Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Anonymous [DP 129]

I am a service user and lately I have notice that since the new recovery strategy as come in to place. The current recovery program has been dis-interpreted by some CRI or Addaction DSP (Drug Shortage Program) staff members to coax and pressure users off their life stabling medication. This is done by disregarding the evidence base and the orange and recovery orientated guidelines set out by the National Institute for Clinical Excellence UK. The pressure seems to be coming from higher up the chain. I have been forced to make enquiries regarding the pressure and coaxing put upon me after I assured them that to make me reduce of my sub therapeutic dose will do me more harm than good. I contacted the National Treatment Agency (NTA) Centre for Policy Director Mr Tim Murray. I have the document enclosed below. In the end I have had to change key-worker but there is a constant change in atmosphere in the service. It seems to be driven on getting users off their methadone. This will have devastating consequences on users who suffer from mental and social problems. I hope a clear message is sent to these new recovery centres soon before it is too late for some user. I would like to remain anonymous as I depend on my medication and want to remain on the pad. Thank you for taking the time to read my letter.

Dear ***,

Thank you for your enquiry and I’m sorry to hear about your concerns. I’ve commented from a national perspective, and tried to address your concerns which seem to be about your fear that a recovery focus will lead to you losing your methadone prescription, and your fear of complaining to your treatment service. However, without knowing more about the local situation and circumstances, I can’t give you more specific feedback, and I would encourage you to raise your concerns directly, with the support of the local NTA team if necessary.

The first main thing to say is that recovery should not mean people having their substitute prescriptions removed against their will. A recovery focus should be about ambition and optimism for all service users, while accepting that some people will need long-term medication treatment.

I suggest that you have a look at Recovery-orientated drug treatment: an interim report by Professor John Strang, who is the chair of an expert group looking at how the range of treatments used in drug addiction can have a clearer recovery orientation. The report signals the direction of new clinical guidance for treating people with opiate addiction in England. I’m sure you’ll find that it’s relevant to your situation and reassure you that you will be supported. It stresses the importance of the recovery care plan and says:

“The recovery care plan… and subsequent revisions when progress is reviewed, must be developed collaboratively so that it is personally relevant and “owned” by the patient. This will increase the likelihood that they commit to, and are motivated by, a personal recovery care plan that is meaningful to them.”

The guidance is also clear that medication should not be all that is offered and points out that “better results can generally be achieved by the proper incorporation of psychosocial interventions within a comprehensive Opioid Substitution Treatment (OST) programme.” It also states:

“Medication can valuably support individuals to make changes to harmful behaviour, just as nicotine replacement treatments can help individuals to quit their previous smoking; but in such cases, active commitment and effort is required from the individual in order to maximise the impact of the medication.”

The second main thing to say is that you have an absolute right (enshrined in the NHS Constitution) to raise concerns or complain and not be punished for doing so. Your letter suggests you are afraid to raise your concerns with the treatment service, but services need to be able to take feedback from service users, even if it is negative. You are within your rights to request a new key worker, and the service should consider this. If that doesn’t work out for you, the service will have a complaints procedure which you should be able to use, without fear of punitive measures taken against you, and you should try this.

If, having gone through the complaints procedure at your local service, you still feel that your complaint hasn’t been resolved, you can contact the local drug partnership, the body responsible for commissioning the treatment services in your area (contact details here1), or the local Patient Advice and Liaison Service (PALS—more info here2) to seek further help, and if needed, a second opinion.

You may also want to notify the local NTA team (contact details here3), which will have a better knowledge of the local situation than we do here at the centre.

If you choose to give us any more information about where you are, we can make discrete enquiries via our local teams. I would stress that anything you do tell us will be held in strictest confidence, and no information about you and your complaint will go back to the service unless you give your permission to do so.

I wish you all the best with your ongoing recovery.

January 2012

1 Not printed.

2 Not printed.

3 Not printed.

Prepared 8th December 2012