A mixed result.
I went along to two meetings with the consultant psych from another drug service in the same borough. It seems that when a complaint is lodged, it is investigated and dealt with by the consultants colleague at another drug unit.
In the initial meeting we discussed the points I had raised in my letter of complaint about the SAU.
I had complained about the lack of patient-doctor time, about how I had had seven keyworkers in the space of five months, that I was concerned for my friends and my own privacy and of course the IV script issue.
The outcome of that first meeting was that my complaint was being taken very seriously, (I had mentioned that I felt the SAU was not even fulfilling its basic duty of care to clients anymore) and it was being investigated etc.
with regards to injectables, it seems that in theory at least, there was no reason why diamorphine could not be prescribed and that he would look into it for us.
This seemed very positive to me.
As we reviewed the NTA injectable opiates guidelines together, I pointed out that my friend met all the inclusion and exclusion criteria, that after ten plus years of IV use, having been prescribed in that time, large doses of both methadone and subutex, even MST/morphine sulphate at one stage, dihydrocodeine, codeine, oxy... etc etc.. she had met the need to prove that optimised doses hadn't helped.
She has no current physical or mental health issues that would rule her out and she was able to make an informed choice.
The doctor agreed with me wholeheartedly, he agreed that every study ever undertaken has shown very positive results for injectable vs oral opiate maintenance therapy.
The upshot of it all was that he would do some research and would know more the next time we met...
So, a few weeks later...
He calls to schedule a second appointment.
Aside from investigating our SAU and the staff/medical team, this meeting wasn't so positive.
In a nutshell... He's on our side, if he could he would consider initiating a diamorphine script for her...
His hands are tied with red tape and politics..
The procedure to start injectable therapy is difficult, time consuming and expensive.
The main issues are:
the requirement in the NTA guidelines to supervise the injecting, this means a facility with government issued license to allow on site prescribing.
The other issue is that injecting in the groin (femoral) or neck excludes the client from the programme.
Now this is an interesting and controversial one.. The problem is that by the time a client is at the stage they may be eligible for IV therapy they probably have very few peripheral veins left!
Now, the way I see it, these two points are the governments 'get out clause' ... The message is:
'yeah, if you push hard enough we might try you on IV heroin or methadone, but, you have to come into a unit twice a day and have your shot in front of nurses and you're not allowed to go in your groin or neck'
So it's kind of a no win situation really.
We discussed the pros and cons of it, the need to travel halfway across London twice a day for the duration of the treatment (and the travelling costs too, she lives 5 miles from the prescribing unit), whether it was even going down that route at all if its going to be so difficult.. Etc etc..
He advised us to seek help and advocacy from the methadone alliance, I honestly don't see what they will be able to do though in this situation. I have spoken with them in the past when I was looking for advice around the same subject. 'Release' are also a good place to talk to if you're interested.
It seems that the patients that currently receive IV scripts are mainly inherited from years ago, when it was easy to get a heroin script. Nowadays it's near impossible to get one started.
It seems to me that 'they' ( the doctors/politicians/the system) will do anything they can to stand in your way of decent, evidence based/proven to work treatment.
For the few people that have written to me asking for help and advice on this issue, I really can't help you much more than what I've written here.
I'd suggest, if you're serious, to write a well thought out, factually correct letter to your units consultant, the manager and the clinical director, detailing your request and citing valid reasons why it wil improve your quality of life and fit in with the governments own harm reduction policy.
I'm happy to try and answer your questions but my knowledge on the subject is pretty much summed up in the last few posts.
I'm no expert in the field but I have always stood up for what I believe in and will always help advocate for others I see being treated unfairly!
Peace out... Sids