Grasping the nettle of alcohol and other drugs workforce development

A post by Dr Steve Brinksman, SMMGP Clinical Lead.

As SMMGP went about its business over the past few years, we were aware of the growing need to broaden our scope in the complex and ever-changing world of drug and alcohol treatment and to grasp the nettle of workforce development in a more structured way.

The combination of SMMGP’s long-held passion for our work, now including FDAP and its accreditation system based on competency, provides a significant, independent, sector-led group that will harness the skills, talent, energy and ideas within the drug and alcohol treatment field. Our aim is to contribute to maximising the ability of a workforce that strives to improve recovery outcomes for those experiencing problems with alcohol and/or other drugs.

Members across both groups include treatment providers, professional and membership organisations, expert citizens, sector skills councils and we have close links with key stakeholders. Strategic leadership is provided by an executive team with many years’ experience in the sector to play a key role and maintain a profile at national level and in key policy fora.

Our vision is to work to protect the provision of high quality, effective services to individuals and families who are experiencing problems caused by the use of alcohol and other drugs, by a robust system of accredited practitioners who work to a Code of Conduct.

We will support workforce development within the sector as we have always done, but now also via the FDAP tried-and-tested system of accreditation based on competency. Starting with the launch of our new website later this month, we will support all our members by providing annual targeted CPD, including clinical updates, themed newsletters, and online learning (e-modules, podcasts and webinars).

This will ensure an alcohol and drug workforce that is competent, confident, skilled and demonstrating evidence-based practice and continuing professional development.

We recognise that the alcohol and other drugs treatment sector is interconnected across public, private and third sectors spanning employment, health, housing, social work and care, and criminal justice and we will maintain levels of involvement in these areas via existing and new partnerships.

We look forward with enthusiasm to supporting the workforce in new and innovative ways in the future.

 – Dr Steve Brinksman
SMMGP Clinical Lead

Naloxone – what the new legislation changes mean

Kate Halliday, SMMGP Programme Lead, discusses the recent legislation changes which make naloxone more readily available for those that need it.

Naloxone counteracts the effects of opioid overdose and while its distribution to current and past drug users has been encouraged in England there has been a patchy uptake of the drug. Many of us have been waiting for the 1st October 2015 when the Human Medicines Act legislation changes came into force to give more options for the distribution of naloxone (see explanatory memorandum from the Medicines and Healthcare products Regulatory Agency). Recent statistics showing a large increase in drug related deaths has only sharpened the desire to increase accessibility of naloxone for opioid users and those in contact with them.

Why has the legislation changed?

Prior to 1st October 2015 naloxone was supplied under prescription, often by patient group directions (PGD) by nurses pharmacists and doctors within drug treatment agencies. Naloxone could be supplied to those:

  • currently using illicit opiates, such as heroin
  • receiving opioid substitution therapy
  • leaving prison with a history of opioid use
  • who had previously used opiate drugs (to protect in the event of relapse)
  • With the agreement of the individual at risk it could also be prescribed to, family members friends and peers.

Whilst this system has led to a great deal of naloxone being distributed in many areas there is a recognition that there were also barriers for many people who were willing and likely to use naloxone from receiving it. For example hostel managers, organisations that provide services for people who are in contact with drug users (e.g. homelessness projects) and family members and carers who for a variety of reasons may not have gained consent from their loved ones could not access naloxone despite the fact that they were clearly in situations which they may use the medication to save a life. There were also structural problems in many services which acted as barriers to dispensing naloxone: some areas had not yet got PGDs in place, and where they did exist the pressure was often on precious nurse time to dispense the medication to individuals, and systems were not always as responsive as they could have been.

What do the changes mean?

There are two main changes the new legislation has brought about. Firstly, anybody employed by agencies providing drug treatment – and not just nurses/doctors – can supply naloxone meaning that it can be distributed by a much wider group of people working in services. Secondly, naloxone can be supplied by agencies providing drug treatment to anyone in the course of lawful drug treatment services where required for the purpose of saving life in an emergency. In other words, named hostel managers and managers of projects which drug users are likely to use, and family, friends and carers of drug users may now have access to naloxone where it is assessed appropriate.

What needs to be in place to implement the changes?

If it has not been done so already, get a policy agreed locally that reflects the changes in legislation. We are grateful to Inclusion for letting us share an example of what a policy can look like that can be adapted to local requirements.

For many drug services the governance will come via the systems that oversee the overall clinical governance for medical services – but this does not have to be the case. The governance can go through social care/voluntary agency structures as long as the agency is providing drug treatment to individuals – consultation with clinical/medical teams should be part of this process.

Don’t forget that SMMGP’s free e-learning module Naloxone Saves Lives can support local training programmes that are set up.

If you do not have one already, set up a naloxone action group to coordinate the implementation across your area. Have you considered all the hostels and agencies in your area who are in contact with drug users that may benefit from having naloxone? Get a strategy for reaching carers in your area who may be interested in having naloxone. Is there a way you can improve naloxone distribution to hard-to-reach groups in your area?

These are exciting times for those of us who have been trying to increase distribution of naloxone to at risk groups; many of the barriers to distributing the medication have now fallen away. It’s up to us to make this legislation work!

Further reading and information

Public Health England have provided information about the effects of the change in legislation.

– Kate Halliday
SMMGP Programme Lead

“Effort Street & Recovery Road” – Recovery Month Reflections

Dr Steve Brinksman, SMMGP Clinical Director, reflects on International Recovery Month in a post inspired by walking down Effort Street and Recovery Street in London.

Effort StreetSeptember is International Recovery Month and so there are many events around the UK this month which celebrate the gains people have made in recovering from addiction to drugs and alcohol.

Recovery is everywhere and in primary care we have many “recovery events” as we celebrate each step in the right drection as a successful one on the road to better health.

Being fortunate to work with people who use drugs and alcohol as a GP, I see recovery in all its many guises on any given week.

I see it in an abscess that has healed, when I know someone has picked up clean needles, or another has started treatment and their family member – who also comes to see me – reports feeling less anxious about their drinking.

Recovery StreetAnd when a patient now stable on OST is able to keep his job, whilst someone else has experienced the amazing “C change” of testing free of the hepatitus virus, they are making their way along Effort Street on the way to Recovery Street.

My drug and alcohol patients are rarely discharged. Rather in the brave new world of self-efficacy where patients are no longer passive recipients of treatment, we continue to work together as we build a long-term relationship and achieve ongoing improvements in their health and wellbeing. Happy Recovery Month.

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

Recovery South African style – SMMGP’s Elsa Browne meets Dr Lochan Naidoo, Durban GP and President of the INCB

A post by Elsa Browne, SMMGP Operational Lead.

On a particularly sparkling sunny morning this week and on a visit to my former home town of Durban, I drove from the upmarket suburb of uMhlanga in the north through the troubled city centre where recent xenophobic clashes had made the BBC news, to the less salubrious southern suburbs where the addictions treatment clinic of Dr Lochandra (Lochan for short) Naidoo is located. Dr Naidoo is a Durban GP, and since 2014 President of the International Narcotics Control Board, the first Southern African; and family practitioner to be elected to that role. In this role, he works with high-level delegations from the World Health Organisation and makes presentations to the UN’s Economic and Social Council and the Commission on Narcotic Drugs. Dr Naidoo was a founding member of the International Society for Addiction Medicine in the 1990s and a plenary speaker at the ISAM conference in 2014.

Like many of his counterparts in the UK, Lochan is passionate about all things related to the subject of addiction. He works as the clinical lead of a private residential rehab in Merebank south of Durban, which he established some 20 years ago as a young general practitioner. On arrival at the spotlessly clean and welcoming clinic I was met by the centre’s psychosocial therapist and shown around the premises, including meeting the genial chef. The walls of the clinic are decorated with posters carrying familiar slogans – Dr Naidoo did a residency at the Hazelden Centre in the US during the 1990s. In a country like South Africa with its many competing health priorities, his determination to keep addiction prevention, treatment and policy on the agenda is crucial and has led him from national partnerships to his current position and international links.

None of the above however takes his focus away from the starting point: people who use drugs problematically. Each and every individual that enters the clinic is case managed by Lochan in person, together with the wider multi-disciplinary team of trained professionals, psychiatrist, psychologists and social workers. The drugs of choice of people that come through the door reflect local trends and are ever more challenging, including an upsurge in the use of heroin or heroin based drugs mixed with anti-retrovirals. Opioid substitution medication – expensive in South Africa – is prescribed. He dismisses a question about his views on pursuing abstinence with a smile and a small shake of his head: “I believe we can all be fully integrated human beings”. And further: “Often the architecture of a troubled life is shaky and unstable. I don’t offer to treat addiction, it’s there. What we do is, together we build a new structure adjacent to the old one, a strong and stable one. And when the new construction towers over the old one, people come across and inhabit it permanently”.

In order to be funded for treatment, people entering treatment have to navigate the South African system of medical aid provision or employee assisted programs. In a genuine and innovative collaboration with its population, the clinic has a web-based system for patient notes and treatment plans (Roots), developed by Lochan, that patients themselves can log into from anywhere allowing them to share it freely with anyone, such as family members and even employers. Once the recommended 28 day programme is completed (longer for some), graduates are welcome to continue to log in to Roots, come to the clinic, attend the drop in, use the facilities such as the computer room, build enduring relationships and provide a glimpse of a possible future for those entering treatment.

As we browsed the SMMGP website together, Lochan was envious of our “brilliant resource” – and wanted to know who funds us. I explained that until fairly recently we were able to attract government funding, but given the current parlous state of funding for the addictions field in the UK, we were in a sense in a similar position to our South African primary care counterparts in terms of zero government financial support for clinical networks. He is concerned that there is no academic centre of excellence for addictions in South Africa and will continue to strive to position the country strategically on the international addictions platform, as he did when he was invited to present on addiction as a non-communicable disease (NCDs) at the United Nations General Assembly high level meeting in New York in July 2014. The meeting undertook a comprehensive review and assessment on the prevention and control of NCDs – chronic diseases that affect the poorest in the world.

As I prepared to leave, I asked whether people from the leafy northern suburbs of the city come to the clinic too. “Of course” came the response “when they are ready”.

Dr Naidoo may have been envious of our comprehensive guidance documents and supportive network, but as I walked out through the rainbow collective of people leaving the morning “Contemplation Meeting” that reflected true diversity including across the spectrum of recovery, I felt envious too. There is much we can learn from each other and you may find Lochan popping up on the SMMGP Clinical Forums sometime soon.

– Elsa Browne
SMMGP Operational Lead

Learn more about Dr Lochan Naidoo, INCB President

Blue Lights and Symbolic Violence

A post by Dr Euan Lawson, who compiles SMMGP’s Clinical Updates, discussing a recent study published in the Harm Reduction Journal

“A qualitative study of the perceived effects of blue lights in washrooms on people who use injection drugs”
Crabtree et al. Harm Reduction Journal 2013, 10:22
http://www.harmreductionjournal.com/content/10/1/22

The aim of fitting fluorescent blue lights into toilets is to make injecting difficult and deter people from using these areas as a location to inject drugs. This qualitative study published in the Harm Reduction Journal asked people who inject drugs about their perception of blue lights in public washroooms (defined as any facility not in a private home). They interviewed 18 people in two Canadian cities in British Columbia. These interviews were around 30 minutes long and were semi-structured. The interviews were recorded, transcribed verbatim and analysed.

The results were presented by the major themes. Preferred geographic locations for using injection drugs. Privacy was a high priority when it came to using injection drugs. However, most of the participants also stated that immediacy was a major issue – sometimes when withdrawing and under pressure then public spaces, including bus stops, alleys, car parks and toilets, were more likely to be used. Perceived effectiveness of blue lights as a deterrent. All the participants understood about the practice of installing blue lights but yet 16 of them described situations in which they had still attempted to inject in a toilet with them fitted. All agreed it was harder to inject under blue lights. The majority said they would try to avoid them, but three of the participants were entirely undeterred. Perceived negative consequences of blue lights. The participants highlighted the increased risk of harm to the person injecting. Participant recommendations in favour of blue lights despite the negative effects. Almost half still made positive statements about the use of blue lights despite knowing the harms. They prioritised other non-drug using people’s health above that of the person injecting drugs.

If you are working in a practice or a healthcare setting where they are using blue fluoro lights to deter people from injecting drugs then you need to take a long hard look. It puts up barriers: violently stating ‘we don’t trust you and you are not welcome here’. The authors talk about the concept of symbolic violence that has been used to describe the impact of blue lights. Symbolic violence often seems natural to both the victim and the perpetrator – and it is obvious in this study in the paradox that the participants accepted blue lights despite the harm likely to be caused to them personally. And, this study, like others before it, also reinforces the evidence that it doesn’t necessarily stop people from injecting in public toilets in any case. It’s a lose-lose counter-productive policy that epitomises a Daily Mail-esque nimby attitude to drug users. They are an act of symbolic violence against a section of society who need support not stigmatisation.

 – Dr Euan Lawson

Note: Euan Lawson is Editor-in-Chief of the Harm Reduction Journal where this paper was published.

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.

Heavy alcohol use and the treatment gap

A post by Dr Euan Lawson, who compiles SMMGP’s Clinical Updates

“My name is Scotland and I have a problem”

The words of Detective Chief Superintendent John Carnochan when he spoke at the RCGP conference in October 2011. He was a co-founder of the Violence Reduction Unit in Strathclyde and I understand he has now retired from the police but he continues to contribute to the development of new public health strategies in Scotland. He’s an inspirational speaker and in those few words he nailed, with typical Glaswegian humour, Scotland and her relationship with alcohol. The rest of the UK is not far behind.

The SMMGP Clinical Update this month has a lot of papers on alcohol. That wasn’t a deliberate strategy; it’s just how they fall sometimes. Perhaps the most notable paper is the one on nalmefene. Nalmefene hasn’t appeared completely out of the blue – there have been two previous studies (ESENSE 1 and ESENSE 2) from which the van den Brink paper in Alcohol and Alcoholism is derived but this summer marks its arrival as a real option.

Nalmefene

This week, the Scottish Medicines Consortium has just announced the go-ahead for nalmefene.

As discussed in the Clinical Update, nalmefene should be used taken on n as-needed basis by drinkers who feel they may be at risk of drinking. The sub-analysis was looking at drinkers who hadn’t reduced their drinking two weeks after the initial assessment – a key group as they have been associated with the poorest outcomes.

The media report is slightly misleading. Nalmefene is certainly not for the casual drinker who fancies taking a pill to keep their drinking down; it is for those with alcohol dependence. The media also reported that people “reduced their consumption by half over a six-month period when they took nalmefene”. Great news – but so did the placebo group and so it can’t all be attributed to nalmefene. The key figure is the treatment effect – which showed a reduction in consumption of just under 15g alcohol per day (just under 2 units per day in the UK). Worthwhile but Wim van den Brink’s paper provides even stronger evidence of the importance of getting people into treatment in order to deliver psychosocial interventions.

Much of John Carnochan’s talk in 2011 advocated the importance of early intervention. Given nalmefene is used in alcohol dependence it is a long way from an early intervention but it is unique in its scope and an extra option for clinicians is welcome. Lobbing a few vitamin B compound strong tablets and some barely absorbed thiamine at heavier drinkers has long felt like a wholly inadequate response. Nalmefene could help close the yawning treatment gap between those who achieve abstinence and everyone else. The scale of harm inflicted on individuals, communities and families by alcohol is staggering.

Nalmefene is harm reduction writ large.

Some do, some don’t, some will, some won’t

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

I became interested in working with people who develop problems due to their drug and alcohol use very early in my GP career. Since then the patients I have met have reinforced the importance of providing such a service in primary care. However a significant number of GPs do not work with people who use drugs and alcohol and some practices even send out a clear message that this group isn’t welcome.

On the one hand there are practices like ours, in which all of us from the receptionists and on, regard this work as a priority and where a few years ago our list was closed, unless the person had a drug problem! This compares with other practices where from the outset it is clear that “your sort” isn’t wanted. Why the difference?

Medical education plays a significant part in attitudes – as undergraduates we receive very little teaching on drug and alcohol problems. Although this has improved a little over the past few years, there is still a great deal more that could be delivered, as evidence suggests that young doctors are quite happy to engage in this role.

At a postgraduate level it is fairly hit and miss. I was fortunate to have a GP postgraduate tutor – Dr Ian Fletcher – who passionately believed in primary care “substance misuse services” as we called it then. He arranged a session for the West Midland GP registrars and one of his patients agreed to come along and share his experiences with us. This was a real eye opener to me, allowing me to see drug use not as a self-inflicted problem but as an attempt by some individuals to try and deal with the trauma they face or experience as they go through life.

Dr Clare Gerada, the current chair of the RCGP council has been a leading light in encouraging primary care to provide good quality care around substance use. She is also keen to increase the length of GP postgraduate training from 3 to 4 or even to 5 years. This would provide an ideal opportunity for the RCGP drug dependence and alcohol training – currently optional for both GP registrars and established GPs – to be a part of the core curriculum.

Another problem relates to GP contracts. The vast majority of GP practices have either GMS (General Medical Services) contracts which apply across the country and do not include or specify providing treatment for drug or alcohol problems; or PMS (Personal Medical Services) contracts which are locally agreed for a range of other services above and beyond GMS, but again many would not have a specific substance misuse category. This doesn’t mean GPs can ignore the physical or mental health problems of people with drug and alcohol problems but they are not obliged to offer OST, community alcohol detoxifications etc. unless they have signed up to specific local contracts.

There also remains a cohort of (often older) GPs in practice who trained at a time when GPs were actively discouraged from getting involved in this field. I hope that as time goes by they are being replaced by more receptive GPs and that it will become as normal to work with those with drug and alcohol problems, as it is to treat someone with diabetes or hypertension.

For this to occur the training needs to be right, the support structures from commissioners, drug workers, and the more experienced GPs need to be in place and the current investment in services needs to be maintained. Given this, my aspiration is that in time, the maverick GPs will be those that are not involved in working with drug and alcohol patients. Until then, I will continue to educate and inform all GPs about providing primary care treatment to this interesting group of patients, giving them the chance to recover from problematic drug and alcohol use in their own communities.

For more information about the RCGP Substance Misuse and Allied Health certificate courses in the management of drug and alcohol misuse, see the RCGP area on the SMMGP web site.

– 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.

B-Safe 2nd Birthday Celebrations, London Borough of Brent

A beacon of positivity and harm reduction for the whole community

Elsa Browne, SMMGP Project Manager

B-Safe (Brent Social Access For Everyone) held a party on Saturday afternoon to celebrate their user led weekend service’s second birthday. B-SAFE is a safe peer-led social space for people with substance issues to relax with others and share experiences on Saturday and Sunday afternoons. All are welcome, and they offer “a chilled atmosphere, hot drinks and snacks, widescreen TV, board games” and info and advice and referrals to other services if that’s what people want. 

B-Safe staff & volunteers

B-Safe staff & volunteers

Because we have been doing some work with them around primary care drug and alcohol treatment in Brent, I went along to their party to represent SMMGP. On a freezing cold Saturday afternoon I set off for Neasden, where B-Safe is based. On arrival I rather tentatively stuck my head out of the unfamiliar Tube station exit. Clutching my Google map, I struck out purposefully for the address I had been given, striding past the massive Job Centre, past thedreary Magistrate’s Court. I pushed open the door to the B-Safe room in the local drug service to the sound of conversation and laughter, where a warm welcome awaited me. There were so many people there that the crowd spilled out into the corridor.

The proceedings commenced with a speech by Andy Brown (Commissioner) who spoke of the leap of faith it took to permit a user-led service to operate on weekends. He likened finding a way out of addiction to running a marathon – saying that “if you’ve been in bed for 6 months, you’re not going to be expected to get up and run without a team of people around you to get you ready to make sure you’re well enough and fit enough to tackle the journey. Then you’re going to need seconds en route that make sure you are watered and looked after to keep going”.  

B-Safe 2nd anniversary cake

B-Safe 2nd anniversary cake

Having initially opened on Saturday afternoons, when in the early days about half a dozen people turned up and “there was a lot of nerves” B-Safe is now also open for a Sunday drop in session. Andy said that the service was a source of great pride to Brent, and should not underestimate its contribution to the area’s successful outcomes figures which in turn impacted positively on funding. A letter of appreciation from Councillor Lincoln Beswick was read out, and other official speakers endorsed the service.

The local Metropolitan Police representative stood beaming in his uniform as the room erupted in laughter when there was a vote of thanks from the floor for the “free wraps” (chicken and salad!) To applause from the floor, Ossie Yemoh, B-Safe co-ordinator and all round enthusiast, thanked “the Met” – a position he said he never thought he’d find himself in. He spoke of having learnt a new approach in his dealings with the police, working together using “feathers, not a baseball bats”.

Ossie struggled to compose himself after expressing his gratitude at having his teenage son and young nephew at the event, more people spoke from the floor about what the service meant to them. A young woman thanked the service for turning their family’s situation around by being there for her mum. The receptionist was mentioned more than once for her open and accepting attitude, which changed the culture of the service and made all feel welcome. Many people said they did not know what they would do without B-Safe to come to on a weekend.

As volunteers and others received Certificates in Recognition and T-shirts were handed out, some toddlers could wait no longer and broke out the toys in the “Children’s Corner” whilst at the table adults settled into a backgammon game.

As I wiped the last of the birthday cake from the corner of my mouth, I said my goodbyes and walked past the clutch of people standing outside, and I remembered being in a meeting recently where someone said they could hardly bring themselves to mention “the R word” because they were so tired of hearing it. It occurred to me that no one had said the R word today – they didn’t really need to.