Archive for the ‘Drugs worker’ Tag

Breaking news – GPs to carry tasers

Thursday, February 14th, 2013

The official bodies representing GPs and psychiatrists have released a joint statement raising concerns about addiction to prescription drugs. I don’t really know who they are raising the issue with as it’s them who are prescribing the bloody things – it’s a bit like punching a child then telling it off for having a bruise.

Bodies representing pharmacists, social workers and drug workers have also jumped on board. The difference is – they mean it. While the GPs and psychiatrists spend 5 minutes every 3-6 months with these patients, it is the pharmacists who have to double-check dates and signatures on prescriptions every week to make sure they are dispensing legally and are not operating outside the law because they have been duped by some pitiful neurotic; it is the social worker who will be trying to monitor parenting skills through a legal, medical haze; it is the drug worker who faces abuse when the patient uses their medication illogically and unmathematically and comes begging for an early script. And the housing workers. And the Jobcentre staff. And Probation. And counselling services. And Women’s Aid. Basically any service that attempts to address the route cause of the ailment instead of smothering it with something sedative.

In exactly the same way that heroin dependence ruins people’s lives, addiction to prescribed medication can be, in many cases, as debilitating. And whilst it is more sociably acceptable, amongst the middle classes at least addiction is still embarrassing, and the lies resorted to in hiding it can be crippling and destructive.

In terms of the physical dependence, benzodiazepines (such as Valium, temazepam and nitrazepam, generally prescribed for anxiety, muscle spasms and insomnia) in particular are horrendous. Along with alcohol, they are one of the few groups of substances that can lead to death from withdrawal. They are so addictive that in heavy abusers, tolerance can eventually overtake capacity – meaning that the amount of the drug you need to stop your body going into withdrawal can be higher than the amount needed to induce overdose. That’s a pretty fine line to walk.

The withdrawals also create a desperation that supersedes even opiate addiction. Whereas a heroin user that has ‘dropped’ (read ‘sold’) his methadone dose will start to panic when he realises he is soon to start squitting out of both ends as the dreaded withdrawals set in, benzodiazepine users will go that extra mile in an attempt to procure what they need. We’re talking threats to kill, smashing stuff up, full-on tantrums and shameless sobbing. Now any but the most integrous GP will swat a script at that to get it out of their consulting room.

There are a fair few people now in drug treatment that have become opiate-dependent due to prescribed painkillers too. Generally prescribed in the first place for toothache or back pain, these clients are chilling reminders that this could happen to anyone. These people never thought they would end up in a drug clinic being treated in exactly the same way as a heroin user.

And the problem with both benzodiazepines and opiates is – they are amazing emotional blockers and make you feel great. Emotional pain – gone. Traumatic memories – vanished. Feelings of guilt – disappeared. And stopping taking them results in sky-high adrenaline production, so that these buried feelings are not only exposed, but anxieties around them go through the roof. So if you couple that with quickly-built tolerance, and the fact that these are being given to you, nay insisted on, by a revered specialist – and are free – it would take a strong person to resist. And the people going to their GP in pain or with depression or anxiety do not meet this criteria.

And while I’m levelling my criticisms at GPs, I want to uncategorically state that psychiatrists are a hundred times worse. In my experience, it is extremely rare to find a psychiatrist that doesn’t just dish out sedating meds. This is despite an ever-increasing evidence base for psychological therapies and social interventions to improve people’s quality of life. You only need to visit to psychiatric ward to see the scrap heap that people with enduring mental health problems get thrown on. There is no inkling that these people might get better, or any real effort made to increase their level of function – they are dosed up and kept quiet until they say little enough to be discharged. Then they are expected to be able to cope in the outside world, on reduced medication (as high levels are only safe to dispense in a controlled environment), and within a matter of time they are back in hospital and whacked up again. No wonder people become institutionalised. To anyone who likes to think that One Flew Over The Cuckoo’s nest is a thing of the past, I challenge you to visit a psychiatric ward and tell me how treatment has improved over the last fifty years.

And in my usual cynical manner, I can’t help but think – you’ve been dishing out tablets for years because it is the cheapest way to keep ‘problem patients’ quiet, so what’s changed? This has got to be laying the groundwork for some political announcement about austerity and impending cuts to prescription budgets, because many GPs and psychiatrists didn’t give a shit about the highly-strung benzo-dependent housewives and the antipsychotic-shuffling oddballs before, and I struggle to see why suddenly they would do now. I reckon it’s another one of those Tories’ ‘we’re doing it for your own good’ measures. Like benefit cuts. And paying bankers’ bonuses. And Care In The Community.

One thing’s for sure – it won’t be the whiskey-drinking doctors or the pill-popping politicians that have their doses reduced and their scripts stopped. And, to be honest, unless GPs start wearing stab vests as standard, I doubt anybody else’s will be either.

Postscript – catslondonmarathon you are a wonderful GP and human being and I do not refer to you or your practice here. There are many more like you – but we both know you are in a minority.

Also, here’s a link to (wait for it) The Daily Mail *gasp* – a scare-mongering set of photos relating to crystal meth, clearly an advert for private rehab programmes, but freakishly interesting all the same. Make you count your blessings it never really took off over here. We’ve got enough on our paste with Cocodamol and Mogadon.

From drugs work to the grave

Tuesday, December 18th, 2012

It’s a funny thing, contemplating a career change. We all spend years expressing internal groans at the sound of the morning alarm, hiding underneath the duvet, begging and praying that some natural disaster has occurred overnight that will suffice as an excuse not to go in today (death for a few people is surely a justifiable pay-off, no?), only to discover from a quick scan of available media that today is a day like any other. Shitbags. But the brief glimmer of hope that you might not have to deal with X,Y and Z today has meant, unavoidably, that you have now carved a brain-path directly to X, Y and Z – and so work starts straight away.

The simple joy of the morning shower is spent internally arguing with the nob-end that sits near you in the office, who you would never come into contact with socially and would subtly shuffle away from if you had the misfortune of a chance encounter in a public arena, but have to not only tolerate but attempt to be civil with, every miserable working day, leaving you resenting your pay-packet because it represents you whoring your soul to the devil. Then breakfast, surely intended as a pleasant and civil part of the day, is made somewhat less so as your bran flakes remind you of the dead, flakey skin around yesterday’s necrotic wound, and you find yourself wondering whether this would have the texture of a freshly-served crisp flake or a milk-soaked chewy one. And despite your attempts to gee yourself up with one of your favourite albums on the way to work, the sense of impending doom induced by the knowledge that today is going to entail battling the Safeguarding referral system (“Sorry, run that by me again – this is supposed to be a high-threshold, fast-response referral process, created to protect children from the most severe types of immediate harm, but you won’t take verbal information and no longer offer the facility for me to discuss the case with a social worker first – so I have to spend an hour completing paperwork, then face the traumatic, potentially damaging and counter-productive scenario of informing the family I have serious concerns about their parenting and so are breaching their confidentiality, in the knowledge that you will probably knock it back or do nothing about it anyway?”) means that you may as well be listening to someone shouting “You are mortal and one day, possibly soon, your time on earth will be over, more than likely following a period of extreme pain” in a broad South African accent, for all the relaxation the music provides. And that’s before you get to work to discover what shit has hit the fan overnight – who has been arrested, who has been admitted to hospital and, unfortunately, on occasions, who has died – and start getting paid.

But – for all its pains and strains and drains – not only does it pay the bills, it has seen you through some hard times. There is no better distraction from a failing relationship than a critical deep vein thrombosis with severe cellulitis; no quicker way to forget about personal tragedy than premature labour induced by persistent crack use.

However, without this job, would the relationship fail? And for everyone one case worthy of your emotional input at a time of personal heartache, how many needless metaphorical arse wipes must you perform? How many faces do you imagine smashing into desks with screams of “If you rip the copper out of your own boiler your landlord has every right to evict you, that doesn’t make you a victim – my own tragedies far surpass yours so I frankly couldn’t give a shit about the hole you have just dug yourself into!”? Imagine getting home each evening with something left to give other than anger and irritation at the world…

It’s a strange pay-off, and one which I am currently making attempts to unpick – is the emotional investment (or drain) offset by the distraction from one’s own problems? To what degree are these intense investments and distractions responsible for the lack of progress in one’s own life? And, fair enough, I might not want to be a drugs worker any more – but if not a drugs worker, then what? Do I have an identity at all? Or if I jack it all in, will I slip into a deep depression, brought on by a sudden lack of purpose, and find myself opening cans of baked beans with a screwdriver underneath a motorway bridge?

The only way I can resolve this internal dialogue is to remind myself that – if I stay in this job, I am likely to become ill(er) in the head, have very little or no chance of maintaining a healthy and drama-free relationship, and will probably, at some point, slip into a deep depression and find myself opening cans of baked beans with a screwdriver underneath a motorway bridge. I think I can make a fair, educated guess that, in this case, it is not better the devil I know. And so, career or no career, there is no healthy future for me as a drugs worker – and whatever the months and years ahead may hold, at least for now I have you lot to rant at, and have a sense of purpose in my attempts to inform and entertain. Thanks guys, you are keeping me (relatively / debatably) sane. And anyway, I like bar work.

To treat or not to treat (Part 2)

Wednesday, December 5th, 2012

Sorry I went off on one a bit yesterday. I was in a vile mood. And sorry to mental health nurses in Community Drug Teams, I do recognise there are some of you out there who are very committed to working with drug users and aren’t just in it for the supervised urine tests.

The point I actually intended to make before I got side-tracked by my own negativity and social bitterness was – who should receive drug treatment, and who shouldn’t? The political back-drop I outlined yesterday does have an impact on this, as there are trends, depending on who is in power, how they feel about drug users, and how much money is available. However what I want to briefly consider here is a more clinical perspective.

When I first started as a treatment worker many years ago, prescribing methadone was perceived as an additional risk factor. The logic was that if someone was taking central nervous system (CNS) depressants, such as heroin, alcohol, benzodiazepines such as Valium, (all of which, may I add, are widely sought-after by engrained heroin users, and a combination of which is almost always present in cases of fatal overdose), and now the new wave of nerve painkillers such as pregablin and gabapentin, then adding another CNS depressant such as methadone would increase the risk of overdose.

Buprenorphine (Subutex) therefore became a popular choice – another opioid but which only works on two of the four opiate receptors in the brain, and so stops withdrawals without sedating. Subutex also blocks opiate receptors, making it difficult to get any effect at all from heroin when taking a regular, reasonably small dose of Subutex. It is brilliant stuff. However, in order for it to work, no heroin can be used for 12 hours before taking the first dose, and of course little effect can be gained from further heroin use – so needless to say, it is not a popular choice amongst the old hardcore. (Now in prisons, where it is crushed and snorted to get a buzz… that is a different matter.)

So, imagine that you are assessing someone for treatment – they come in and tell you that they are using heroin every 6 hours and their mental health isn’t great. Subutex might not be appropriate as they want the sedation provided by heroin to manage their mental state, so you decide together to opt for methadone. But this person has no intention of stopping heroin use at present because it is the only way they can block out the trauma they experienced as a child, which they do not feel ready to address until they have somewhere stable to live.

So the question is – do you offer them treatment?

In the olden days, the answer would have been “No”. People had to say they had no intention to continue using heroin once receiving a prescription, and this was monitored through regular drug tests. Any heroin-positive urine samples sent heads spinning, and would probably result in being given an ultimatum, and possibly no prescription (ouch). The logic behind this was that dual use would increase overdose risk.

The harm reduction movement changed that – once people had dared to continue to prescribing to those still using heroin, research showed that high doses of methadone not only ‘drowned’ opiate receptors and so also had a blocking effect, making it more difficult to experience the euphoric effects from taking heroin – but the surprise conclusion was that people were actually LESS likely to overdose when taking heroin on top of methadone. This was because people’s tolerance to opiates was so high that risk of overdose was greatly reduced, as long as they took their prescribed dosage daily to maintain their tolerance at this level. (If you imagine an alcoholic, who is used to supping a bottle of whisky a day, drinking half a Carling… if you want to try this experiment at home, get yourselves down Wetherspoon’s with a £1.40 in your pocket and talk to anyone sitting alone at the bar.) Plus, taking a decent dose of methadone meant no withdrawal symptoms; and so less frequent injecting, less dodgy, desperate injecting, and so less hepatitis C, HIV, deep vein thromboses and cellulitis. And so the answer back then would have been, “Yes, treat, and keep treating until they get bored with paying for something they aren’t getting an effect from”.

So how would the question be answered today? Well although methadone in itself is pretty cheap, and Subutex not unreasonable, the cost of these medications often lies in the level of monitoring that is required, because they are ‘controlled medications’. This often means paying the pharmacist to dispense it in single doses and supervising its ingestion each day. It also means more frequent monitoring by doctors and drug workers to ensure that prescribing is safe and to reduce extraneous risk factors such as mental health problems and homelessness.

The truth is, as the money dries up, doctors and mental health trusts are going to be significantly less interested in working with heroin users. Half of those still walking around have got bits dropping off them – open abscesses you could fit your fist in at the top of each thigh and swollen, purple legs, from injecting into the femoral vein and irreparably damaging the blood supply to the legs; terrible general health from years of poor diet and jabbing bacteria-laden substances directly into their blood vessels; and quite probably hepatitis C. To treat, they are expensive and time-consuming. And so, I fear, the answer to the question will increasingly be, again, “No”. And doctors can be extremely eloquent and creative when it comes to finding justifications for why someone is ‘not appropriate for treatment’.

Oh god, I’m having a go at doctors now, what is my problem?! I’d better go before I piss off the whole medical profession and start making wild claims like “All radiologists are gay”…

To treat or not to treat, that is the question

Monday, December 3rd, 2012

A recent paradigm shift within the drugs field has further complicated an already difficult and lively debate around what constitutes drug treatment and who should qualify for it. This movement has, weirdly, sprung from a combination of both grass-roots support groups and the Coalition’s austerity measures.

In years gone by (and still in some regions today), Community Drug Teams were primarily made up of mental health nurses who, from what I could see, had got fed up with shift work on acute wards (having to work nights with full-blown nut jobs) and decided that community work was probably a cushy number (9-5 weekdays and 44p a mile). On the whole, these services met very nicely the needs of the nurses – and the prescribing psychiatrists – who admittedly had to endure sitting in grubby rooms in run-down buildings (god forbid drug users be seen in health centres and mix with the public), escorting their patients to the toilet for weekly supervised drug tests in return for a methadone prescription. Services were there to treat, almost exclusively, heroin users; a social group who, at the time, were massively excluded and disempowered, and who were very much at the services’ mercy. The power dynamic was engrained and aggressively maintained – CDT consultation rooms were reminiscent of Dickensian orphanages, and for those of us new to the field and not (at that point) full of cynicism, it was uncomfortable to witness. The approach was not holistic, nor did it address the psychological or social needs of the individual, and only those prepared to dip their caps, express their subordinate gratitude, reduce their drug use as instructed, attend regular appointments, and grovel for several weeks, if not months, ever made it past the waiting list for a prescription.

For those who did make it as far as an appointment with the prescriber, the only treatment available was low-dose, short-term methadone. The standard treatment plan was: enter treatment, stop using all drugs immediately, then reduce methadone dosage rapidly until opiate-free. Unsurprisingly, this method was rarely successful, as not only did it leave service users in a state of opiate withdrawal from treatment start until several weeks after treatment end, it also failed to take into account the person’s reasons for starting to take heroin in the first place – so as the opioids reduced, past trauma resurfaced, mental health problems were unmasked and exacerbated, and the reality of life hit right between the eyes. And should Mr Druguser share his concerns with Mrs Nurse, possibly disclosing self-prescribed codeine or Valium use to manage the symptoms produced by fast detoxification from methadone, he ran the risk of being labelled ‘not ready for treatment’ and being plonked back onto the waiting list. People could sit on these for up to a year in some areas, and the nurses seemed to miss the fact that heroin – well, it’s quite moreish. Needless to say, what became known as ‘The Revolving Door of Treatment’ only helped anyone whose motivation was extremely high, support networks were excellent, and mental health was completely stable. Everyone else spent their time trying to get onto a script, only to be either kicked off mid-treatment, or detoxed so fast that relapse onto heroin to manage withdrawal symptoms from methadone became almost unavoidable.

Then people started dying. Or at least, the public started to notice people dying. Bodies were being dumped in wheelie bins and skips because the Police automatically attended overdoses with ambulances. Families of the dead started to campaign, drug services came under fire, and at the same time, the links between Class A drug use and acquisitive crime were being formally logged, making these problems not just for those at the bottom of the social strata, but for the whole community.

And so came the 10-Year Drug Strategy, the new Labour Government’s attempt to tackle the problem. Money came flooding in to fund new services, and the focus of treatment shifted from purely medical to consider social and psychological aspects, meaning that there were opportunities for non-medical staff within the field (sometimes even within the mystical and superior world of prescribing). Services even started to employ ex-service users who had furthered themselves in education and experience. The power dynamic between service provider and service user started to dissolve, drug users were listened to – and, in many cases, preferred and pampered, with complementary therapies, immediate access to specialist education provision, and vulnerability tags when applying for housing.

The philosophy became – treat everybody. The research providing the evidence-base told us that a heroin user is less likely to die in treatment than when not in treatment; lessons from the 80s told us that legal and public denial of injecting practices led to steep increases in HIV and hepatitis C infection as a result of needle-sharing; the costs of treating health problems associated with long-term IV use and policing drug-fuelled acquisitive crime became clearer; and so thresholds for access to treatment were reduced. Harm Reduction was the phrase of the era, and this was extended to the harm caused to communities as well as to drug users themselves. Year by year, the money kept on coming and, to be honest, drug users and drug workers alike became a bit spoilt.

And so we move into a recession and a right-wing government. New presentations into opiate treatment are few and far between because heroin is so passé, and those with the will have made use of the plethora of services and reintegrated into mainstream society. The group that are left are not happy – no more free gym passes or massages, no more sick pay for providing sick notes stating ‘substance misuse issues’, but instead an expectation to attend medicals and Jobcentre courses.

At the same time, the Recovery Movement becomes popular. Now the phrase, ‘Recovery’, does not sit comfortably with me. It is a phrase that comes from the mental health domain and conjures in my mind images of the sick – all very 12-Step Model, where substance use is not a choice but a disease for which there is no cure, where the victim must struggle through and put faith in a ‘higher power’ to help them manage this terrible affliction. Dodgy. I personally find it disempowering, patronising and lacking in the notion of personal responsibility – it’s not a disease, it’s a lifestyle choice, you haven’t got cancer for christ’s sake – but I appreciate that it is a phrase that was chosen and adopted by a group of service users, and so who am I to criticise. If it works and people relate to it, that’s fine by me.

The Recovery Model also promotes working towards abstinence. Now abstinence became somewhat of a taboo phrase during the Harm Reduction Years, as the focus was on engagement and retainment in treatment, to reduce the damage drug use did to individuals’ health and the overall damage done to communities (admittedly for financial reasons, not the sympathetic reasons Tony might have had us believe). And so what the Coalition has done, somewhat cleverly it has to be said, it to take a service user-led movement which focuses on moving people away from substance use by moving them towards ‘recovery’, and twisted this into “You know that expensive drug treatment you’ve all been getting for years? Well, much like your benefits, you’re not going to be getting it for much longer. Get your head round it. Oh and – it’s for your own good you know”. Handy – and cheap.

Now I’m not one for enabling drug users to remain unquestioningly stationary – and anyone who has read my other posts will know that I am also sick to death of the ‘dependency culture’ that has developed in this country. But taking a group of people who have been socially vilified then pitied, who have been consistently encouraged to get in treatment, stay in treatment, and routinely drink the green nectar as their contribution to society for the last ten years – and then giving them six months to fully detox from methadone and get a job – that is just too much to ask and too great a challenge to the belief system of someone who thinks that going to the chemist every day is a vocation.

Some services, fearing decommissioning, have done exactly that – employed a ‘six months and you’re out’ policy. Others have decided that if someone drops out of treatment, that ‘probably means’ they don’t need treatment any more and so must be classed statistically as a ‘successful discharge’. This lack of any real health-focused philosophy within drug services is driven by the Government’s new system of Payment By Results – and the results they want are drug users out of treatment and into work (hence the targets around successful discharges). As well as the questionable morality of removing what has been sold for many years as a medical intervention (without a change in the research-base about its effectiveness, may I add), it chooses to turn a blind eye to the lack of skill, experience or motivation of most of the people left within this (pretty hopeless) group. Most importantly, it fails to acknowledge the level of psychological dependence on the medication that has enabled the opiate-dependent to function as normal human beings, given that methadone and buprenorphine (Subutex) both have long half-lives where heroin’s is very short, and so users take their medication once a day and then can go about their business (probably watching Jeremy Kyle, training their Staffies to fight, and seeing who picks up benzodiazepines at the chemist today if I’m honest – but many also work, parent successfully, and lead more stable lives than I). The fear of opiate withdrawals is significantly worse and longer-lasting than the physical withdrawals themselves, and politicians encouraging, promoting and feeding that dependency for TEN YEARS, then withdrawing it, is, in my mind, nothing short of abusive.

And where will it take us, I wonder, when in a few months’ time this group are poorer, more desperate and without the crutch that for so long has reduced their risk of dying? Is that a revolving door I see…?

Help! I think I’m turning into Margaret Thatcher!

Saturday, November 24th, 2012

Writing ‘I heart NHS’ left me pondering on why the wonderful, socialist systems of which our country can be so proud are nowadays so readily and shamelessly exploited, and questioning my own political standpoint. While I consider myself a big old soft romantic leftie to the core, my journeys into human nature have singed me and turned purity of belief, naivity of youth, and blissful idealist indulgence, into pragmatic cynicism.

There is no part of me that feels the welfare state is a bad idea – I am glad to contribute to keeping those unable to work in a decent of standing of living. But then, in the words of someone wise, the welfare state was meant to be a trampoline but has become a net – and I scare myself sometimes these days when I sympathise with the Daily Mail, or nod when I hear Cameron speaking of welfare reforms. I mean, really scare myself.

It is an internal clash I face daily as a drugs worker. No, dear client, you are not unfit for work because you are taking methadone, lots of people hold down jobs whilst on medication. Yes, dear client, you will almost certainly be less depressed and feel better about yourself if you get off your arse and do something constructive with your time to evoke a sense of satisfaction and purpose. No, dear client, the benefits you choose to live off are probably not yours morally, even if you are entitled to them legally. Yes, dear client, you might start sleeping at night without Valium if you do something with your body and brain other than watching Jeremy Kyle.

Once, as I attempted to convince a client that losing his disability benefits might be a blessing in disguise, an opportunity to be grasped, a chance to evolve and progress, I was asked, “What mug would go to work when he can get paid to stay at home?”. I managed to hold myself back from flying-kicking him across the consultation room (I’m a professional, you know), or from screaming my true feelings of “One with a sense of morality / work ethic / conscience / anything other than HIMSELF, you egocentric sponger!”, or from leaping over the desk, ragging off his Nikes and touch-screen mobile phone (why do you think it was so cheap – because it’s STOLEN!), shoving them up my jumper, and running out, howling “They’re mine! I paid for them with my taxes!”. Like I said, I’m a professional – I just reduced his methadone by 10mls and booked him in for some unnecessary and painful capillary blood tests.

It’s a poignant question though. The father of the welfare state, William Beveridge, would have answered that it was each person’s aspirations “to provide more than that minimum for himself and his family”. I suggest he somewhat over-estimated a significant proportion of the present British public’s aspirations. Possibly a few days in my job, working with the third-generation unemployed, would have made him question his basic premise.

Back in his day, though, the working class sat cross-legged on the floor of the social stratosphere. Nowadays, although standards of living are higher for everyone and we all have chairs to sit on, I suppose the working class are the middle classes in that they are the ones who go to work, and an under-class has developed of people who are out of work. (I was tempted to put ‘an under-class of people who don’t want to work’ but freaked myself out that the Daily Mail within was starting to ooze out – but, in all honesty, many of the jobs that have been created locally are currently filled by Polish people because the local, English-speaking unemployed for whom they were created do not want them.) It could be labelled ‘dependency culture’, but ‘dependency’ for me conjures up images of vulnerability and need, which are the people who the welfare state should exist for – for me, it’s more an entitlement culture, represented by the right to choose not to work.

So, I find myself over-worked, though not under-paid, feeling down-trodden, and somewhat resentful (and jealous?) of the people who do get paid to sit at home all day, make a few extra quid from selling bent cigarettes (and therefore by-passing paying tax which would otherwise contribute towards their and their customers’ impending heart failure / lung cancer treatment), laughing at mugs like me running around like a blue-arsed fly trying to reduce their health inequities – which, largely, they create, and I / we / definitely not they, pay for. So, the question I ask myself, and put to you, oh readers who have pledged to be honest and true – am I a bigot?! Are my frustrations with the current systems justified and rational – or will I soon find myself agreeing with headlines that fail to differentiate between refugees and illegal immigrants facilitating sex trafficking? Will I next find my hand, on Election Day, quivering with pent-up anger and resentment, unconsciously drawn towards the box marked ‘BNP’? And if so, what next – all drug users are scum? All Muslims are suicide bombers? Premiership footballers are rightly the role models of future generations? Tits on Page 3 and Babestation are examples of equality in employment and, as such, good for women? I just don’t know anymore, readers, I am so confused and feel so compromised, having already strayed so far from my pure, true, clean socialist belief system and resenting the unemployed!

The fear encroaches…

Wednesday, November 21st, 2012

We rejoin our heroine on her quest from the land of No Hope and Stress to find peace of mind and satisfaction, and she is pleased, for she is enjoying the mission more than she could e’er have hoped, and though she still faces the adversities of social media and the potholes of complex software, she takes much joy in the sense of purpose this journey provides.

Now the woman turns around, and back along the path she sees a group of people walking behind her. Some of these people she recognises as friends; other she hath ne’ev before set eyes upon. And she feels at once supported by this lowly rabble, for though they lack basic hygiene and smell a bit, they are kind enough to listen to her words and encourage her to continue on her quest, and she takes great comfort and joy in their comments, and in regularly viewing her stats page, and all this feeds her desire to go on, for she cannot believe that sending out a few emails and Facebook messages could create such a wonderous response. And she looks back at the crowd that have gathered, many of whom are wise and carry vast experience of the world, and she is gladdened and gratified by their commendation.

But she also feels the weight of their gaze, for many of them hath knowledge that far outstrips her own, and carry with them linguistic elegance and letters after their names, and she is at once petrified that she will fall and expose her clumsiness and stupidity to those that walk behind her. For she is but a drugs worker, a public servant, and while her experience of depression, deprivation and wound botulism is great, ne’ev before hath she trod the literary path, and she knows not what is expected of her, and it has been many miles since she left her Comfort Zone, and she is scared.

And the traveller fears she will tread the wrong path and take the kindly clan down a road which may not fulfil their needs, their desires, their own quests for knowledge, and she is filled with angst that the track she chooses to follow may become unclear and dull, and that she may fritter away the support which these followers offer or, worse still, she may take them on a path on which they lose the will to live and die of boredom.

But then she has a word with herself and realises that she is being that a dimwitted narcissist, a despicable ignoramus, an unworthy cretin, for these people are not a burden but a joyous blessing, a gift sent to help her, to kick her if she slows, to redirect her if she wanders, and she asks the crowd always to be honest and provide genuine feedback, harsh though it may be, to keep her on the path which she needs to be on. For these are her clients now, since she hath traded the needle for the pen, the script for the script, and when she thinks of those she left behind and how they hung from her so she ne’er before was able to progress, and told her daily how she failed them despite her best efforts (for she hath not a magic wand, and could not turn water into methadone, nor loaves into pregablin), and she compares them with this vibrant cluster who now stand behind her, she is glad for the choices she has made, and she wants not only to take these people with her on her quest, but also to serve them and give them everything their hearts desire.

Maurice the Feline (or MCat to his mates)

Saturday, November 17th, 2012

First there was J-Lo, then there was R-Pat, then SuBo (strange that Pete Doherty hasn’t jumped on the celebrity name abbreviation band-wagon..) – so when I overheard someone talking about MCat, I asked, “Is he on X-Factor or TOWIE?”.

Just kidding, of course. I’d heard about MCat, or mephedrone, before it was made illegal, referred to as a ‘legal high’. The term, legal high, is as misleading as it is out-dated, as not only does it point out the degree to which drug production now rapidly out-strips drug policy both in speed and guile, but is also value-laden with implications that ‘legal’ is synonymous with ‘safe’ – which of course, it is not. The Government just aren’t as fast or as clever as teenagers with laptops or the Chinese.

Referrals first started coming in for young adults taking mephedrone at parties – dropping out of college or work, refusing to leave the house, hearing voices, self-confidence obliterated. Now these were the tip of iceberg, we knew, as is generally the case with those who become so desperate that they consider presenting to a drugs service asking for help, and we knew that for every one referred, there were probably a hundred more using the substance without requiring assistance. But then a local teenager died, schools started to confiscate white powder from thirteen-year-olds caught taking it in school toilets, and presentations to GPs of worried parents with nervous-looking teenagers increased.

And then, oh god, the adult heavy-end drug-using population got hold of it. Now many of these are people who would pick up a tablet they had found on the floor of a public toilet and take it without knowing what it was. Some of them carry their prescribed meds out of the pharmacy, where they are supervised ingesting their dose of controlled medication by the pharmacist, in their black-toothed, gum-diseased mouths (no it’s not the methadone that makes your teeth rot, just BRUSH YOUR TEETH), and then spit it into the mouth of a waiting compatriot, either directly or via a used Coke can, for a couple of quid. So imagine the frenzy when a new drug, five times cheaper than heroin, scarily stronger than amphetamine, and more abundant than skunk weed, arrives in town. Remember the crystal meth epidemic the media howled about that never came (but that obliterated areas of America, Australia and New Zealand) – well I don’t want to scare-monger, but from where I’m standing, MCat looks like the UK’s crystal meth.

To call the white powder or crystalline substance being snorted, swallowed and injected ‘mephedrone’, ‘meow meow’ or ‘MCat’ is a dangerous generalisation – people in fact have no idea what it is that they are taking. Any term can only be used as an umbrella, and describes a white substance with stimulant effects which shows up on our current urine tests as amphetamine, methamphetamine (crystal meth), or neither. The truth is, no-one actually knows what they are putting into their bloodstream, and presentations and self-reports of experiences and side-effects vary wildly. When the UK Government picked up on the new drug and mephedrone was made illegal, the Chinese, who originally manufactured and distributed the drug in its initial form, got immediately wise to the change in UK legislation and the associated problems with importing the drug, and so changed the chemical composition slightly to get round this slight hitch in their marketing strategy. So our Government made the whole family of drugs, cathinones, illegal. There was, however, one rather huge problem – the Police had no way of testing for this new group of substances, and so amounts of white powder, once seized, even when accompanied with a confession of possession of mephedrone, were at times released, along with a somewhat sheepish drug dealer. (I’m pleased to report that drug testing facilities for MCat and associated substances have now been developed and laboratories are working with the Police to detect the drug.)

Imagine then being a drugs worker – as well as the client group’s ever-growing sense of rights without responsibility, the public sector cuts and all the associated inter-service bitching, and the lazy public-sector piss-takers sneering at you for being a mug for trying to make a difference – and an already difficult job starts to look somewhat less appetising. Then envisage that your drab, depressed, wet-lettuce clients (miserable and demotivating but at least manageable and consistent) start presenting wide-eyed, two stone lighter, covered in lumps, abscesses and what looks like chemical burns appearing from the inside out, and with a paranoid and aggressive approach to their social interactions. And you are trying to work with these people around a substance that you (and the rest of the field) know almost nothing about, can’t test for, and have no resources or points of reference to address for support or an evidence-base. One of your usually calm and polite clients smashes up his workshop with a hammer and then threatens to punch you; another genuinely nice guy with an alcohol problem and penchant for diazepam holds his mother at knife-point; the waiting room goes from looking like a queue outside a crematorium to an 80s football terrace.

I was around for the crack explosion, and I remember when all the heroin dealers started giving away a £10 rock with a bag of heroin to market their new product. Crack – scary stuff. But to be a crackhead – not a part-time, recreational user sharing a rock on payday, but a full-blown sell-your-arse type crackhead – you needed a serious income stream, and one that was rarely available outside of city centres with a sex-working industry. MCat – well that’s going for £10 a gram, less in some cases, and anecdotal reports indicate that people buy a fat bag and then are generous with how they share it around – a poor man’s cocaine, if you will, exchanging crisp £20 notes and smearless mirrors with grotty fivers and 1ml insulin syringes, and silicone implants with dodgy tattoos. So users can’t tell you how much they have used because they haven’t paid for it, they struggle to avoid it because it gets shoved underneath their noses every time they walk through a door, and they aren’t even sure what they’re taking because one bag will be euphoric while another bag will be prang. And what do drug users do when they haven’t slept for five days, they are ready for passing out because their stomachs are like walnuts, and they start seeing things and believing that everyone is trying to kill them? Take the world’s best antipsychotic – heroin. Ah the new wave is here my friends, get ready for it…

Hence, again, the summary of this entry is – I’ve had enough, I need a new job.

Public servant craves freedom

Tuesday, November 6th, 2012

So, my first attempt at a blog, where to start..

We all come to crossroads in our lives as part of the privileged world of choices we exist in, and yes, I fully accept that choosing one’s career path is a luxury which the majority of the world’s population do not enjoy, and so I don’t want to get too whimsical or self-pitying here. However, it has to be said, my choice of career was one which left my school teachers and lecturers scratching their heads and asking ‘why?’ and telling me ‘there isn’t much money in it, you know’, both of which, at the time, as a fresh-faced, political, optimistic young woman, meant nothing to me. I thought I could change the world – not the whole world, but the individual worlds of people who were struggling, which is all one ever really wants as a psychologist. Maybe it was a desire to make a difference, maybe it was the result of teenage years spent unwittingly wrangling with low mood, maybe it was the values of a socialist, fierce but compassionate mother, maybe, as a boyfriend put it, my need to take on a caring role was a form of self-validation, or maybe it was just middle-class guilt. Whatever the reason, I launched myself into drugs work like a dwarfed Wonder Woman out of a cannon. And I loved it.

Back then, drug users were a genuinely socially excluded group. They didn’t access healthcare because doctor’s surgeries wouldn’t accept them as patients, and if they did make it through the door, they would cope with health complications rather than go back to be treated like sub-humans. Only people with an address could register with health centres, and people presenting with a bedraggled or unkempt appearance were considered unfit to be seated in waiting rooms with ‘normal’ patients. Women especially did not present asking for help or treatment because the party line was that drug users were not fit to be parents, the substance use instead of the parenting was assessed, the failings instead of the need recorded, and so people struggled on alone, quietly, rather than put themselves up to be judged, criticised, and risk losing their families.

It was a great job, back then, being a drugs worker. You had battles with GPs about the definition of the word ‘healthcare’, you compiled evidence-based arguments to challenge psychiatry’s refusal to treat drug-users, quoting research about the co-morbidity of substance use and mental health issues, you waved the flag of the vulnerable and battered down doors until people listened to the plight (or just got sick of hearing you banging on) and agreed to let you in. It was hard, but god was it rewarding, and the clients were just grateful that for once someone was listening to them and was on their side.

Flash forward eleven years… A Labour Government has been in place, social equality has been a priority, times have been affluent, public sector wages are brought into line with the private sector, and drug users have been given recognition as a vulnerable group – no longer perceived as waster layabouts, some have addressed their issues and gone on to successful careers, breaking down prejudices and presuppositions about substance users, while the others are acknowledged as probably having had experienced childhood abuse and have therefore developed poor coping strategies, needing intensive rehabilitation if they are to address their issues, and so are sympathetically cradled by the system.

But hang on, there’s a global recession, funds are being cut, and the luxurious ten years of the Drug Strategy seem long behind us. So now drugs services start pitching themselves against each other for funding, long-existing relationships become strained, GPs start to wonder if it’s really worth having this type of patient in their surgeries if the money is drying up..

But worst, by far the worst, change to the landscape of the role of a drugs worker comes from the client group themselves, the very people you went into this role to help. They too have had a few comfortable years – now not only able to access healthcare, training opportunities, support with parenting, housing and finances, but with an ever-growing, burning sense of entitlement. They’ve had their legal aid, they know their rights, they’ve learned to exploit every loophole in every system, and they are used to being fast-tracked to the front of every queue because they are IN NEED. And they see ME, their drugs worker, their advocate, their bodyguard against inequity, as their root to a happy life, their guarantee that never again will they be poor, homeless, badly-treated or in need.

Now the twenty year old me might have been willing to attempt to fulfil that impossible role – but by now I have faced my own fair share of adversity, been on my arse a few times as we all are as humans, and learned to pick myself up, dust myself down, and get on with what needs to be done. And so regular attempts at emotional black-mail to the cry of ‘if you don’t get me some benzos so I can sleep / sort out my rent arrears so I don’t get evicted / tell Social Services I’ve stopped using so I don’t lose my kids / have me a new prescription at the pharmacy by 12 with an increase to my methadone dose, it’s YOUR fault I’m going to use’ wore thin and, frankly, I started to find the lack of personal responsibility and dependence of the State tedious, irritating and, at times, downright infuriating.

And so here I am, stuck in a miserable, unrewarding, emotionally-exhausting job, wondering where the last eleven years have gone, unsure if I have the skills to transfer to another profession which, likely as not, will also be subject to cut-backs and job losses, and really much preferring the idea of disappearing up a mountain alone, never again to address humankind. You don’t see the best in life, working as a drugs worker, and I don’t want to keep seeing the world like the big pile of shit I have been for so many years. I used to be an optimist, for god’s sake! Now it seems I am unshockable, unscarable, and have the emotional range of Oscar the Grouch.

The English language was always my first love, sadly neglected over the years of personal austerity, and life events and puzzles started taking me back to it during periods of lone reflection. And I thought to myself – I’ve paid my dues, I’ve done my time, and I’ve got enough material to start writing now and never stop.. And so here begineth the attempted transformation from drugs worker to writer…

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