Drug related deaths are at their highest on record and the call to action has been predominantly targeted towards treatment professionals. Volteface met with Michaela Jones, Community Director of in2recovery, to find why mobilizing the community would be key to reducing this alarming rise in drug related deaths.
Michaela Jones is a person in long term recovery and has engaged a wide range of recovery related activities across the UK under the banner of in2recovery CIC. Michaela would describe herself as a “recoverist”.
Michaela explained that:
[..] there’s all this big focus that only treatment has access or is a pathway to people with drug and alcohol problems, but the bottom line is… we’re still only talking about 40% of the population, and we know that the vast majority of deaths are not just drug related deaths but a result of life limiting conditions. All those kinds of things are happening in the 60% that is not engaged in treatment, so how do you reach them?
Though treatment providers could increase their outreach efforts, Michaela advocates that the “60% has mothers, has partners, has brothers and sisters and friends who are all in a very good position to support them,” as well as the ‘thousands of people who are engaged in service user groups’ and the ‘peer groups who are in regular contact’. These groups have access to the people who may have never entered treatment or have spent years outside of it, and can be equipped with naloxone (the antidote to a heroin overdose) and overdose management training.
Yet community networks in England are far from equipped, with the last estimates from the Naloxone Action Group reporting that 50% of local authorities do not provide naloxone. National Naloxone programs have been implemented in Scotland and Wales but no such program exists in England. Reasoning comes down to cost, but cost considerations are rarely consistent among different demographics. Michaela reminded Volteface of another health care crisis which hit the UK in 2009:
Do you remember swine flu? Well, you know, sadly there were 138 deaths as a result of that, which is awful, but the government response to that was to stockpile tamiflu and they spent 473 million pounds on doing this, over an issue that caused 138 deaths. In comparative terms, providing naloxone to members in the community would be significantly less costly, it’s got a three-year lifespan and is around 15 pounds, so you’re talking 5 pound a year. Why aren’t we recognizing that we have a significant health issue here and why aren’t we making that investment and enabling everyone in the community to have access to naloxone? I wish I knew the answer, I can only sort of speculate but… are some lives worth more than others?
Levels of investment in overdose management training are equally limited, with Michaela adding that:
[..] it’s absolutely horrifying how little people know about overdose. You know most people’s response is to slap people, to try and walk people around and it’s mostly drawn from television. And people are, if not causing deaths, they are contributing to deaths by not knowing the simple things to do in an overdose situation.
Research from the University of South Wales on opiate user’s experiences of fatal and non-fatal overdoses reported a need for the wider provision of overdose management training, as there were concerns that people in the community were not effectively prepared for overdose situations.
Worryingly, there were instances of participants not being able to recognise an overdose. This delay sometimes led to fatal consequences.
“Everybody in the party thought he was just asleep. We’d been up for days. We thought he was just like, but he was dead.”
When an overdose was recognised, there was then the challenge that people’s first responses were generally shock, panic, screaming and shouting, again leading to further delays.
“… everyone was screaming and shouting.”
“I just stood there like a shivering wreck.”
Alternatively, due to a lack of understanding of what the appropriate interventions were, people would deploy ‘folk methods’, defined by the researchers as ‘inappropriate actions taken by witnesses in the mistaken belief that they will help reverse an opiate overdose.’
“… I just remember waking up soaking wet. But they did all the wrong things to me anyway, the way they were going on. They were slapping me, the usual stuff people think brings you round, which it doesn’t, does it? Throwing water in my face, slapping me, trying to walk me around.”
Finally, the researchers found the message that naloxone should be carried at all times had not been communicated effectively to the community. Examples were given of interviewees not carrying their kit and having to leave the scene to return to where they had left it.
‘It took me about five, 10 minutes then, to ride home on my bike, get the naloxone, come back, and administer it. And it was just too late, I think; he was already dead by then.’
Yet what was most poignant was that there was a clear desire to help. It was the norm for people to help one another, even if this help was delayed or misguided. Though there are friends, family, bystanders and peers out in the community, ready and willing to help, Michaela does not ‘feel they’ve been mobilised in any way or allowed to engage in this health issue.’
As someone who is in recovery from substance misuse, Michaela felt that “professionals really still haven’t got their heads round that service users and people in recovery are actually sentient thinking people who can have a real role in this, I think the general public are often seen as the great unwashed.” This is coupled with the stigma that is put upon people who have a problematic relationship with drugs and alcohol. When first entering treatment as a service user, Michaela said she was “absolutely appalled at the way people with substance misuse issues were treated by many of the health services that were set up to help them… It’s like being in a different class.”
Whether this lack of engagement is due to cost considerations or stigma (but probably a bit of both), it’s disappointing that community networks aren’t being mobilised, considering they may be the people best placed to make a difference. Michaela Jones warns ‘ignore the public at your peril’.
Lizzie McCulloch is a Policy Advisor at Volteface – read her report ‘Black Sheep: An Investigation into Existing Support for Problematic Cannabis Use’. Tweets @mccullochlizzie1