovery in the form of
long-term abstinence, but also feel we need to have a pragmatic
and kind response to those for whom prognosis is poor.
Danny had been a heroin user for 30 years. Having started in
the early 80s he had a history of IV drug use and had been diag-
nosed as hep C positive in prison, but never really felt he was stable
enough to think about treating it. As he got older he engaged with
treatment, stabilising on 80ml of methadone and stopping illicit
use. After a couple of years he was thinking of stopping OST and
we talked about his hep C and the significant improvement in
treatment. He agreed to a referral to the liver team.
Two weeks before this appointment he attended surgery with
weight loss and nausea, noticing that his urine had become dark.
I was concerned about his liver function and encouraged him to
keep his hepatology appointment. His ultrasound scan and
fibroscan showed minimal fibrosis but unfortunately a mass in
his pancreas and a subsequent CT scan revealed an inoperable
pancreatic cancer.
As his condition worsened we were initially able to control his
pain by increasing his methadone dose and switching it to three
times daily. The local hospice team were involved and he was
admitted for three days while being switched to long-acting
morphine. On discharge he was able to manage with oral medi-
cation for a few more weeks, although his doses were significantly
higher than for many patients because of his opiate tolerance.
Danny lived alone and had not seen his family for years. When
we had talked about his preferred place to die he had asked to be
back in the hospice. The team there dealt with him without stigma
and he passed away peacefully five days after being admitted.
The way that we deal with end of life scenarios for our drug and
alcohol using population defines how caring we are as a treatment
system and a society – and yet this remains an area that commiss-
ioned services rarely address. Perhaps it’s time that they did.
Steve Brinksman is a GP in Birmingham and clinical lead of
SMMGP,
THE END, MY FRIEND
Dr Steve Brinksman
calls for kindness and compassion in palliative care
‘I am seeing
more and
more people
who are at
the end of
their life...’
