Saturday, December 18, 2010

Drug Addiction, When Is Intervention Really Justified?

A quick update on my MMT campaign before posting.   Most Government MPs that the information was forwarded to, did have the courtesy to at least acknowledge receipt of campaign material.   The exception being Hon Tony Ryall National Minister of Health, Ruth Dyson spokesperson Labour Party, Keven Hague spokesperson Green Party, and Russel Norman National Minister of Health & Well Being.   These MPs not responding at all indicates their level of respect and integrity for others views and concerns.   All that responded though stated Hon Dr Jonathan Coleman held the portfolio for Alcohol & Drugs so he would be addressing the issues raised in my MMT campaign.

Hon Dr Jonathan Colemans letter regarding my MMT campaign was received 26th November.   His response however was disappointing.   The letter read like a transcript that had been written for him promoting the value and benefits of using Methadone.   His attitude towards my views and concerns was somewhat arrogant and belittling, and he failed to really address any of the issues I'd raised.   His views were definite on the treatment programme and Methadone.   Quotes such as:   Some people may never withdraw from Methadone but live happy, productive lives.   The guidelines emphasise that long-term treatment is common for many medical conditions, and should be seen as a cost-effective way of prolonging and improving the quality of life, rather than as a treatment failure.   And it's 4.2 percent of people that voluntarily withdraw from opioid substitution treatment a year, not 2 percent as you stated.   He acknowledged therapeutic residential facilities have enabled many people to gain control over substance use.   However, such programmes are not useful, recommended, or cost-efective for everyone with substance use problems, so that aspect of my campaign was addressed but completely disregarded.   I have forwarded a letter back to Hon Dr Coleman responding to his response.

Lain Lees-Galloway, Labour Party spokesperson on Alcohol & Drugs did send an encouraging response though.   Stating:   I am aware you are not alone in your concerns regarding the MMT programme and that there are various opinions in the community as well as amongst treatment professionals about the way Methadone should be administered.   He was interested to know what response I'd received from the Government Ministers I had written to.   Copies of Hon Dr Colemans letter of response to the MMT campaign and my letter of reply dated 1st December was forwarded to Me Lees-Galloway for his interest.

I did also receive a very encouraging response from Mr Robert Steenhuisen, Regional Manager, Community Alcohol & Drug Services Auckland.   He addressed at length my concerns regarding Methadone and the treatment programme, and he did so with empathy and understanding.   He welcomed my comments and views and had pasted my information on to his staff.   An invitation was extended to have a meeting with him at CADS Auckland to further discuss the issues I'd raised, which I will endeavour to do early next year.

There has been no response received as yet to my MMT campaign from Media, or District Health Boards, except from Garry Smith, chief executive Auckland DHB, whom asked Mr Steenhuisen to respond on his behalf.   I assumed from Mr Steenhuisens letter that CADS personal are not permitted to respond unless it is approved by their area DHB, so that may be the reason for lack of response from Community Alcohol & Drug Services nationally.   Readers will be updated further down the track on MMT campaign.   Now to my posting and I will try and keep this one as short as possible.

Our first visit to Shane in Waikato hospital and my appointment with the hospital doctor was on the Wednesday, the day of his final surgery.   I was expecting to be greeted by a stressed, edgy Shane knowing his addiction and injury status.   But this wasn't the case in fact he was in a really buoyant mood and looked remarkably well considering all he'd been through over recent days.   Shane did speak of his pain and discomfort but said the pain medication 'Tramadol', plus his Methadone and sleeping sedative was helping to minimize this.   His good mood was apparently due to having his first cigarette this day since his admittance to Thames hospital the previous Thursday night and also this three ward companions.   Shane was confined to his hospital bed with his leg in traction for elevation until until his final surgery was completed at 10am that morning.   Even though he'd been on daily nicotine patches to ease his cigarette craving, he stated, they hadn't helped much and he was hanging out for fresh air and a smoke.   As soon as Shane had recovered from the anaesthetic the nurse located a wheelchair and one of the men from his ward took him outside for a cigarette.   Obviously, he'd been a good patient and room mate, or otherwise the staff nurse and his ward companion wouldn't have been so helpful and obliging.

I was so thankful of his buoyant mood and attitude because we'd decided that on this visit Shane would be forewarned to some degree about my rehabilitation plans, thus allowing him time to hopefully accept the changes before being discharged.   Which the doctor had indicated would be on the Friday.   Although necessary, it was a task I wasn't looking forward to especially knowing how protective he was of his drugged lifestyle.   However, Shane listened intently as I calmly and briefly explained that I'd be responsible for his Methadone and medications upon his return home.   Even though he accepted the news with dismay, it was very clear he understood why.   Choosing to omit telling Shane though, of the extreme measures I'd taken for that responsibility was intentional, knowing how sensitive the issue of my authority, especially for his Methadone, would be.   Privacy and lots of diplomacy, I knew, were going to be required to fully explain this news.   Therefore, this would be done on his discharge from hospital.   Overall I thought the visit and discussion went quite well, considering the bombshell I'd dropped.

Although Shane seemed reluctant to talk about the accident, it was obvious by his comments that he'd reflected enough to know how lucky he'd been to have survived it with only leg injuries.   Maybe the experience had frightened him, I hoped so.

The authority paperwork, requiring my signature and identification had been faxed through from CADS to the Methadone dispensing pharmacist in Thames.   All paperwork had been duly signed, verified and was ready to commence upon Shane's discharge.

Although I did feel confident and eager about rehabilitating Shane, there were moments of doubt and also this instinctual gut feeling of apprehension that was constantly churning within me about it.   I'd done all the research so I knew there were more negatives than positives regarding forced rehabilitation, and that's what I was basically doing.   Did Shane want it? Yes, deep down I think he did.   I'm sure most of those that are addicted loath and hate what drugs have done to them, I knew Shane did.   He always referred to himself as a 'scumbag' drug addict.   He'd witnessed what normal life was like for others around him and what they had accomplished, especially his two siblings.   Just simple things like husbands, wives and families while his life had stood still, and had done so for twenty odd years now, all because of drugs.   He had so much potential, and that's what was so heartbreaking for me about his addiction.   Shane did have the desire and loath of his drug lifestyle, but I think he honestly feared normal life as well.   Anyway, at what point or stage in a persons addiction is intervention really justified?   Do we wait until they are dead? Or maybe laying in hospital in a comotose state?   For days now I had grappled with my decision about taking control of Shane's life/addiction, but the answer was always the same, do it now because later just might be to late.   Those in life that have never failed, have never tried to succeed.

I would like to wish all my readers a very Merry Christmas and a happy festive season.

Saturday, December 11, 2010

Harsh Decisions, Will The Means Justify The End?

Sorry my postings are a bit long, it's difficult to keep to my story short with so much to explain.

For years I'd watched with a heavy heart Shane's decline into the hell hole of drug addiction without really knowing what to do about it.   I'd witnessed his torment and guilt and listened to his promises, but still didn't know what to do about it.   I just kept hoping and praying year after year that one day Shane would find the strength to finally cast his demons out, but alas that hadn't happened.   A mother's hopes and dreams can't be foiled that easy though, hence the reason why I never once in those years considered abandoning Shane's battle with drugs.

In all honesty though, he had continued to withdraw down his daily dose of Methadone, so he was making an effort to cast his demons out.   However in doing so, had been with the ever increasing risk that his abuse of other substances deployed.   My concern now was would the means justify the end.   This was a  dilemma I feared and one that I was in constant turmoil about, and worsened of course by the fact that I had no control over what the end may be for Shane.

But that fateful night of his accident proved my worst fears, that the means doesn't always justify the end.   I also determined at this point that intervention was required to allow Shane to be safely rehabilitated off drugs.   My intent was to gain authority to uplift and administer Shane's Methadone and medications, removing the temptation would help solve his drug abuse problem and hopefully keep him safe.   I would attempt to rehabilitate him myself in the home enviroment, but professional rehabilitation facilities would be investigated if difficulties arose.   So his accident although upsetting was to turn my dilemma into opportunity, it's success however, was an unknown entity.

I realized to do this would mean, basically, taking control of every part of Shane's life, especially the Methadone, which he was very protective of.   Contolling someone's life might sound harsh and drastic, and it is.   But an addicted person doesn't have control over their lives anyway, the addiction does.   So, really, I was only taking control of the addiction, not the person.   As a persons addiction progresses so does the risk and irresponsibility attached to it, and I didn't need research to verify this,  it was a pattern I'd witnessed, always watching, waiting and wondering, what to do about it.   I knew in my heart Shane never had a death wish, so I definitely wasn't prepared to accept death for him on any level, but certainly not by drugs anyway.

It's time to stop wondering, I told myself, just do whatever it takes now.   At least, gaining authority for Shane's Methadone and medications would give me some control over the abuse.   I thought, if he doesn't abuse then his mind will become clearer, and, in time he will see how good it feels to not be so drugged up.   Yes, it was being fanciful to think this, but feasible enough to believe it.

Well, it was the morning after Shane's accident and, even without sleep I felt invigorated.   Some huge decisions had been made overnight and I was eager to get the authority process underway, and have my rehabilitation plan established ready for Shane's discharge from hospital in a weeks time.   Contact was made daily with Waikato hospital for udates on Shane's medical status.   Shane had two trips to theatre, one on his first day in hospital, the Friday and again on the Sunday, to clean the leg wound.   After the last wound cleansing on the Sunday an open plaster cast was put on the leg.   The following Wednesday, Shane had his last trip to theatre to stitch the leg wound and pin the breaks in his ankle, then a more permanent plaster cast was applied, his leg remained in this cast for six weeks.   So his leg had suffered quite serious, significant injuries, which did reinforce the decisions I'd made and the reasons for them.

The first stage of my plan was contacting Shane's CADS caseworker in Manukau City, firstly, to inform him of Shane's accident and injuries, also of his serious abuse of other substances and the Methadone.   All of which had been responsible for the events that had lead to his accident and near death the previous night.   Secondly, to inform him of my intention to gain authority to uplift and administer Shane's Methadone, to hopefully end his abuse, hence, keep him safe.

I hadn't had a lot of contact of recent years with Community Alcohol & Drug Services regarding Shane and the Methadone.   However, my past contacts with them about my concerns hadn't been all that satisfying due to their obligation to protect Shane's privacy.   Therefore, I knew how this request for authority might be viewed.   But this time, I was staunch in my belief that, privacy issue or not, my concerns were justified and  weren't going to be flogged off.   I was determined to battle whomever I had to within the service to gain authority for Shane's Methadone, and that was that.

But, surprise, surprise, this time I received a courteous, understanding response.   Shane's CADS caseworker listened intently as I explained the accident, injuries and Shane's drug abuse.   He understood that my intent for authority was out of desperation and despair to help Shane.   To my great relief, no privacy issues were quoted this time.   And my concerns were immediately acknowledged and accepted as serious by Shane's caseworker.   He also agreed, under the circumstances, my request for authority of the Methadone wasn't unreasonable, and gave assurances it would be taken up urgently with the CADS medical practitioner/Director.   The CADS protocol to gain approval required Shane's injury status and blood results being verified and confirmed with Waikato hospital.   Final approval for authority was granted later that same day by the CADS medical practitioner/Director.

I was also informed by the caseworker of Shane's blood test results that were taken on admittance to Thames hospital, and they confirmed abnormally high amounts of 'Benzodiazepines' in his system.   Which confirmed my concerns and I'm sure aided my approval for authority over the Methadone.   Shane's drugged state was obvious on admittance anyway, but I feared a drug overdose may occur if severe pain relief was administered.   So as a precautionary measure I'd spoken with the attending doctor re: Shane's addiction, drug abuse and Methadone.   Doctors are naturally cautious, especially with the obvious so it was stupid of me to assume bloods wouldn't be taken before pain relief was administered, all the same the doctor was respectful of my concerns.   Hence, Shane had a very painful, uncomfortable night, but did receive his dose of Methadone and strong pain relief on arrival at Waikato hospital the next morning.   But I'm more than certain all those 'Benzo's' in his system would've helped ease his pain anyway.

Shane's caseworker was extremely knowledgeable about addictions inn general, and explained some of the problems that can be experienced when withdrawing off Methadone.   Which most I'd experienced first hand dealing with Shane, but he was such a nice man that I extended him the courtesy of listening anyway.  He did explain the rehabilitation process, and that it can be slow and difficult outside the professional arena of a residential centre.   However, I was informed that Shane's transfer to CADS Thames had been completed, and Shane's new caseworker would be working closely with myself and Shane with the rehabilitation and withdrawal off the Methadone process.

Stage two of the plan was contacting Shane's general practitioner to inform her of what had befallen Shane and why, and to make her aware Shane will abuse any medications prescribed, and for that reason it was my intent to gain authority over all his medications upon his discharge from hospital.   The doctor only required Shane's approval for me to be given this auhtority.   I didn't foresee a problem gaining that, once his situation was realized upon discharge from hospital.

Stage three was making an appointment with the doctor in charge of Shane's care at Waikato hospital.   With whom I discussed the drug abuse, why and how Shane's accident happened, his injury convalenscence, our concerns for his safety, and of my request for authority over all his prescriptions upon his discharge from hospital.    My authority request was granted without hesitation.   I did realize the approvals for authority from CADS and the doctor at Waikato hospital were only granted due to the circumstances of Shane's accident and his drug addiction problem.   All concerned were aware that my intention for authority was, firstly, to try and keep Shane safe and, secondly, to attempt rehabilitation.

The last phase of my plan included contacting residential rehabilitation facilities within the Auckland region, for professional advice on Shane's addiction, rehabilitation methods, and also the criteria regarding entry into their treatment facilities.   This inquiry was a back up measure, just in case I needed it.

I'd been extremely busy organizing my plan, but I'd also fought all day with my conscience about the right and wrongs of the decision for authority, and what I was about to do but, in the end decided it was my only option to minimize Shane's drug abuse.

Shane had abused over a long period of time so to regain control of the addiction he now needed to be stabilized.   Removing control would accomplish this, as it would remove the temptation for further abuse.   With these 'authorities for control' and the extra knowledge I'd acquired through research, I was hopeful, and quietly confident, of reclaiming my son's life and soul back from the evil and darkness that addiction had shrouded him with for many years now.

Although quietly confident, I was slightly nervous though about having to explain to Shane the contacts I'd made and the measures I'd taken since he'd been in hospital.   I fully expected him to question everything I'd done, especially my authority over his Methadone with some distaste and anger.   But, after many years of waiting, I now had the opportunity to finally crack Shane's addiction.   Even the anticipation of small disagreements and problems on his return home from hospital, couldn't faze the positivity flowing within me about this.

The first stage of Shane's rehabilitation plan was his convalescence, and it was important not to just strengthen his body, but his mind and soul as well.   Love and respect would restore Shane's dignity and self worth, but pride in his life, and the value of it, wouldn't be so easy to restore.   This addiction journey had been a difficult one for all concerned, but as I'd grown older the journey was becoming more difficult for me, so I knew this had to be my final battle.

Rehabilitating Shane wasn't the challenge, but removing the addictions that had plagued him for years was.   Shane had multiple addictions now, so each addiction, including the Methadone, would have to be dealt with separately.   I felt two years to achieve this goal was being realistic.   The proverb 'you can conquer anything with faith, love, courage, and strength,' I hoped, was true.