A name not a number

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Nov-2016) is a guest post-it written by Judith Yates and appears below with kind permission from DDN.

Post-it Past Practice – from the RCGP Conference 2016
A guest post-it by Judith Yates

I first met David in the 1980s when, as a small child, his mother kept him away from school all too often. She struggled to cope with life. By the end of the 1990s, in his early twenties, David was a regular attendee at my surgery, prescribed methadone and supported by my drug worker.

One night he banged on the back door of the surgery after 7pm when we were supposed to be closed and trying to pack up and go home. Our gentle hearted nurse Angela opened the door to ask what he needed and stepped back as he staggered in, fell to the floor, stopped breathing and turned rapidly blue. My quick-witted partner ran to the emergency cupboard and dug out our newly acquired naloxone kit. Naloxone is the antidote to opiate overdose and David was breathing again, although still groggy when the ambulance arrived.

When he returned to my surgery for his routine appointment the following Tuesday he was surprised to be met joyfully by the reception staff who had thought he might have died. On waking in the hospital he had had no idea how he got there, how close he had been to death, nor the role played by the surgery team. His was the first life I had known to be saved by naloxone.

It was therefore a shock two weeks ago, to see David’s name in the stark “drug related death” summary I was reading on a clear sunny day in Birmingham. I had trodden a familiar path to our local Coroner’s Office to review the thick ring-bind folder containing reports of all inquests held in the city during 2016, as part of the preparation for our newly re-formed “Drug Related Death (DRD) Local Inquiry Group”.

It seems that David had no longer been in treatment at the time of his death as only heroin had been found on toxicology. I suppose there was nobody around to administer naloxone on this occasion.

This reviewing of the inquest reports is a miserable job, not only because beneath the terse language of the certificates lie the shocking stories leading to these sudden and unexpected deaths, but also because having been a GP in the area for over 30 years, I have known many of the people who have now come to the end of their lives in ways which might have been avoidable. It is always especially upsetting to find that one of my old patients has died in this way.

Last week, standing at the podium to address the audience at the 21st RCGP/SMMGP “Managing Drink and Drugs problems in Primary Care” conference, I felt the warm glow of a room full of people who have been working together for all of the 21 years and more, but my subject matter, a review of drug related deaths in Birmingham, replaced this with an icy chill and a feeling that we must be missing something. I thought of David and the other people I have known who have died suddenly and unexpectedly in this way.

We have all read the headlines telling us that heroin related deaths have more than doubled in England and Wales, between 2012 and 2015 (Ref 1). Prof David Nutt speaking at the same conference asked the question “Why are we collecting all these statistics if we aren’t doing anything about them?” It is only by looking behind the statistics that we can have a chance of understanding what may be the causes and more importantly, what solutions can be found.

It is shocking that in many parts of the country, as in my city, drug related death inquiry groups fell victim to the financial cuts in services, and often no longer meet at all. As a result, nobody has been investigating the deaths of people not actually engaged with treatment services at the time of their death. The latest analysis by PHE shows that more than half of people who die in this way have never been involved with drug treatment services, at least since NDTMS records began seven years ago, and more than 70% were not engaged with treatment services at the time when they died (Ref 2).

We need to learn from each of these tragedies and add to the frequently simple and usually not even expensive actions, which we already know from international evidence contribute to reducing future deaths. These include: low threshold prescribing (and welcoming rapid re-engagement for those who drop out), supervised consumption facilities offering cups of tea, conversation and a safe hygienic place to inject for the most vulnerable who are not ready or able to come into treatment, and wide access to take-home-naloxone wherever it might be used to save a life.

David was only in his late thirties when he died, an increasingly common age for people to suffer accidental overdose. He was of course more at risk because of his age and history, because he had fallen out of treatment, and because he had a history of non-lethal overdose in the past. His death almost certainly could have been avoided.

We have powerful examples of effective analysis and action, for example from the airline industry, the maternal deaths confidential inquiry groups, and the investigations into every road traffic accident death, all of which have found ways to prevent avoidable deaths.

In 2009 Airline pilot Captain Sullenberger astonished the world when he made an emergency landing of his plane on the Hudson River, saving every life on board. When asked how he knew what to do, he said, “Everything we know in aviation, every rule in the rulebook, every procedure we have, we know because someone somewhere died. We cannot have the moral failure of forgetting these lessons and have to relearn them” (Ref 3).

Local inquiry groups are needed now more than ever to look at every fatality and ideally at the near misses as well, to inform our treatment efforts and perhaps even more powerfully to inform people who use drugs how to keep themselves alive and safe into the future.

– Judith Yates

References

1. www.ons.gov.uk
2. www.nta.nhs.uk
3. Quoted in “Black Box Thinking” by Matthew Syed, 2015

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Return of the “Post Code Lottery”

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Feb-2016) appears below with kind permission from DDN.

My practice has long had a reputation in Birmingham for working with people who use drugs and alcohol, and who are much more complex than those seen in most shared care practices. We were recently approached by the newly commissioned service to see if we would treat a man whom – for a variety of reasons – wasn’t engaging with the main drug service. This has happened before and no doubt will again; as whilst a commissioned service is designed to deliver a good level of service to the majority of its clients, by virtue of commissioning arrangements it has to work within defined parameters.

So what happens when a client falls out with a service, or a service falls out with a client! It is a fact of life that we don’t see eye to eye with everyone and sometimes irreconcilable differences develop, in my experience within drug and alcohol treatment this is frequently due to intransigence in both parties. However the service user can’t fall back on or blame “procedures”, “staff shortages” or “we aren’t commissioned to do that” statements!

Previously when drug and alcohol treatment was part of health services, a service user would usually be placed in an alternative treatment system bearing in mind that access to NHS treatments should be fair, equitable and available to all. However since Public Health has moved into the realm of local government this seems to have changed. All councils will commission drug and alcohol services but I suspect they are less willing to fund the “square pegs” that may need to be sent to a different service. I have come across a number of clients now who simply fall through the cracks and due to a breakdown in the relationship with the “only show in town” are outside of treatment and despite wanting help, they can no longer access it.

We are fortunate in Birmingham to have a number of highly skilled GP practices as well as the central service for drug and alcohol treatment, so it is usually possible to accommodate most clients who have a problem with one provider, in an alternative service – albeit that a client may need to embrace change within themselves too for the arrangement to work.

I worry about what may happen elsewhere in the country if this diversity isn’t available, how many people are excluded from their local treatment provider [for whatever reason] and simply not able to find an alternative? And what should we do about it?

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Ask the right question!

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Sep-2015) appears below with kind permission from DDN.

Marco rarely came to the surgery; he was a 44 year old restaurant owner with two young children but on a routine screen had been picked up as having high blood pressure. He had been given advice to lose a little weight and exercise more but this made no significant difference to his blood pressure. He was started on an anti-hypertensive and his blood pressure improved but 12 months later it was up again and as he was adamant he was taking his medication every day, a second drug was added in. Three months after this he had come back to see one of our registrars and she had noticed his blood pressure was again poorly controlled. She decided to discuss this with me as part of her learning portfolio.

His notes showed he had been overweight but his BMI (Body Mass Index) was now 26 so this was unlikely to be a significant factor, he had stopped smoking when his first child was born 7 years earlier, his renal function was normal and no significant past medical history was recorded. I asked her if he drank alcohol. “I’m not sure,” she said and indeed nothing was recorded in his notes about alcohol consumption. I explained that excessive alcohol use was a major factor for hypertension and cardiovascular disease a fact unknown to many patients – and quite a few medics as well!

He was due for review the following week and told her he drank a bottle of red wine every day, as it was good for his heart! She explained to him about the effect alcohol has on high blood pressure and cardiovascular disease and he had been shocked by this. He decided to try and cut his alcohol down rather than take a third medication. His blood pressure improved over the next few weeks and it was possible to stop one of his tablets.

I was the next person to see him and this time his blood pressure was within the normal limits albeit that he was still taking a single drug to control his blood pressure. He told me he had reduced his alcohol to half a bottle one night during the week and half a bottle each day over the weekend. I wonder how many patients have physical and mental health problems related to their drug or alcohol use that pass unnoticed because a health professional doesn’t ask.

SMMGP have launched an introductory online training module about the Community Management of Alcohol Use Disorders which can be completed free of charge on the SMMGP e-Learning website.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Treatment complete?

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Nov-2014) appears below with kind permission from DDN.

There is yet a lot of – sometimes heated – debate about whether drug services should be recovery or harm reduction based and some people seem determined to pursue this as a doctrine of dichotomy rather than as part of the same spectrum. Yet I rarely hear the same passion when we talk about treating viral hepatitis. Services will talk about high levels of BBV screening and uptake of hepatitis B vaccination and yet have tiny numbers of service users going into hepatitis C treatment. Now I admit that I am biased – a good friend and colleague, who did more than anyone else to show me how important it was to treat drug users, died of hepatocellular carcinoma, caused by his hepatitis C. To my mind the failure to get people into treatment that will not only potentially save their lives but also save large amounts of NHS funding, is a travesty.

We have effective and ever improving curative treatments and yet many people languish in primary care and community based services knowing they have chronic hepatitis, without referral or with high “DNA” rates for those who do get a referral. Perhaps we should stop talking about hard to reach patients and start accepting that we have hard to access treatment services instead.

We need to acknowledge that the current provision of BBV care for those who are in drug treatment is failing. And if we can’t get those who are being seen regularly and supported by clinicians and key workers into treatment for their viral hepatitis then what hope of treatment is there for those who aren’t on substitute prescribing and who are not in established treatment?

Treating people who inject drugs has been shown to be effective and reducing the pool of people with chronic infection can help lessen the spread. We need to create systems to support people into and through treatment and these are the sorts of outcomes that should appear in primary care and community based drug treatment tender specifications. Public Health, Primary and Secondary care all working together – perhaps we could call it something radical like a National Health Service! – to design a service that delivers effective, evidence based treatment that saves lives, reduces disability and saves money.

At the SMMGP conference in Birmingham during October we heard about a pilot project in Birmingham where the specialist hospital staff will be going out into primary care and delivering treatment alongside service users’ regular reviews and key working sessions. I know similar services exist in Newcastle, Nottingham and London.

The newer anti-viral treatments are producing cure rates of over 90% even in the more difficult to treat genotypes of hepatitis C. Even newer treatments promise “tablet-only” therapies that will minimise many of the side effects and adverse events seen in current treatment, albeit at greater financial cost but yet these will still be cost effective interventions. The only way we can advocate for these treatments to be available for our service users is to have the right systems in place to make sure that they are screened, referred and supported through treatment. The health gains for someone who has successful viral hepatitis treatment are immense and at least as important as them being “discharged treatment complete”.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

The golden key (worker)

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Sep-2014) appears below with kind permission from DDN.

For the past six months my practice has been providing the medical cover for some of the homeless and vulnerable persons’ drug service sessions in Birmingham. Due to the fact that the doctor who usually covers these clinics is on sabbatical, it has been my privilege to do these clinics for the last three months.

Most of the patients are IV poly-drug users, many are rough sleeping, and there are high rates of Hepatitis C, much higher rates than usual of HIV. A lot are groin injectors and DVTs and cellulitis are common and we had one patient recently who had a femoral artery pseudo-aneurysm rupture but fortunately survived.

The police have of late started to clamp down on begging and many of the patients have received criminal anti-social behaviour orders and are banned from large chunks of the city centre that makes collecting their prescriptions and attending appointments, a breach of their orders. There are no safe places to inject so under flyovers, on flat roofs and in bushes by car parks there is needle litter and desperate people hurriedly injecting with all the risks that entails. This may make grim reading and sound very negative and indeed much work is needed to change some of the attitudes within authority.

However my time there has felt incredibly positive as despite these problems the staff are highly motivated and committed to working with this group, both through key working and support from the clinic, but also outreach. I was buoyed by their resilience and enthusiasm and reassured to see how individualised the care was for each and every client.

For me this has emphasised again the essential role the key worker has in an individual’s treatment journey. For the first 12 years I attempted to treat people with problematic drug use at my practice, they had to go elsewhere for keyworker support, this disconnect meant much higher drop out rates, difficulty in communication and multiple journeys and appointments for the patients. The day when the shared care system in Birmingham formally launched and we had key workers in our GP surgeries was probably the most effective change that has happened in my career.

I have come to realise over the years that whilst a prescriber’s role is important what we do by providing a prescription for OST is give people a choice. Without a script they have little option but to use drugs. On a script they have a choice to not use, however the confidence and ability to do that comes from within them and is usually a result of the strong therapeutic relationship that effective and caring key work brings.

Working with people who use drugs problematically needs a true multidisciplinary approach; the bedrock of this is carers, peers and social support, but within treatment systems it needs doctors, nurses, pharmacists, counsellors and key workers who care about their clients and who communicate and work together to deliver the needs identified by the individual patient across the whole spectrum of treatment – from harm reduction to supporting abstinence.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Jack and Bill from the service up the hill

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Jul-2014) appears below with kind permission from DDN.

It is my firm belief that the majority of people with drug and alcohol problems can be managed in primary care, albeit with the proviso that appropriate access to psychosocial treatments are in place. I was initially therefore fairly downbeat about having to refer Bill back to our local secondary care provider.

He and his brother Jack are both registered at our practice and have been for a number of years. Now in their late forties, they each have a long history of chaotic IV polydrug use and alcohol dependency punctuated by numerous prison sentences.

Over the years their lifestyle has taken its toll and they both have a number of physical health problems mainly related to alcohol use and previous encounters with mental health services with diagnoses of explosive type personality disorders.

Jack, the older of the two, was being treated by the secondary care drug service for a number of years when we were approached to see if his care could transfer to our practice as due to some of his other problems attending the CDT was becoming more difficult. In the 3 years since then there have been spells when he has lapsed into more problematic drug and alcohol use, however with a lot of input from his keyworker based at our surgery we have succeeded in integrating his care into our practice. This is also testament to the skill of our receptionists who have managed to build a good rapport with him that on the whole nullifies his occasional outbursts.

Perhaps feeling flushed with success we then agreed that his brother Bill’s opioid prescribing could also be transferred over from the secondary care provider to us. Despite trying the same approach as we used with Jack, this has been much less successful. Three local pharmacies have barred him due to abusive language and he would regularly cancel or not attend key worker or doctor appointments, only showing up finally if the script was altered. His alcohol use escalated and he was verbally offensive to the receptionists on several occasions despite this being discussed with him by both doctor and keyworker.

We have a policy of discussing patients with any conditions whom we are struggling to manage either clinically or behaviourally at our weekly practice clinical meeting. As a result of one of these discussions it was decided to transfer Bill’s care back to the secondary care drug service.

This was a difficult decision to make and made me realise that whilst we may be fortunate within our team to have the clinical and case management skills available to support less stable people the roles of other staff and colleagues are equally important. Primary care is a fantastic place to deliver care to those using drugs and alcohol problematically, however some will need extra support and care and I am grateful that additional services are available.

Bill still comes to see me and we are now starting to address some of his physical and mental health issues and our discussions are no longer dominated by requests for changes in prescriptions. I hope that at some point in the future he may again receive all of his care at the practice but for now transferring his opioid substitution treatment out has meant he has remained a patient at the practice. For all concerned – a positive outcome.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Different perspectives

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Apr-2014) appears below with kind permission from DDN.

Primary care is a funny old world, heading in more or less the same direction as other services with our patients who use drugs and alcohol problematically, but with some major differences. For a start I never discharge patients, they don’t “exit as treatment completed”. If one issue ceases to be a problem I may well see them for something else. Perhaps this colours my view, but to me getting to abstinence as soon as possible isn’t the be-all and end-all, what is desirable is having the person lead what they feel is a normal and hopefully enjoyable life and experiencing the freedom of choice that inevitably provides. Most diabetic or hypertensive patients – despite often expressing a desire to enjoy greater health and wellbeing – don’t change their lifestyle so much that they are effectively cured, and whilst some do make great strides – and that is something to celebrate – I continue at the same time to support those who haven’t managed that, because they are my patients.

Over the past couple of months I have seen two men, both in their mid-thirties now, who have been in treatment for problematic drug use with us for a number of years.

John had been titrated up to 90mls of methadone before he stopped injecting heroin and crack. A big step forward. He had stayed on that dose for over a year and had engaged with a local peer support group. Over the past 9 months he had slowly been reducing down and then having “stuck” at 25mls decided to do a lofexidine assisted withdrawal. Two weeks after this concluded he came for his appointment and we were discussing next steps and what his options were; he decided not to take naltrexone, and he was intending to continue with his mutual aid group.

David had been with us a similar length of time, twice previously he had stabilised on 60-70mls of methadone and then started to reduce, only to drop out of treatment and relapse. Fortunately on both occasions we were able to get him rapidly back into treatment. This time round he had reduced down to 30mls without mishap and we were discussing where to go from there. He was working, had a stable relationship and was in his own flat. He had been to some mutual aid meetings and felt he wanted to be abstinent in the future but, he said, he suspected that trying to achieve that now might risk what he currently had.

We will continue to discuss David’s feelings about this every time I see him and the offer of support to help him achieve abstinence will always be there. Equally, if John should relapse he will always have the option of returning to treatment. Because they are my patients!

As I said – a funny old world primary care, and one that commissioners and politicians often struggle to understand.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Dry January and different strokes for different folks (A tale of two drinkers)

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Feb-2014) appears below with kind permission from DDN.

As the role alcohol plays in ill health and social dysfunction is increasingly in the spotlight, the whole SMMGP team decided to support Alcohol Concern by taking part in Dry January. It would be fair to say that it was anticipated that it would be harder some of us (i.e. me) than some of the others.

I decided that the best approach for me would be to tell as many people as possible that I was taking part, thus feeling compelled to complete it. One of the knock-on effects was that one of my GP partners and his wife decided to join in, I also had several interesting conversations with patients including one with an older lady who said “Oh, I didn’t realise you were an alcoholic and needed to dry out”. Hopefully she now understands a little more about the concept of dependence!

Frank had an appointment about his high blood pressure, he was taking medication for this and we were discussing adding in another tablet. He is a self-employed plumber and has always admitted to drinking “a lot” at weekends and “a few” during the week. That said when work was busy he would sometimes go 3 or even 4 days without a drink. Now in his mid 40’s he had watched his weight go up with his blood pressure, especially after he stopped smoking 3 years ago. He was surprised when I suggested he consider Dry January but faced with the prospect of more medication he somewhat begrudgingly agreed it might be worth a go.

Linda on the other hand brought her plan to participate in Dry January up with me. She told me a friend at work was intending to sign up to the campaign and she thought she would too. She had a stressful job with a firm of solicitors, had lost her driving licence due to drink driving 12 months ago and had been seeing the local CBT counselling service for anxiety and depression over the past few months.

This led to a deeper exploration of her drinking habits: she arrived home from work and immediately had a large glass of wine, followed by a couple more during the working week and probably twice this at the weekend.

She had gone a couple of days without a drink earlier in the year when she had flu but said she felt really ill and had been retching and shaky which she blamed on the virus.

An AUDIT score of 28 supported my view that she probably had a degree of physical dependence and after some persuasion she agreed to see our alcohol counsellor rather than attempt Dry January. She has done well and over the course of January she has cut back to about half a bottle of wine a day and towards the end of the month has even managed a couple of dry days, she is now focussed on getting her licence back and is starting to think that her life might be better without alcohol.

As for Frank he came in looking great, he had lost 4kgs in weight and his BP was back under control, I had thought he might struggle but he told me he had stopped going to the pub and started going for a run: “I’d like to do a marathon Doc, it’s quite addictive this running, you know”.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

Every Step

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Dec-2013) appears below with kind permission from DDN.

If you have read this column before, you will know that I am always keen to promote recovery, defined by the individual in respect of their own journey and not from a political or ideological concept. That said I am reasonably long in the tooth and having worked with people who use heroin for 20 years I am well versed in the concepts of harm minimisation, and the truism “dead people don’t recover” springs to mind. Harm reduction is the solid foundation on which we can build future recovery.

With this in mind the treatment system I operate within in Birmingham has now started actively encouraging service users to undergo training in the administration of naloxone for the treatment of suspected opioid overdose, alongside placing the person in the recovery position and calling an ambulance. I have been told that “people in treatment shouldn’t need prescriptions for naloxone”; yet I have come across people in treatment who have used naloxone to reverse overdose in people outside of the treatment system, and I am sure we would all accept that despite people’s best intentions use on top of a script occurs. There have been enough uses of naloxone in Birmingham now that I can be confident that there are people alive today, who would not have been, were it not for the availability of naloxone.

To back this up there is growing evidence from around the world that it is not only clinically effective, but that it can be safely administered by peers and reduce overdose deaths. Our service users have embraced this, but in a system with a large number of GPs operating in a community setting, it is proving more of a stumbling block to get these clinicians involved, a vital step if prescriptions are to be issued. Talking to colleagues around the UK shows that we are not alone in this.

There are a number of ways to try and address this, The National Treatment Agency [NTA] supported a number of pilot sites and in 2011 produced a report recommending this – “The NTA overdose and naloxone training programme for families and carers” (PDF).

The Medicines and Healthcare products Regulatory Agency (MHRA) has just announced a consultation on a proposal to allow wider access to naloxone for the purpose of saving life in an emergency. The consultation runs until 7 February 2014 and is available online.

At SMMGP we recognise that lack of knowledge and training are significant factors that hold clinicians back from adopting new treatment approaches and so we have committed to develop a free to access e-module that will cover the rationale behind naloxone prescribing as well as the practical aspects.

We also need those of you who work with clinicians, those who commission services and those who provide education to recommend the prescribing of naloxone. Drug related deaths from overdose remain a significant problem and I believe a widespread roll-out of naloxone could significantly reduce this. We have as much a duty of care to people who use, as we do to those at any stage of their recovery.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.

A lunchtime stroll

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Oct-2013) appears below with kind permission from DDN.

I went for a stroll the other Sunday, which isn’t remarkable in itself, but it was unusual in that 5000 other people were doing the same thing! The 5th UK Recovery Walk had come to Birmingham and I was fortunate to be able to participate. It was a hugely inspiring sight to see so many people come together with a single positive aim.

As we made our way through the streets of Birmingham accompanied by drums, the waving of banners and a lot of noise from the walkers there were an array of responses from onlookers – a few were bemused, the odd motorist looked fed-up at waiting for thousands to cross the road but the overwhelming attitude was of support and encouragement. For me the elderly lady on a mobility scooter who stopped and clapped and cheered the walkers saying “Well done!” exemplified this.

Having been involved in the treatment system in Birmingham for more than 20 years I did recognise a few of the walkers. One of these, John, had decided that he wanted to be treated in general practice as “it felt more normal”. He came to register with us as his own GP didn’t provide OST. He was encouraged to look at getting support from a mutual aid group and after about 12 months he finally went to an NA meeting. Over the next few months he came to the conclusion that for him he needed to be abstinent from medication as well as illicit drugs and he wanted to do a residential detoxification. Supported by our shared care worker, arrangements were made for him to go into our local unit. He has now been abstinent for 2 years and finds the fellowship he gets from mutual aid a key part in supporting his recovery.

Gary has been with the practice for over 15 years. In that time he has gone from fairly chaotic IV heroin and crack use with regular spells in prison, to a stable period on a methadone script during which time he became alcohol dependent. I was able to support him through a community alcohol withdrawal programme and following this he has found full time employment and no longer drinks. He doesn’t yet feel he wants to stop his OST but he was as buoyant as anyone on that walk and I think he had earned his place there too.

I was delighted to take part in the recovery walk and I hope that over the years I have worked in Birmingham I have helped some people take a few steps on their own journeys, but the main thing that struck me was how humbling it was to be amongst such a multitude who know that recovery is real and tangible and who wanted to celebrate that.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.