A thoughtful piece

If like me you are an avid reader of the IPU Review then you would have seen the editorial below that appeared in August’s issue, penned I assume by the editor, Marie McConn MPSI. For those of you who did not see it I am posting it here (with permission of course).

To my mind the Methadone Programme has been responsible for immeasurable good. With some proper communication it can do a lot more.

The Revolving Door Serves Nobody
 
He was released from prison on a Friday evening. He had completed his sentence. He is familiar with the system, having been in and out many, many times. He is a heroin addict and other members of his family have died of overdoses. He has three children and has been very keen to combat his addiction. He got his chance with the last prison term, because there was enough room to keep him for the full four months. In that time he stabilised on methadone, agreed to go to rehab, reduced his dose to insignificant levels, all while staying clean – a difficult thing to do in prison evidently!
 
Anyway, the process was in train. The authorities rang us to check his registration details a few weeks before his release. The application was made, approval given, all he needed was a place. The plan was that he would be released from prison direct to rehab. Despite his criminal record, he is vulnerable, and this is probably the best chance of success. Time passed, the release date loomed, still no place, so they increased his dose again. Then came Friday evening. He was released. There is no clinic on Saturdays. The prison doesn’t give take-outs. Saturday morning he begged us to give him a supply, but we simply couldn’t. So there he was, newly at liberty, with no support. He got arrested again. I don’t know what he did, but he had a charge sheet with him on Monday. Eventually, he got a dose Monday, Tuesday and Wednesday, still waiting for a bed in rehab. He failed to show up the next day, and the following day the prison rang to confirm his dose. He is back in again.
 
Some heroin addicts commit crime. Some heroin addicts get arrested. Some heroin addicts go to prison. Some heroin addicts get released. Then they commit crime again, get arrested again, go to prison again and get released again. The cycle continues, creating more and more victims all the time. Victims include the obvious ones, the person who was burgled, had a handbag snatched, was subject to a hold-up, but also the clients, their children, their families, even the hard-pressed taxpayer, who pays for this merry-go-round.
 
And a merry-go-round it is.
 
The Methadone Programme is a valuable tool in the fight against drugs, but it is only one tool. It is very rewarding to see clients face their addiction, stabilise, re-build relationships with family, get a job, and integrate into society. And this does happen. But some clients don’t have the personal strength to achieve all this in the community. Some don’t have the family support, or may live in an area with a huge prevalence of drugs, so that local contacts can undermine their determination. Community based treatment can work, and has a place, but so does in-patient detox, residential rehab, and the use of other agents besides methadone. And sadly, sometimes prison could play a part as well. Prison is meant to rehabilitate as well as punish offenders. In the above case it was doing this, but ironically, the client’s sentence was too short. Maybe this “extension” will be a good thing. Liaison between the prison service and the health service is a must. People shouldn’t be released on Friday evenings with no means of continuing their treatment. That simply isn’t fair on them, on the pharmacy who regretfully has to turn them away, or on society at large.
 
Clients in custody are another problem. When people are in garda custody, they are literally between two stools. Clients in the community are the responsibility of the HSE. The health needs of prisoners are the responsibility of the Department of Justice. But clients in custody, being questioned or whatever are in never-never-land. The protocol is silent as to how they should get doses. Sometimes gardaí call to pharmacies seeking to collect the dose for the client. The difficulty here is that if the client has taken something, or swallowed something to avoid detection, the methadone may be too much. And the issue of liability in the event of a problem is at best unclear. If a GP is called and authorises a dose, he is meant to requisition it and pay for it himself and administer it to the client. Can you believe that? But no one can check to confirm that the client is registered on the programme. One man has already died of a methadone overdose in garda custody and I have had at least one experience of a client telling the guards he was attending us, when in fact he wasn’t. If he had got a dose on those terms he could also be dead.
 
The Methadone Programme is being reviewed at present. The HSE are going through the usual “policy” of seeking submissions and then making up their own minds. It obviously doesn’t occur to them to actually engage with and consult service providers and discuss issues.
 
I suppose that there is no chance that representatives of practising GPs, pharmacists, outreach workers, gardaí and prison officers might actually sit down together and tease out the issues in the system. I suppose that would be too simple.

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What’s the story with all the “Out of Stocks” at the moment?

If you are in community pharmacy like myself you cannot but notice the growing list of drugs which seem to be permanently out of stock with the wholesalers. Only recently sorted was the great paracetamol shortage. Now to be followed by the ibuprofen shortage. While some of the items may not be critical life saving drugs many do not have any reasonably priced equivalents. Yet many of these are still available across the water in the UK. I cannot help but wonder if this is the drug companies way of saying to the HSE and the Dept of Health “Sod it. You are paying so little for these now that it is not worth it anymore.”

The HSE and DoH loudly proclaim that they have driven down the amount that they pay for medicines. They make no mention of the shortages as drug companies quietly decide that a small market like Ireland is not worth the candle. Over time patients will be slowly but surely switched to more expensive (i.e. still available) medicines and the savings will be eventually wiped out.

It makes me wonder if any of the drug companies who may have contributed to any politicians electoral fund feel that they have got value for their money.