Author Topic: You're in pain, you must reduce ?  (Read 3059 times)

Filskit

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You're in pain, you must reduce ?
« on: December 08, 2016, 02:14:02 PM »
Hello friends, same service different Consultant Psychiatrist, has problems with spoken English like last time but is at least 15 stone lighter.
Last psych. told me that I wasn't long for this world due to the 120ml meth prescribed alongside some fairly weak pain relief that was prescribed for PRN use. The pain relief was stopped but started again after having to go through a formal complaint procedure, my GP who had previously prescribed all medication told me that " they " ( the new DSP ) would maybe go a bit easier on me if I reduced my dose a bit, which I did to escape the ECG hassle really more than anything.
I don't & haven't given any positive test results for 10 years approx. , attend all my appointments so as far as I'm concerned am a maintenance patient who gives no problems to the service.
I attend a Pain Clinic where I see the Pain Consultant, his advice to the DSP is for me to remain on my current dose....so it seems I don't fit the Recovery agenda, not that it bothers me one bit. Like I said I'm a happy maintenance patient.

So the new psych has hatched another plan to get me out of treatment, I've been told that it's not within their remit to prescribe meth for me anymore as it's being used for pain management. I said fine, put my care back into the hands of my GP. The practice manager there says that GP's working from that surgery do not prescribe meth & so the DSP now want's to reduce my meth 10ml/week, I'm meant to meet with the Recovery Nurse once a week who will ask me about my " pain experience " report back to the GP's at the surgery & advocate for pain medication as needed.
It all sounds a bit dodgy to me, I'm fine on my current medication though obviously cannot be " recovered " so am being discharged because I suffer pain.
Can't say that I've ever heard of anything like this before, has anyone else ever been reduced because they suffer pain ?

Scallywag

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Re: You're in pain, you must reduce ?
« Reply #1 on: December 08, 2016, 04:16:20 PM »
I've come across lots of people with pain issues which have prevented them exiting treatment because they can't reduce below a certain amount.. but this sounds wrong clinically, ethically and is not in the best interests of the patient. This is a huge issue in the feild but nobody wants to address it because, i think it's the stigma of addiction hindering effective pain management.
You need to write to the service manager and state your case because at least iit's documented.
Good luck

simon

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Re: You're in pain, you must reduce ?
« Reply #2 on: December 08, 2016, 04:50:01 PM »
Let's not forget that also people who've been on opioids a long time will likely have hyperalgesia and pain will feel much worse to them, they then get labelled as 'drug seeking'.
If you've been seen in a clinic for the treatment of addiction then why has he been moonlighting as a pain specialist then?

Filskit

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Re: You're in pain, you must reduce ?
« Reply #3 on: December 08, 2016, 05:08:03 PM »
Pain Consultant is a different person, he says " don't reduce ", DSP psych can't recover me if that's the case ! Don't see why the patient has to suffer just because they're not using illicit substances ?

simon

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Re: You're in pain, you must reduce ?
« Reply #4 on: December 08, 2016, 06:51:55 PM »
Pain Consultant is a different person, he says " don't reduce ", DSP psych can't recover me if that's the case ! Don't see why the patient has to suffer just because they're not using illicit substances ?
I mean if he thinks he's prescribing it for pain then surely he's working outside his remit, why did he do that?

sapphire

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Re: You're in pain, you must reduce ?
« Reply #5 on: December 09, 2016, 05:19:16 PM »
I was going to say hyperalgesia too Simon.

BUT, if you're still using methadone so that you don't relapse into previous behaviours then you're technically not just using it for pain management, so the prescribes need to know that.

At any rate, telling someone who's been on methadone for more than a decade that they've got to reduce  y 10ml a week is preposterous, that would really be nearly as bad as doing it cold turkey.

Is there someone you can complain to?

simon

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Re: You're in pain, you must reduce ?
« Reply #6 on: December 09, 2016, 06:30:31 PM »
I was going to say hyperalgesia too Simon.

BUT, if you're still using methadone so that you don't relapse into previous behaviours then you're technically not just using it for pain management, so the prescribes need to know that.

At any rate, telling someone who's been on methadone for more than a decade that they've got to reduce  y 10ml a week is preposterous, that would really be nearly as bad as doing it cold turkey.

Is there someone you can complain to?
I expected you would think of hyperalgesia and as for the rest of your points, spot on as ever.
No section of society cannot be treated worse.

OP8S

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Re: You're in pain, you must reduce ?
« Reply #7 on: December 11, 2016, 02:11:21 PM »
Very much sounds to me that they re just taking a shot on the dark & trying to " recover " an unwanted maintenance patient, I wonder if maintenance prescribing is within their remit.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

Filskit

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Re: You're in pain, you must reduce ?
« Reply #8 on: December 12, 2016, 03:11:07 PM »
Got a text message from the DSP Nurse this morning to tell me that, she wasn't sure what was going on ( nice to know ) & I will receive another text message when they know what the plan is....

That's really what the problem is as far as I can see, they have no plan. Certainly not one that my GP, or anyone else seems to know about & if the DSP are unsure of the plan then who does ?

What a bloody farce, either incredibly devious or incompetent. It's a unwanted reduction, disguised as a transfer of care. Wonder what the next message will say...? I imagine I'll be called in to discuss the matter rather than be informed by text message or email, both of which can be stored & used as evidence for a formal complaint.

Used to get Christmas cards from the DSP wishing their patients all the best, I even remember mince pies being provided & having a festive laugh with staff. Discussions regarding reductions or any changes in medication were always put on hold for a few months unless the  patient brought it up. How have we gone from that to this type of service ? Oh, Recovery. I forgot !


sapphire

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Re: You're in pain, you must reduce ?
« Reply #9 on: December 16, 2016, 02:15:01 PM »
That's appalling really,  and shows their lack of knowledge regarding mmt patients. It's awful to just leave someone not knowing what's going to happen with their script.

Filskit

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Re: You're in pain, you must reduce ?
« Reply #10 on: December 19, 2016, 08:00:19 PM »
That's appalling really,  and shows their lack of knowledge regarding mmt patients. It's awful to just leave someone not knowing what's going to happen with their script.

Situation sorted today. Had a meeting with Recovery team who seemed very concerned that I was talking legal complaint as well as formal complaint. I had thought that they were playing some devious game but instead I think you're right Sapph, total lack of knowledge, incompetence, these people shouldn't be allowed near anyone unless that person wants to go down the Recovery = Abstinence route because that's the only model that they are interested in.
Appalling but I've got them off my back & increased back up to the dose I wanted. I hope that's the end of it.

simon

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Re: You're in pain, you must reduce ?
« Reply #11 on: December 19, 2016, 09:30:17 PM »
Situation sorted today. Had a meeting with Recovery team who seemed very concerned that I was talking legal complaint as well as formal complaint. I had thought that they were playing some devious game but instead I think you're right Sapph, total lack of knowledge, incompetence, these people shouldn't be allowed near anyone unless that person wants to go down the Recovery = Abstinence route because that's the only model that they are interested in.
Appalling but I've got them off my back & increased back up to the dose I wanted. I hope that's the end of it.
wow, they're only paid to know this stuff, dreadful time you've had.

John Divney

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Re: You're in pain, you must reduce ?
« Reply #12 on: December 20, 2016, 11:49:52 AM »
Well done Filskit, pleased its sorted. You should ask for a copy of your care plan now which everyone is entitled to, ensure its all written up as stated and agreed, sign it, and keep a copy for yourself. Everyone should have a care plan. You are dead right about the knowledge of staff recruited by these recovery agencies though, I think only one or two wirral NHS staff went over to CGL when they came here, and they were extreme 'recovered' catholics bent on recovering the staff as well as patients! Its not just about pay and pensions, its about philosophy and belief systems, we all have them. You only have to look at CGLs recruitment pages, recovery GPs, recovery nurses, recovery champions etc etc etc. It lies at the heart of it really, NHS services cant do recovery, and recovery services cant do HR, they are mutually exclusive. To ask a recovery service to take over everything in a town is as wrong as asking NHS services to do a bit of this new recovery malarkey.
The CCGs should commission and run HR services, and the LA can commission all the recovery stuff. Commissioners then ensure that their task is to ensure that drug users benefit from both approaches when needed and when required. This is very much how Liverpool has evolved, both HR and recovery do their thing and in the main do work together, odd snidey comments and punch ups accepted of course! The current pressure on funding will I fear result in a Wirral response, i.e. go out to buy one service.
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Filskit

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Re: You're in pain, you must reduce ?
« Reply #13 on: December 20, 2016, 12:45:27 PM »
Paperwork appears to be very thin on the ground, I found out that the detailed " plan " of my reduction in methadone & onto a similar long acting opioid for analgesia was being written up 2 weeks after the reduction had started & on the Friday afternoon before my meeting first thing Monday. That was the written plan I had asked to see before agreeing to any changes, apparently they thought that I just wanted to get it over with quickly so forgot about doing things in a proper manner & just decided to rapidly reduce me in a see what happens manner.
Obviously pain issues soon worsened & withdrawals became very noticeable after the 2nd 10ml reduction. Even with my past experiences with these Recovery people I'm still rather shocked that they just went for it. Xmas would of been awful & after another reduction of 10ml New Year would either of seen me being colder than the leftover turkey from the week before or more than likely getting back into the swing of using again. I've not been involved in that scene for a decade, but like any old head knows a score is usually only a phone call or two away.

I am to receive documentation of the new plan ( heard that one before ) but have the entire meeting recorded, something that I had told them in advance over the phone & in an email but still caused a bit of a stir once they realised I was actually doing so. I wonder if the outcome would have been different if I hadn't taken that precaution ?

I was informed they were working to local guidelines, which they couldn't produce. I've looked at these guidelines online this morning & they basically say that practitioners should follow something called the Orange Guidelines, how odd  ::)

Also been informed that I am not to discuss my care with any other of the Recovery Teams patients, I wonder why not ? Could it be so that they don't get challenged by any other people who are receiving punitive treatment who are being told that they have to adhere to " local guidelines " which do just say that National guidelines should be followed.

The Recovery team including the Consultant have just made themselves look extremely amateurish, which I think is more worrying than them being plain devious.
Glad it's over, two formal complaints since the service has changed to follow the Recovery agenda. I really hope that they don't try for a hat trick.

John Divney

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Re: You're in pain, you must reduce ?
« Reply #14 on: December 20, 2016, 02:17:55 PM »
"Also been informed that I am not to discuss my care with any other of the Recovery Teams patients, I wonder why not ? Could it be so that they don't get challenged by any other people who are receiving punitive treatment who are being told that they have to adhere to " local guidelines " which do just say that National guidelines should be followed."

I have been told that on more than one occasion. Its so others cant find out whats going on who are in a similar position to you, the keyworker/patient or Doctor/patient is always just us on our own in a room with a professional, who frankly can write what the like. They can discuss your treatment with whoever they like but you can't. Wank! The more of us like we on this group, who do stand up and say 'hold on, that's wrong', the better. Its just a shame most fear that they will lose their script, so put up with any old recovery shite to keep it. The power imbalance in drug treatment is appalling and has never been addressed.

Can you imagine if you asked if you could use a room once a fortnight to start a MMT patients meeting to discuss treatment issues? Like the rooms they give all the recovery people chanting how happy they are or rooms for music lessons or poetry or whatever they do.

Recording meetings seems to be the way forward to me, given technology these days. What a state to be in though! Shameful..