Alcohol at last

I have been neglecting you, for which I apologise.... the months whip around and before you know it, I am behind on posts by 2 months. So what is new? well at last alcohol seems to be getting some priority: the pathetic little DES for screening new patients is sure to be followed up with locally commissioned more serious interventions, and I am pleased to report that the RCGP SMU is "on the case", and an Alcohol Certificate should be introduced next year: it will aim at screening, brief interventions, community detox etc and will be kite marked and DANOS referenced, we are very excited about it - watch this space.

Drugs and The Law

Here is a REALLY useful resource which many of you would benefit from: Release, which has campaigned tirelessly to reform drugs laws over the past 25 years, has produced this excellent booklet. It is a very pragmatic and easily accessible document which gives exellent and authoritative advice on all matters pertaining to the subject, including advice on criminal records and employment, a step by step guide through the process of Court appearances, Police powers, the legal classification of drugs and much more. Make sure that you have a copy in your practice library, end even more important, make sure that your Shared Care worker has a copy available at all times - better still, buy him/her a copy as a Christmas thank you present for all their hard work. They are available online or on paper, and Release need your support and donations - click the link on the right and contact them.

Prescription Wording

Possibly the most miserably tedious bit about the work that we do, is writing out FP10MDAs - we are bound by the most absurd and pedantic regulations - and any slight straying from the rules places the poor pharmacist at risk of censure from his monitors, and our patients at risk of having their essential medication stopped until a properly worded script is obtained. I am grateful to my colleague Nigel Modern for preparing templates for methadone and buprenorphine in Rich Text Format which make the whole business of prescription writing easy and legal - if you would like me to send them to you, then please email me: gordonmorse@gmail.com . They can be used on any computer system and all your problems will go away - now that is something useful from this Blog at last!

To check whether the wording on your templates is concordant with the latest from the DoH, look to pages 106 and 107 in the 2007 Guidelines.

CHRISTMAS SPECIAL!!! Don't forget to add the magic words to scripts over the Holidays: "Instalments due on pharmacy closed days may be dispensed on the day immediately prior to closure"

Conferences, conferences

OK - so you a re a very busy GP and have little time for your family, let alone feeding your brain.... but your career depends on you being both up to date, and refreshed after taking time out to relax, to be stimulated and to hone your skills. So treat yourself to a conference or two.... and this year in the South West you can treat yourself to two excellent events: the SMMGP annual conference rotates around the UK and this time it is our turn. And the South West regional Shared Care conference also has a particularly strong line up of presentations. And finally, don't forget the Release conference - where you can get radical, get educated, and get objective.... I wont prioritise these excellent events because they are different and are all excellent .... and sadly even I can only get to two of them.... so you all make sure that you get to at least one.... see you there.

STOP PRESS - you can get ALL the presentations at The 2008 National Conference on Injecting Drug Use by clicking here thanks to those marvellous people at Exchange Supplies.

Buprenorphine in Overdose?

Fellow devotees of "Addiction" magazine will have shared my fascination for a case report in this month's edition of a heroin addict whose life was apparently saved by the timely administration of buprenorphine by his mate..... as we all know, most injecting heroin users have themselves experienced overdose or been with someone else who has, and the majority of most overdoses that end up dead are witnessed long before calling an ambulance. This has led many to distribute naloxone injection with education to those in treatment, so that they can identify signs of overdose in others, and administer it before emergency services arrive.
But this is the first time I know of where a resourceful user (on take-out bupenrorphine) recognised the state of his friend with the blue lips, crumbled up one of his tablets and placed it under the tongue of his unrousable colleague. The subject woke up "all angry" within 10 minutes....
We all know of the paradoxical antagonism of buprenorphine at dose initiation, and this of course makes sense.... I wonder if we can make better use of this "off piste" use of buprenorphine?

“Recovery” – what’s in a name?

Some of you will have been bored by me banging on from various platforms, about the idiotic mud slinging that goes on between the ultra orthodox abstentionists, and the similarly entrenched harm reductionists. The slurs of danger and ineffectiveness have reached the public whose knee jerk take on all this, is that treatment of drug misuse simply doesn’t work.
In an attempt at some sort of mutually agreeable interpretation of the word “recovery”, Professor John Strang and various professionals and service users from ALL across the divided treatment spectrum got together in a smoke filled room for two days to thrash it out. Known as the UKDPC Consensus group, this is what they came up with:

Recovery is a process, characterised by voluntarily maintained control over substance use, leading towards health and well-being and participation in the rights, roles and responsibilities of society.

And I rather like it. It means that recovery, being a continuous process of accruing benefits, may begin well before abstinence (indeed abstinence may never occur in some cases, despite big recovery gains), and similarly, there may be further recovery to take place after abstinence has been achieved.

So that’s the end of the arguments then………..!

Ketamine

Either I am just looking for it, or there really is a phenomenon going on out there.... I seem to hear of more and more people using ketamine. What was once just one of many chemicals used occasionally at raves seems to be becoming much more widely used. You will recall that it was popular with anaesthetists as a safe short acting anaesthetic that didnt depress respiration - but because many people found the onset of anaesthesia very frightening, reporting hallucinations, nightmares and out of body experiences, it fell from favour but was taken up by vets, presumably because either animals like dissociative experiences, or more likely, they can't tell us about them afterwards.

But clearly some of our patients love the stuff: usuall snorted, it can cause an unpleasant inflammatory sinusitis, and if injected, getting the dose right is tricky or anaesthesia follows rapidly and you can injure yourself. Long term heavy use often causes a painful and non infective cystitis. But noone seems to know what more harms can follow the use of this drug, and perhaps websites such as this can help. So if you have come accross any stories of ketamine related harms, please let me know and I will spread the word.