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N
owadays I live a long way from my friends and colleagues in the UK
drug field, but I’ve not forgotten you. So when news reached me even
here on the Pacific rim that politicians back home were trying their
hands at rubbishing scientific evidence when determining treatment
practices, I sighed and started to take note.
First, a bit about me and my life to date. I’ve been an AIDS worker, a manager
in the NHS, and CEO of The Alliance, which was a very satisfying experience. I’m
now the counsellor for a family practice here on Vancouver Island. And all that
time I’ve also been ‘in treatment’ myself – being a methadone patient, with a
couple of breaks, for the last 35 years.
Being born in 1950s Southsea of Canadian parents was my own particular
lucky break in the game of life. Nothing like the UK drug and alcohol treatment
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drinkanddrugsnews
| September 2012
Treatment |
Activism
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Galvanising the service user
movement in the UK before
returning to Canada’s inferior drug
and alcohol treatment system has
given
Bill Nelles
a unique
perspective on treatment policy.
Time to unite, he tells DDN
system existed in Canada in 1976 (and it still doesn’t) and I had a UK passport.
By leaving Canada when I did, I got to live while all the Canadians I started using
with got to die. In 2004, I returned to live in Canada where my own treatment was
finally available – at least where I happen to live.
Starting The Alliance in 1998 was a high point in my life. We gave a voice to people
using treatment services and a say in the way their treatment was provided. We
showed we could be partners in determining treatment policies. We educated people
with information about treatment and how to reduce overdoses. And we fought the
stigma and opprobrium that is often heaped on the heads of methadone patients.
By 2001 our helpline was taking several hundred of calls a year. These calls
sometimes turned into cases and from these we also developed advocacy services
that had credibility with services users and treatment providers. We followed the
principle of an ‘honest broker’, and followed a step-by-step protocol that helped
both advocate and client work through cases together.
Our cases ranged from helping individuals who couldn’t get more than a 50mg
dose to an entire town of patients who had suddenly found themselves all put on
supervised consumption (honest). Besides this advocacy service, we provided
training to service users about their treatments and how they worked. This in itself
could lead to improved outcomes and happier patients. Lastly we helped set the
stage for the many service user organisations that now exist up and down the UK.
The Alliance never sought to make methadone the ‘only’ treatment for opiate
dependency but we wanted to make sure it was there if it was needed. I don’t want
to go back to the unhappy times that existed when I started in treatment 35 years
ago. Patients took what they were offered and there was no effective way to
challenge it. Some were badly underdosed and subjected to arbitrary changes. The
result was a patchwork of clinical inconsistency and a state of uncivil war between
many of the consultants.
When
Putting full recovery first
came out in early 2011, I read it with little
enthusiasm. I trusted that the raw imperiousness of the document would be
leavened with common sense and indeed this seems to have been the case.
The recently published guidance on
Medications in recovery
is a well-written
document produced by a working party representing all the views. Professor John
Strang brought together all the major players in the ‘recovery’ debate including