Last week, Viv and I (Erin) gladly took up an opportunity of; 2 days in Brighton, hotel by the seaside, and an interesting conference with the Royal College of General Practitioners,
"Meeting the Needs of Diverse Populations: Hard to Reach or Easy to Ignore?" Well, we know the answer to that one. The night before we traveled down there Viv and I had been talking about the title of this conference - how 'Hard To Reach' was still a slogan used regularly when commissioning services. Discussed yes, but rarely addressed. Viv pointed out that we are still in the habit of creating services for drug users based on a very prescriptive (scuse the pun) model. We don't cater for the person who dosent fit in the box. The service or opportunity for drug treatment or support for the person who doesn't speak the language, is of another culture, who works full time or is in shift work, the 'poly' drug user (which the vast majority of people are these days), has mental health problems, is extremely vulnerable or homeless. Viv was right of course. Yes, we have a few specialist services but we don't loosen up existing services to be more flexible with todays drug user's needs. We have older users, younger users, users from different cultures, imprisoned users. As i discussed with others at the conference - really, its not rocket science. So why are we still battling with it?
The conference was in itself, very interesting. Over 600 delegates, a large proportion GPs and those that work along side them, and a good sprinkling of user activists as well, which is always good to see (A big thanks to Dr Chris Ford for ensuring we all got there). In terms of the sessions, from BP's point of view perhaps one of the most interesting was a session by XXX entitled 'How do we manage pain in drug users?' Always a struggle for the average opiate dependent person, pain relief and management is an area where many doctors are flailing. (See BP's article The Pain Paradox).
In fact it is an area where opiate users themselves are often flailing in the dark. Well, opiate users brace yourselves; I heard one very interesting bit of information about methadone. Yes we all know it is a good pain killer - yet we all know it is wholly inadequate at times and even when we increase the dose it dosent always seem to hit the spot. Well, I learnt - and I can't understand why we all don't know this, that while methadone lasts for 24-36 hours and works the entire time to stop one withdrawing thus staying in the system, for pain relief - it's different. For pain relief, methadone works only 4-8 hours, therefore if one is using it for pain relief, one should split their doseage and use it 3-4 times a day, instead of the usual once or twice.
You can find out if your methadone is working at reliveing your pain by asking whether you get some relief shortly after you've taken it, but that you find it wears off and you end up taking heaps more. Now you know! Now, you should just SPLIT your dose up, take it throughout the day at 4-8 hourly intervals, and then you may well see that you get some relief. (To be continued).
Speedballing: opportunities and challenges for harm
reduction interventions
