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U.K. - My working week during coronavirus pandemic: 'I worry about giving a drug user a week's worth of methadone'

S.J.B.

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My working week: 'I worry about giving a drug user a week's worth of methadone'
Adrian Riley
The Guardian
April 27th, 2020
It’s all hands to the pump to make sure the people we work with can still get their prescriptions. Many have underlying health conditions that make them vulnerable to complications if they catch Covid-19.

We’ve moved the vast majority of people on daily prescriptions of opioid substitutes to a weekly dose, helping limit how often they need to leave the house to go to the pharmacy. Our staff conduct risk assessments with people over the phone before working with the local GP to change their prescription. It’s a truly herculean effort, especially as the majority are working from home.

Opioid substitutes are a vital part of treatment, but giving someone a week’s worth of a controlled substance when they are isolating comes with some dangers.

A person may use it all before the week’s up, try to sell it on or end up a target for someone looking to exploit them.

...

Adrian Riley is a team leader at We Are With You in North Somerset
Read the full story here.
 

F.U.B.A.R.

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Don't care for Adrian Riley very much I hope he get the most invasive aggressive form of hemorrhoids known to man
To be fair though, he's got a point. Giving junkies excessive amounts of medication isn't usually a good move. But in these unprecedented times, it's better than nothing. If they fuck up, it's on their own heads...
 

PrincessDiz

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It is on their own heads but their own heads aren’t really right that’s why they are getting their meds the way they are. I feel awful for someone who has now to deal with the temptation of having excess tablets. It would take someone of a very strong constitution to stick to their daily dose whilst isolated like this at the moment.
 

Nightraver

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I thought the same about my prescription for pain meds so in case k started popping extra out of the boredom I gave them to my partner to dose out but soon as this is over I'm taking them back because I can just tell she is loving the thought of a control over me . Means i have to be with her rigidly so I don't miss any doses
 

PrincessDiz

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I thought the same about my prescription for pain meds so in case k started popping extra out of the boredom I gave them to my partner to dose out but soon as this is over I'm taking them back because I can just tell she is loving the thought of a control over me . Means i have to be with her rigidly so I don't miss any doses
That’s horrible! I even feel shit collecting my monthly script of opioids for my condition. Like a total baby being given them. I am looked at like a drug seeker so I can’t imagine what anyone with addiction who use that service must feel like. It’s degrading.
 

Nightraver

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That’s horrible! I even feel shit collecting my monthly script of opioids for my condition. Like a total baby being given them. I am looked at like a drug seeker so I can’t imagine what anyone with addiction who use that service must feel like. It’s degrading.
I'm not on them for addiction issues I'm prescribed then after a triple digit amputation though that's not to say I'm not majorly addicted to them
 

PrincessDiz

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I'm not on them for addiction issues I'm prescribed then after a triple digit amputation though that's not to say I'm not majorly addicted to them
Ahh I misread you, sorry! Anyway, it’s not nice feeling someone is enjoying having control over you in that way.
 

Captain.Heroin

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...baby you're a freak show, just like me...
I never understood the "daily dose" thing. If I woke up and didn't have bupe next to me I'd just relapse... at least when I was on the shit. Isn't the idea to let the person live a normal life anyway? Normal people don't go to the pharmacy daily.

Addicts go to their dealers daily/weekly, etc... I think the idea is to break them out of that cycle.
 

sekio

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Where I'm from the endpoint most methadone clinics want to strive for is some sort of long-term carries. Usually it's given in stages though, you get daily monitored doses for a few months, then you get biweekly carries, then weekly, etc. Eventually it's once every month or so.

It's usually contingent on continual clean urine tests and observation of general stability. If the doctor sees you are employed gainfully, honestly trying to better yourself, and you have been compliant with therapy they usually actually prefer to have people moved to take-home doses, just to lessen the burden.

Even people on daily monitroed doses can ask to get carries in special circumstances. When there was an impending public transit strike in the city I live in, several people I knew who were on MMT were given a week's worth of carries by just asking politely.

If you are stupid enough to put yourself in a situation where you end up with no methadone for a couple days, the doctors usually are much less willing to consider giving you any doses in future.

They might replace your prescription if you could prove you were assaulted/robbed (police report) but even then, that works precisely once before it's beyond belief. The expectation is that you are given carries with the understanding that you are responsible for their security and proper usage. Some doctors will require you present some proof that you have a secure (locked) storage area for your carries, and will not provide them to people who are e.g. in a homeless shelter. I know at least one person who is honest enough with himself that he remains on daily carries. To him, there's nothing to gain from the possibility of theft or abuse. I really admire that.

Normal people don't go to the pharmacy daily.
Objectively speaking, having to make a trip to the pharmacy to get your daily dose is much less hassle than having to hustle to get $20 (by whatever means, be that theft, pity, panhandling, prostitution), then wait for a dealer to arrive, and then only get a couple hours of relief at best before you're back at it.
Going to a pharmacy once per day, having a polite chat with the pharmacist, and being given a reliable, clean, accurately measured dose of narcotics is top-tier service in comparison.

Also, despite a hazy recollection that the practice was greatly limited by some act of law, some pharmacies will even go the extra mile and deliver the methadone to your door. I also have met clinics that will offer a service (I believe it's run by volunteers) where someone will pick you up and give you a ride to the clinic, and back home, every day.

If you want to come up with reasons to restrict opioid use, the legal record shows it's not very hard at all. But by that argument, nobody should ever be dispensed more than a single dose of opioid medication at once, either. It won't stop the desperate users, but it will make life that much more difficult for everyone using them as directed.
 

Wilson Wilson

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I receive emails from other staff members saying some people who use our services have reported being offered the synthetic opioid Fentanyl in place of heroin. Fentanyl is around 50 times stronger than heroin so has a far higher rate of overdose.
This is very fucking worrying. If fent starts taking off in the UK during this it will stick around after the virus once addicts get tolerant to it. We're gonna follow the footsteps of the US at this rate.
 

THECATINTHEHAT

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It's been making inroads to the UK for the last couple of years. I believe there were a lot of cases in one particular area up north that traced back to one particular group of importers.

I think it's more a case of when it becomes the norm in the uk rather than if.
 

PrincessDiz

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It's been making inroads to the UK for the last couple of years. I believe there were a lot of cases in one particular area up north that traced back to one particular group of importers.

I think it's more a case of when it becomes the norm in the uk rather than if.
100% when not if. Totally agree.
 

THECATINTHEHAT

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I don't see how it can't become the norm. Making contact with a chinese chemist and then ordering and importing 100g of fent to cut down in the country is so much cheaper and easier than importing 100kg of heroin I can't imagine why it wouldn't become the norm.
 

PrincessDiz

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I don't see how it can't become the norm. Making contact with a chinese chemist and then ordering and importing 100g of fent to cut down in the country is so much cheaper and easier than importing 100kg of heroin I can't imagine why it wouldn't become the norm.
Well I can definitely see it happening. The press would also have a field day with it, we are a much smaller country which should mean it would and should be easier to contain and control when it eventually does make its way here. Which it will.
 

Wilson Wilson

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It has been kicking around the UK for a few years but hasn't really taken off in any big way, definitely nothing like it has in the US. I think @PrincessDiz has a good point that us being a much smaller country plays a big role. But I also know that our police take fent very very seriously and dealers know this. Police ain't stupid they know that any council estate will be roaming with dealers and they tend to leave it alone unless they're being especially bait or something. But if they know fent is going around they will kick down doors. The extra risk is not worth it for dealers so it's not become widespread.

The situation we find ourselves in now where we're looking at a real chance of a drought for the common drugs like H and the ease and cheapness of getting fent as a replacement may very well push the market more towards fent anyway. This is looking like a catalyst of sorts.

The one small silver lining in all this is that a lot of (most of?) the fent going around in the UK seems to be getting sold as fent rather than being cut into smack, so at least people know what they're taking.
 

JessFR

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That’s horrible! I even feel shit collecting my monthly script of opioids for my condition. Like a total baby being given them. I am looked at like a drug seeker so I can’t imagine what anyone with addiction who use that service must feel like. It’s degrading.
I don't find it degrading.

But maybe I'm fortunate, I get my methadone from a pharmacy, 3 days a week, and my pharmacists are very nice and accommodating. I've never felt looked down on.

In the past I've gotten my methadone from a dedicated clinic, and while those were worse, I usually didn't find those too bad either.

Only at the public methadone clinic I used to go to did I feel at all judged by the staff.
 

Wilson Wilson

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I've been waiting in pharmacies while people got served their methadone and tbh I do often see judging looks on the pharmacist's faces.

The pharmacy I go to is good though. No methadone or anything for me but I've picked up many opiate scripts and other CDs, never felt judged. Bloke is always chill and even keeps a bottle or two of codeine linctus in just for me on the dl.
 
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