The Scottish Government

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4 Appendices

4.1 User Involvement Focus Groups Questions

1. What is your experience of substitute prescribing services?

• Accessing services
• Waiting times
• Drug information including benefits/drawbacks/safe storage?
• Decision-making e.g. dosage, length of treatment - detoxification, maintenance or mix of both?

Other key areas:

• supervised dispensing or receiving a prescription,
• Views on drug testing/leakage?
• Frequency of attendance (accessing services)
• Key workers e.g. consistency

2. Can you describe any personal plans made with the service offering prescribing?

• Do you have care plans?
• Stabilising your drugs with a plan towards drug maintenance or working towards coming off drugs?
• Preparing or making training, education and/or employment links?
• Help with other areas - childcare, housing, finances and advice covering health and criminal justice matters?

3. What impact has Methadone and the support/treatment had on your life?

• General ( e.g. drug use, offending, stability)
• Relationships

4. What parts of prescribing services (including treatment and support) are you:

• Satisfied with?
• Dissatisfied with?

5. If you were in charge of Drug Prescribing Services, what changes would you make to improve things?

4.2 Carers Focus Group Qs with prompts

1. Can you tell us about your experiences of looking for help for someone with a drug problem?

• Information re services
• Access to services/easy - difficult

2. Can you describe the help you and your family have received from services offering methadone?

• Information re methadone/substitute prescribing
• Were your views/opinions heard
• Respite/childcare/support - counselling

3. What impact has Methadone and support had on you and your family?

• Relationships
• General wellbeing
• Financially

4. What parts of prescribing services (including treatment and support) are you:

• Satisfied with?
• Dissatisfied with?

5. If you were in charge of Drug Prescribing Services, what changes would you make to improve things?

4.3 Workshop priorities from open meetings

4.4 Further quotes from the focus groups

Impact of methadone

"I think the main benefit of methadone is that it is regular and it does stabilise you. It stabilises you so that mentally and physically just stabilises your life out and it can get you into a routine and when you are leading a chaotic life that is really a big thing. I mean eventually you need to move on from that but I think that is the main benefit of it you know. I think that is the main benefit I have had that it stabilised me and it has actually kept me head together."

"In the long run I think it does, in the beginning I was still using and I was abusing it but I think in the long run it has got me off everything. It has got me off of all the illicit drugs and it has got me into college, got me coming here and I think in the long run it has been great."

"… instead of (using heroin) 6 or 7 times a day. So as far as I'm concerned and I'm sure if they were actually sitting listening to that to me that's a 95% improvement and I'm sure anybody would agree. Going from that to a job and stable and everything, a 95% improvement but they don't look at that, they just look and say he's missed an appointment he gave a positive sample lets get rid of him. So then their forgetting I'm living with my wife and 2 kids so I've went from being stable on my script living with my family to like a say with a 95% improvement to blowing out the door and right back to taking drugs again obviously on a daily basis, a few times a day or whatever now my bairns have got an injecting drug user living with them so obviously the danger that that causes. I'm struggling to keep my habit, properly end up offending again and stuff like that and that's all through their one decision looking at a bit of paper. Whereas if they would maybe sit and speak to you and find out a bit of the story behind what's going on rather than just looking at their statistics ant there meeting..."

"Some people would gladly stay on methadone for the rest of their life. They can work, they can get on...they can do what needs to be done without having to...obviously the carry on of being chaotic. But then like you say some people don't want to...they might take it for the short time to get their self stable or whatever then cut down. If that's what they feel they need then that's what they need but I think if somebody who's happy enough to go to the chemist every day for the rest of their life, if their willing to do it and if they feel happy enough doing it then it should be an option that's available to them. I mean I can assure you I'd happily go to the chemist everyday for the rest of my life it meant being able to live a stable life, being able to hold down a decent job without having to take days off because I'm rattling or because I'm in the cells because I've been caught shoplifting or whatever. I'd happily go to the chemist every day for the rest of my life. "

"…. it is great to get the stability back into your life you know, I mean it is good at that but its not, there not really treating the addiction, the causes of the addiction or moving on from addiction. But it does, I suppose it gives you the support so you can go on and deal with these kinds of issues if you want to deal with them and move on with your life."

"Well it means you're not spending the money on the drugs but you're spending it with your family."

"It's amazing how much money you seem to have in your pocket."

"Plus you've got more time on your hands as well."

"It's not easy living on benefits but it's a lot easier if you're not using(heroin)."

"That's what I was saying about when you've being clean for a few years you start to think, patting yourself on the back even though you're not properly clean cos you're still using methadone. You've got your life straight, you're not going out thieving. You're not waking up fucking ill. You do feel good about it."

Yeah she's on methadone, it keeps her all right. I mean I don't agree with it in one way and in another way I do agree with it because it does it helps them, it keeps them stable but it's just, it's not the answer and I just think all these places that's the only answer they've got. Put them on methadone, there making them just the same there not any different, there still talking a substance...

To me that's all it is and I know it does keep them from going out and robbing and it helps them but it is very hard and very very difficult for them to come off it. When our Donna was on it was really terrible I mean we'd the screaming and ohh this that and she was terrified absolutely terrified to come off it. She'd say oh don't put me down any more just leave it another week and all this I mean eventually she did come off it and as I say she doesn't take anything at all now but emm I just think its an easy answer for them. Tape jump...it's just put them on that and shove them out the road. Forget about them because I mean there still, still taking a substance...

Consistent standards of care

"But the whole process does need some kind of central so that peoples experiences are similar, there is a continuity and it's not just you know like the turn of a card, its just pot luck what doctor you get, what service."

"It seems to be when you move from area to area. If you go to different areas there seems to be different levels of you know... I came from XXXX and the whole way of dealing with drugs seems to be different when I came down here. I'm glad I'm cleaner down here because it seems to be worse down here…"

"That's what I mean, you go from different areas and it seems to be different rules. He said he came up from XXXX. There was a set of rules in XXXXX but, when you come up to Scotland or whatever, even different parts of Scotland, the rules seem to be all different"

Worker continuity

"It's always someone different like I say out of 12 appointments I probably seen 8 different people, although I did have a named key worker it was never as simple as that. I mean if you were to say to them "have they got a named key worker" they would say "oh aye".

Information

"At the tolerance tests they've got the methadone handbook and they go over that with you, just to make sure that you understand like the peak of the methadone, it's got the chart and everything showing you like, but obviously when you take the heroin it just peaks right up and back down. It shows you like the methadone staying level. They go through quite a lot of that with you, but that's just recently I think that they've been doing that..."

Moving area

"It's like, again, if you want to move, and I really do want to move but, I can't move out of the XXXX area cos I don't want to happen what happened before were they fuck your script up."

Choice

"At the end of the day they come back with a decision and you've just got to accept whatever decision they make."

"You should be able to go say this is what I need and they should be able to give you it without them saying no they can't give you that. You don't have a say in what you want."

Flexibility

"I got the chance to build up the trust with my doctor and then I was allowed to collect it twice a week and then down to once a week and then once a fortnight because I was doing courses and going to college and that so it is kind of giving you a wee bit of rope, not to hang yourself but giving you, building up that trust so that he can trust you to take away your prescription on a weekly basis or a fortnightly basis and know that you are not abusing it and that."

"Makes you feel a bit normal."

"He is giving you a bit of respect and a bit of I don't know…"

"To build yourself up."

"To build you up so that it is you know giving you a pat on the back saying you are doing brilliant so what about trying this or… "

"Giving you a wee incentive to keep doing better…"

"Aye it's not enforced on you."

"I start on Monday as well and she is giving me it away. I go in on the Saturday and take Saturdays in the chemist and I get the Sunday, Monday right up to Friday away with me because I have showed her proof that I am starting college and that I am starting at 9 o'clock."

"Well they know I am starting college and that. I am going to ask them but I have seen people ask before and just not getting it at all."

"Yeah, they don't like emm, it's a maintenance script eh, and they don't reduce me just like all the time. I'll say to them when I feel like reducing again and they will take it down maybe 3ml and then again whenever I feel ready, cause they start with...id been diagnosed with depression as well so I was like not wanting to rush it and go down to fast. They have totally given me support for that and its going really well."

Relapse prevention

"Yeah aftercare, there should be something. Either when you're actually finished your methadone or when you're like just about finishes. There should be something at the end of it to, just to make sure you're not going to fall back the way again. I mean if it's somebody that really wants to do it anyway I suppose they would be able to keep there self in that frame of mind and not go back"

Swifter access

"One of the things is with addicts is when you in yourself decide you need help they need to strike straight away and get you that help straight away. See when they are saying they will stick you on the list and you are seeing someone in 3 months. By the time that comes you have lost the motivation again and you don't want to, but if it was a couple of weeks and they could get you then you would do it and there would be a lot more coming off it."

"The time that you have to wait, definitely the time you have to wait to get anywhere with them. It's quite a while like, I mean I can remember when I was waiting this time round and I kept phoning them up to find out where I was on the list and it was like oh you've waited 16 weeks, you've still got 16 weeks to wait. It's dragging in and dragging in ken, I think there should be, definitely try and cut that down a bit"

"See you can get methadone within a fortnight now…… it took between six to eight months before that."

Stigma/prejudice

"….all that having to go to chemists, feeling everybody is looking at you, people have got a right attitude towards you standing there. They are meant to have wee rooms; they don't have wee rooms you are standing there at a chemist drinking it in front of everybody. It is all over the papers and everybody knows exactly what you are doing, security guards will only let you go in certain doors, even the staff have got an attitude towards you."

"Everybody, see like if you have got a drug problem, especially with females and kids and all that they find it difficult. Once you have got prescribed methadone and you get it supervised, everybody knows your business. Your chemist is always busy and they are always gossiping in the chemist old women saying oh I seen that one in, oh and so and so's son or daughter is on methadone, junkie xxxxxx, excuse my language."

"Aye but you are forced to do it because you have no other option and some of the chemists, like the one I go to they don't have a wee separate bit for you to take your methadone and what I don't like is when you are standing in the chemist and weans come in with their mums and their grannies and all that and the lassie is like that, here XXXX there is your methadone, you are like that with your eyes to her you know I just stand and I wont take it because there are weans standing there and they are wanting you to stand and drink a cup. I wouldn't like my daughter standing watching people drinking methadone you know and through no fault of your own it turns people against you. They don't even know what you are like, they have just seen you standing drinking methadone in the chemist and they go there is one if those junkies."

"Are just thinking get you on that methadone but see these sort of things, not for everybody, everybody is different but some people are going to be so sensitive that they will not deal with it and they are back out the door and running because they would rather be undercover eh buying illegal drugs and keeping…"

"Than putting their face upfront and getting treated like that…"

"Than putting your face up, that vulnerable state that is just going to get too much for some people"

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