Author Topic: Time limit  (Read 10180 times)

OP8S

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Re: Time limit
« Reply #30 on: December 25, 2015, 11:20:35 AM »
Yes Merry Christmas John & to everyone else also.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

Doc Nuke

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Re: Time limit
« Reply #31 on: February 09, 2016, 07:09:38 PM »

As other people here have noted, the UK ‘Full Recovery’ drug strategy means that funding of treatment agencies is now dependent on them meeting set targets for how many service users are drug-free at the end of each year (called ‘payment by results’).  Funding and support for harm-reduction has suffered heavily because of Recovery’s domination of drug treatment. Unsurprisingly, heroin-related deaths in the UK are now at an all-time high – boosted by things like users leaving prison and treatment ‘drug free’ with no tolerance to opioids, and then returning to heroin use and overdosing. And there are growing reports that many long-term methadone maintenance clients who have been forced out of drug treatment with a ‘drug-free’ smiley-stamp have killed themselves.

Someone earlier mentioned the Wirral – there have been reports of a significant increase in suicides and other deaths among local users since the award-winning Wirral Drug Service lost its contract to CRI. But that’s the price you pay for getting more people drug-free. As a recent well-researched blog put it (slightly edited):
"recovery can be absorbed into existing public health strategies, but may have a heavy cost for some drug users"
https://ndarc.med.unsw.edu.au/blog/absorption-recovery-english-drug-policy

In other areas, rather than old HR providers losing out to new recovery-providers and chumpions, the old HR providers have instead jumped bandwagons to the new ‘dosh before drugs’ recovery model.  For a notable example, Lifeline have spent the last 5 years casting off their old harm-reduction image and replacing it with a new squeaky-clean recovery identity. Bandwagon jumpers follow the money not the evidence.

Today I saw that a study has been published by top UK drug treatment researchers which identifies 26 core indicators of ‘Addiction Recovery’ – the full paper can be downloaded here:
http://www.tandfonline.com/doi/full/10.3109/09687637.2015.1100587 
The top two indicators in the list are 'Not using street drugs' and 'Not drinking too much'. In short, the thrust of the Recovery model is that you are ‘recovered’ from your diseased state of addiction when you have stopped using all illicit drugs – though you can carry on using alcohol as long as it is ‘safer use’.  But safer use of illicit drugs (harm reduction) does not count.

The main evaluation research conducted over the last 2 years shows that Recovery is neither effective when measured by its own indicators, nor cost-effective. But the Tory government is clearly not interested in the evidence, instead being more interested in saving money which they disguise as a prioritizing of ‘recovery’ over harm-reduction.  I don’t want to end this by coming down as angry and hard on Recovery as I feel like doing, so I will pull my pretty punches and just say that UK Full Recovery is hypocritical nonsense. The truth will out - but Recovery will probably remain.



sapphire

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Re: Time limit
« Reply #32 on: February 10, 2016, 02:29:00 PM »
A lot of the problem is service user themselves, when asked they will say "I want to be opioid free" or "I want to come off methadone".

When really they don't, they just don't want to admit that they want to stay on it as it's working for them and they know abstinence wouldn't.

Hopefully people can stop saying this, then services would at least get an accurate picture of what SU's want/need.

Doc Nuke

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Re: Time limit
« Reply #33 on: February 10, 2016, 05:45:36 PM »
A review of the literature on 'payment by results' came out this week, and the author concluded: "the evidence base is not able to give a clear indication as to whether payment by results works."  No surprises there then...

http://russellwebster.com/documents/Lessons%20from%20the%20Payment%20by%20Results%20literature%20Russell%20Webster%202016.pdf

OP8S

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Re: Time limit
« Reply #34 on: February 11, 2016, 12:51:13 PM »
I suppose it's how you define the above quote. Are DSP's hitting the targets in getting people off O.S.T. ? Look's like it if you read Lord Patel's speech. Are they then going on to live happy, wholesome & financially productive lives, paying their tax ?! Some maybe, but if recent figures on drug related death are included in the purple picture then the whole  Recovery Agenda starts to look discriminatory to say the least.


What's next ? Should we outsource pregnancy termination to US style clinics ? Sterilise those who use them more than once ?

May as well if the only real principle is to save money & it's up to your healthcare provider to make judgement on how they think we should live our live's.


" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

richard`944

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Re: Time limit
« Reply #35 on: January 30, 2017, 04:20:12 AM »
This kind of thing is what scares me the most.
Everyone tells me, this site, people I know in the business, etc. that this is not true. Yet CRI and probably others are seemingly doing whatever they want.
Where are PHE, or the Local Authority or the commissioners who bought this service. How is it that patients can be told this? I cannot believe that CRIs doctors invented this, their bosses in CRI must have told them that this is happening. It can't come out of thin air.
Who is in charge of this rotten system that is either lying to people or knows the truth. IT STINKS.
Quote the orange guidlines each person is individule this tottally untrue ask for the gov paper ,its not there!

richard`944

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Re: Time limit
« Reply #36 on: January 30, 2017, 04:34:24 AM »
That's right John. They can do whatever they decide locally and there is nothing that anyone in London can do about it. That was the whole point of the LOCALISM platform which the government was elected on
your dui unit sounds just like 1/00000 ,

richard`944

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Re: Time limit
« Reply #37 on: January 30, 2017, 04:41:24 AM »
From a professional standpoint...and after a couple of decades in the field I know this is utter horseshite....yes there is unrelenting pressure on services to produce the golden egg that is an opiate successful discharge but to be told that is a disgrace. A summary of your consultation will be held in your casefile, write and ask for a copy as part of a complaint with the support of your service user rep ( CRI should have one) . Nice guidelines are very useful but there is a vital element that clinicians often choose to ignore " PATIENT CHOICE" !!!

Clinicians can give opinions, recommendations and guidance but they cannot lie or deceive like this .
whoever tells their!client this has gust broke all trust report them and ask to see someone ellse no trust froma patient defunkt key wrk,r

richard`944

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Re: Time limit
« Reply #38 on: January 30, 2017, 04:58:35 AM »
Hi

I have an excellent key at the moment supported by a doctor who is totally against enforced/coerced abstinence and will ask about these rumors during my next review in early Jan.

There is a new national drug strategy due to published in March 2016. However, the government's own advisory body published another report concerning OST and recovery in October, again warning against the introduction of time-limited treatment. Due to NICE and other clinical guidelines, withdrawing the option of long-term methadone/bupe treatment would be, not only detrimental to health and a threat to life, but open to legal challenge.

With public health funding being slashed and a new drug strategy on the horizon, this is a worrying time for anyone on a prescription. We hope, once again, that the evidence (not to mention common sense) will prevail.

Jack
the latest orange book guidlens that werecrebuked for this very reason it,a coctail for causing inhuman potentialy leathel outcome and has human rights violations ,strangley one the main docters supposedlly expert in addiction has taken over the stapelford centre now called the o.a.d cetre.

John Divney

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Re: Time limit
« Reply #39 on: January 30, 2017, 01:36:36 PM »
I think that in reality there already is a time limit, that limit is when CGL or Addaction or Lifeline take over from the NHS drug treatment provider. The whole philosphy of treatment changes. Older HR staff don't stay with the new service, new staff are recruited as true believers and recovery becomes all; MMT or drug use become second class choices. Pressure comes overtly from some staff and their doctors or by simply having to call into their purple painted offices and their grinning staff once a week. Combine this with the PHE outcomes they were commissioned against and you have a disaster waiting in the wings. Its easier to 'recover' some groups than others and these are the ones that these charities focus on more and more. CGL here work with ex-veterans, problem drinkers not street drinkers, users who really do want off, middle class pill poppers referred by GPs, even suicide survivors now; all groups which in my opinion are easily recovered, get a positive outcome for the commissioners, get added to the numbers and most importantly don't come back into treatment.
Relapse is our failing, it always has been and CGL can't handle it. The group of serious user, the meth head crack head pill head....you know who I mean! They are too hard to recover, and even if they do have a go because we are nice people after all, the inevitable rate of relapse means that they become an obvious client group in the town, hanging round and being generally annoying; rather than being brought back into treatment or left alone on their script. CGL don't bring people back in, it seems to me that on the Wirral an early death is the consequence of trying recovery, then relapsing, then failing to get a script back. Birkenhead is full of street users/drinkers, homeless beggars and violent gangs of young men involved in internecine drug wars among themselves. Two more stabbings this weekend.
We are in the 'too hard to do' box, so far better to get us out and then leave us out. There appears to be enough of the other groups of user to keep CGL busy anyway without having to have any moral scruples about us. After all, we will all be dead soon anyway.

Mark Gilman

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Re: Time limit
« Reply #40 on: January 30, 2017, 01:54:15 PM »
I still haven't found any evidence that key working or case working or any psycho social interventions (PSI) add ANY value for people who committed to Opioid Substitution Treatment. Yet, staffing costs to provide these irrelevant talking therapies (to people on OST) are the biggest cost in any tender process. People committed to OST (because it is working for them) get ALL their benefits from the PHARMACOLOGY of the maintenance opioid. So, the most pressing issue is how best to get a therapeutic, optimised dose of the most appropriate opioid to the people who want and need it with the MINIMUM of interference from anyone. Despite austerity and cuts there is still more than enough money in the system to provide OST. What there isn't (yet) is a commissioner with the vision and the guts to commission a system for the people who USE that system (and those who might use that system if it worked as it could and should). All of the treatment systems that we currently have exist, primarily, for the people who WORK in those services and not for those who do or might use them. And the answer to this is...?

John Divney

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Re: Time limit
« Reply #41 on: January 30, 2017, 03:48:39 PM »
Somewhere who is considering tendering out...Liverpool....and may well take a calculated risk or two. Someone who knows some people on the inside. Maybe a smaller place, a smaller borough etc. But it needs someone who does understand what pharmacological interventions do for individuals involved as well as the town they live in. I can argue all day about who CGL looks after and why, but what they fail to see is what an absolute violent shithole Birkenhead has become since their two year tenure began. It has gone back twenty years to the bad old days. A well run drug service serves the town as a whole, not just its addicts, and if it serves its addicts well then the town benefits not only from less burglaries but healthier families.

Mark Gilman

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Re: Time limit
« Reply #42 on: January 30, 2017, 04:45:11 PM »
Somewhere who is considering tendering out...Liverpool....and may well take a calculated risk or two. Someone who knows some people on the inside. Maybe a smaller place, a smaller borough etc. But it needs someone who does understand what pharmacological interventions do for individuals involved as well as the town they live in. I can argue all day about who CGL looks after and why, but what they fail to see is what an absolute violent shithole Birkenhead has become since their two year tenure began. It has gone back twenty years to the bad old days. A well run drug service serves the town as a whole, not just its addicts, and if it serves its addicts well then the town benefits not only from less burglaries but healthier families.

Well, I am happy to speak to any commissioner who wants to design a system that includes an Efficient, Effective and Economic OST system

John Divney

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Re: Time limit
« Reply #43 on: January 30, 2017, 04:58:00 PM »
Errr, don't have many commissioners in my address book Mark but you must know some who are as pissed off with all this as we are, not to mention all the dead customers from the last four or five years or so!
CGLs contract is up here February 2018, they seem to be killing more of us than most and have created a lot of bad press for the LA. Perhaps they would like a return to a better pharmacological service for the towns sake at least. Loads cheaper than it used to be and still keep the bones of the recovery growth intact. Because recovery has undoubtedly grown here at the expense of MMT, the Gold Standard..!

sapphire

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Re: Time limit
« Reply #44 on: February 03, 2017, 04:51:58 PM »
Lol John!

That there's no evidence to prove that PbR works or not does not surprise me at all. Since it was implemented drd's have increased, and the whole treatment system is falling apart.

Really it would be cheaper in the long run just to leave people who want/need maintenance to be left alone to get on with it.

If they're consistently giving drug free screens over a period of time, ideally a GP could just take over the prescribing. Leaving drug services free to deal with people who need/want their service/time.

Money saved and happier more stable patients, what's not to like?!

As far as the new Orange Book guidelines, I can'tsay I'm impressed at all. They're WAY too vague, and some of it's so open to interpretation it's downright dangerous.