Archive for the ‘Social’ Category

“See, I’m not an alcoholic.”

Wednesday, January 14th, 2015

I’m a bit slow off the mark with this one (and everything else, currently), but I have just become aware of the Dry January campaign. I know, for many, a solid ten days of fourteen-hours-a-day alcohol consumption, and the subsequent kidney pains and whole-body lethargy, is enough to prompt a natural reduction in drinking. The concept of New Year’s Resolutions – new year, new me – may also bring about a vague idea of slowing the ingestion of post-festive calories, with some ill-informed belief that the thought itself will result in change. “I think, therefore I am (thin).”

In substance misuse services, we would discourage these types of contemplations. Real change, we would advise, requires setting realistic and achievable targets; lasting change is made from pledging to maintainable goals. Plucking unattainable standards from the ether and imagining to reach them, with nothing more than blind optimism and a lack of self-knowledge behind you, is bound to lead to failure. So instead of a glowing complexion, reduced waistline and normal-sized liver, all you are really likely to be left with is a dissolved sense of your own ability to change and diminished self-worth. (And a sad look in your yellow-tinged eyes.)

The other opposition to the positive notion of a short period of abstinence is that this bolsters our belief that our drinking habits cannot be problematic. If we can stop, just like that, then clearly we are in control. This false sense of security is in fact a clever method of self-justification to return to dodgy patterns of alcohol use post-abstinence. We are extremely good at finding ways of doing exactly what we want, and by telling ourselves we have stopped drinking (for a few days, then just having the odd glass, until after a couple of weeks we have chanted the mantra that we have stopped drinking so many times, to so many different people, that we completely believe it ourselves), we give ourselves the perfect excuse to enable our greedy, childish true selves to feast unquestioningly for the rest of the year.

I’m sorry if this is a bit close to home. I don’t want to knock your achievements, or pretend that, for regular and heavy drinkers, a period of abstinence will not be good for your health. I like to think that, if you manage a couple of weeks completely alcohol-free, you will start to sleep properly instead of knocking yourself out with booze, and begin to see the benefits of natural sleep. Maybe you will develop a renewed sense of fun, and alter you social habits to reduce your contact with alcohol-soaked environments and associates in the future.

Or, maybe you will just sit on your flabby arse, bored shitless, waiting with a clenched jaw to flip the page on the calendar so you can get slaughtered again. Guilt-free. Safe in the knowledge that your drinking habits are aligned with those of Nigel Farage.

* WARNING – this post should not be taken as an excuse to STOP STOPPING drinking and returning to your old habits before the end of the month. Just think about what you want to return to when you do start drinking again, and how that will look in the context of your own life.

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Drug service, anyone?

Thursday, October 2nd, 2014

I have been quiet for some time, but something momentous has happened, there are things that need to be said, and again the words have started whirring..

This week, our drug services have been privatised.

I need to make a few obvious political statements, but also want to pick through what this means.

The backdrop: in this area in the late 80s and the 90s, as a result of high unemployment and entire communities lacking self-worth, heroin became rife. Intravenous amphetamine use, which had long since died out in most parts of the country, was also a firm favourite amongst the socially forgotten, given its relative cheapness compared to the city folks’ crack. Drugs services were, it has to be said, sparse and extremely poor. Methadone was virtually unobtainable, the tightly-clenched fists of a few dangling it like an ever-retreating green carrot, and healthcare was an emergency commodity.

Unsurprisingly, people died. All over the place. Bodies dumped in wheelie bins and found in skips.

Political moves meant that something had to be done. Drugs had been the Number One Priority for local Police forces for some time, but the criminal justice angle had reaped few benefits. And so the other group saddled with the problem – the healthcare providers, who until now had primarily just responded to overdoses, deep vein thromboses, septicaemia and liver failure – stepped into the void. Drugs became a health problem. Ring-fenced funding direct from Central Government arrived, and substantial NHS drug services began functioning with vigour.

The deaths ground to a halt. In the first month, burglary reportedly decreased by 80%. Methods were crude, targets were basic. But it was an intervention of unrivalled success, not only for the drug users themselves but for the communities as a whole.

I’m not implying that things were perfect. In the years that followed, it has to be said, there was a period of relative affluence under Labour when services carried some dead wood. The overarching easiness meant that, in some corners, a lazy malaise developed. And the service users’ sense of entitlement, exploiting this new enhanced status, grew way beyond empowered independence.

Yet despite this imbalance, the interventions continued to work. The previously most excluded members of the community now had health opportunities, and with that came life choices.

Things have changed. The current Government have taken away the ring-fenced budget. They have separated financial decisions from the care providers, and moved public health money across to local councils. These councils are having their funds cut constantly. Services have been put out to tender, and decisions have been made not on quality of service provision or importance of outcome, but on finance alone. And the NHS cannot compete with private companies who pay less and offer less.

Concurrently, the Government’s smear campaign of the poor – portrayed as the cause of the financial crisis rather than the victims, a voiceless scapegoat for the mistakes of those few at the top – has made the vulnerable an easy target for funding cuts. The first service to go under council cuts in our area was rape crisis counselling. Drug services were never going to be far behind. If it’s not society’s problem when someone gets raped, it definitely isn’t when someone doesn’t have enough aspiration, self-esteem or identity to “just say no” to a drug problem. If I’m honest, I’m surprised the drug services have lasted so long.

So what does it mean to move service provision to private providers? On the plus side, in the private sector there is no room for dead wood. And there is no bureaucracy, so decisions will not take six months to make and a further six to implement.

However, no-one would want G4S running the police force. There is a reason why these services are so much cheaper to operate. Managed at arm’s length, lacking in local knowledge, paying less than an experienced, qualified professional is prepared to work for – my experience is that these organisations are inferior. And they are not healthcare providers. They are narrow, isolated ventures. So they do not have practice nurses on hand to dress wounds; they do not share a building with health visitors and school nurses to keep tabs on troubled families; they can’t run symptoms past a GP or psychiatrist to see if someone needs admitting; they have no way of providing integrated, holistic healthcare by sharing service provision with associated professionals for no extra cost.

They provide the required statistics and meet specific targets. And as anyone who has worked in healthcare knows, meeting targets is easy. Anyone can fiddle stats and ‘reinterpret criteria’ to appear splendid. Providing good care is much more complicated than that.

I worked for a similar organisation a while ago. They were never fully-staffed, because they employed inexperienced (cheap) staff who subsequently moved on as soon as they had good enough CVs to apply for other jobs. That won’t be an option for these guys – there is nowhere else for anyone to go now – but I am confident that the same attention to finance and not quality of care will rule supreme.

Recent investigations into private care homes has shown us what happens when we pay poorly and devalue care. When we treat staff like dispensable cattle, it will be those receiving the care that suffer the most. Especially when those receiving the care are once again the brunt of society and once again voiceless.

Given the bumper Afghani crop and the rate of novel psychoactives arriving, it doesn’t bode well. And whose problem will it be when drug services struggle to address the need? Not a Government organisation, that’s for sure.

Turning health policy into Benefits Street

Thursday, April 10th, 2014

Blood borne viruses have hit the mainstream news this week. This is rare, given the magnitude of the public health crisis awaiting us, but has been reported in an unsurprisingly trashy manner.

Steroid users are sharing needles. This is not a new phenomenon – last year I told you about a needle exchange I worked in twelve years ago, where steroid users would attend like cocky peacocks, using excessive machoism to ensure you knew they ‘weren’t drug users’. Their bulk and their glowing fake tans were a contrast to the usual grey-faced, skinny clientele, but their knowledge of what they perceived as a health intervention, injecting, was significantly inferior to their skeletal counterparts.

Before buying substances over the internet was commonplace, all the local gym owners were selling steroids – but only one of them attended the exchange to provide clean works along with them. He told stories of four or five men cramming themselves into toilet cubicles, passing round a single needle. This was twelve years ago – so one can only imagine the extent of the veinous damage and cross-contamination that has taken place in that time. Couple this with increased, aggressive sex drives, the other likely routes of Hep B and HIV infection. Then consider the additional cardiac strain, potential pulmonary problems, potential for bacterial infections.. Under all that fake tan and muscle, health may just be a mirage.

Which makes it only more irritating that next to news articles shouting the dangers of IV use, on the same page in some cases, are inflammatory pieces about heroin users getting paid to quit. This cheap attention-grabbing seems to miss the point that the clinical trial which paid injectors to receive a course of Hep B immunisations is in fact attempting to avoid the very same public health crisis. And if it only costs £30 to stop someone getting hepatitis, given that it costs £50,000 for a liver transplant, I’d say crack on.

And whilst I really cannot see a £10 shopping voucher acting as a deterrent to serious substance use, in light of current figures showing that over half of our IV drug users already have Hepatitis C and each course of treatment costs up to £14,000 – again, it doesn’t take a maths genius to substantiate the equation. If it reduces injecting rates, it’s worth a go.

It makes us all uncomfortable, of course, the idea that a mother should be paid to breastfeed, or a drug user could get money for accessing basic healthcare. But who, exactly, do we think we are to stand in judgement if these interventions actually work? We Guardian and Independent readers might have the education and social inclusion to make positive decisions about our health without taking bribes – well done us, let’s give ourselves a pat on the back. To presume that everyone operates in the same manner is naive and unempathetic. I wouldn’t inject into a necrotic, stinking hole in my groin, yet thousands do. Should our health policy exclusively fit those who need it the least?

Legal drug-pushers and the US smack boom

Monday, March 3rd, 2014

It’s nearly a year since I warned about bumper heroin crops in Afghanistan, and months since raising the issue of soaring opiate painkiller abuse in the US. Yet the debate is still fresh, it seems, after reporting this week about the speed with which heroin use continues to increase in America.

Using stats from the substance misuse treatment centres in a sample district, heroin use increased 425% between 1996 and 2011. Four out of every five people presenting for treatment for their heroin use reported first becoming addicted to opiate painkillers. Use of these painkillers, in the same sample, had increased 1,136%.

But the really interesting part is how and why this happened.

On one side, there is the argument that this epidemic rise in opiate use is due to the drug companies. Marketing techniques for OxyContin, for example, were apparently so aggressive that doctors were ‘convinced’ (by what means, I am unsure, but we can imagine) that the tablets were completely safe to prescribe long-term. (Now I haven’t got a degree in medicine, but it would take more than a marketing campaign to persuade me that making an opiate slow-release stopped it from being addictive..)

Whatever methods the drug company used, they worked, and as sales soared, so did the deaths. In 2009, more than fifteen and a half thousand people died of opiate painkiller overdoses in the US – more than double the numbers in 2002.

The manufacturers were later fined over six hundred millions dollars for misleading doctors and patients about the addictive nature of the pills.

But there is another perspective – that the War On Drugs is to blame for the over-prescribing and addiction problems. The DEA, according to some, have turned decisions that should remain in the medical domain into legal issues – by scapegoating legitimate prescribers.

The case of pain specialist William Hurwitz is a poignant one. Of the hundreds of patients under his care, fifteen were found to be selling their medication. This was without Hurwitz’s knowledge. However, he received a custodial sentence of fifty-seven months for distributing narcotics.

As someone who has worked in drug treatment for many years, this is a chilling tale. There is no way of ensuring that meds are not diverted – even on daily supervised consumption, where pharmacists are paid to watch people take their medication every day, people will hide meds in their cheeks, sneak them out and sell them on in the spat-out form. And people will buy them. Such is the desperate nature of opiate addiction. But if I were held responsible for my patients making these choices, would I continue to provide prescriptions? Unlikely. And then, for the majority taking their meds as prescribed, where would they turn when the script stopped and the withdrawal symptoms and agonising pain set in?

Unsurprisingly, this type of prosecution discouraged doctors from signing legitimate prescriptions for people with genuine chronic pain, raising human rights issues for sufferers. In response, unscrupulous, or humane (depending which stance you take), doctors set up ‘pill mills’ – centres where prescriptions for opiate painkillers were provided more freely than was medically advised, both to pain sufferers and to addicts. The black market became flooded and, conversely to DEA intentions, that meant that the tighter legislation in fact enabled the boom in opiate dependence.

Whatever your beliefs about opiate prescribing, there is no doubt that America is facing a top-down public health crisis. And now, here we are – 2014. Poverty, depression and opiate addiction. Just in time for the heroin mega-crop. Yeehaa, as the they say in the States.

Ooo, doesn’t it make you nostalgic…

An acceptable overdose

Tuesday, February 4th, 2014

Another prominent drugs death, that of Philip Seymour Hoffman, has again exposed society’s moral judgements about drug users. Reports of the ‘tragedy’ of his death portray Hoffman as a victim, a tortured soul, an artist battling inner demons. I feel for the poor guy, even more so for his three kids – but I am also left questioning the discrepancy in reporting between his death and the reports in my local paper about comparable situations. I wonder why the kid who spent his childhood watching his dad kick his mum’s head in, being raped by his uncle, then living an adult life of deprivation and misery before overdosing in a skip, only gets three lines on page 15.

You could say it is because the local lad never made a dint on the world. He didn’t offer art, beauty and insight to the masses. The difference in media representation reflects the size of the social impact each man had.

You could also say it is a class issue – a rich death is mourned, whilst a poor death is ignored. Maybe human value is just measured in wealth.

But why is it that Philip Seymour Hoffman, a man of considerable intelligence and opportunity, is considered a victim? Where is his agency in this situation?

It goes back to the same moral position I recognised in myself many months ago, this presumption so unwittingly common, that using drugs is bad. And, as with all immoral activity, for those who we choose not to perceive as bad – possibly because we relate to them, or respect them, and struggle to look at them without also seeing a reflection of ourself – we must instead formulate them as either mad or sad. So they become ‘tortured’, a victim of their ailment, circumstance or art. With such brilliance, it could happen to anyone.

Of course, your average die-in-an-alley heroin user does not evoke this sense of admiration. He would have lacked eloquence, instead conveying his pain through aggressive expletives, and probably smelled a bit. We would have tried our best not to identify with him – to imagine how we would have coped with the hand life had dealt him, how he might feel as door after door shut in his face, his options reduced to their basest – to live or to die.

And yet whose death really is tragic? A man whose life embodied success and choice, whose demise resulted from an informed choice?

It is sad, as almost every death is. I do not feel, however, that Hoffman deserves our pity. He made his choices. And when he chose to inject himself, he had a number of other options available to him that day, chances most only ever dream of.

For those who stand in Daily Mail judgement of the drug users in their community – not the professionals who have the odd line or the students using MCat, I mean the drug users who with pasty, clammy skin and homemade tattoos – I recommend you watch “Stuart – a life backwards”. I had no idea it was possible to fit twelve years of drugs work into one film. And, as with many of my clients, the main character is mad, sad and bad all at the same time – as well as being a man worthy of admiration and bloody hilarious.

I just wonder, without presupposed moral judgements about drug users, how much more we would learn about the human experience. Hoffman must have had reasons for choosing to take the risks he did, not because he wanted the deification his death seems to have provoked. But no doubt any realism of his motivations will be media-ised into a preformed box to prove he was mad or sad. Whilst the local lad will be remembered for his convictions.

What do you like more: your drugs or your genitals?

Monday, January 13th, 2014

I know some of you probably think I was scare-mongering when I wrote Maurice the Feline, and I know there are many MCat users out there who take the drug without more than mild side-effects – but spare a thought for the poor sod who apparently came back from university for Christmas, took mephedrone, then stabbed his mother and cut off his own penis.

The story sounds bizarre, but national newspapers ran it and I can’t find anything disproving it. And I can’t say, in the time I have been working with mephedrone users, that it comes as a huge surprise to me. Despite some young MCat users responding with claims that “there’s no way MCat could do that”, I have seen the scary impact the drug can have on the mind. A serious psychotic episode, with no previous mental health history, is something I have unfortunately witnessed more than once – and that’s only from the cohort of people who come to the attention of drug services. I would imagine, behind closed doors, there are many people suffering from from paranoid and suicidal thoughts, and all the horrifying and damaging behaviours that come alongside them.

I am doing my best to set up some testing facilities – because, at the end of the day, no-one currently knows what they are taking. At least if you know something has not sent you crazy once, you have a greater chance of avoiding a negative experience thereafter. But please do not underestimate the potential this drug, or group of drugs, can have on your mental health. If you have any previous issues with your mental state, or any history of psychosis in your family, I would genuinely advise you to steer entirely clear – but, unfortunately, these factors are not strong enough indicators, in the case of this drug, that all will be well.

And as for the poor guy in the news – although I would not like having to heal the relationship with my mother after I’d tried to kill her, nor would I want to embark on a life with a mutilated, floppy todger, I would rather face either of these futures than live with paranoid psychosis. Let’s just hope he hasn’t triggered off something that lasts a lifetime.

Random drug testing is ‘grievous and oppressive’

Sunday, January 5th, 2014

Drug testing is becoming an increasingly common phenomenon in the UK, and is gaining popularity both in workplaces and criminal justice systems. Agreeing to random drug tests is often a contractual requirement – no drug tests, no job – and refusal to provide a specimen is considered tantamount to a positive result by Police, social workers and employers.

It is therefore extremely interesting to hear that this week, in Florida, a Supreme Court has ruled that in all but exceptional circumstances, drug testing without justifiable suspicion of drug use is unlawful, and is only legal if it protects public safety.

The ruling was made in relation those in receipt of state benefits for childcare, so, whilst not directly transferable to our own systems, it may have future relevance – given that drug testing benefit claimants in the UK has already been mentioned in the Government’s recent poor-bashing campaign (scapegoating benefit claimants for bankers’ fuck-ups), and is only one step further than setting Jobcentre staff targets to stop payments, and making systems inaccessible so as to exclude more vulnerable recipients.

But the reasons for the ruling are very relevant here in the UK. In the first part, political attempts to align the poor with illegal drug use were thwarted when the court case revealed that only 2.6% of child benefit recipients tested had provided a positive sample. This percentage of illicit drug use was lower than in the general population.

Even more poignant were the legal challenges to random drug testing brought forward by the case, which was filed by a Navy veteran-turned-student whilst single-handedly caring for a disabled mother and young son. He refused a drugs test given there was no reasonable suspicion of drug use, and as a result had his claim for public assistance turned down. He won the case on the grounds that random drug testing is “unconstitutional”.

The judge deemed mandatory random testing outside the law because, under the Fourth Amendment of US Constitution, drug tests are classed as a search, and as such can only take place in response to suspicion that a crime has been committed. This law was introduced in 1700s when British search warrants enabled the colonists to enter and seize property at will. Fury at this lawful breach of human rights was thought to have started the Amercian Revolution. The resulting Declaration of Rights clearly stated that any searches on a person “whose offense is not particularly described and supported by evidence, are grievous and oppressive and ought not to be granted”.

How incredibly refreshing. Especially at a time when, in the UK, choices we make outside of work, which have no impact on our professional functioning, can mean we lose our jobs; or when a substance we used days ago, which has no effect on our ability to drive safely now, can mean we lose our driving license. Cannabis, a drug with a very weak relationship to social harm which is now legal in parts of America, can show up in urine tests for up to four weeks. Yet what, over such timescales, is the relationship to reduced ability or function, either in the workplace or behind the wheel?

I am sure that, forty years ago, employers felt that had a right to know the sexuality of their employees. Their choice not to employ homosexuals would have been supported by the authorities, despite this lifestyle choice having no impact on their professional capacity or any relevance in the workplace.

I hope this week’s ruling is the start of a thought revolution on the issue of drug use. What a person chooses to do behind closed doors should be private, unless this choice poses a risk to the other people. So in the case of drug use, unless an employer can evidence reduced productivity or increased risk as a result of suspected substance use, drug tests should not be carried out. Most employers condone, even support, the use of alcohol outside of work, despite use of this substance being well-documented to increase risk when operating machinery – the difference in the handling of the use of other drugs outside of work can therefore not be justifiably linked to risk.

This case is a reminder that we have human rights, a fact which seems to have been lost in this country where drug use is concerned. It is possession, not use, of a drug that is illegal. We cannot be arrested for having a drug in our system – yet we can lose our livelihood, without putting a foot wrong. That certainly strikes me as grievous and oppressive.

Comment from follower

Thursday, December 12th, 2013

This comment, sent by a follower of my blog, is both and informative and hilarious enough for me to want to share it with you all. I couldn’t agree more – or put it more eloquently.

Uruguay have today / yesterday moved to legislate about cannabis and take the trade out of the black market.. What with this and the crude and brash capitalist stance of Colorado and Washington Teresa May is worth a shot at this time I reckon or at least the superficial nature of her tenure .. If she can’t do a proper turd get her off the pot , we are losing money in austere times and disabling the true opportunity of capitalism via her policies – she is even crap at being a Tory !

Stick reclassification up your K-hole

Wednesday, December 11th, 2013

The Government are now considering upgrading ketamine to Class B, as they have just realised it is popular and causes bladder damage. Fingers on the pulse again there, guys. Not only did they miss the original ketamine boom which took place years ago when I was a student (and spent a considerable amount of time watching people slumped in corners wondering why anyone would want to do that to themselves) – and then miss the more recent frenzy which occurred a few years ago in the wake of MCat legislation – but by increasing the penalties for possessing the drug, the Advisory Council for the Misuse of Drugs have very much missed the point. The people who are taking ketamine daily and dissolving their urinary tracts are not going to stop just because the label is changed, or they are told they are now very naughty. They will just be less likely to disclose their use to anyone in the health profession, and their treatment will be less timely, less effective and more expensive.

It’s not exactly breaking news that ketamine causes significant health problems, either. The impact on the bladder is well-documented, and very young people are also being found to have irreversible damage to their kidneys, liver and brain. It’s not that I don’t think these facts need to be made more available – which I’m sure is the Government’s intention – it’s just that the last fifty years of prohibition have proved that the punitive method just does not work.

And I wonder, if there is any other policy which had failed so dramatically, and which had caused so much harm as a by-product? Why would any political organisation continue to implement a method so poor at achieving its targets?

I have been told not to bitch about Theresa May any more as apparently it has started to sound like a personal vendetta – but if she had listened to me on the khat issue, maybe her bumbling drug policies wouldn’t get her into so much trouble. Under pressure last week to reverse the ban, Khat Woman herself has been accused of implementing legislation without any supporting evidence, and, in the process, potentially damaging relations with Kenya. As a Home Office report has pointed out, given that khat is not associated with any social or medical harm, and there was no consultation with the people who use, produce or import the drug, this may have been a somewhat rash and uneducated decision to make. It could, in fact, impact negatively on unemployment and crime figures, as livelihoods are destroyed, and has led to accusations of hypocrisy within a supposed free market.

Instead, Keith Vaz MP has recommended introducing a licensing system for the substance. So maybe Keith has been reading even if Theresa hasn’t.

If the UN trust politicians, should we trust them?

Monday, December 2nd, 2013

Another international agency has formally documented its concerns about the UN’s data collection methods around international levels of drug use. In my article about Count The Costs’ Alternative World Drug Report, I mentioned that the UN’s report about drug use across the globe had been criticised for relying on government self-reporting – leaving opportunities for those in power to be less transparent than we might hope. Opaque, in fact.

This time, Harm Reduction International has released a formal challenge to the UN figures. This worldwide organisation claims that the data collected by the UN is incomparable to the 2008 data due to the difference in the methods of data collection, and that, again, government self-reporting is unreliable and unscientific. Given that over a third of the data set collected were done so by annual review questionnaires – completed by governments without any traceable references to how data was collected – analysis of the results is impossible given the lack of openness about how the figures were compiled.

Worryingly, it seems that some countries may be under-reporting their levels of drug use and HIV infection. Russia, for example, have reported that HIV rates amongst their injecting drug using population have almost halved in the last three years. Even considering why a country would want to do this feels quite sinister – but the potential impact on service provision for the drug users with the highest health needs within these countries is frightening.

Harm Reduction International have taken the decision to ignore the UN’s most recent global data, and instead continue to refer to the 2008 figures, where data collection methods were less subjective. They acknowledge that this data is out-dated but, until peer review of the data is possible, they feel the new data may misrepresent the actual international situation. They do, however, recommend that the data is considered on a country-to-country basis, as some countries have provided apparently sound figures.

I suppose this raises questions for me about the integrity of the United Nations and the standards of their publications, and the lack of power they apparently now have in extracting reliable data from politicians. This means that, instead of international agencies working together to tackle the global problems the drug trade produces, there are rifts between them – and confidence in the organisation central to finding some conclusions and solutions is weakened.

On a different note, I do also want to apologise here for my lack of consistency with my blogs recently, which I have otherwise been writing faithfully every week for the last year. I am pleased to say it is because I have some exciting new ventures afoot, which have been sapping me of my time and energy – but I am fully back on board now, pen poised, and will be bothering you with new posts yet again.

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