I work as a GPSI addiction. Remember that the evidence base for OST (methadone and buprenorphine) advises doses 60mg and not to detox unless the patient wants to / or there are safety issues. Under treating opiate dependency & inappropriate detoxes contribute to the escalating DRDs.(This is in response to the first comment)
A big issue with iatrogenic opiate dependency, is that often the patient doesn't understand / admit that they have an addiction issue. Many would benefit from conversion to OST but decline this intervention. The stigma associated with methadone /addiction exacerbates this problem further.
Primary care isn't in a position to deal with this massive issue. From experience our local specialist addiction service don't have the capacity either, even if this group of patients was willing to attend a service mainly catering for street drug users.
Addiction to heroin or prescribed meds is a response to stress/ trauma / poverty / our culture and society. There needs to be more focus on the root of the problem.
A drop in the ocean.....
What impact are we actually having in the UK when elsewhere in the world antibiotic use is unregulated and massive quantities of antibiotics are used in agriculture to boost profit?
Wow, I hope you are joking. I have a friend attending a 3 week GMC hearing following a medication issue ( OTC medication). It doesn't take much for things to spiral out of control with the GMC.
An ear problem is generally a gift for a GP, a 5 minute consult. However being able to see the EAC is surely vital? Is there a perforation, bulging TM, possible cholesteatoma, vesicles, impacted wax, blood, malignancy, fluid behind TM etc. No doubt the vast majority of examinations are pretty normal but isn't that what we have to suck up as GPs and use our skills to diagnose treatable conditions? If we don't know how to examine something then advise the patient to see somebody who does, do some training or leave the profession before somebody dies.
"I do feel sad that someone felt this way because of me."
I totally identify with this thought process which then leads to negative emotions and distress.
However it is totally wrong - the patient feels the way she does because of her own ego / perception of self / upbringing/ conditioning etc. The anger coming from this individual was there before she had the consultation with you. Maybe in some small way the fact you were able to remain assertive and focused during the consultation will help her in the long run.
Thanks for this. I am sorry for your loss and identify.
I lost my Dad in November 2015, very suddenly due to a brain haemorrhage. He died in Glasgow SGH, I managed to get to the hospital in time to watch him die but too late to speak to him. He had been speaking to my mum 30 mins before I arrived,he went for a CT head and came out GCS3. Sat round the bed with my mum and sister and basically watched him cone, stop breathing and die. His heart kept beating for at least 4-5 minutes after he stopped breathing, it really freaked me out and I had to get up and switch the ECG monitor off.
I have seen so many families do this bedside vigil and didn't realise how painful an experience it can be. I wanted to run away and not be there, I also wanted my Dad to die quickly so it would be over more quickly. None of my medical training seemed to help at all and maybe was unhelpful, blocking my ability to process the pain and loss, with my mind trying to medicalise the experience.
Thought I would connect via this forum, nothing prepares you for the loss of a parent. I have used writing before to explore my feelings and what you have written prompted me to write this snapshot of my day in 2015. With love, Ian
"Our resignation to this reversible disease is comparable with the acceptance we have for letting large sections of society remain on opiate substitution treatments, a policy recently questioned by addict-turned-campaigner Russell Brand.2"
Don't agree with this part at all. As already mentioned we have a massive evidence base that ORT reduces illicit drug use, reduces overdose risk, reduces DRD,reduces the risk of BBV, reduces criminality, improves employment potential, improves family stability and improves pregnacy outcomes.
The use of ORT should be combined with a recovery orientated care approach, linking in to as much psychosocial support as possible. When the individual feels ready a move towards detox may be possible if the correct support is in place. Forcing people to detox from ORT is inhumane, not evidence based and driven by a general misunderstanding of the addiction process.
As it happens I am in recovery from opiate addiction and have a similar approach to recovery as Russell Brand (12 step and abstinent). I have a lot of time for his vlogs etc. I used to feel the same way about methadone as he does, until I found out more and started working within the addiction field. Abstinence based recovery from opiates is undoubtly possible but this doesn't mean that ORT has no value.
We remain at risk of throwing the baby out with the bath water and further marginalising and stigmatising the large section of our society who remain on ORT..
I work as a GPSI in addictions. I have also worked in the prison system in Scotland and seen the demand for gabapentin and pregabalin. The drugs are used either on their own or combined with opiates/benzos to achieve an enhanced hit.
I now work in the community and many of my patients report misuse of these drugs and great difficulty in detoxing when they try.I know one person who overdosed with gabapentin( prescribed by his GP for back pain) in combination with opiates and lay on his floor for 36 hours suffering carpet burns and nerve damage.
I am not anti drugs and I don't believe drugs are the cause of addiction. There is time and a place for gabapentin or pregabalin. However as a prescriber I need to feel confident that I am dealing with a genuine case of neuropathic pain and consider other pharmaceutical/ non pharmaceutical options in somebody with risk factors for addiction before considering this drug type. I am very sceptical about using pregabalin for "anxiety" symptoms as well. Diazepam has caused so much harm due to inappropriate prescribing over the last few decades and I believe we are dealing with a similar type of drug with the gabapentinoids.
We can be under so much pressure to prescribe drugs to patients in an attempt to alleviate suffering, not always the caring thing to do.
I also received help from the Cameron Fund back in 2010/2011. I was out of work for almost 2 years due to illness and they were really supportive. We have three children and I was the sole earner so the financial aid was a lifesaver. There was also financial advice given which helped me access the correct benefits and mortgage support payments.
An amazing charity, so grateful for the help. Merry Christmas to everybody at the Cameron Fund.