This certainly appears to be getting stronger almost by the day and although to be welcomed some of the proselytizing is over powering.
I also suspect some people are trying to spread their bets in anticipation of a major shift in drug treatment policy coming our way soon.

Agree completely - its really important we keep explaining that abstinence is one end of a spectrum which includes harm reduction etc - they are not separate Plus recovery must be self-defined and is not the same thing as abstinence! Plus another anxiety is that many people who are pushing the recovery agenda in UK have never used and are non-clinicians, unlike the US where most of them are recovering people

I'm also seeing a push to get rid of Nurses within the drug field, this is very worrying. There are quite a few vocal Nurses who have advocated for patients it could be seen as trouble making to the narrow-sighted.
It seems we have a battle with many services being recommissioned.

I cannot say I have seen a push to get rid of nurses and would welcome further details. I do recognise that cost is increasingly to the fore and unwise commissioners might be seduced by low costs. As my old mum says
"buy cheap buy twice"

quote:

Originally posted by Perseverance:
I cannot say I have seen a push to get rid of nurses and would welcome further details. I do recognise that cost is increasingly to the fore and unwise commissioners might be seduced by low costs. As my old mum says
"buy cheap buy twice"

I've seen lots of instances where 'pretend' charities are tendering for services and Nurses are being replaced with 'Drugs workers'. I'm not saying anything bad about drugs workers, what I'm saying is we shouldn't be reducing the skill mix.

As for the push towards abstinance I'm feeling this and we have to advocate for our patients and challenge what we know works.
I fully agree that detox and rehab should be available but we know for many this cannot be met because of a target.

These patient's are not like a hypertensive target and if we treat them as such them we will have many more deaths!

We are not treating numbers we are treating people and their health.

I think "skill mix" is right, Simon. I've not seen a reduction in Nurses.. in fact more and more nurses are doing the Independent Prescribing thing .. Do we now have to wait til parliament gets back from its summer hols for the independent prescribing of methadone to extend to nurse and pharmacist prescribers?

There are those who worry that there will not be enough work for all who want to work in this field, and that psychiatrists will be put out of work by GPs , and GPs by Nurse prescribers, and I suppose Nurses by support workers. However I think all these people bring useful skills to this complex field, and one of the privilages of working in this area is working with people who have such a wide range of experience.. from social work, housing, nursing, psychology, primary care, psychiatry, OT, etc etc.. and both I and the patients benefit and learn from all these people.

I suppose there might be an attempt to provide a service using the "cheapest" possible people, but hopefully commissioners would have something to say about a service not offering the particular skills that a nursing background and training can bring.

Going back to the "recovery" debate, I agree with both Chris and Simon. I haven't seen any sign of this suggested conspiracy to encourage everybody to take methadone all their life I am only too happy to help people by whatever means to stop taking it as soon as they are fed up with it, which then has the added bonus that I can stop signing all those boring scripts.

However I have found that there are as many methods of stopping opiates as there are people using them, and the trick is to keep offering lots of opportunities which people can grab when they are ready (another reason for having a wide skill mix in the team) and there are many other parts of a person's life which I would take as indicating "recovery" before looking at the script.. .

This message has been edited. Last edited by: judith yates,

One thing that would really help with the advancement of medication assisted recovery would be examples of people on maintenance medication who are also leading 'normal lives'. That is, working and paying bills and taxes, successfully looking after children etc etc etc. I know it is difficult to highlight these cases as I appreciate that people want to stay under the radar and get on with their lives. I assume that you guys are in contact with people who are successful in recovery whilst on medication. A higher profile of such people would go a long way to counter the image of "methadone, wine and welfare". Could this be something for one of your conferences?

I've said it before, but one of the outcome measure I use is whether someone is paying income tax. If they are, then a whole raft of other recovery elements must be in place, and it does not require abstinence from anything.

If I can keep someone in the grip of the Inland Revenue I reckon I am doing a good job.

quote:

Originally posted by jimjones:
I've said it before, but one of the outcome measure I use is whether someone is paying income tax. If they are, then a whole raft of other recovery elements must be in place, and it does not require abstinence from anything.

If I can keep someone in the grip of the Inland Revenue I reckon I am doing a good job.

Exactly.

Blimey, Regenerate, you ask for examples of people leading "normal" lives while on a script. There are loads. I have lots of patients in full time employment or full time education while on maintenance methadone or buprenorphine, and spend a lot of time encouraging everyone else into training towards work, as soon as on a stable script. All part of coming back to being part of mainstream society.

A chap I saw today works in a furniture making factory (on short time at present), there is a dental nurse, a horticulturalist, several tree surgeons, fully badged security chaps, several care workers of different kinds, lots of self employed and sometimes very successful builders, plasterers, roofers, scaffolders, as well as musicians, artists, just as examples..there are many more, and this is a very deprived inner city area. There are also several people on degree courses and HNDs etc, and lots of excellent parents, with delightful children. Many people who have found themselves dependent on opiates, but who otherwise have reasonably sound physical and psychological constitution, keep full time jobs and lead "normal " lives while on prescribed opiates, once the street drugs are not needed. Getting rid of the last bit of the script might feel tidy, and can be very cheering, but is nowhere near as important to the person, the family and the community as all the rest of the journey.

quote:

Originally posted by judith yates:
Blimey, Regenerate, you ask for examples of people leading "normal" lives while on a script. There are loads. I have lots of patients in full time employment or full time education while on maintenance methadone or buprenorphine, and spend a lot of time encouraging everyone else into training towards work, as soon as on a stable script. All part of coming back to being part of mainstream society.

A chap I saw today works in a furniture making factory (on short time at present), there is a dental nurse, a horticulturalist, several tree surgeons, fully badged security chaps, several care workers of different kinds, lots of self employed and sometimes very successful builders, plasterers, roofers, scaffolders, as well as musicians, artists, just as examples..there are many more, and this is a very deprived inner city area. There are also several people on degree courses and HNDs etc, and lots of excellent parents, with delightful children. Many people who have found themselves dependent on opiates, but who otherwise have reasonably sound physical and psychological constitution, keep full time jobs and lead "normal " lives while on prescribed opiates, once the street drugs are not needed. Getting rid of the last bit of the script might feel tidy, and can be very cheering, but is nowhere near as important to the person, the family and the community as all the rest of the journey.

Judith,

Thanks for this. It is very encouraging. If we could work on the creation of a higher profile for these people that would be great. Is there a communications resource available to SMMGP for such work? What do people think about the possibility of countering the image of "methadone, wine and welfare" by profiling these sucesses stories at one of your conferences?

I imagine we all have many patients who work, it's a bit of an inconvenience having to have 5 early morning clinics and three staff all doing two late nights. I guess it's a burden we have to put up with for the working people.

Our clinic has a large amount of patients who work, pay taxes and contribute to society.
The workers have a low profile, often not able to attend service-user events, they are too busy. The workers tend to be often unaware of what plans people may or may not have to force them into detoxing from a drug that keeps them well.

quote:

Originally posted by Simon Greasley:
I imagine we all have many patients who work, it's a bit of an inconvenience having to have 5 early morning clinics and three staff all doing two late nights. I guess it's a burden we have to put up with for the working people.

Our clinic has a large amount of patients who work, pay taxes and contribute to society.
The workers have a low profile, often not able to attend service-user events, they are too busy. The workers tend to be often unaware of what plans people may or may not have to force them into detoxing from a drug that keeps them well.

What kind of % would we expect the " large amount of patients who work, pay taxes and contribute to society" to be?

quote:

Originally posted by Regenerate:

quote:

Originally posted by Simon Greasley:
I imagine we all have many patients who work, it's a bit of an inconvenience having to have 5 early morning clinics and three staff all doing two late nights. I guess it's a burden we have to put up with for the working people.

Our clinic has a large amount of patients who work, pay taxes and contribute to society.
The workers have a low profile, often not able to attend service-user events, they are too busy. The workers tend to be often unaware of what plans people may or may not have to force them into detoxing from a drug that keeps them well.

What kind of % would we expect the " large amount of patients who work, pay taxes and contribute to society" to be?

I'm not telling you as it'd become a target :-)

Make it up the "pretend" charities certainly would.

quote:

Originally posted by Perseverance:
Make it up the "pretend" charities certainly would.

I dont recognise these "pretend" charities, what they would make up and why?

I am taking Simom's lead from earlier in this post re the "pretend" charities.Fabrication, or embillishment is not the exclusive preserve of these organisations.
Targets are there to be hit, and in these difficult times it might be the survival of the meanest as well as the leanest.

Slightly off topic here but feel i must say that.......I HATE targets, please don't anybody explain to me how they are fundamental to healthcare delivery and ensure spending is in the correct areas blah blah blah they are the ruin of quality work and make workers feel like they are not trusted to manage their own time, no acknowledgement of the work you've put in, just the 'target' you didn't meet. For conscientious hard working individuals targets can be soul destroying. Our work is not always measurable. Hmmm maybe a little pent up emotion there!!

quote:

Originally posted by clurr:
Slightly off topic here but feel i must say that.......I HATE targets, please don't anybody explain to me how they are fundamental to healthcare delivery and ensure spending is in the correct areas blah blah blah they are the ruin of quality work and make workers feel like they are not trusted to manage their own time, no acknowledgement of the work you've put in, just the 'target' you didn't meet. For conscientious hard working individuals targets can be soul destroying. Our work is not always measurable. Hmmm maybe a little pent up emotion there!!

I seem to remember years ago we managed without targets, we saw patients and didn't bother about such things. I seem to think when more target driven things came in so did massive tiers of management I imagine this costs money.

quote:

Originally posted by Perseverance:
I am taking Simom's lead from earlier in this post re the "pretend" charities.Fabrication, or embillishment is not the exclusive preserve of these organisations.
Targets are there to be hit, and in these difficult times it might be the survival of the meanest as well as the leanest.

And where is the patient in all of this?