Sarah was only five years old when she first began experiencing chronic pain . Despite this , she didn ’ t receive a formal diagnosis until the age of 15 , and by this point she was already using heroin to manage the condition . Using illicit opiates on top of her prescribed medication soon became untenable , and Sarah entered drug treatment at the age of 19 .

Patients who report chronic pain can be treated with suspicion at the best of times – when also accessing drug treatment , that suspicion is compounded . When she first presented at her local treatment service , Sarah was being prescribed a range of pain medications including opiates , diazepam and gabapentin . In order to begin methadone treatment , however , she was told that she would have to give up all of these medications – no effort was made to factor her disability into her treatment plan .

Part of the problem comes down to the fact that substance dependence and pain management are dealt with by different doctors sitting within different institutions , making it much harder to take a holistic approach .

After several years without sufficient pain medication , Sarah was fortunate enough to see a consultant at a specialist orthopaedic hospital . The consultant had particular experience working with patients with a history of illicit drug use and dependence , working from an assumption that pain patients are telling the truth and are generally not exhibiting ‘ drugseeking behaviour ’. As such , the consultant prescribed Sarah an adequate amount of medication to control her pain , and took the view that to not do that would be more risky as it would leave her under-dosed and forced to top up through the illicit market .

Unfortunately for Sarah , this principle was not well understood by her other doctors , despite it being stated in the NICE guidance . Prescribers would often seek to reduce her pain medication even when she was being seen by them for entirely unrelated reasons . On one occasion in 2022 , Sarah saw her GP

regarding recurring eczema . With little discussion , the doctor made the decision to completely stop Sarah ' s diazepam prescription , without tapering and despite Sarah ’ s objections on the grounds of dangerous withdrawal . Sarah went on to experience symptoms including delusions , hallucinations , and three or four seizures every day . By the fourth day of withdrawals , Sarah turned once again to the illicit market out of desperation . After a week the prescription was quietly reinstated .

Sarah is now in recovery – for her , this means no longer using non-prescribed illicit drugs . For others in the recovery world , however , this is insufficient – Sarah has continued to encounter hostility and suspicion in recovery support spaces that deem any substance use , prescribed or not , to be unacceptable . She ’ s found that a lack of understanding of chronic pain and disability is widespread across all levels of the drug and alcohol field . Since then she ’ s gone on to work in treatment services herself , and has worked hard to advocate for improved accessibility and inclusion for disabled and chronically ill clients .

Drug treatment services have a difficult task ahead of them , as the fractured health and social

Sarah was only five years old when she first began experiencing chronic pain . At 15 she was using heroin to manage the condition .

care system makes it more and more challenging to provide any person with holistic care . These services have a greater responsibility to do better by people experiencing chronic pain , as we know that without addressing the pain itself , many of the goals people come to drug treatment with will not be realised . While structural changes are ultimately needed to address the fragmentation of healthcare , we can start to do right by patients with chronic pain by advocating for them to get the person-centred treatment they need , and – above all else – by believing them when they tell us what the problems are .

Fraser Parry is drugs advocacy and support adviser at Release

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