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Listen
1 SUMMARY OF KEY FINDINGS
The Scottish Executive is undertaking a Review of the Role of Methadone in Treatment for people with drug problems.
Scottish Drugs Forum ( SDF) was commissioned as part of this review to canvass the views of those directly affected by, or working in the field of, substitute prescribing through conducting focus groups of users and carers, holding open meetings and providing the opportunity for the field to submit written evidence.
In total we listened to the views of over 250 individuals from across Scotland.
We are grateful to all who gave up their valuable time.
The following summary covers some general themes, which emerged from all the evidence gathered. These themes are then explored in more detail in subsequent sections of the report.
1.1 Impact of Methadone
"It takes the madness out of your lifestyle."
"It reduces the risk of bloodborne viruses."
"Methadone isn't the answer but it is the start of the answer."
Methadone was recognised as an important part of treatment for drug problems by drug users, their carers and by workers.
Methadone was identified as helping individuals to:
- Gain stability and reduce the chaos in their lives
- Lead to improved relationships including improved ability to care for dependent children
- Improve their financial position
- Assist with the move into training, education and employment.
- Gain or regain self respect
A small number of those consulted were critical of the impact of methadone. In particular a minority of the carers felt it only replaced one drug with another and that the driving force was crime reduction rather than helping the individual.
It was recognised that the effectiveness and impact of clinical prescribing could be significantly improved through the provision of:
- Consistent standards of high quality care
- Needs-led rather than service-led help
- Co-ordinated services which meet the full range of needs
- Swifter access to services
- Increased resources
1.2 Consistent standards of high quality care
"…it's just pot luck what doctor you get, what service."
The lack of consistency in and the variable quality of services came out strongly across all those consulted. Services received varied between different areas, often within an area - and even within the same service.
From the users' perspective, a good relationship with a worker was crucial. Yet many said that their ability to form or maintain such was undermined by being seen by different workers at each appointment. The user and carer groups, in particular, reported the importance of trusting and supportive relationships with workers.
The need for the appointment of a Key Worker to every individual case was highlighted and supported, as was effective implementation of the national quality standards.
1.3 Needs-led rather than service led response
"You need to feel like it's you making the choices rather than (feeling) it is being made for you? You do need to feel…… part of the choices made throughout your life."
The need for services to move away from providing the kind of help which was designed to suit their particular working practices to one which was truly responsive to the individual needs of service users. This was viewed as an issue of critical importance in improving the impact of treatment, by all those consulted but was a particularly strong theme coming through all the user focus groups.
Choice, flexibility and information were consistently mentioned by user and carer focus groups and pinpointed as key issues in eight of the 14 working groups involved in the open meetings.
Choice was defined as being involved in decisions about:
- treatment options, including substitute drugs
- dosage levels and reduction
Assessments, the development of Care Plans and regular review of the Care Plans were identified as the way to ensure service users could exercise choice.
Flexibility was very much linked to choice. It meant that services were able to respond to the changing circumstances of an individual.
Service users also remarked that there were no routine patient information notes to accompany their supply of methadone. These should be made routinely available, as with other prescribed medications, to highlight issues such as warnings on side effects, contra indications etc.
1.4 Co-ordinated services to meet the full range of needs
"…Need help with everyday life…"
"I found it really difficult trying to adjust to become "normal" again because all you have known all those years is drugs and going to make money and ducking the police and going to jail."
The fundamental need for methadone treatment to be much more than providing a narrow pharmaceutical prescription service was consistently identified across those consulted.
Some interviewees highlighted how many DTTO schemes operate complementary services which "wrap around" the core methadone prescribing, which they much preferred to what was described by users virtually as a "prescription only" service provided through most community addiction/drug teams.
Respondents considered that the holistic approach should include sufficient time for counselling and an opportunity to explore and respond to the underlying reasons behind a person's drug problem.
Participants also felt that a holistic service should include a focus on encouraging and enabling access to education, training and aftercare support. Recognising the risk of relapse - and the need for pragmatic, non-punitive and therapeutic responses when such incidents arose - was another aspect which had widespread support across those consulted.
1.5 Swifter access to services
"One of the things with addicts is when you in yourself decide you need help, they {services} need to strike straight away…"
"The criteria is … if she gets her self pregnant she'll get her prescription. If she wants it. Or ….if she's got a mental health problem but not caused by drug abuse, it's got to be there before she starts taking drugs. Or, If she's got dependant children."
"And that's the only 3 criteria's. If you are not in those criteria you don't fit into anything. About 18 month on waiting list. (carer)"
A consistent theme was that services needed to be more accessible.
Users and carers said it was vital that a service was available when a person was motivated to change because a significant wait would result in this opportunity being missed.
Among the suggestions raised at the open meetings were:
- moving to locality-based delivery in urban areas
- developing assertive outreach models
- offering drop in/flexible appointment systems
1.6 Increased Resources
"I know they're trying their best and there isn't a lot of resources here but, they're pathetic, absolutely pathetic" (Carer)
"Doors close on her everywhere. It's always we'll refer you to this, we'll refer you to that, and it just doesn't happen" (Carer)
"They should have the whole range of treatments………you're helping people get on with their lives, but you won't see results straight away."
There was a recognition that while better use could be made of existing resources, the move to providing holistic services, which are needs-led and offer choice and easy accessibility, would require further investment.
The view from the open meetings was that the entrenched nature and scale of the problems would require long-term investment.
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