SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Medications in recovery: Robbie's story (Sep 2012)

I was pleased that the recently published "Medications in Recovery" report makes it clear that "arbitrarily or prematurely curtailing opioid substitution treatment will not help sustain recovery", for whilst I am keen to see people become abstinent from illicit drugs, I have never been a proponent of time limited treatment. I believe that the individual patient has a much better idea of where they are and what they are trying to achieve and my role is to help facilitate them to achieve their goals - albeit that this may occasionally entail a gentle push.

Reflecting on the sensible advice from the expert group reminded me of Robbie who first turned up at the practice about 15 years ago. He had been sleeping rough, was underweight, unkempt, had chewing gum stuck in his hair and the broadest Scouse accent I had heard since moving down from Liverpool to Birmingham 10 years earlier.

Much of his story would be familiar to you; he was estranged from his family in Liverpool and felt too much shame to return whilst he was still using drugs. He had rapidly progressed from smoking heroin to injecting it and as a result of poor technique his arms were a mass of scars and lumps and he had begun to inject in his groin.

Over the next few months he stabilised on OST, started a relationship [although a fairly stormy one!] and generally he felt he was doing well. He would come and see me every few weeks and I hope he got as much out of these visits as I did. After about 18 months he told me he wanted to come off methadone as he "owed it" to his family and partner. A slow reduction ensued and all was going well, and the last time I saw him for a while he was down to 5mls of methadone a day.

Somewhat naively at that time I assumed he had simply stopped taking methadone and not felt the need to come back and see me. I was quickly disabused of this idea when his name came up on my computer screen and I went into the waiting room to call him.

Things had deteriorated quickly when he realised that his relationship was not the source of support he had hoped it would be and having ended it, he effectively became homeless. Sofa surfing amongst "old friends" had led to a reintroduction to heroin and guilt-ridden, he was indulging in riskier drug use than before and his neck veins were now the choice for injecting. Despite this, he admirably had found the strength to come back and tell me what had happened.

We restarted his methadone and with persistence from his drug worker, permanent accommodation was found for him. Stable once more, he went off and did a college course to improve his literacy skills. He started volunteering with a local church's mental health support group. After a couple more years he told me he wanted to come off methadone again, although this time he said he wanted to do it for himself and not out of a sense of duty to anyone else.

Partway through the reduction he got offered a job and moved to a different part of the city and off my list. This time I had to hope he would continue to do well. Many years later there was a Christmas wish from him in my inbox: he had been off all drugs, including medication, for 5 years, he was working, and still volunteering and had found a role in society he had thought impossible to achieve when we first met.

No one is beyond recovering from problematic drug or alcohol use, but it is their recovery, not ours, and they define it. We are just lucky enough to share the ride.

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