TREATMENT
POWER
IN PRACTICE
Service users are accustomed to professionals exerting power over them . Nowhere is this more true than in drug and alcohol services , says Tom Zagoria
I work in a service where the power we exert frequently occurs at the overlap between ‘ risk management ’ and ‘ medication control ’.
We prescribe people with ‘ opiate substitution ’ treatments , providing buprenorphine or methadone to reduce their physical need for heroin or other opiates . However , if a service user is not engaging with support and regular risk reviews , I will be asked to put their script ‘ on hold ’ in the pharmacy , requiring that they attend an appointment prior to accessing their medication . For service users who are living in chaotic circumstances , I ’ m doing this regularly .
This is considered an important part of risk management , as if I were unable to properly assess a service user it would limit the support I could offer . If a service user never engaged with the service , we could not continue to prescribe opiates for them as it could pose risks to themselves and others in the community .
MENTAL HEALTH However , feedback from service users has been clear that this feels like a coercive imposition on their lives . While some have thanked me for putting their scripts on hold – forcing them to come into the service to ask for help – and others simply recognise it as a ‘ normal ’ part of how services operate , I ’ ve had service users arrive in tears because I ’ ve put their scripts on hold . Sometimes service users have shared that they missed appointments due to crippling anxiety , and by putting their script on hold I ’ ve made them the centre of attention in the pharmacy and forced them to attend the service on a ‘ bad mental health day ’.
Service users have shared similar feedback around being forced to collect daily supervised medication , rather than being provided with a week ’ s medication at once . These decisions do not fall under my power – they ’ re clinical decisions – however as the keyworker I ’ m the face of the organisation .
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10 • DRINK AND DRUGS NEWS • DEC 2023 – JAN 2024 WWW . DRINKANDDRUGSNEWS . COM