An interesting view of Community Drug Services.

[DavidS]

One of our regular methadone clients also has some alcohol "issues." We know this because she is never seen without a bottle of special water, which she prefers to our make of water for washing down her supervised dose, and everything else..

Yesterday she ran out of money, and, being honest, rather than shoplift her usual daily requirement of two litres of cheap vodka, had virtually* nothing alcoholic to drink.

This gave rise to a medical emergency: delirium tremens in a big way.

Anyway, I told her that rather than go without she should have got some tablets from the CDT which would have helped with the withdrawal. Here she stunned me with her pharmaceutical knowledge: "Oh, I've asked them to give me chlordiazepoxide but they won't let me on the program." I complimented her on her knowledge nd she told me that she's been on narcotics and alcohol since she was twelve, so has picked up a few facts along the way (she is now 30ish.) I asked her why they wouldn't let her on the program, and she said several uncomplimentary things about the CDT, that they didn't care, and said that seeing as she had been a regular customer of theirs for over 15 years they sould be prepared to spend some of the money they've made out of her, on her.

An interesting view.

*("virtually nothing" would still probably have killed me, but hey. And barely enough details have been altered to protect the characters)

[hibernia]

and she said several uncomplimentary things about the CDT, that they didn't care, and said that seeing as she had been a regular customer of theirs for over 15 years they sould be prepared to spend some of the money they've made out of her, on her.

An interesting view.

She makes a good point.
If it wasn't for her and her mates none of them would have a job!

[kathrynrothwell]

Just to defend the CTD to some extent, it would be very unsafe practice just to hand out benzodiazepines to every client who turned up saying they had run out of money for alcohol without a proper assessment and treatment plan. A positive decision to stop drinking is a very different thing from involuntary enforced withdrawal which may well lead to a situation when a client ends up both drinking AND taking the benzos which is clearly unsafe.

[DavidS]

which may well lead to a situation when a client ends up both drinking AND taking the benzos which is clearly unsafe.

... and which is often if not usually exactly what happens. I take your point.

Might it be ok to give cdp to help her to cut down, or is the mix just unsafe, period?

[kathrynrothwell]

I am a specialist nurse in substance misuse and hepatology rather than a pharmacist but in my experience to give chlordiazepoxide to someone who was still drinking would not be considered good practice and would be against clinical guidelines in normal circumstances. It would generally only be prescribed in cases where someone had made a decision to stop completely. If they wanted to cut down they could more safely be given advice on a regimen to reduce it with minimal withdrawal. The only common exception to that would be if someone with alcohol dependence was admitted to hospital for a short stay when they would be given chlordiazepoxide for the duration of their stay so that they did not withdraw, although this would be stopped on discharge unless the hospital had an alcohol in-reach service able to continue it.

[DavidS]

OK, thanks for sharing your expertise with us.

[admin]

Interesting......I once called a GP who had prescribed chlordiazepoxide to a guy I had just seen downing pints in the local pub! He still got his next script though.....

[johnep]

Drug abuse provides jobs for customs officers, police, and companies providing exchange supplies. If drug abuse stopped tomorrow, then unemployment would rise.
The multiple I was working for set targets for numbers of abusers on methadone etc. Said each addict worth £1,000 a year.
johnep

[kathrynrothwell]

Possibly, but some of us choose to work in the field because we think its important and valuable work rather than for the money

[johnep]

Drug abuse work is important and valuable in that the harm reduction it promotes means less HIV and hopefully less chance of my being robbed.
However, only know of two addicts who managed to change their lives around and become free.They did it by breaking free from those 'who led them astray'.
Noted that many addicts set up home together and they tend to gather together in groups. Unfortunately, drug use is the common factor.
What is the solution? I am tending towards the answer, remove the glamour, excitement and possibilty of dealer as a career by legalising and allowing on prescription.
That and banning drinking on the street as in USA, where my shoulder was tapped when I stepped outside of a bar to enjoy a drink in the spring sunshine on Cape Cod.
Or we could follow the example shown in Bankok Hilton.
Prohibition demonstrated not to work by USA experience.
johnep