What I’ve Learnt: Independent Prescriber for Drug and Alcohol Addiction

During my last placement I had the wonderful opportunity to spend time with a nurse working for a local drug and alcohol addiction service. Here’s a bit of what I learnt:

The hidden community

There is a whole group of people living out in the community suffering from a variety of different drug addictions. These people often do not seek help from services and can sometimes have their own priorities when it comes to their treatment.

Alcohol withdrawal can kill you

Prior to spending time with this nurse I had absolutely no idea that if a person who is very dependent on alcohol goes cold turkey, then they are at a really high risk of having seizures. This is something I’ve written about in more detail here.

Opiate alternatives aren’t a bad thing

Despite what the media will tell us about how terrible it is for addicts to get opioids on prescription, sometimes this can be the only way for the person to manage their addiction. When a person is having to try and source heroin etc on the street, this can not only be incredibly expensive, but reduces their ability to hold any form of job or ‘normal life’. Ensuring that the client has access to an adequate supply of a safer drug (no chance of random ingredients being mixed in, something that can happen with street drugs) and that they don’t have to go on a hunt for it can enable them to get somewhat back towards a more ‘normal’ life.

Witnessed doses

Something else I didn’t know was a thing. Some clients can get their opioid drugs on the condition that they take it in front of the pharmacist in the pharmacy. This can be done every day, or the client may be given more than one day supply, but still have to have a witnessed dose every other day etc. This not only ensures that the client is taking the drug and not selling it but can also add some structure to their lives.

Most addicts don’t actually like being addicts

This didn’t actually surprise me, but I did find it quite striking listening to the clients talk about the impact of drugs on their lives, particularly the social and financial costs.

The role of an independent prescriber in alcohol and drug addiction

These nurse (and pharmacists) travel around the county assessing and reviewing opioid treatments and alcohol detoxes. They’re involved in a lot of health promotion and education as well as helping their clients get tested for a number of blood-borne viruses such as hepatitis B and HIV.

Stigma

There is still a lot of stigma associated with drug addiction, something that can sometimes be detrimental to people seeking treatment.

If the mountain will not come to Muhammad

Sometimes nurses need to find extra ways to ensure that their patients get any treatment they need – the nurse I spent time with had set up an informal clinic in a pharmacy so that clients in the area could have access to her services. She explained that if she hadn’t done this then it was unlikely that most the clients would have either been able to get to an appointment somewhere else or just wouldn’t have wanted to engage.

Extra bits

If you want to learn more all of the current guidelines relating to drug misuse can be found in the Orange Book and the BNF and NICE have created guidelines on alcohol dependence found here.

The nurse I was with recommended this book to me and it is excellent as explaining not only the background to most legal and illegal drugs, but also discusses research, guidelines and politics.

 

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