PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

“To be a more successful country we need to see an overall improvement in our population health, and we need to close the gap between the health of our wealthiest communities and the health of our poorest. Only through an effective partnership, can we make the best use of our collective resources and work together to tackle our most difficult challenges – making a real difference to the prosperity and wellbeing of our communities.”
Rt Hon Nicola Sturgeon MSP
First Minister of Scotland

In order to positively impact the financial and emotional burden upon the A&E-NHS of vulnerable people seeking help with mental and addiction healthcare issues it is time to actualise expanded acute care clinics that can be implemented into the public health sectors.

I am a person in longterm recovery – 31 years of lived experience that began with an encounter in A&E following a failed suicide attempt.

I failed not because I am alive today, I was fortunate to not have the courage to kill myself… flipping this into having the courage to live, is primarily because of an intervention by a psychiatrist in recovery who offered me choice: return to 12step meetings. OR be admitted, and medicated but not be treated for substance mis-use (cocaine) alcohol dependency (straight vodka), and prescription pill abuse (valium).

I returned to 12step meetings, which takes courage to admit defeat, and humility to ask for help…which I did as I spoke about the past 24 hours, walking through Central Park looking for someone to murder me…and that familiar feeling of desperation….something shifted… and I knew I needed to get help…I left Central Park and caught a cab to Payne Whitney, a psychiatric hospital where the intervention took place…

From that moment on I have never been alone in my recovery. I ask for help. At different stages in my recovery it has been of great value to work though the 12steps with my A.A. sponsor.

The befits of recovery are numerous…one is that I am kinder, compassionate, happier and available to do service in the recovery community: starting step and topic meetings in remote rural Indian Villages and Chelsea, London.

When I lived in NYC I went along with a few people in recovery to learn how to take meetings into hospitals and prisons. It is challenging to see, hear and and witness incarcerated people whose entire existence is absent from love, care and community, they are so isolated yet the ones who want help seek us out…even if their “recovery world may be unconfined space…their recovery world is huge–millions of people are in recovery and available online to talk about how to not relapse and shift the focus from self sabotage to one of self care….

In my longterm recovery experience, I will have 31 years on the 12th October, 2019…and my trainings in the fundamentals of addiction, coaching, counselling, psychotherapy, life is incredibly fulfilling.

Despite people in need of recovery resisting engaging in treatment….I know from experience that if that person sitting opposite them is in recovery they will have better chance of surrendering… as a clinician that people suffering who are within the spectrum of addiction: sex addiction, sugar, fat salt addiction, illicit drugs, prescription drugs, alcohol, and or workaholism…. whatever their drug of choice is, they can recover…there is hope…to break the cycles of deep suffering.

Addiction is complex…and can be exacerbated by trauma from the past being triggered in the present…creating a cascade of obsessive thinking, (cravings) irrational behaviours (compulsivity) anxiety, depression and suicidal ideation.

My therapeutic biopsychosocial approach is compassionate, mindful and is about empowering people, meeting them where they are….when they in need of help with addiction.

Vulnerable, at risk people have a right to be treated, not dismissed, and discharged. However, due to cutbacks, long waiting times and lack of experienced in addiction trainings first responders, doctors, nurses and associated healthcare workers, people are being turned away away instead of receiving treatment.

We are experiencing a health emergency. A radical restructuring of mental and addiction healthcare needs to actualise how people in need access and receive healthcare.

It is not good enough to say universal addiction will cost millions, actually addiction is costing people their lives…. addiction and mental healthcare is already costing billions globally: loss of income, loss of family, loss of life….

Changes in how vulnerable people access treatment is what I am suggesting for them to have a choice: a medically supervised impatient detox, impatient primary treatment plan with aftercare upon discharge to support the varying stages of addiction recovery or be discharged with appropriate medicine.

The NHS Health Scotland “Burden of Disease” study highlights that alcohol and drug dependence are major contributors to absolute inequalities and recommends that alongside other measures we must tackle conditions that are more prevalent within higher levels of deprivation.

Like many international cities, Glasgow has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased tenfold, with a dramatic spike over the past few years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Glaswegians reported knowing someone who had died from an opioid overdose.

The 2018-19 death toll 1,127, is even more tragic in light of the many effective treatments for opioid use disorder that exist. Overdose-reversal drugs, naloxone and -approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths, but they aren’t consistently getting into the hands of the individuals or the communities that need them most.

What motivates me to continue to do service in the wider recovery community, to raise addiction awareness, and strive for essential changes in the dismissive, negative, judgemental language and perceptions that defines addiction? In my daily commitment to recovery I know I ned to reach out to my recovery tribe. It is my connecting with other recovering people that I feel “at home” accepted, seen and heard.

It is by overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) and making accessible inpatient and outpatient primary care, inpatient and outpatient addiction medicine treatment programmes that will save lives, NOW that is needed.

Let’s stop talking about what to do about addiction recovery ….we know what to do, and we know why people are dying from opioid overdoses…

I am currently engaged in forming strategic partnerships with Scottish recovery organisations to strengthen the focus on a full spectrum of addiction care: prevention, treatment, remission, aftercare, and re-generation of relationship with family, workplace and recovery communities.

The plan includes: patients and their families and will highlight the personal experience of addiction in much closer view aimed at leading scientific and medical progression in the field. It also exemplifies a firm recommitment to providing continued education for all treatment providers.

Renewed and redesigned goals amass to form a robust foundation and profound course of action in the spirit of the recovery from active addiction.

With a strategic plan in place, the opportunity to set standards, pioneer research, educate healthcare professionals and the public, challenge stigma, endeavours to enhance the goal of holistically treatments from medically supervised detoxes, to save lives, and reduce the financial burden upon the person in need of recovery, their family and community..
This strategic plan provides to guide and prioritize that way forward.

• Positive changes are seen as starting points for the recovery process: reduced harm, safer use, reduced use, moderation and potential abstinence.

• A comprehensive initial assessment will determine an initial personalized treatment plan based on substance use severity, the psychobiosocial factors, multiple meanings and functions of the behaviour, motivation to change, and insight.

• Effective treatment has a primary focus on engagement and therapeutic alliance throughout the assessment process that “starts where the person is” with empathy, respect and acceptance, because creating safety and support are seen as essential to the therapeutic outcomes.

• Teaching self-management skills to address urges and difficult emotions is often essential. An ongoing assessment throughout treatment deepens both client and therapist awareness of the addiction severity and its meaning and functions.

• Exploring the client’s resistance about change reveals the issues that need new solutions. As these issues are clarified, positive change goals around the substance use and these issues can be established.

• And, finally, a personalized plan for pursuing these positive changes can be developed collaboratively between client and therapist. The plan may include a variety of therapeutic modalities, lifestyle changes, health practices and medications depending on the client’s needs.

It is time for sustainable addiction healthcare programmes, that are accessible 24/7.

Elizabeth Hearn, HP/NCH. SMAPPH
ELIZABETHHEARN.COM
+447894084788

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

“Addiction is a global health emergency. Policy makers, and mental health ministers can work with third sector recovery communities in changing the addiction healthcare narrative from “what to do?” …to actualising implementing addiction healthcare clinics: 24/7 A&E-NHS hospitals settings within the United Kingdom” Elizabeth Hearn. Addiction Clinician. Therapist. Educator. Addiction Healthcare Influencer.

I founded Universal Addiction Healthcare in response to the consistently increasing number of drug and alcohol related deaths in the UK but particularly in Scotland.

The aim is to provide comprehensive addiction training for all healthcare medical professionals, so that they can work along side third sector, recoverists , to provide a compassionate and holistic treatment in response to people in need of mental and addiction healthcare, in crisis at Accident and Emergency Departments.

Addiction is not a criminal justice issue but a public health issue which requires specialist training and insight into the medical and psychosocial nature of the illness.

I believe in the benefits of accessible and available addiction healthcare and of an individual’s right to expect effective, inclusive and compassionate treatment from NHS Services without fear of judgement or negative consequences

I am an addiction clinician and therapist, with 28 years of addiction healthcare treatment programmes experience, and 30 years of longterm addiction recovery to support fulfilling my professional and personal recovery obligation: continuing to provide addiction and mental healthcare to individuals and families in need of help.

In January 2019 I initiated a partnership with the American Society Addiction Medicine to provide evidence-based/fundamentals in addiction trainings and resources to augment healthcare providers in the United Kingdom of the skills and knowledge they need to treat addicted patients.

I am proposing implementing 24/7 addiction emergency treatment clinics within A&E-NHS settings. facilitated by trained in the ASAM “Fundamentals of Addiction” medicine healthcare professionals, in addition to the Scottish Recovery Consortium lived experience – third sector support volunteers for people in need to access 24/7 addiction and mental health primary care integrated treatment programmes. Easy access to the most effective approach for supporting person-centred addiction and mental healthcare.

The following links reveal the backbone of the American Society of Addiction Medicine’s evidence-based research and teachings:

The ASAM definition of addiction:
http:// https://www.asam.org/resources/definition-of-addiction

“We know it’s possible to make inroads and see real progress in preventing addiction and advancing its treatment,” concluded Dr. Earley. “And while the cost of addressing every facet of the addiction crisis is substantial, the cost of doing less than what is absolutely necessary is far more.

We need the political will of lawmakers to pursue bold, systemic solutions. There is no time left for incremental policy changes – we need to come together as a nation to both implement and fund the programs that will comprehensively address the complex, chronic disease of addiction.”

ASAM advocates urged Congress to support the following legislation to address America’s addiction crisis.

The Comprehensive Addiction Resources Emergency (CARE) Act (H.R. 2569/S.1365). This legislation will provide critical funding and resources now and over the next decade to strengthen our nation’s addiction prevention and treatment infrastructure and expand access to evidence-based care.

The bill allocates billions of dollars in funding to train health professionals in the diagnosis, treatment, and prevention of substance use disorder (SUD) and helps standardize addiction treatment by directing the Department of Health and Human Services, in consultation with the American Society of Addiction Medicine (ASAM), to develop model standards for the regulation of SUD treatment services based on Levels of Care standards set forth by ASAM in 2013 or an equally strong set of standards.

It also allocates funding to states, local governments, and other institutions to support SUD treatment programs and expanded access to evidence-based prevention, treatment, and recovery support services.

The Opioid Workforce Act of 2019 (H.R. 3431). This legislation will increase the number of residency positions eligible for graduate medical education payments under Medicare for hospitals that have, or are in the process of establishing, approved residency programs in addiction psychiatry, addiction medicine or pain medicine, with an aggregate increase of 1,000 positions over a five-year period.

The Medication Access and Training Expansion (MATE) Act is legislation designed to ensure all DEA controlled substance prescribers have a baseline knowledge of how to prevent, identify, treat, and manage patients with SUD. The MATE Act will require that all DEA controlled substance prescribers receive one-time training on treating and managing patients with SUD, unless such a prescriber is otherwise qualified.

It will also allow accredited medical schools and residency programs, physician assistant schools, and schools of advanced practice nursing to fulfill the training requirement through a comprehensive curriculum that meets the standards laid out in statute, without having to coordinate the development of such education with an outside medical society or state licensing body. Importantly, the legislation’s required education also satisfies the DATA 2000 X-waiver training requirement to prescribe certain medications for addiction treatment, as long as a separate DATA 2000 X-waiver is required by law.

This legislation is expected to be filed soon.
The Humane Correctional Health Care Act (H.R. 4141 / S. 2305). This legislation will allow states to use federal Medicaid matching funds to cover healthcare services provided to inmates of public institutions under Medicaid.

The Community Re-entry through Addiction Treatment to Enhance (CREATE) Opportunities Act (H.R. 3496 / S. 1983). This legislation will create a new grant program within the Department of Justice for state and local governments to cover and provide evidence-based opioid use disorder (OUD) treatments, including medications for addiction treatment, in their correctional facilities and connect individuals to continued OUD treatment upon release into the community.

Additionally, ASAM advocates are asking Congress to make strategic investments to incentivize and train clinicians to specialize in the prevention and treatment of SUD by fully funding previously authorized programs. This includes allocating $25 million in the fiscal year 2020 Labor, Health and Human Services, Education, and Related Agencies appropriations bill for the Substance Use Disorder (SUD) Treatment Workforce Loan Repayment Program and $10 million for the Mental and Substance Use Disorders Workforce Training Demonstration Program.

About ASAM

The American Society of Addiction Medicine (ASAM), founded in 1954, is a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine.

ASAM is dedicated to increasing access and improving the quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addiction. For more information, visit:

http://www.ASAM.org.

ADDICTION RECOVERY RESOURCES.

Google is launching a new website it’s calling “Recover Together” that collates resources for addiction recovery in the United States. The site includes Google Maps-based search for resources like recovery support meetings and pharmacies that offer Naloxone without a prescription — it’s a drug that can be used to counteract opioid overdoses. The new site will be linked under the search bar on Google’s most valuable real estate: its home page.

The company says that it’s partnering with the Recovery Resource Hub to fill out its maps. Vetted sources are especially important in rehab, where scams can run rampant. Google itself ran afoul of those problems in 2017, when we reported on how rampant scams were in Google’s own search results. Google cracked down, banning many rehab ads, though it allowed vetted ones back onto the Google homepage beginning in April 2018.

The new page Google is launching today won’t feature ads, instead offering basic information on recovery, treatment, and prevention — with links to trusted resources.

Click on the link to find out more:

https://www.theverge.com/2019/9/12/20861764/google-addiction-recovery-website-resources-naxolone

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

For 28 years I have worked as an Addiction Professional in all three sectors within the UK, Australia, India and America.

I am committed to changing how people in need of addiction and mental healthcare access treatment. Addiction treatment has varying stages to engage the person seeking recovery from active addiction: I recommend that a person-centred addiction treatment programme begin with a psychosocial assessment, treatment evaluation process to determine the appropriateness of an inpatient medically supervised detox.

Often I will post updates via the interdisciplinary approach being implemented @ Boston Medical because we do not have the standard of services here within the uk. We desperately need to be adapting addiction medicine protocols within A&E-NHS Hospitals.

UNIVERSAL TRAINING EXPANDS ACCESS TO TREATMENT

Medication for Addiction Treatment (MAT) has proven to be highly effective in addressing substance use disorder, yet only a fraction of those who could benefit from it are receiving it. One hurdle is that health care professionals must be authorized by the Drug Enforcement Administration (DEA) to prescribe addiction medications like buprenorphine. Under DEA regulations, providers must be “waivered” to prescribe MAT.

The Grayken Center launched an initiative that makes Boston Medical Center a leader among hospitals nationwide by implementing universal waiver training for physicians and other medical professionals across all of its primary care departments. The importance of the waiver training goes beyond prescribing MAT, and establishes BMC’s commitment to reducing the stigma around treatment of SUD and creating an environment where there can be an open dialogue between patients and all providers, leading to better care.

“The urgency of the opioid crisis means we have to accelerate everything and provide access to evidence-based medications when and where our patients show up.” said Colleen Labelle, Director of Office Based Addiction Training and Technical Assistance and of the Opioid Addiction Treatment ECHO at BMC. “Part of that effort involves making sure we train all providers, giving them the knowledge to have conversations with patients about substance use and facilitate seamless access to treatment. It’s also an important part of ensuring that providing addiction care isn’t optional but becomes a standard part of medical practice.”

BMC has already completed Phase 1 of this effort, which involved training all general internal medicine residents. Family medicine providers have also been trained. Trainings are underway for residency instructors and emergency department clinicians and next up are OB/GYN physicians and nurse practitioners, family medicine residents and general internal medicine physicians.

ABOUT ADDICTION
Addiction is the most pressing public health crisis of our time. It is a chronic, medical condition that can impair health and function and is characterized by repeated use of a substance despite harmful consequences. Prolonged substance use can cause changes to the brain, making it important to get someone with unhealthy alcohol or drug use into treatment as quickly as possible. People with substance use disorders often have other chronic health conditions, and they can be made more difficult to treat because of substance use. There is effective treatment available for substance use disorders and most people with substance use disorders do recover.

ADDICTION CAN OCCUR FROM:
Genetic predisposition
Psychological factors (i.e., stress, depression, anxiety, eating disorders, personality and other psychiatric disorders)
Environmental influences (i.e., exposure to physical, sexual, or emotional abuse or trauma, substance use either in the family or among peers, references within popular culture)
Starting use of alcohol, nicotine or other drugs at an early age
More than 20 million people in the United States now live with an addiction, costing more than $400 billion in health-related costs each year. At BMC, we care for thousands of individuals with addiction each year. In fact, 34% of individuals transported by Boston EMS for drug-related illnesses are brought to BMC for care.

WHO IS AFFECTED?
Everyone is affected by addiction. It is not a disease of the underserved, of those who encountered a rough patch in life, or the uneducated. It is affecting every socioeconomic bracket of our country, every neighborhood, and every ethnicity. Consider the following:

21.7 million people aged 12 or older needed substance use treatment. 2.3 million (10.8) received treatment at a specialty facility in the past year.

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

Medication for Addiction Treatment (MAT) has proven to be highly effective in addressing substance use disorder, yet only a fraction of those who could benefit from it are receiving it. One hurdle is that health care professionals must be authorized by the Drug Enforcement Administration (DEA) to prescribe addiction medications like buprenorphine. Under DEA regulations, providers must be “waivered” to prescribe MAT.

The Grayken Center launched an initiative that makes Boston Medical Center a leader among hospitals nationwide by implementing universal waiver training for physicians and other medical professionals across all of its primary care departments. The importance of the waiver training goes beyond prescribing MAT, and establishes BMC’s commitment to reducing the stigma around treatment of SUD and creating an environment where there can be an open dialogue between patients and all providers, leading to better care.

“The urgency of the opioid crisis means we have to accelerate everything and provide access to evidence-based medications when and where our patients show up.” said Colleen Labelle, Director of Office Based Addiction Training and Technical Assistance and of the Opioid Addiction Treatment ECHO at BMC. “Part of that effort involves making sure we train all providers, giving them the knowledge to have conversations with patients about substance use and facilitate seamless access to treatment. It’s also an important part of ensuring that providing addiction care isn’t optional but becomes a standard part of medical practice.”

BMC has already completed Phase 1 of this effort, which involved training all general internal medicine residents. Family medicine providers have also been trained. Trainings are underway for residency instructors and emergency department clinicians and next up are OB/GYN physicians and nurse practitioners, family medicine residents and general internal medicine physicians.

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

IT’S TIME FOR METHADONE TO BE PRESCRIBED AS PART OF PRIMARY CARE
BY JEFFREY SAMET, MICHAEL BOTTICELLI, AND MONICA BHAREL
This article was originally published by STAT: https://www.statnews.com/2018/07/05/methadone-prescribed-primary-care/ on July 5, 2018.

Opioid use disorder, which claims 115 lives a day by overdose in the United States, is a complex, chronic medical condition, but one that can be successfully treated with proven medications. And yet, one of the oldest and most effective medications to treat this disorder – methadone – is out of reach for many people, largely due to outdated federal laws.

Of the three medications approved by the Food and Drug Administration to treat opioid use disorder, federal law relegates only methadone to be dispensed in separate clinics apart from the general health care system. It’s not unusual for methadone clinics to be in out-of-the-way locations and often inaccessible by public transportation, especially in rural and suburban communities. When individuals trying to treat an opioid use disorder can’t get to a methadone clinic on a daily basis, they can’t get treatment.

The other two federally approved medications, buprenorphine and naltrexone, can be prescribed and administered in primary care settings, where treatment can take place as part of an overall clinical care plan.

Methadone is typically taken daily in a highly structured setting, an approach that benefits many patients. But methadone should be treated no differently than other FDA-approved medications for opioid use disorder. As we write in the New England Journal of Medicine, it’s time for Congress to remove this barrier to treatment and allow methadone to be prescribed in primary care settings, as well as in existing standalone clinics.

Only about 20 percent of Americans who have an opioid use disorder are being treated with buprenorphine, naltrexone, or methadone, a woefully small percentage that shows the extent of the barriers to treatment that we need to remove to stop this public health crisis. Restricting the availability of methadone to designated clinics has contributed to this treatment gap.

Methadone has been available by prescription in primary care clinics in Canada since 1963, in Great Britain since 1968, and in Australia since 1970. In these places, methadone is the most commonly prescribed treatment for opioid use disorder, and it isn’t controversial because it has been shown to benefit the patient, the care team, and the community.

Methadone works. In a 2017 review of all causes of death among people with opioid use disorder, those receiving this medication were one-third less likely to have died during the study period than those not treated with methadone.

Methadone is a synthetic opioid that reduces cravings and withdrawal symptoms for heroin and other opioids. Developed in 1937 as a pain medication, it was first studied as a treatment for heroin addiction in New York City in the 1960s.

By the 1970s, the system for delivering methadone that we know today had been fully developed. Patients visit a designated clinic, typically every day, take methadone under observation, and get specialized, highly structured care, including counseling and periodic drug tests.

The methadone clinic model was carved into law in the United States in 1974, when Congress passed the Narcotic Addiction Treatment Act. The regulations around methadone, driven by fears of accidental overdose and diversion, evolved in such a way that primary care physicians almost never delivered methadone treatment. Stigma and a not-in-my-backyard mentality resulted in the placement of a sizable number of methadone clinics in locations that were hard for many to reach.

The last time Congress expanded access to medication for opioid use disorder in primary care was when it passed the Drug Addiction Treatment Act of 2000. It allowed physicians to prescribe and administer buprenorphine in their offices, making this medication more available to thousands of patients. But the barriers to the delivery of methadone remain intact.

Methadone has saved many lives and could save many more. Several studies have shown that methadone treatment in a primary care setting is both feasible and successful. In rare cases, it has been allowed in primary care offices. Our experience in Boston over a 10-year period with a limited number of patients who received methadone treatment in a primary care setting after being stable in a methadone clinic was excellent, with no adverse incidents.

We call on Congress to allow methadone treatment to be delivered in primary care settings, as well as through special methadone clinics. That would be just the beginning. We also need to enhance physician training about opioid use disorder, create incentives for prescribing medications to treat it, and integrate treatment into existing models of care.

From the federal government down to community partners, we are all desperately searching for solutions to stem the opioid epidemic. Increasing the availability of medications that can effectively treat opioid use disorder – including methadone – will be essential if we are to succeed in saving lives.

Jeffrey Samet, M.D., is the chief of general internal medicine at Boston Medical Center and a professor of medicine at Boston University School of Medicine. Michael Botticelli is the executive director of the Grayken Center for Addiction at Boston Medical Center. Monica Bharel, M.D., is the commissioner of the Massachusetts Department of Public Health.

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

END STIGMA: Addiction healthcare is not a criminal justice issue…it is a human justice, public health and third sectors issue which requires holistic support, access to mental services, specialist trainings in addiction medicine, and public service education about the treatment of addiction.

The September 12th Scottish Parliament debate stresses an urgent health emergency is called for to action immediate changes.

https://www.scottishparliament.tv/meeting/members-business-scotlands-drug-death-public-health-emergency-september-12-2019

AREAS FOR IMMEDIATE URGENT CHANGE. Radical action.

STOP BUDGET CUTS: Driving forward investment in reform, policy changes, services and health services.

SHORT MEDIUM AND LONGTERM SOLUTIONS.

The right to health does not differentiate between mental and physical health. They are both central to human wellbeing. In reality, this is not often recognised.

Despite the significant social and economic burden of mental illness, provision for mental health often comes a very poor second to physical illness.

The need for specialised addiction medicine trainings and treatment directives in which addiction is treated concurrently with related physical health, mental health and social issues combines essential medical and psychopharmacology interventions uniquely tailored to each person’s needs.

New strategic opioid prescribing and tapering guidelines for specific pain needs can strengthen patient awareness of potential pain medication dependency/addiction in the longterm for short term pain medication.

Implementing Addiction Care Clinics within A&E-NHS settings where all healthcare professionals, doctors, nurses, first responders are trained in the fundamentals of addiction will saves lives.

It is time to include personal recovery into every aspect of the continuum including peer support, housing, and employment.

I am proposing a frontline lifesaving addiction healthcare services that tackle this health emergency crisis with the urgency and care it deserves.

Our aim is to provide comprehensive training for front-line medical staff, nurses, first responders and volunteers, in order that they can provide a compassionate and holistic response to drug or alcohol addicted adults who present themselves in crisis at Accident and Emergency Departments.

Mentally disordered individuals are often subject to multiple inequities, and to significant burdens of stigmatisation and marginalisation.

In the absence of resources, harsh restraint is used. Realising the right to health means refusing to discriminate against the mentally ill at all levels.

I believe in the efficacy of person-centred addiction healthcare and of a client’s right to safe prescribing, effective, inclusive and compassionate carewithout prejudice, fear of judgement or negative consequences.

Mental health issues and addiction are often inextricably intertwined. Some individuals begin their descent into addiction by trying to self-medicate untreated mental illness; others develop mental illness as a result of years of substance abuse. In either of these cases, successful long-term recovery hinges on addressing both of these issues in treatment.

Physical health can also be extremely damaged in multiple ways by long-term drug addiction. Effective drug addiction multidimensional assessment treatment programmes:

Addiction medicine trainings learning objectives offer interventions that are appropriate to specific substances and severity of usage pattern.

Respond to high risk alcoholic drinking with brief intervention strategies, appropriate to the patient’s willingness to engage in a medically assisted detox, inpatient continuum of care programme.

When appropriate conduct an assessment to provide a diagnosis and match the patient to an appropriate level of care.

The plan may include a variety of therapeutic modalities, lifestyle changes, health practices and medications depending on the client’s needs.

Recovery treatment plans are an affordable way to introduce this model through training experienced staff who are already working at the sharp end of the service with the support of peer-led trained volunteers who will also be based within these services.

I am a person in longterm recovery. I have 31 years of continuing abstinence from addictive substances and working in addiction and mental healthcare that began in in 1989 when I volunteered at the “Manhattan Centre For Living” co-founded by Marianne Williamson and Louise Hay. This experience of working side by side with holistic therapists prompted my trainings in addiction counselling and psychotherapy in America and England.

My work continues today in the capacity of Addiction recovery advocacy, educator, compassionate interventionist, counsellor, and clinician. I am an experienced group facilitator, former outpatient director, government advisor and broadcaster.

In addition to my role as the former Vice President to National Association Drug & Alcohol Counsellors (N.S.W) in Sydney, I advise the Australian Government advisory panel in harm reduction. .

I have worked in the private sector as the lead Primary Care Clinician in residential care settings in Melbourne, NYC, Pune, Delhi, Kent and London in England.

Prior to my recovery: former fashion magazine editor (Mode, Australia) art director, film and video producer (NYC, Tokyo, L.A. London, & Sydney.

I believe that by integrating the fundamentals of addiction training, providers as part of the dialogue with respect to the opioid epidemic can change the focus from a criminal justice perspective to a medical perspective.

Addiction medicine is a medical subspecialty, formally recognized since 1990, concerned with the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances, including nicotine, alcohol, prescription medications, and other licit and illicit drugs.

I am dedicated to the universal recovery vison of overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) by making accessible inpatient and outpatient addiction medicine treatment programmes.

Motivating people to engage in the multiple programmes available, i.e. 12step fellowships, SMART Recovery, means addiction recovery continues to evolve into being better organised and supported.

I have worked successfully in treating addiction as a chronic primary disease of brain reward, motivation, memory, and related circuitry dysfunction, and how this leads to characteristic biological, psychological, social, and spiritual manifestations.

Many people/patients have gone onto train in the field, augmenting their recovery assets by maintaining the momentum/continuing self care that defines personal recovery.

Let’s change the way in which people in need access addiction healthcare.

Addiction is characterized by an inability to consistently abstain or reduce substance use, impairment in behavioural control, craving, tolerance, and interference with interpersonal relationships, occupational responsibilities, recreational activities, and emotional response.

Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and will often result in disability or premature death.

At a record 867 drug deaths in 2016, and 247 deaths per million people, Scotland has the highest drug death rate in Europe: 12 times the EU average, 42 times Portugal’s rate, and 4 times the rate in England and Wales.

There is an HIV epidemic. Among Glasgow’s 500 street injecting population alone, there have been over 100 infections since 2015. In the 10 years prior to that, there were 10 infections per year in this group.
This is a financial time-bomb – lifetime treatment costs for someone with HIV are £360k.

Like many international cities, Glasgow has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased tenfold, with a dramatic spike over the past few years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Glaswegians reported knowing someone who had died from an opioid overdose.

The death toll is even more tragic in light of the many effective treatments for opioid use disorder that exist. Overdose-reversal drugs, naloxone and -approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths.

Together we can actualise life saving services and dramatically reduce loss of life.


Posted on August 29, 2019 Edit

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

The opposite of addiction is connection, Johan Hari.

When there is an experienced person in recovery working alongside first responders, doctors nurses and healthcare practitioners the patient is able to be assessed for addiction recovery treatment.

Without training, the risk of being misdiagnosed, incorrectly prescribed medication, and discharged into the night without support. Relapse is inevitable when there is an absence of a continuing care programme.

It is time to change how vulnerable addicts in a health crisis receive healthcare.

Actualising acute care addiction clinics within A&E -NHS settings addresses the global health emergency.


Universal Addiction Healthcare was created in response to the consistently increasing number of drug and alcohol related deaths in the UK but particularly in Scotland.
The aim is to provide comprehensive training for front-line medical staff, nurses, first responders and lived experience volunteers, in order that they can provide a compassionate and holistic response to addicted individuals who present themselves in crisis at Accident and Emergency Departments.

Addiction is not a criminal justice issue but a public health issue which requires specialist training and insight into the medical and psychosocial nature of the illness.

I believe in the benefits of accessible and available addiction healthcare and of an individual’s right to expect effective, inclusive and compassionate treatment from NHS Services without fear of judgement or negative consequences

I am an addiction clinician and therapist, with 28 years of addiction healthcare treatment programmes experience, and 30 years lived experience to support fulfilling my professional and personal recovery obligation to provide addiction and mental healthcare to individuals and families in need of help.

In January 2019 I initiated a partnership with the American Society Addiction Medicine to provide evidence-based/fundamentals in addiction trainings and resources to augment healthcare providers in Scotland of the skills and knowledge they need to treat addicted patients.

I am proposing implementing 24/7 addiction emergency treatment clinics within A&E-NHS settings. facilitated by trained in the ASAM “Fundamentals of Addiction” medicine healthcare professionals, in addition to the Scottish Recovery Consortium lived experience – peer-led support volunteers for people in need to access available addiction and mental health primary care integrated treatment programmes to provide the most effective approach for supporting person-centred addiction and mental healthcare.

The following links reveal the backbone of the ASAM evidence-based research and teachings:

The ASAM definition of addiction:
http:// https://www.asam.org/resources/definition-of-addiction

The ASAM “Strategic Plan”
https://www.asam.org/about-us/about-asam/theplan

ASAM “Fundamentals of Addiction Training”
https://www.asam.org/education/live-online-cme/fundamentals-program

Addiction and mental health disorders are medical conditions and their treatment has impacts on and is impacted by other mental and physical health conditions, integrated addiction and mental healthcare programmes can help address health disparities, reduce health care costs for both patients and family members, and improve general health outcomes.

Well-supported evidence shows that the current substance use disorder workforce does not have the capacity to meet the existing need for integrated health care, and the current general health care workforce is undertrained to deal with substance use-related problems.

Health care now requires a new, larger, more diverse workforce with the skills to prevent, identify, and treat addictive disorders, providing “personalized addictive care” through integrated care delivery.

A new strategic plan strengthens the focus on a full spectrum of addiction care: prevention, treatment, remission, and recovery.

• Biopsychosocial assessment
• Medically assisted detox
• Medically assisted treatment programmes
• Lived experience community support services

The New Model: Many Paths to Recovery.

• The understanding of addiction described above suggests the need for specialised addiction medicine training and treatment directives in which addiction is treated concurrently with related physical health, mental health and social issues.

• Universal addiction healthcare combines essential medical and psychopharmacology interventions uniquely tailored to each person’s needs.

It is time to put an end to v. long waiting times, overprescribing pain medication, and blocks to medication assisted inpatient treatment programmes. Let’s remove the barriers to accessing compassionate care.

We need clinics that support clinician and peers working side by side to educate, empower, inspire and help engage people in need in a recovery process.

PERSON CENTERED: ADDICTION HEALTHCARE & RECOVERY

There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”

– Desmond Tutu

The universal addiction and mental health care crisis has been building for decades—due to decades of neglect by political leaders.

Positive changes are seen as starting points for the recovery process: reduced harm, safer use, reduced use, moderation and potential abstinence.approach that tackles this crisis with the urgency and care it deserves.

Implementing Addiction Care Clinics within A&E-NHS settings where all healthcare professionals, doctors, nurses, first responders are trained in the fundamentals of addiction will saves lives.

It is time to include recovery into every aspect of the continuum including peer support, housing, and employment.

I am proposing a frontline lifesaving addiction healthcare services that tackle this health emergency crisis with the urgency and care it deserves.

Our aim is to provide comprehensive training for front-line medical staff, nurses, first responders and volunteers, in order that they can provide a compassionate and holistic response to drug or alcohol addicted adults who present themselves in crisis at Accident and Emergency Departments.

Addiction is not a criminal justice issue but a human justice, public health issue which requires specialist training in addiction medicine, and knowledge about the treatment of addiction.


The right to health does not differentiate between mental and physical health. They are both central to human wellbeing. In reality, this is not often recognised.

Despite the significant social and economic burden of mental illness, provision for mental health often comes a very poor second to physical illness.

Mentally disordered individuals are often subject to multiple inequities, and to significant burdens of stigmatisation and marginalisation.

In the absence of resources, harsh restraint is used. Realising the right to health means refusing to discriminate against the mentally ill at all levels.

I believe in the efficacy of holistic addiction healthcare and of a client’s right to safe prescribing, effective, inclusive and compassionate carewithout prejudice, fear of judgement or negative consequences.

Mental health issues and addiction are often inextricably intertwined. Some individuals begin their descent into addiction by trying to self-medicate untreated mental illness; others develop mental illness as a result of years of substance abuse. In either of these cases, successful long-term recovery hinges on addressing both of these issues in treatment.

Physical health can also be extremely damaged in multiple ways by long-term drug addiction. Effective drug addiction treatment must contain medical monitoring and interventions to ensure the individual’s health and safety during detox, treatment, and beyond.

Many individuals often fall prey to addiction in an effort to treat underlying chronic pain or other issues. Medical services can provide alternative, non-addictive ways of treating these triggering conditions.

Addiction doesn’t just destroy individual lives; it devastates families as well. By the time that drug abusers finally enter treatment, they have often caused considerable damage to their family relationships as well.

The guilt and shame over these damaged family bonds can often cause addicts to relapse even after treatment if they are not acknowledged and repaired, making family services an essential element in effective drug addiction treatment.

I envision implementing Addiction Emergency Care and Recovery Clinics within the A&E – NHS Hospitals for 24/7 people  in a health crisis  to be able to access to addiction primary care: 

  • Biopsychosocial assessment
  • Medically assisted  detox
  • Medically assisted treatment programmes
  • Long-term recovery community support services  

A biopsychosocial model treatment plan is a meaningful approach to trauma, pain and suffering. 

A proactive way forward would be to make addiction medicine directives including trauma recovery and, suicide prevention training mandatory for all NHS staff who receive mandatory physical health training: doctors, nurses, psychologists, allied health professionals and pharmacists will help children, young people and adults.

Addiction is a complex interaction of these vulnerabilities and is unique to each person giving rise to the reinforcing quality of the addictive personality. 

In this context, substance use intensity/risky behaviours take on complex personal and social meanings and functions that contribute to the addictive process. 

Common examples of addiction are in the self-medication of emotional pain.  People whose substance use serves important, often life-saving functions experience the substance as helpful; they are frequently in pre-action Motivational Stages of Change in which they are not ready or able to consider changing their behaviour. A

 The need for specialised addiction medicine training and treatment directives in which addiction is treated concurrently with related physical health, mental health and social issues combines essential medical and psychopharmacology interventions uniquely tailored to each person’s needs.

The treatment plan should begin “wherever the person is” in terms of a health crisis. There should be no “jumping through hoops” such as having to produce clean urine samples in order to access treatment services

A new strategic plan strengthens the focus on a full spectrum of addiction care: prevention, treatment, remission, and recovery. 

The plan includes: the voice of patients and their families and will highlight the personal experience of addiction in much closer view. 

Grounded in integrity, the plan outlines ambitious research goals aimed at leading scientific and medical progression in the field. It also exemplifies a firm recommitment to providing continued education for all treatment providers.

Renewed and redesigned goals amass to form a robust foundation and profound course of action in the spirit of the Universal Addiction Healthcare’s mission. 

The opportunity to set addiction healthcare treatment standards, pioneer research, educate professionals and the public, and challenge stigma is in treating addiction and saving lives. 

The following strategic plan provides a road map to guide and prioritize that way forward. 

  • A comprehensive initial assessment will determine an initial personalized treatment plan based on substance use severity, the psychobiosocial factors, multiple meanings and functions of the behaviour, motivation to change, and insight.
  • Effective treatment has a primary focus on engagement and therapeutic alliance throughout the assessment process that “starts where the person is” with compassion, respect and acceptance, because creating safety and support are seen as essential to the therapeutic outcomes. 
  •  Teaching self-management skills to address urges and difficult emotions is often essential. An ongoing assessment throughout treatment deepens both client and therapist awareness of the addiction severity and its meaning and functions. 
  • Exploring the client’s resistance to change reveals the issues that need new solutions. As these issues are clarified, positive change goals around the substance use and these issues can be established.
  • And, finally, a personalized plan for these positive changes can be developed collaboratively between client and therapist.
  • The plan may include a variety of therapeutic modalities, lifestyle changes, health practices and medications depending on the client’s needs.

Recovery treatment plans are an affordable way to introduce this model through training experienced staff who are already working at the sharp end of the service with the support of peer-led trained volunteers who will also be based within these services.

I am a person longterm recovery. I have over 30 years of continuing abstinence from addictive substances. In 1989 I volunteered at the “Manhattan Centre For Living” co-founded by Marianne Williamson and Louise Hay that prompted my training in addiction counselling and psychotherapy in 1991.  

My work continues today in the capacity of Addiction recovery  advocacy as a compassionate interventionist, counsellor, clinician, group facilitator, outpatient director, government advisor, broadcaster in addition to my role as the former  Vice President to National Association Drug & Alcohol Counsellors (N.S.W) in Sydney. Primary Care Clinician in residential care settings in Melbourne, NYC, Pune, Delhi, London & Edinburgh. 

Author, former fashion magazine editor (Mode, Australia) art director, film and video producer (NYC, Tokyo, L.A. London, & Sydney.

I believe that by integrating the fundamentals of addiction training, providers as part of the dialogue with respect to the opioid epidemic can change the focus from a criminal justice perspective to a medical perspective.

Addiction medicine is a medical subspecialty, formally recognized since 1990, concerned with the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction, of those with substance-related health conditions, and of people who show unhealthy use of substances, including nicotine, alcohol, prescription medications, and other licit and illicit drugs. 

I am dedicated to the universal recovery vison of overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) by making accessible inpatient and outpatient addiction medicine treatment programmes.

Motivating people to engage in the multiple programmes available, i.e. 12step fellowships, SMART Recovery, means addiction recovery continues to evolve into being better organised and supported.   

We are still very behind in the UK in treating addiction as a chronic primary disease of brain reward, motivation, memory, and related circuitry dysfunction, and how this leads to characteristic biological, psychological, social, and spiritual manifestations. 

Addiction is characterized by an inability to consistently abstain or reduce substance use, impairment in behavioural control, craving, tolerance, and interference with interpersonal relationships, occupational responsibilities, recreational activities, and emotional response.

Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and will often result in disability or premature death.

In addition, I want to highlight that Overdose Presentation Centres (Supervised Injection/Consumption Sites) need to be a part of the conversation and the strategy. Unfortunately, they remain illegal. 

This is in spite of their successful operation and multiple scientifically valid studies that provide clear and convincing evidence of their efficacy in the opioid crisis.

From the recently published Scottish Drug Policy Reform:

A deadly snapshot – change is needed 

  • At a record 867 drug deaths in 2016, and 247 deaths per million people, Scotland has the highest drug death rate in Europe: 12 times the EU average, 42 times Portugal’s rate, and 4 times the rate in England and Wales. 
  • There is an HIV epidemic. Among Glasgow’s 500 street injecting population alone, there have been over 100 infections since 2015. In the 10 years prior to that, there were 10 infections per year in this group. 
  • This is a financial time-bomb – lifetime treatment costs for someone with HIV are £360k. 

Like many international cities, Glasgow has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased tenfold, with a dramatic spike over the past few years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Glaswegians reported knowing someone who had died from an opioid overdose. 

The death toll is even more tragic in light of the many effective treatments for opioid use disorder that exist. Overdose-reversal drugs, naloxone and -approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths.

Together we can actualise life saving services and dramatically reduce loss of life.

UNIVERSAL ADDICTION HEALTHCARE


Universal Addiction Healthcare is a global healthcare initiative that provides accessible treatment options for vulnerable drug users who are choosing to engage in recovery treatment programmes.

We are proposing opening Acute Care Clinics within UK A&E settings where clinicians and volunteers work side by side to treat drug users.

In March 2018, the Drug Policy Alliance led a delegation of 70 U.S. advocates to Portugal to learn from its health and human-centred approach to drug use.

The trip provided an opportunity for drug policy reform advocates to appreciate how effective a dramatically different approach to drugs can be.
Read the briefing paper about the Portugal visit and the link to:

Drug Decriminalization in Portugal: Learning from a Health and Human-Centered Approach

Universal Addiction Healthcare was created in response to the consistently increasing number of drug and alcohol related deaths in the UK but particularly in Scotland.
The aim is to provide comprehensive training for front-line medical staff, nurses, first responders and lived experience volunteers, in order that they can provide a compassionate and holistic response to addicted individuals who present themselves in crisis at Accident and Emergency Departments.

Addiction is not a criminal justice issue but a public health issue which requires specialist training and insight into the medical and psychosocial nature of the illness.

I believe in the benefits of accessible and available addiction healthcare and of an individual’s right to expect effective, inclusive and compassionate treatment from NHS Services without fear of judgement or negative consequences

I am an addiction clinician and therapist, with 27 years of addiction healthcare treatment programmes experience, and 30 years lived experience to support fulfilling my professional and personal recovery obligation to provide addiction and mental healthcare to individuals and families in need of help.

In January 2019 I initiated a partnership with the American Society Addiction Medicine to provide evidence-based/fundamentals in addiction trainings and resources to augment healthcare providers in Scotland of the skills and knowledge they need to treat addicted patients.

I am proposing implementing 24/7 addiction emergency treatment clinics within A&E-NHS settings. facilitated by trained in the ASAM “Fundamentals of Addiction” medicine healthcare professionals, in addition to the Scottish Recovery Consortium lived experience – peer-led support volunteers for people in need to access available addiction and mental health primary care integrated treatment programmes to provide the most effective approach for supporting person-centred addiction and mental healthcare.

Vulnerable, at risk drug users human right is to receive treatment, not be dismissed, and discharged. However, due to cutbacks, long waiting times and lack of experienced in the fundamentals of addiction trainings: first responders, doctors, nurses and associated healthcare workers will soon be able to sign up for the American Society of Addiction Medicine training, so that people will no longer be turned away away instead of receiving treatment.

We are experiencing a health emergency. A radical restructuring of mental and addiction healthcare needs to actualise how people in need access and receive healthcare.

It is not good enough to say universal addiction will cost millions, actually addiction is costing people their lives…. addiction and mental healthcare is already costing billions globally: loss of income, loss of family, loss of life.

Changes in how vulnerable people access treatment is what I am suggesting for them to have a choice: a medically supervised impatient detox, impatient primary treatment plan with aftercare upon discharge to support the varying stages of addiction recovery or be discharged with appropriate medicine.

The NHS Health Scotland “Burden of Disease” study highlights that alcohol and drug dependence are major contributors to absolute inequalities and recommends that alongside other measures we must tackle conditions that are more prevalent within higher levels of deprivation.

Like many international cities, Glasgow has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased tenfold, with a dramatic spike over the past few years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Glaswegians reported knowing someone who had died from an opioid overdose.

The 2018-19 death toll 1,127, is even more tragic in light of the many effective treatments for opioid use disorder that exist. Overdose-reversal drugs, naloxone and -approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths, but they aren’t consistently getting into the hands of the individuals or the communities that need them most.

What motivates me to continue to do service in the wider recovery community, to raise addiction awareness, and strive for essential changes in the dismissive, negative, judgemental language and perceptions that defines addiction? In my daily commitment to recovery I know I ned to reach out to my recovery tribe. It is my connecting with other recovering people that I feel “at home” accepted, seen and heard.

It is by overcoming prejudice, and stigma, (which stopped me initially from getting help when I most needed it) and making accessible inpatient and outpatient primary care, inpatient and outpatient addiction medicine treatment programmes that will save lives, NOW that is needed.

Let’s stop talking about what to do about addiction recovery ….we know what to do, and we know why people are dying from opioid overdoses…

I am currently engaged in forming strategic partnerships with Scottish recovery organisations to strengthen the focus on a full spectrum of addiction care: prevention, treatment, remission, aftercare, and re-generation of relationship with family, workplace and recovery communities.

The plan includes: patients and their families and will highlight the personal experience of addiction in much closer view aimed at leading scientific and medical progression in the field. It also exemplifies a firm recommitment to providing continued education for all treatment providers.

Renewed and redesigned goals amass to form a robust foundation and profound course of action in the spirit of the recovery from active addiction.

With a strategic plan in place, the opportunity to set standards, pioneer research, educate healthcare professionals and the public, challenge stigma, endeavours to enhance the goal of holistically treatments from medically supervised detoxes, to save lives, and reduce the financial burden upon the person in need of recovery, their family and community..
This strategic plan provides to guide and prioritize that way forward.

• Positive changes are seen as starting points for the recovery process: reduced harm, safer use, reduced use, moderation and potential abstinence.

• A comprehensive initial assessment will determine an initial personalized treatment plan based on substance use severity, the psychobiosocial factors, multiple meanings and functions of the behaviour, motivation to change, and insight.

• Effective treatment has a primary focus on engagement and therapeutic alliance throughout the assessment process that “starts where the person is” with empathy, respect and acceptance, because creating safety and support are seen as essential to the therapeutic outcomes.

• Teaching self-management skills to address urges and difficult emotions is often essential. An ongoing assessment throughout treatment deepens both client and therapist awareness of the addiction severity and its meaning and functions.

• Exploring the client’s resistance about change reveals the issues that need new solutions. As these issues are clarified, positive change goals around the substance use and these issues can be established.

• And, finally, a personalized plan for pursuing these positive changes can be developed collaboratively between client and therapist. The plan may include a variety of therapeutic modalities, lifestyle changes, health practices and medications depending on the client’s needs.

It is time for sustainable addiction healthcare programmes, that are accessible 24/7.