PRESCRIBING HOPE

DISPENSING HOPE

A pioneering approach to reducing harm from drug abuse is changing lives. Jackie Rankin met the nurse prescribing much more than medication and the people who benefit.

Shane is a resident at Liverpool’s YMCA hostel. He’s 35 and has been addicted to heroin since he was 18. Desperate to be reunited with his young son in Ireland, he’s tried and failed to beat the drug. Now hope has arrived with a new programme that takes his treatment to him. Previously residents would attend regular clinics, then travel up to half an hour each day to collect their medication from a pharmacy. Now Shane and 40 other residents are reviewed by their drug service at the hostel and receive their methadone on site.

The service was launched in 2017 when nurse prescriber John Gerrard (above) realised that clients were struggling to keep appointments and not taking their medication, with often dire consequences. John explains: “Research recommends easy access to opiate substitute treatment (OST). But if someone whose addiction consumes their every waking hour must attend regular clinics, then travel somewhere else every day to collect their medication, they can be overwhelmed, give up and revert to illicit drugs and more risky behaviour. YMCA Housing Operational Lead Jason Thomas agrees. “Being caught up in addiction and having to fund it is a 24 hour activity. You have every intention of going to your appointment, but your addiction gets in the way of your efforts to give up.” Funding illicit drug use can cost upwards of £100 a day so people resort to borrowing, dealing, begging or criminal activity. They suffer physical health issues from Hepatitis C and HIV to infections and deep vein thrombosis and at worst accidental overdose and death.

The service faced resistance from those who felt having controlled drugs outside of pharmacies was high risk. But John and his team held strong the belief that removing barriers to treatment would reduce harm and save lives. Within weeks of the launch numbers swelled from eight to 25. “People who had never been consistent were keeping appointments,” said John. There were obstacles – we were breaking with established practices. We had to bring GPs, managers, pharmacists onside to develop new procedures. But ultimately it was about the client and the local community.”

The programme was working well, yet the team felt simply prescribing on site wasn’t enough. “People would still have to travel up to half an hour to a pharmacy every day to pick up their medication,” said John. “If you miss three consecutive days of methadone your tolerance levels drop and there’s a risk of overdosing, so pharmacists won’t dispense. Consequently people dropped out of treatment.”

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Nurse prescriber John Gerrard.

Being caught up in addiction and funding it is a 24 hour activity.

People who had never been consistent were keeping appointments.

Partnership working took on a new dimension. A local mobile pharmacy agreed to deliver medication to clients, and hostel staff were trained to dispense. The programme adheres to protocols and is closely monitored. University of Liverpool research supports the team’s findings – residents were more likely to stay in treatment and their overall quality of life improved.

Hostels now alert John to new residents, so he can introduce them to the programme early and work towards detoxification when they’re ready.

He won’t rush a client. “The timing must be right. Someone may be able to deal with the physical aspects of a detox but living without the crutch of drugs brings its own anxieties. I’ve seen hardened criminals break down and cry talking about their past. People need help to deal with things that have been masked with drugs and alcohol.”

When we met Shane had been stable for almost six months. He’s humble and seeks no sympathy, but when he talks it’s clear that fighting addiction is exhausting. “I was in care when I was younger – I was pretty wild, I did petty crimes, but I only took heroin in prison. It takes you out of the place in your head, but it hooks you quickly. I suffer from depression and anxiety but even if I’m feeling really bad I still come down and get my medication.”

That same humility and regret is evident in 51 year old Glyn as he prepares for his final detoxification. “I’ve wanted to stop for 20 years – the drugs don’t work. This is helping me feel now’s my time. If I can get clean and help people like me I’d be happy.”

Alison, once a solicitors’ secretary wants nothing more than to get off crack cocaine and back to work. “I don’t enjoy it, I really don’t. But it’s a vicious drug, I don’t want to go out where everyone around me is using and you get judged – that’s why this service is so brilliant.”

Jason Thomas (below) sees that renewed hope in his clients. “People are in survival mode; they don’t have time to think. This set up takes away that feeling of being judged for where you’re at. ‘It gives someone space to reflect on what life without substance use could look like, starting the journey towards stability and future recovery’.

Fighting addiction can be exhausting.

For more information on Mersey Care’s drug and alcohol service visit: merseycare.nhs.uk

Many people have been given very little opportunity in life to thrive.