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I thought you might be interested in Paul Hayes... See more’ latest-to service users via the Alliance. This is a copy of Peter McDermott’s account of the meeting, and if there’s one person I do trust to put the case for evidenced based treatment to government it is Peter. Here goes, FYI: Meetings with Paul Hayes « on: July 19, 2010, 05:09:22 PM » Last week, I had a couple of meetings with Paul Hayes talk about the issues raised by the remark in the NTA business plan regarding time limits on substitute prescribing. The first meeting was really a meeting with me as an NTA Board Member, in which he gave me some sense of the background and the political context in which all this takes place. He asked me to treat this discussion as being in confidence, and so I am. However, he went on to give me some additional background to the whole issue of time limits which he then shared with Alliance staff and a representative of the National User Network, which I'll share here today. According to Paul, the NTA have been increasingly concerned by the fact that we successfully get a lot of people into treatment, but we don't get quite as many out. They've got concerns, some of which I share personally, about the quality of the psychosocial input that many of these service users have been receiving. As I said, I think that this is, by and large, fair comment. He claims that nothing will take place prior to the establishment of an expert group that will take another look at the clinical guidance and try and assess what that person best needs. That group should recognize that some people will be in treatment for extended periods -- and for some people, perhaps even many people -- their involvement in treatment may be life-long. That said, abstinence is the primary objective treatment, and so there's a hope -- or an assumption -- that for most, that will be the primary goal. So, some of what Paul told us was partly reassuring. He claimed that the expert group will be pursuing an evidence-based approach to the issue. and nothing should make it in if it isn't supported by the evidence. He told us that the group would be chaired by an eminent clinician -- though it will also include some of the more vocal critics of methadone treatment. I suppose I have a couple of major concerns/objections to the issue at this stage. I'll try and list them here: 1.) The Alliance was initially established because of the poor quality of methadone maintenance here in the UK. Back in the 90's, inadequate access to prescribing, sub therapeutic doses and arbitrary time limits were common features of methadone treatment that we've fought long and hard to contest. 2.) Methadone treatment has long been stigmatized as a 'second class treatment' in certain quarters -- somehow inferior to abstinence-based treatment. From here, it's a relatively short step to the idea that people in pharmacologically-assisted recovery are somehow inferior, or that the quality of their recovery is somehow inferior, to abstinence based recovery. This attitude may well reduce the number of people who access methadone treatment, thereby depriving people of a treatment that has proven benefits re. the avoidance of overdose, the reduction in blood born virus infections and involvement in crime. 3.) Drug treatment providers in the UK do nuance and subtlety very poorly. Already, service users are being told by their service provider that treatment is being limited to two years for everybody. This is already beginning to cause anxiety and having an impact on people's stability. It's pretty clear to me that this agenda is being politically driven to some extent. While it is reasonable for politicians to set aspirations with regard to various aspects of health policy, issues concerning patient care currently are, and should remain, to be matters for discussion/negotiation between patient and clinician. In summary, while the picture might not be as bleak as it appeared last week, there are still some significant causes for concern. As usual, The Alliance will continue to monitor the situation on behalf of people who use the drug treatment system, campaign for maximum patient choice and for the availability of optimum care, and will continue to struggle against stigma and discrimination in the treatment system. We're interested in what's going on with regard to this agenda, so if you've been affected by it in some way -- please get in touch and let us know what's happening. mcd Oh, by the way, yesterday's Guardian carried a piece on this issue. No doubt the issue will arise again soon. Best wishes, Francis