Volunteering policies – helpful of hindrance?

  This article

Volunteering and the concept of Social Capital

refers to a case study analysis of a ‘socially deprived community’ in the North West of England, carried out between 1999-2001 shows how volunteering can be crucial in the development of social capital for some members of the community but for others it presents exclusionary issues. 

MUTUAL AID THROUGH NESESSITY

Volunteering has many different benefits, in some situations it is seen to be the ‘altruistic’ movement that arises out of the need to support others in times of struggle. Offering your time to help others less fortunate to survive in the face of adversity, this can be broken down even further into two distinct categories. The first as a means of achieving personal goals, perhaps volunteering within an organisation with the motive of gaining employment, alternatively, it may also be a community based method to bond against a common cause that is destructive to the community and therefore offering your support and time would then be to benefit the entire community.
Another aspect of volunteering which seems to be becoming more and more prominent is the use of volunteers as a means of ensuring the survival of organisations under constant threat of closure in times of austerity. Either way it is quite a significant, and some might say imperative part of society on the whole, one that combines needs, wants and unity for the greater good.
Amongst socially excluded groups, the need for mutual aid has an extremely important role. Exclusion from society has many detrimental aspects to it, mortality, significant health issues, hunger, poverty, homelessness, educational issues, to mention but a few, many fuelled by propaganda, media’s misguided misrepresentation which then becomes fear of what is misunderstood. And, perhaps it’s just my glasses that are dirty but when you look at a large number of the more socially excluded groups, the initial reasons for being excluded are because there is an element of previously mentioned fear, lack of understanding and education, and primarily a ‘common difference’ that is evident in say, drug user communities, disabled communities, ethnic/cultural communities, LGBTQ communities, aging communities, etc. The majority are vulnerable due to the afore mentioned detrimental aspects, and, in some circles, blamed for the prevalence of those very same aspects, which in turn promotes further reason for exclusion, ironically instigated by the very same people who implement the lies and propaganda in the first place.
Areas where this form of culture, status and class ‘discrimination’ is most prevalent reflect low social capital, where there are high levels of isolation and a reluctance, or resistance, which transpires negatively resulting in community members being less likely to partake in social activities, or contribute to the economic growth of their surroundings, let alone have any value for political governance. Here is where mutual aid can and does flourish, almost naturally, as if it were, a deeply engrained, human instinct to unite against a common threat and protect each other against further detrimental effects from external sources. Regardless of how this manifests in the community, protests, drug use, violence, crime, the majority of reactions can be whittled down to fear. Fear of further discrimination, fear of lack of support in health matters, hunger, homelessness, higher mortality rates. Fear of further punishment over their reaction to the degradation and ostracised nature of their community. And the more fearful the community become, the more extreme the reactions, and the more isolated they become. Until you are left with a community that has no prospects, no funding, and all relevant support services withdrawn through ‘lack of funding’ due to false economic claims and austerity measures.
Social inequalities in this scenario have increased fatalities, crime statistics, drug use, homelessness, etc, and the answer from our governing bodies and currently non-elected leader is to impose further sanctions, reduce funding, resulting in the closure of support services and build Mega-prisons to punish those who defiantly stand up for their rights, and the rights of others. (I believe In America there is the same principle but they call them FEMA camps) How sad is it that the defence of basic human rights is now a crime. How did we ever let it get to this?

PROFESSIONAL VOLUNTEERING

A second model that is quite common is the professional who volunteers their time to offer some form of support, for those less fortunate than themselves. The ‘altruistic do-gooders’ who feel they have a moral obligation to support their fellow human beings in times of distress and adversity. Those, quite possibly, unaffected, or minimally affected, by the social inequalities, but who still have a conscience that compels them to offer their time and support to others. This is, on the surface, a humane and much appreciated approach to providing a plaster that partially stems the flow of life from a gaping wound.
The government openly supported this form of volunteering as part of the big society project by stating that those who in stable employment who were of the nature to offer their time in support would be allowed three days out of their normal work regime to carry out volunteer work in the community. But there is a catch with this kind of volunteering, highlighted in the article….

“An understanding of formal volunteering requires an appreciation of the informal social networking processes going on in the local community”

At risk of seeming partially objective to the volunteers that fit into this form of volunteering I would dare to say that someone who is in employment, healthy, and to a degree secure will not, with sufficient depth or weight, relate to the hardships encountered by those they seek to support. One particular aspect of this volunteering I find unfavourable is the university student who as part of their curriculum seeks a placement in the community to better understand the complexities that are a huge part of their subject matter. Like the law student who might volunteer in a drop-in service with a high prevalence of individuals who have, or still do, commit crime, or possibly an agency primarily supporting children excluded from school for being unruly. The negative impact of this form of volunteering might be that an individual might warm to the attention mistaking it for real concern and, as a result, gain a false hope only to be once again ‘let down’ when the student returns to full time education. This can be detrimental to those who are being ‘studied’ by those studying. Affecting trust, confidence, self-esteem. Personal value and personal security. However, it does have fantastic personal growth potential and adds to the security of a more fortunate future for the student.

GIVING BACK TO SOCIETY

This form of volunteering is one that has become quite prominent in addiction circles, where those fortunate to achieve ‘full’ recovery, as part of an amends process, or, as a step towards gaining employment in the field of addiction, remain in the safety bubble of the support network where they found their recovery to give freely of their time to help others through the turmoil of chaotic addiction. This form of volunteering has numerous benefits, and almost as many risks. For many, the concept of giving back toy a society that did nothing but take, quite possibly creating the whole scenario that resulted in your seeking support and guidance in the first place, can be a bitter pill to swallow, one which is eased down the throat by the ever
supportive councillor who crushes down the pill and lubricates the throat by stating that it is part of your program to learn patience, tolerance, forgiveness and accountability.  Well placed guilt trip put heavily on the shoulders of the still fresh and vulnerable recoveree, and, this also, coincidentally, expands the scope for delegating the workload to enable the providers to gain a more realistic possibility of achieving all the key performance indicators set out by commissioners, which they promised to achieve in their tender bid, for a ridiculously low amount of funding. These outcomes quite possibly would be otherwise unachievable without the use of volunteers.
So, realistically, and quite negatively, speaking, volunteers are, in this aspect, quite an imperative part of the overall success of the provider, just as much as the provider may have been an imperative part of the overall success of the individual. This importance and use of volunteers in this process has the added curveball of being equally beneficial to the individual.  Volunteering improves confidence, self-esteem, self-worth, dignity, and empowers people to move forward with a new lease of life, supported by the increased presence of all the afore mentioned skills and attributes promoting a more sustainable recovery journey and making long term success more attainable. Its almost like a ‘fluffy cloud’ form of aftercare.
Another supposed benefit of this volunteering model is that it disciplines you in preparation for the real world, learning skills such as time keeping, team dynamics, routine, etc.
But, there is a downside to this, that goes against the grain, quite drastically, delaying ‘full’ recovery.

YOUR RIGHTS AS A VOLUNTEER

Volunteer rights lays out the governments guide to your rights when volunteering. Which are quite basic, not compulsory, and as usual with governmental documents wide open to interpretation. It is flimsy and lays out what you can expect, but is not obligatory and quite often is not honoured by numerous organisations quick to use your services and free time. The level of supervision is normally quite low and if involved in the running of needle exchanges, or similar services within services then there is also the question of clinical supervision. Any training must be relative to the volunteer role, which doesn’t, in my opinion, support the final breakaway into mainstream society, restricting the scope for moving on, and perhaps in some cases delaying the moving on of some people. Although you should be covered by the companies public liability insurance, my experience tells me that this is quite often not the case, in fact, everyday staff are not always covered by this insurance, especially where nonmedical prescribing is concerned, have you checked? And, despite the importance of your valuable time and effort, you are not entitled to any kind of volunteer payments this is more protective of the companies rights and legal situation than it is of your rights and legal situation, which, it has already been established are practically non-existent.
Any payment given for volunteering can be mistaken as a form of contract for services rendered. This in turn blurs the lines should there be a tribunal for any reason. This non-payment clause, expands into any misleading promises or hints that you are working towards any possible employment, or paid work with the company in the future. Something I was lead to believe when I was volunteering was that I was working towards employment, an added bonus, but not why I was volunteering. I might not have stayed as long in the same place, if I’m totally honest, but, the fact I was called a peer supporter rather than a volunteer, effectively
meant I was still classed as a service user, somehow. It took me two years of passionate, uncompromising support to uncover that little gem. All in the title!
So, considering this do the benefits of volunteering actually help or hinder the early stages of an individual’s recovery journey?

A final question which expands on the ‘title’ scenario which although something you may not consider huge, actually makes quite difference, would it make any difference to make a ‘donation’ rather than a payment? A loophole that worked around the legalities of entry fees to support the illegal rave scene. Donations towards future free parties was not illegal whereas payment for entry was.

 Any feedback on this topic would be much appreciated.

Do you have personal experience of volunteering?

  Are you a volunteer manager and have found a way round policy of payment?

How do you show your respect and value for your volunteers?

 

e-mail: drugactivist@gmail.com

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Support Don’t Punish day of action

Reblogging from NAG England website, a blog contributed by Blenheim CDP. It’s a pleasure and a privilege to not only be a bonafide Nagger, but also to be in a position to attend all three UK events as a host, a presenter and a Naloxone distributor. What a month July is turning into. Hope to see as many there as can possibly make it. Please share this where appropriate. #SupportDontPunish # #JusticeForKarl #NAGEngland #NaloxoneGuerilla #EuroNPUD #SUSSED #SCUF #WeRise

Naloxone Action Group - England

The Support Don’t Punish global day of action is on 26th June every year and this year is set to be the biggest yet with 160 cities joining forces to call for drug policy reform.

The aim for the Global Day of Action is to produce high-profile and visually symbolic local actions. The events are planned locally and you can see here what events are happening near you on the campaign page. Look out for the NAG members that are getting involved in London, Liverpool and Bedford.

There are plenty of inspiration and useful resources online.

You can find out more information about Support Don’t Punish on their website.

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A CROOKED disability assessor – Capita – bragged on TV that he earned £20,000 a month.

These assessments are far from productive as it is. The assessment decision is based on what is,seen and heard on the day. It does not include any historical evidence, and should not be valued above an individuals own GP evaluation of your condition. Disability rights used to be in a position where they were overseeing the whole situation but were effectively paid to deliver a days training to Maximus, Capita and Atos, then dismissed from the overseeing position. So now you are actually assessed by someone who’s knowledge is based on a few hours experience in the role. And your livelyhood depends on the outcome. An outcome that for many has resulted in fatalities. And the pay scale for the job is ridiculous, varying between £46,000 to £86,000 depending on ‘experience’ and, wait for it….’Gender’!!!!

Naloxone: The Next Episode

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“1996, when Dan Bigg first brought the case for community use of Naloxone, and the wider need for this medication in the user community. Overdose, a primary cause of death among those who use opioid pain medications, illicit substances, etc has been known to be a risk that can be dramatically reduced by Naloxone since 1961 when first cited. As with needle exchange, and indeed many other campaigns where the basis was firmly in the realm of public health but not commercially acceptable, if you like. drug-war politics introduced a number of hurdles which meant delays in reaching a decision—and many needless, preventable fatalities. The User / Recovering community needs to shout louder and be more forceful in its advocacy so this is appropriately approached and adequately distributed within our communities”

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Since the start of this campaign, when HIV and HCV were also an imminent risk to the user community things have moved forward dramatically, HIV and HCV are not only treatable but amenable to numerous prevention campaigns. New HIV infections among drug users have been cut in half in the last decade, largely due to the inception of harm reduction programs and approaches such as needle exchange programs, along with effective support, education and direction from peers, and peer led NGO’s such as INPUD (International Network of People who Use Drugs) to name one, whose priority was to reduce the risks associated with BBV route transmission, health risks, etc to reduce the risks of further harm and fatality in the user community, thus reducing the risk of spreading in to the wider community.

In 2016, we have now moved into an era where there is in fact a cure now available for HCV, unfortunately those that need it most may not be able to access it due to the extortionate costs as Gilead join the opposition in the drug war extorting the most vulnerable. So in general this shows that there can be positive outcomes, if we can just overcome the greed of big pharma, and other drug war barriers, when there is a platform where we can effectively work together, the the numerous campaigns and actions of relentless peer support groups and individuals have had an amazing impact on this.

On the subject of the high price of HCV cure a court case has just been launched in USA where a legal battle has erupted over a medicaid service provider refusing to prescribe HCV medication to two Apple Health patients based on the fact it is too expensive and only to be prescribed in special circumstances, these special circumstances seem to find their basis in financial groundings. The case is based on the fact that it is technically illegal to withhold medicines on the basis of cost. And to do so would therefore be negligent by default.

So onto the case for Naloxone globally, why are we still seeing marked resistance to the wider distribution of this life saving medication. Why have we not seen similar improvements here? Nationally I am very lucky to have been in a position to see this campaign take shape and launch itself with some of the most dedicated and passionate individuals I have ever met at it’s very core keeping it’s presence on the agenda in every region. As a result of this push from the community and our supporters we have managed to get Naloxone availability reviewed and as a result new legislation promoting wider access went live on October 1st, 2015. This was an amazing step forward and campaigners were more than appreciative of the recognition of our plights that our community members were dying needlessly in record numbers, we took the changes, we analysed them, we got legal reps to analyse them and we scrutinised every word of the amendment to the medicines act, which can be found here,

Amendment to Human Medicines act (no. 3) Regulation 2015 

This stated that any provider or….

‘persons employed or engaged in the provision of drug treatment services provided by, on behalf of or under arrangements made by one of the following bodies–

(a) an NHS body; (b) a local authority; (c) Public Health England; or (d) Public Health Agency.

The explanatory note that accompanied the amendments which are in legal talk and hard to follow for the typical lay person like myself can be found here….

Explanatory Memorandum

In this it again clearly states that ‘Regulation 10 amends Schedule 17 to the 2012 Regulations to enable the prescription only medicine naloxone hydrochloride to be supplied by drug treatment services for the purpose of saving life in an emergency‘

And just to make sure I’m not missing anything out. The explanatory memorandum that accompanied the correspondance e-mails and messages is here in full pdf….

Full Exlanatory Memorandom (pdf)

Very clear and precise in it’s aims and objectives. And to make it even clearer in it’s aims and objectives, here is a little snippet from the ADHP Position Statement on Naloxone

The Public Health England guidance published to inform commissioners about the impact of naloxone and the new regulations, makes clear that the legislative change that came into force in October 2015 means that, similar to Water for Injections, naloxone is exempt from prescription only medicine requirements when it is supplied by a drug service commissioned by a local authority or NHS (or Public Health Agency in Northern Ireland or Public Health England). It may then be supplied to any individual needing access to naloxone, which could be:



someone who is using or has previously used opiates (illicit or prescribed) and is at potential risk of overdose



a carer, family member or friend liable to be on hand in case of overdose



a named individual in a hostel (or other facility where drug users gather and might be at risk of overdose), which could be a manager or other staff.

Now we can respectively look at the impact the amendment has had so far. There are still at least one third of the 152 Health and wellbeing boards that have shown no change and no signs of change. Which is unacceptable and once the information has been collated and verified as to where they are exactly there will more likely be another media campaign launched in each respective local area. Up until now the majority of campaigners have for the most part refrained from directly mentioning specific services when raising issues at national level, it has been entirely focused on legislation and initiating changes from the top down with numbers of activists on the ground preparing their communities by training and raising awareness of the campaign in general, the real advocates for change and without a doubt the real heroes of the frontline movement, My hat goes of to you guys and I have nothing but respect for every one of you. You all know who you are. Kudos.

But I believe the next stage will be more upfront and personal. The bottom line is that the individuals that providers are in charge of under their primary care are dying, statistics are rapidly rising at an alarming rate and you have the green light to do something about it, but choose not to. As I see it you should not be in the sector professing to be something you are not. It’s time to start relegating services and showing support for those who openly show compassion and understanding and really do care whether their clientelle / stakeholders live or die. It seems to be forgotten who actually is in the position of power here despite the fact the title gives it away….service providers. Providing a service that should be fit for purpose and designed with the needs and wants of the customer first, not agenda. If a service is performing badly it reflects in the actions and feedback of those who access it and if that feedback is correctly placed and consistent, then it has to have an effect on the future survival of that service.

IN the remaining two thirds there is a varied level of acceptance around the legislation and how it has been adopted. The more common report that is coming through is that the majority of providers have adopted the program and are handing out kits to their service users. Which is good but takes us back to the original amendment to legislation in 2005 where it was recognised that there was a glitch in the law, in that there was no point providing a kit that was illegal to use for anyone except the one whose name was on the prescription. This was amended to read that it could be used by anyone for the purpose of saving a life. This meant as time progressed and the law fell into place that when the current campaign came about we had the added bonus of this little clause that basically gave right of way to anyone who had a vested interest in saving lives and who might find themselves in an overdose situation, which could mean absolutely anyone with an ounce of compassion. So given the progress in the battle for Naloxone and the background leading up until now surely the 2005 amendment and the more recent 2015 amendment together in their aims would mean that anyone can present at the door of a provider where naloxone is available and either present a certificate stating that they have been trained by a recognised trainer or be trained by a recognised trainer inhouse and walk away with a life saving kit…..

Surely?                                                                   No?                                                              Why not?

Is it cost again that is rearing it’s ugly head, so let me take you back to the current court case where it is being fought that this is against human rights and discriminatory, so what if the court judges in favour of the case, and campaigners or even more pertinent Parents who have lost children or similar bring out a case here on the same basis…..just a thought.

Here’s an interesting little section of law that I have been finding interesting in it’s content and context. It’s an area known as tort law and it basically states this…

(Elements: Duty, Breach, Causation, Scope of Liability, Damages)

Duty of care

1.General Duty of Reasonable Care.

a. Imposed on all persons not to place others at foreseeable risk of harm through conduct
b. Adults Reasonable person standard (objective)
c.Children Child standard of care i.Same age, experience, and intelligence
d. Physically disabled persons reasonable person with same abilities

2. General Duty

a. Duty to act reasonably to protect persons you may come in contact with if you have:

1. Knowledge of probable danger arising.
2. Knowledge that danger may affect others other than specific individual.
3. Proximity or remoteness of the outcome is a factor to consider (scope of liability is expanded and knowledge pertaining to scope of liability)

Limited Duty Rules

a. No duty to assist, act, or rescue
Exceptions
1. Misfeasance – where you’ve caused harm through your actions
2. Special Relationship (special dependency, working relationships, business relationships)
3. Voluntary Assumption of duty
a. Must rescue in a reasonable manner
b. If have special skill set, standard of care is reasonable person with the same skills
c. If ∆ is negligence places good Samaritan rescuer in harm’s way, ∆ is also liable to rescuer
4. Innocent prior conduct – (Misfeasance)
a. Duty to act to prevent the harm from occurring
b. Duty to assist if harm does occur
5. Reliance on a gratuitous promise
6. Intentional prevention of aid by others
7. Statute

or another more understandable definition might be…..

“A failure to behave with the level of care that someone of ordinary prudence would have exercised under the same circumstances. “ The behaviour usually consists of actions, but can also consist of omissions when there is some duty of care.

 

The House of Lords decided to create a new principle of law that stated everyone has a duty of care to their neighbour, which thereby supports this particular situation. Negligence is a form of tort which evolved because some types of loss or damage occur between parties that have no contract between them, and therefore there is nothing for one party to sue the other over.

And so goes the case for Naloxone provision without restriction of access or conditional supply only.

And there I rest my case……for now.

In you have any Naloxone stories you’d like to share please send them to ….

drugactivist@gmail.com

I’d love to hear from you.

Also If you would like to share your testimony….

 

 

” I miss my daddy every day,he was my best friend”

This testimony was given to me last week. It shows the harsh truth of the devastation left behind after the loss of a parent to overdose. I have kindly been given permission to reproduce the testimony in the hope that it raises awareness of the effects overdose can have on significant others left in it’s wake. I personally found it extremely emotional to read and due to the nature of the content have also ensured that the owner of the testimony has been supported throughout all interactions. Further support options have also been offered and ongoing support is currently being put in place.

Please take a moment out of your day to read this testimony and imagine how it must feel to have to deal with something like this every day of your life, from a child who lost her father, and could never understand why he had left her, almost blaming herself thinking that it was her fault, to an adult who still struggles to come to grips with the whole event. Living through the cold attitude of not only the strangers who taunted but those around her who she thought were her friends, her carers…..how cruel life can be. Then imagine how you would feel if someone told you, or you read somewhere that things could’ve been different, his death was preventable. Can you feel the anguish and sadness, the pain, the shame, the anger, the deep feelings of loss and powerlessness over not only the actual loss but the reactions from other people. Reactions that reach out beyond you and into your own family life, affecting your children. I personally couldn’t. I’ve lost close friends and acquaintances but not a family member, a parent. I wouldn’t dare say I could even remotely come close to feeling the same.

What I can do is continue to try my best to ensure that everything that can be done to reduce the risks of fatalities, reducing the numbers of children being left without a parent, or parents being left without a child. So can you.

Every life lost is someones daughter, someones son, and every loss is preventable….

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  “I am the child of an addicted parent, my father was a heroin addict who eventually lost his battle with addiction.  I miss him every day”

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  On august 9th 2004 I was minding my own business when I had a phone call  from my uncle who  wanted to know where I was. My mother and step father had gone away the day before so I thought he was coming to ask if I wanted something to eat. I was living in a hostel at the time so the offer of a free meal was always a bonus. He said he was coming to pick me up.

I waited for him to come and get me, and when he turned up he wasn’t smiling, the reason for this was that he had to tell me that my father had died.  I laughed, a nervous reaction, I don’t really know if it was disbelief or shock,  but then he repeated those words and this time it sunk in, I realised that it was real and I broke down, the tears came, and I couldn’t control them, I cried so much. We didn’t know what he had died of at this point, we only knew that our daddy was gone. I remember it like it was yesterday, that day I lost my best friend, my daddy.

My dad was known to the police, which is not something either he or the family were proud of, but the addiction taken a hold of him.  He was in prison and out again, and on and on I seemed to go, never ending. Prison didn’t seem to make any difference to my father, he didn’t seem to care. I didn’t know the underlying reasons at the time so couldn’t have understood just how much control his addictions had over him. But looking back I understand better now I know. I can see that prison wasn’t the solution or what he really needed. He needed help, not punishment.

I remember when I found out my father was taking Heroin and how. I went off the rails for a short period after the loss of my father and the local Police Station became my second home for near on two weeks.

I remember one day when I had gone in to the police station and the CID were talking to me about my father, saying to me heroin and drink doesn’t mix. I didn’t understand? I kept saying that my daddy didn’t do heroin.

This was their way of telling me, a grieving daughter, that her daddy was a heroin addict.

I didn’t believe them, I didn’t want to believe them but I kept hearing the same thing over and over, and it got worse. Eventually I rang up the coroner to ask for him to tell me the outcome of the post-mortem, he wouldn’t give me the information, I found out later that he had spoken with my auntie and she had requested that I not be told. The first time I actually found out for certain what my dad had died of when it was released in the local paper. My whole world fell apart when I read the headline, there it was in black and white ‘WELL KNOWN DRUG USER DIES OF OVERDOSE’ That was how I found out that my dad had died of a overdose, I felt annoyed, hurt, lost, and numb, all at the same time. I couldn’t believe that I had lost my daddy in this was….something inside me died with him that day.

 Everyone I met afterwards, I would tell them upfront who I was and how my father had died.  I think it was because I was scared that if people found in son other way, they would like me, this was my way of coping with it. There is a lot of stigma attached to addiction, people judge you and because my daddy had died this way, some people used to call me names like ‘dirty smackhead’ and shout nasty things to me in the street.

Because of the way my father died I was made to feel like I didn’t belong, and ended upon my own a lot. Son people told me it was only a matter of time before I started taking drugs as well.

This all had a negative effect in me and my whole life was effected by this spiteful, horrible, ignorance.

 I have a child who for different reasons, went to live with her dad. As part of the process I had to undergo an assessment. At the assessment the lady kept saying to me I shoul
don’t / couldn’t  class my dad as my best friend because he was a drug addict, but he was still my dad, I believed at the time that his addiction had killed him. All I know I that I didn’t have him there any more, and how it affected me. The past and everything in it became a huge thing used against me regarding my ability to look after my children, questioning my parenting skills?
Underneath all of this no-one seemed to notice that I had lost my dad and a huge part of my heart died with him.

 I now know that there is medication available that can reverse the effects of an overdose and wish that this has been available when I lost my daddy. I might still have him today.

Prison didn’t help my daddy, no-one ever offered my daddy the help that he needed, instead he just became ‘just another junkie’ a label that deeply affected my future and my child’s future.

I was only 18 when I lost my dad has been dead 12  years this year and will never meet his grandchildren nor will he see my little sister or me get married.

 

To find out that he could have been saved and that he could still be here has made me realise that there are other, more sensible ways of dealing with addiction and the people who fight with it daily. Things need to change and we need to start showing that we care, offering help where we can and when we can. My daddy wasn’t a criminal, he was a man who was struggling to  dope every single day of his life, and I loved him so much….

 

“I can still hear my daddy sometimes, I can see him when I close my eyes, I can even smell him close by sometimes. I remember his smile and all the good things about him. But I can’t touch him, I can’t feel his touch, I can’t reach him at night just before I wake up crying and he’s left me again, over and over. I miss my daddy so much. He was my best friend”

(Original post can be found here….A testimony from the child of an addicted parent.)

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Thank you all for taking the time to read this and please do let me know your thoughts..

The young lady who wrote this has kindly given her details so that others going through the same can connect. They have not been printed for obvious reasons but if you would like to get a message to her she is available via this link. If you feel that you would like to share your testimony or would like to get involved in any current or future campaigns to help reduce the harms and risks of overdose and any other harm induced by current policy and legislation. Please don’t hesitate to me at….

drugactivist@gmail.com

or alternatively call me on 07500948157.

 

 

 

 

Take-home naloxone from October 2015

So today the new legislation goes live in England and Naloxone is available without presciption. One trust has set the ball rolling with a simple and effective governance structure for wider access using the SMMGP eLearning module as their training option. Once this module has been completed and signed off by lead clinician in service, both staff and any other person taking the time to do the training will be provided with a kit. This new legislation will reveal just how many service providers in England do actually still put their client wellbeing and safety first. Its going to be an interesting period.

Naloxone Action Group - England

Naloxone, which can be effective in reversing heroin overdoses, is, from the 1 October 2015, more readily available for those that need it. Although naloxone will remain a prescription only medicine, the legislative change will crucially mean people working in drug treatment services are able to supply the drug, without a prescription, to anyone needing it to stop a heroin overdose. In addition to previous legislation, from 1 October 2015:

Naloxone can be supplied by a drug treatment service to any individual needing it for saving a life in an emergency.

So it can be supplied without prescription to:

• someone who is using or has previously used opiates (illicit or prescribed) and is at potential risk of overdose
• a carer, family member or friend liable to be on hand in case of overdose
• a named individual in a hostel (or other facility where drug users gather and might be at…

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A Letter to Law Enforcement About Medication-assisted Treatments

An excellent and very informative letter to officers in the good old US of A. I remember when you used to get a little letter inside exchange kits stating that the property remained in ownership of the Nx where it was collected from. I wonder if there could be a similar approach brainstormed. I also wonder I there have ever been statistical records collated around stop and searches involving prescription medications. Would be interesting to see if there is a high prevalence. Any way digressing. I found this letter quite like a breath of free air through the smog. 😉

A RESPONSE: MY VIEWS AROUND CURRENT BARRIERS IN DUAL DIAGNOSES.

Firstly to qualify me for being in a position to input on this subject. I have been involved in drug user advocacy and substance use research on many different levels,  including dual diagnoses, which occurs in a high number of those accessing support through services and mutual aid groups. My role in the field is to add a realistic voice to an often idealistic approach in dealing with and supporting those with multiple disorders and reduce the risks and harm to those living with various conditions including pre-treatment, treatment, aftercare, stigma and various other issues that arise during the care of those I come in contact with. I am lucky enough to be employed in the drug and alcohol sector in UK and also dedicate a lot of my personal time to researching and supporting those living with conditions within our communities.  I would like to also take the chance to thank Louise Rugman for her input and research in this topic and for her ongoing support with regards to the support and care of those living with dual diagnoses, homelessness, and a number of other related issues,  despite her living with an ongoing condition herself. An inspiration by all accounts whose input into my response was valued and informative.

Many thanks Opi Ferum our Australian connection for the thought provoking questions.

1: How do you see people who use substances first-hand living with a mental health issue being treated in the current field of alcohol and other substance care? Do you see harm reduction practices being practiced or not?

With a basic understanding of a number of co-morbid conditions, I’d agree that there has to be first and foremost an element of reducing the risks and harms in this line of care. A number of mental health conditions are not curable, and are indeed long term, and therefore the emphasis needs to be on reducing the harm to the individual and their significant others with regards to minimising the symptoms of the condition and various other aspects of the condition. Harm Reduction  focuses on the minimisation of the physical, social and legal harms, primarily, of those who are living with any kind of condition or disorder among other aspects of care. However, when there is an underlying element of substance use running alongside the condition, which realistically there often is. This can cause controversy with regards to the continuing care for an individual if not addressed and implemented correctly, which unfortunately seems to be all too common. I agree that some form of development orientated practice must also be administered into the care but wholeheartedly feel that the basis of any care, and throughcare,  especially when dealing with dual diagnoses needs to be firmly rooted in reducing harm and minimising risk to the individual whose care is priority and this should be carried right through the journey of that individual, and, those surrounding that same individual without prejudice or discrimination for the use of substances restricting ongoing support.

Harm reduction primarily deals with reducing the consequences of high risk behaviour and sets out to improve the positive outcomes of an individual with regards to supporting them to get the best out of their current situation regardless of their condition. An ideal model of care that I would suggest would be, first and foremost establishing a solid rapport with an individual who is currently living with dual diagnoses, this is imperative with regards to the continued care of that individual. There are a number of benefits here with regards to mutual aid being an integral part of the care of an individual with regards to the concept of an ‘expert by experience’, however due to the nature of the condition there is an obvious need for more comprehensive care and attention, there are agencies that operate a buddy system, whereby the peer support can be advocated for throughout the whole journey of the individuals care. This has proven to be quite effective where practiced. Establishing the cost benefit ratio of continued use and the possible effects when engaging in risky behaviour of any type associated with the condition can be a positive aspect of engagement, however this is not always paramount in an individuals mind when having an episode, for instance, but, it does serve as a positive piece of work with regards to raising awareness around pro’s and con’s of continued use and perhaps preparing a proposed care plan to support specific situations once triggers are recognised. Relapse prevention and setting individual goals for change are again an imperative topic for discussion with regards to an individual’s care. Discussing possible coping mechanisms for any given situation and looking at how to deal with crisis as and when it arises. Mutual aid forums and positive social network interaction again is something I advocate for with a passion, right through an individual’s care and beyond.

So, do I see this working effectively in services designed to care for and support individuals with co-existing conditions. Yes, I do see this happening, but not as often as I would like to…sadly there seems to be a lack in partnership working to fully support an individual living with dual diagnoses.  Also another take on this from an individual who has accessed service for dual diagnoses is that there is an element of confusion with regards to the message being delivered on interventions. Her view was that harm reduction was openly advocated for and promoted within the mental health support service, however, most of the therapies demanded abstinence? One specific report that I have been given in a number of feedback scenarios is access to Dialectic Behavioural Therapy. This is now being highlighted as a therapy that could be used in drug and alcohol services but until then is primarily given as a therapy via mental health services and complex needs teams. This however along with a number of other therapies that are specifically aimed at promoting wellbeing within the sector ‘demand’ abstinence, even from prescribed OST, and therefore there are a number of dual diagnoses individuals who will not be able to access a number of therapeutic treatment options. This in turn excludes a number of individuals with dual diagnoses from entering effective therapeutic alliances with supportive structured therapy options until not only have they moved away from their substance use, but, also way from their OST as well, I have met a few who have been put in the unrealistic situation where they are being ‘pressured’ to implement rapid reduction detoxes to continue their care, or face closure until such times as this is achieved.  Therefore by my reckoning, the tools needed to promote well being are not always fully available, and further to that are not accepting of the fact that there are those who may relapse during the therapy, due to stress and a number of other contributing factors. This unfortunate situation has arisen a number of times both in my personal life and also in my professional capacity where there has been an almost non-existing care plan offered from mental health services dealing with dual diagnoses other than a demand for abstinence when referring in for support for substance use, or, completely the opposite, an extremely comprehensive care plan that cannot be put into action until abstinence is achieved, putting undue stress on the individual going through the process.   Now although I understand that there are a number of reasons why abstinence would be suggested, the main one being it is hard to diagnose an individual who is currently taking a substance which could possibly alter the chemicals in the brain to a point that a correct diagnosis may not be reached immediately, which could cause further distress with the individual, also the fact that substance use on top may not be as effective when using illicit substances on top. However, this becomes a catch 22 situation if an individual is self medicating and presenting with dual diagnoses. If there is no structured joint work between substance misuse services and mental health services and this demand for entire abstinence becomes a barrier to dual support for a dual diagnoses, then, this in my opinion leaves a wide opening for lack of persistent and consistent care and promotes a support network that is fraught with holes. Which are all too easy for those seeking care to fall through.

So to summarize yes I do see harm reduction initiatives working well in Mental health services but there is room for improvement and a more responsive and productive alliance with other services and also within service, to reduce the stress for an individual in the system, by promoting clear and direct access to consistent therapies designed to reduce the risk, without unrealistic ‘requirements’ being imposed or exclusion for substance use, especially substitute medications therapy.

2: How do you personally see harm reduction as a sensible approach to dealing with substance use and mental health? After all, a lot of people that use substances are co-morbid in diagnoses.

I see harm reduction as being of maximum importance when dealing with those living with co-morbid issues in this context. Firstly, as I have stated there are a number of dual diagnoses individuals that have conditions that are ongoing and require ongoing assistance and intense support. Mental illness is not something that can be taken lightly and most definitely not something than can be covered with a blanket policy under the abstinence banner. There are a number of diagnoses that until science and research moves forward, which it does on a daily basis, are constant and require consistent reviews at any particular time to reduce the risk and harm to the individual and those surrounding the individual, as mental health and substance use  can also be a strain on family and significant others, which needs to be, and indeed is, focused on harm reduction with a view to supporting all involved to achieve the best out of a current situation or occurrence, or general well being.

With bipolar disorder for instance there are a number of contributing factors that require a solid and comprehensive approach based in the harm reduction ethos. This is a condition that presents itself with a number of reasons that support harm reduction due to the nature of the condition. Although there are major concerns that would advocate for the abstinence route, and this should at all times be the desired goal, it is not always as clear cut as it may appear. Bipolar and substance use go hand in hand, and, this condition is one of the more prominent that I have come in contact with, with regards to dual diagnoses. Yet as I have said before, a lot of the proposed therapies that are designed to support an individual with this particular diagnoses are aimed at those who are abstinent? Therefore, putting a major barrier up for those who are living with similar conditions, rather than, supporting and offering alternative therapy,  to increase chances of any positive steps towards recovery, by definition, from certain aspects of the condition.

The duty of a substance misuse support agency is primarily to deal with the substance side of dual diagnoses and with all the best intentions it is not really common that you come across a practitioner that is equally qualified in both sides of this coin, this being said, as a practitioner in the substance misuse field when I am dealing with those with current and historic dual diagnoses I am constantly advocating for joint, partnership working for the better outcome and not always successful in this due to unrealistic requirements for continued care and support, which is not ideal in supporting an individual through the process.  Although I have no doubt there are a number of highly trained individuals out there who do have a full understanding of both sides (I unfortunately am not one)  Therefore, they would primarily be dealing with the substance and all it’s related issues. However, once a certain level of reduction in substance use is reached there is the risk of relapse due to the mental health condition taking prevalence, especially if the individual has been using a substance to self medicate? This is where I feel the abstinence call from mental health services gets taken out of context and should be re-evaluated with regards to a demand for abstinence, amongst other things. And this is again where a number of those with dual diagnoses end up falling through the net through lack of joint working between services, or unrealistic requirements being set out prior to continuation of care.

Harm reduction in the role from the substance misuse angle provides a solid safety net for those who are going through the mental health service support network and may fall through the net for a number of reasons. That being said harm reduction drug and alcohol services are not an alternative or as I have heard it affectionately called a ‘dumping ground’  for those who structured support within the mental health service is proving to be partially unresponsive. It is a complimentary support service to run alongside the already existing support network yet all too often seems to be seen as a completely separate service prior to mental health service engagement.

Another issue that rears it’s ugly head here in this arena is the fact that there were a number of services set up to deliver specific services based in dual diagnoses, exclusively,  but due to the payments by results scheme, which has been a roaring success?? the services which were aimed specifically at this field were not seen to be a financially secure ‘investment’  in that the outcomes of ‘complete’ recovery as a dual diagnoses outcome is not always achievable in this particular arena. Thus putting pressure on the relevant services to enforce policies and procedures that are not truly reflective of the individual needs. There is clear and professional guidance for mental health services to promote joint or collaborative working relationships for the due care and attention of an individual that presents with dual diagnoses, however, those services are now commissioned based on a recovery model that given the nature of the condition is unrealistic to uphold without ‘enforcing’ specific requirements, one of which unfortunately is the abstinence ‘need’ for therapy in certain cases. Herein lay the dilemma where if an individual is not currently abstinent or not seen as being someone who can achieve abstinence, in a specified timescale, they then become a burden on service that has targets to meet in order to secure it’s funding for the next year. Harsh but sadly the truth. Hence the lack of joint working or restricted joint working until abstinence is achieved. Verging on Nimby-ism?… possibly!

3: How do you feel a mental health diagnoses affects a person that uses substances? Do you feel it puts them in a position whereby their drug use overshadows their mental health, for example? Or the opposite? Or don’t you think it makes any difference?

I think that a mental health diagnoses can be a lot to deal with for an individual, but at the same time can be a relief due to there actually being a basis for otherwise unexplained episodes during the individual’s life. Whatever the outcome following a diagnosis there is without doubt an element of stress, confusion, fear, and a number of other contributing factors that could put an individual at added risk. Its not every day that you are given a diagnosis that could have a major effect not only you but on every other aspect of your life and those involved in your life.

This can have quite an effect on an individual. And in turn on their substance use, if this is a co-occuring trend in that individual. I wouldn’t say that it doesn’t make any difference as it most definitely would. The effect however would depend massively on the individual. Neither ‘should’ overshadow the other as both are issues that overlap in a number of ways and both are relevant in the progress of the other, however, I can see how one could take prevalence over the other at any given time during the individual’s journey. Another reason for comprehensive dual support.

Again relaying from a discussion around this with my partner, who has been through this situation. When given a diagnosis, although there was a sense of relief that went alongside it there was also understandably a sense of overwhelming fear and lack of understanding that came with the diagnosis which resulted in her pulling away from services for a period of time to digest the information, an obvious reaction in a situation of this magnitude, however…..this highlights a concern, in that, this is obviously a testing, scary period and quite a vulnerable situation for an individual, yet with the facts being presented to the relevant services, she was then able to ‘disappear under the radar’ for a number of years without due care and attention being given to support the news given. Surely there is a duty of care here with regards to this? Or am I mistaken in believing that this may be a regular occurrence that repeats itself in similar situations, which, given the serious risky behaviour (a recognised trait) that could follow, could put an individual in the red on the RAG system, (high risk to self or others) and in a precarious situation. Here I have to ask, how is it possible for someone to effectively disappear, and in all honesty, be able to disappear without being subject to some kind of preventative measure being taken to ensure minimal risk to the individual after being given news of this kind? However, once resurfacing the first place she accessed was the substance misuse service for support as it was made  clear on her first access in treatment, where she was diagnosed with her condition, that her substance use would have to be dealt with prior to her mental health issues being effectively addressed?

There are a number of research papers and debates surrounding dual diagnosis that are almost reminiscent of the chicken and egg scenario, however this seems small in comparison to the fact that there is an individual presenting with a need for immediate support regardless of what came first. Surely? This would transpire during care within a systematic approach that involves substance use and mental health services joint working for the better towards an outcome that promotes well being for the individual.

I must also add here that there is a massive responsibility here on the way news of this nature is delivered to an individual and also how it is seen to be supported in follow on care. Both sides of the care spectrum here are of equal value in promoting the best outcomes for an individual when on the outside devising further care plan. however as I have said there will be different responses from every individual who finds themselves in this situation. And each individual response should then be taken into account with regards to next steps with the care of that individual encompassing all avenues of care equally and with dual importance inclusively.

If one is left to put more emphasis on the other then I fear that the evidence would create a never ending circular effect rather than one of positive steps forward towards any positive definition of recovery.

4:  How would you like to see services engage with people that use substances with a co-existing mental health issue…for example…would you like to see more advocacy for mental health issues within the alcohol and other drug community? Are more services needed? If so. can you think of any in particular?

Collaboratively? There seems to be a distinct barrier towards supporting individuals with dual diagnoses and other co-existing conditions. And  trend for ‘either or’ support. Not totally, I might add,  but it does exist and it is quite frustrating to a professional trying to wade through the paperwork and the requirements and the target setting etc, etc, to meet specific requirements set out to ensure continuity of  care. So, that being said, is it any wonder there is a high rate of drop out in dual diagnosis recovery statistics. There is also the existing and very relevant social inequalities issue around differing support and care that also adds a little spice to the state of play. Another issue worthy of debate on another platform, social, economical, environmental, etc….

With regards to advocacy within substance misuse services I feel that there is always room for more advocacy for something of this magnitude which is of high importance and can be severely detrimental to an individual if they are not given an all inclusive support package to coincide with the delivery of a diagnoses. Having said that I am fortunate to be able to say that, in my experience, there has always been a frontline approach within substance misuse services towards mental health issues in ensuring there is full support and wrap around service engagement when dealing with dual diagnoses at every level, within remit. I do think that there could be more peer support and support groups put in place on the mutual aid front to support individuals living with dual diagnoses. And that this is something that is possibly being overlooked in the current abstentionist movement. Because of the high risk of relapse in thoughts feelings and behaviours, as well as substance use, however, this is where harm reduction is all inclusive in it’s outlook to promoting ‘full’ recovery and supporting those for who ‘full’’ recovery may not be possible, in every aspect of their lives. It supports the individual to achieve a full and positive outcome regardless and also to achieve acceptance both personally and within their respective communities regardless, without putting unrealistic targets, requirements and aspirations on them at the same time.

With regards to services, it is unfortunate that there were services out there that were primarily set up to deal with dual diagnoses, but as mentioned previously they are being systematically dispersed due to cuts, and, being in the unfortunate position of not meeting current payments by results criteria. A sad state of affairs where an already stigmatised group of people are now being restricted in care options because of financial and economic distress. The negative impact this could have on an individual seems to have been lost in a quagmire of finance and social cleansing. Perhaps if we were to challenge that brilliant marketing tool for big pharmaceutical companies, the DSM, and bring it back to individual care rather than profit then there would be more realistic and less idealistic approaches and more funding to put into supporting these individuals rather than paying out extortionate fees for excessive over prescribing of medication.

More services are always needed to cover dual diagnoses, in my opinion, however a re-assessment of those already existing services that are involved in the care and attention of those with dual diagnoses would serve purpose for the time being in a climate of ‘more for less’ at the cost of less intense care and support for the individual at the heart of it all . And a more open and inclusive approach to dealing with and supporting those who are living with co-morbid conditions which includes more support groups aimed at peer support and mutual aid and more public understanding of the realities of dual diagnoses.

It would appear that there is a flaw in the current recovery agenda that does not take into consideration those for whom ‘full’ recovery may not be possible, and with current financial cuts hitting the sector hard where it is most effective, and indeed most needed, the safety nets are being dismantled and taken away from the providers that cater for those who are caught in the middle.

SOMEONES DAUGHTER, SOMEONES SON.

(The title of this blog is from a poem written by a very good friend of mine who’s words resonate with me a thousands of others globally who are joining together in advocacy for the provision of naloxone in their respective communities which can be read the end of this article)

As the fatalities rise, on a global scale , and opioid related deaths tear families and whole communities apart, there is momentum growing in the debate to get naloxone out there into the hands of everyone who would be prepared to carry this lifesaving kit, PUD’s, friends of PUD’s, family members, concerned others, street pastors, dealers, community groups who may find themselves faced with an overdose situation, in fact, absolutely anyone who had a desire to carry a kit.

With Scotland (Scotland should be releasing figures following an audit internally in the prison system over the next few months to add to the evidence that this program has successfully reduced the DRD stats in those leaving incarcertion. This will directly show that although N=ALive pilot, which is still ongoing, had the right idea, it could have been done for lot cheaper and a lot quicker. And guess what it will also show that ‪#‎prenoxad‬ works, surprised?)and Wales (An Evaluation of the Take Home Naloxone Demonstration Project can be found here) leading the way, in the UK, with national programs and Ireland not far behind, (Ana Liffey Drug Project are coming through as a glowing example of best practice when it comes to saving lives in Dublin’s fair city. Statistics in Ireland have shown that almost 4,000 PUD’s exchanged 24,000 needles at drop-in centres across Ireland last year. Merchants Quay Ireland have recently shown the extent of the country’s drug problem as demand for its services soared. These statistics are shown to be closely related to poverty and hardship when looking at demographics of need in relation to specific areas. Statistical data also showed that 75% of those accessing structured service were poly drug users, with a combination of heroin, benzodiazepines and alcohol most commonly used substances, and also the most common in related overdose situations. Design has also shown that there is a current trend which is reaching out to regional areas outside of the city and the need for services outside the city is becoming increasingly evident. There are estimated 20,000 Heroin addicts in Ireland, with 10,000 men and women on Methadone programs. With this evidence coming out that clearly shows a desperate need for the expansion of services to support the growing need and funding cuts hitting where support is most needed this is a potential time bomb waiting to explode in the face of the communities where poverty and addiction are rising) it would seem that for some unknown reason England is dragging her heels with a devastating pace that is leaving its marked evidenced in the 32% rise in drug related fatalities last year. Recently, July, there was a glimmer of hope in the form of a letter from the Department of Health to Les Iverson, chair of the ,Advisory Council on the Misuse of Drugs (who first endorsed take home naloxone in 2009), stating that following a survey by the MHRA there had been a resounding call for a national take home naloxone program. Following this there was a date set for a National Take Home Naloxone (THN) Program which, and wait for it, is, October 2015? Now although this is a shimmering silver lining to those among us who have been advocating for this for quite some time now, it is still not acceptable.

As stated, in 2013 there was a huge rise in opioid related deaths, and this is just the ones that were recorded as that.

Although we do not have 2014 statistics through, my fear is that they could well show another rise, and again in 2015. I digress and hopefully misplace my fear but the truth and evidence cannot be denied here, any death that is preventable is unacceptable. So I ask you what could possibly be the hold up with getting this out there. So far there has been no solid evidence to support a delay. Well none that could possibly warrant such Negligence towards the cost of a human life….is there?

Best practice and substantial evidence to support can be found in Scotland where the Lord advocate, the chief legal officer of the Scottish Government saw fit to sign off a national program which is showing us, over time, that there is a need for such a program wherever there is a prevalence of opioid related deaths. This also showed us that, time, is something that we do not have when it comes to getting naloxone out in the community.

“In many countries, overdose is the leading preventable cause of death among people experiencing problems with drugs. Overdose prevention measures delivered in community settings are incredibly effective; the introduction and scaling up of such measures would save lives of thousands of people” (Eurasian Harm Reduction Network (EHRN))

http://www.harm-reduction.org/library/guide-developing-and-implementing-overdose-prevention-programs-eastern-europe-and-central

Naloxone has been around since the early 60’s and has, to date, given us no reason to doubt it’s efficacy. There have been no fatalities attributed to it’s use in whatever arena it has been used, there is no diversionary value, it has no long lasting side effects that overshadow it’s benefits and yet there is still a debate as to whether it should be available in the community for the purpose of saving lives. Some might say that there is an underlying issue here as to the lives that are being saved and would argue that there is more risk associated with Epinephrine autoinjector (EpiPen), and yet there are no concerns with that and there was not the same debate or delay when it was being passed through as an injectable medication.

Naloxone has the potential to help services reach out to those who may be hard to reach in the community. People who use Drugs are extremely conscious of Criminalization, Stigma and Discrimination whenever they access any kind of service, so knowing that naloxone is safe and legal could put people at ease. Naloxone programs can provide a safe starting point to engage in more open conversations about their health and choices, like seeking out and using clean needles, regardless of whether that is legal or encouraged” Not to mention staying alive in order to promote chances of making a ‘full’ recovery. There are a number of those out there who have been on the receiving end of naloxone who have stated that that second chance was indeed a turning point in their journey.

As it stands now there is an overwhelming outcry not only from Drug User Organisations, such as International Network of People Who Use Drugs (INPUD), National Users Network, and recovering community groups and structured services such as UK Recovery Walk charity, RISE Manchester, COPE Lincoln,morph – Southampton, NHS Highland, Scottish Drugs Forum, Release, Support. Don’t Punish, International Drug Policy Consortium, IDHDP, SUSSED , Bedford, Harm Reduction Coalition, SCUFF, Nottingham, World Health Organization, Criminal Justice Drugs Team, Leicester, Martindale Pharma, Department of Health (The list is endless and I am sorry if I have missed anyone out) but from Significant others (although following this hyper link it shows that in the scientific use of significant other there is still some work to be done), mothers, fathers, sons and daughters, and a number of professionals with regards to this becoming more widely available to those who may be witness to an overdose situation. For a number of reasons when faced with an overdose situation and calling the emergency services there is again fear around the already mentioned criminalization and stigma and therefore sometimes the emergency service are not called. Also the response time if there is any mention of substance use seems to take longer sometimes when thy are called. I’m not taking away the importance of calling the emergency services it makes perfect sense to me for those at the scene as and when it happens to be able to administer naloxone and potentially save a life alongside the services being called.

There are 150 Health and wellbeing boards (follow hyper link to find contact details for your local board) in England. At present, one third of them are actively rolling out programs, one third are in debate and discussion and the final third are still resistant yet unresponsive when questioned around this. So what barriers have they given us so far….

1: There is a risk due to it being an injectable medicines? (follow hyper link for guidance on safe use of injectable medicines) So is the epipen and insulin yet there was no problem when this was being put out there in order to save lives. (In fact the only recorded risk that I am aware of was an American police officer using it to ‘kill’ someones buzz?) No other recorded risk since the early 60’s when it was first marketed. There is no diversionary value….nothing. It does have the potential to cause problems with liver if liver is already compromised, as do most medications, but this is treatable whereas death is final.

2: It’s not licensed? Neither are a number of medications but they are still put out there around an off license route. And….there is a licensed product specifically for community use in the form of Prenoxad Injection

3: It’s not cost effective? (I know, ridiculous but a barrier none the less!!!) Well lets look at that, 20,000 for a basic overdose fatality when you look at the services cost, the coroner inquiry, the hospital bed, the machinery used, etc, not to mention the cost on the surrounding family members, emotionally, mentally and financially,  and community this cant be into monetary value! 400 estimated cost here naloxone was used successfully. In Bedfordshire alone during the last year there were 40 kits handed out and in the last three months 9 reversals, that’s, in monetary value, 720 cost of kits for all 40. lets say services were called on all situations, thats an average count, based on the estimated successful situation cost from Wales, of, 3600 which makes a grand total of under 5000. Savings on community budget in 9 highlighted cases? 175000!!!!! So in my humble opinion then damn straight it’s cost effective and there are still 9 individuals walking around breathing. This information cannot be used officially sadly due again to the current state of play, but there are a number of areas that are coming up with the same math and adding to the evidence to support community provision of naloxone, yet I am still waiting to here the evidence against!!!! (Cannot cover all evidence in all areas at present and have used my home town to demonstrate how a small group of user activist have managed to conduct a small pilot with the potential to save quite a significant amount of funding on the emergency services and in general on the community)

And to show the overview of cost effectiveness in rolling out naloxone programs….

http://www.medscape.com/viewarticle/777455?src=stfb

4: Political agenda? Lets take it back to the political agenda in the shape of the 2010 strategic agenda. It actually fits into that quite nicely into the full recovery setting by keeping people alive and giving them that second chance at recovering. And reducing drug related fatalities. But doesn’t fit in with the general election next year? Possibly why there is an October 2015 date?

So given this very basic but clear little picture what is missing? Other than another 32% of the opioid user community and some common sense? Yep, the evidence and reasoning to support the argument against..why? Because there is none?

So lets backtrack a little bit and look at the stages and times when naloxone has been highlighted and not adhered to in a number of areas.

One of the key directional questions in the 2011 JSNA Support pack for commissioners in section three on the first page of guidance in setting up a recovery oriented integrated service it clearly advocates for naloxone when asking the clear and direct question…..

•Is effective overdose awareness training and information
available? Where appropriate, is naloxone provided for service
users and their family/carers?

All drug users SHOULD have prompt access to:

•Interventions to prevent drug-related deaths and blood-borne
viruses.

•A range of early interventions, treatment and recovery support
appropriate to their needs, at all stages of their recovery journey.

(Sadly this need is not being fully met with regards to naloxone being the ideal intervention along with other recognised and structured interventions)

Effective integrated commissioning of services that achieve
positive outcomes for individuals, families and communities by:

•Effective partnership working between local authorities, health
(including mental health) and social care, and criminal justice.

(And effective service user input surely?)

•Operating transparently according to assessed need.

(Unless it involves explaining why naloxone is not recognised as a high priority need and why members of our communities are dying)

•Bringing providers together into cost-efficient delivery systems.

(Naloxone is a blatant evidenced based cost effective medicine with regards to savings on emergency services and communities on the whole with regards to emotional and mental wellbeing cost)

•Fully involving local communities.

(Providing they are in agreement with the way the agenda has been adopted and don’t put the value of human life first)

A seering indictment to the lack of support and attention to this issue from those that have the power to make the relevant changes can be found here in a blog by John Jolly Blenheim CDP who clearly calls out the English shame and highlights that People are dying because of a lack of harm reduction and again in another excellent article here…

http://recoveryreview.net/2014/09/enforced-recovery-unethical/

 As User Activists and supporters have pushed as far as they can in their respective areas, some more successful than others, Nottingham and Birmingham proving that this works and is effective, to mention two early adopters of programs. Where is Englands equivalent of the Lord Advocate? With great emphasis on the medications in recovery report, surely this should include naloxone? And although I am possibly a little dubious with regards to the review of the Orange Guidelines that is currently in progress, I find comfort in the fact that naloxone has been highlighted for discussion in that review, but fear that in other aspects there will be a price to pay.

(The following poem has been reproduced with kind permission from Lee Collingham. Nottingham rep….)

“SOMEONES DAUGHTER SOMEONES SON”

Why do we do the things we do,
Well it’s not for money that bits true,
For personal gain usually not,
It’ for what, most have forgot.

Our dream is everyone will have naloxone,
Somewhere safe in their home.
We don’t look upon ourselves as saviours,
We just think of it more we’re doing life a favour,
For someone’s daughter for someone’s son,
For their fathers and for their mum.

Is it not human nature to help someone?
Especially when all their Hope has gone,
And for those who moan about round here,
Try spending 6 months in Crimea.

See most only strive for what they can’t get,
They’re close minded and often forget,
But for the grace of God go they,
Who knows maybe it will be one day.

Our dream is everyone will have naloxone,
Somewhere safe in their home.
We don’t look upon ourselves as saviours,
We think of it more we’re doing life a favour,
For someone’s daughter for someone’s son,
for their fathers and for their mum
(c)lrcpublications

‘WE CALL ON THE ‪GOVERNMENT‬ TO HONOUR THEIR COMMITMENT TO ‪SOCIAL JUSTICE‬ AND RESPECT THE BASIC HUMAN RIGHT TO LIVE, AND MAINTAIN SERVICES THAT PROTECT THE MOST ‪VULNERABLE‬ MEN AND WOMEN IN OUR COMMUNITIES, OUR VIEW IS THAT IF YOU ARE NOT PART OF OUR SOLUTION THEN YOU ARE INDEED PART OF OUR PROBLEM”

21st July 2014 – International Remembrance Day

21st July 2014 – International Remembrance Day.