What Works in Treatment?: Sapphire’s Story, Part 3

rsz_dscf2263We’ve been following Sapphire’s Story with a focus on the treatment she received, recognising that treatment can either facilitate or have a negative impact on the recovery process. We’ve seen Sapphire courageously overcome heroin addiction, crack addiction and most recently an addiction to benzos. There’s more to overcome.

‘Once I was off the benzos and feeling a little more like myself, I went back to work. I hadn’t worked since having the crack-induced event, so was really scared that I wouldn’t be able to cope with a job.

As I had come off the benzos, and now had the proper support of a partner and my family, I started thinking about reducing my methadone with a view to abstinence. I knew I had the willpower, as I’d managed eight nightmarish months of the benzo detox and I’d also kicked a crack addiction about two years earlier.

To start with, the reduction went quite well. The CDT doctor and keyworker were well aware of how my previous attempts to reduce my methadone had been hampered by overzealous treatment staff. Therefore, they encouraged me to take control of my reduction, and only go at a pace at which I felt comfortable. It also helped me knowing that I could stop reducing my methadone, and even increase it again, if things got too much.

In fact, I didn’t increase the dose again, but I did stop reducing a few times, to let my body reacclimatise to the smaller doses. I felt empowered by being in control of my treatment and having a real say in what was going on. I felt confident in myself and in the drug treatment staff.

Unfortunately, this situation did not last. [That rings a bell, having happened earlier – DC] Both my doctor and keyworker left to take up different jobs, and I was then shunted between various keyworkers, all of whom told me that I should increase the speed of my reduction.

As I was doing well, and not using on top, I didn’t feel it was prudent to do this. However, my new doctor thought I’d be fine. He and the treatment workers said I was being argumentative and stubborn for not agreeing to go faster, so under pressure I agreed to increase the speed of the methadone reduction.

I managed to get down to 26ml/day, where I really started having problems. I was craving drugs like crazy. Whereas I had not thought of using when prescribed higher doses of methadone, now I kept thinking about drugs.

I also had no confidence in either my keyworker or doctor doing something to help me if I told them I was struggling. I worried that if I relapsed it would affect my job, which I couldn’t afford to loose, and I would let my partner and family down. Life became a stressful nightmare.

Ultimately, I ended up relapsing onto opiate-based pain medication that was prescribed by my GP for chronic pain issues relating to my arthritis. When I was on a reasonable dose of methadone, I was able to control any pain from the arthritis with paracetamol or Voltarol.

However, I found that as my methadone dose was reduced to under 40mg/day, I experienced more pain and needed higher doses of the prescribed painkiller, or a stronger drug, to be able to function. The pain was so bad some days I could only walk a few steps.

My GP, who was well aware of my addiction history and knew I was on methadone, signed me up for a medication trial of a new drug that was supposed to be like Tramadol, but less likely to cause constipation. At this point, the pain was really bad, and the last thing I wanted to do was use more methadone, so I agreed to take part in the trial.

The pain tablets were quite a lot stronger than I had thought they’d be, and they did a wonderful job of relieving the pain in my legs. Unfortunately though, they spoke to the addict in me! I started taking far more than I was supposed to, and was soon telling the doctor they weren’t working and I needed more.

I ended up eating them like sweeties and spending all day drooling in my lap! After having enjoyed the cotton wool cocoon of the pain tablets, it was only a short step for me to acquire some heroin.

Luckily, I began to see a new keyworker who really listened to me. I felt able to tell her about my relapse with the pain pills and heroin, how much I was struggling, and how I felt that I had no say in my treatment any more.

There is much said about drug workers needing to be a recovering addict to do their job well, but from my experience I would say that this is not a prerequsite. As long as the person has empathy, experience of life and good listening skills, then they don’t need to be a recovering addict to be able to be an excellent keyworker.

My new keyworker quickly got me an appointment with a different doctor at the CDT. I explained to him how I felt about being ‘encouraged’ to reduce my methadone far faster than I was comfortable with, and as a result had started abusing my pain medication. It felt great to get everything off my chest.

The doctor gradually increased my dose, to where it kept me comfortable for 24 hours, and although I still had some cravings, they were manageable with the good support system I had. Once my methadone dose was increased, I no longer needed opiate- based pain medication every day. I therefore asked to be switched onto a non-opiate pain killer to eliminate the risk of me abusing the meds.’

Once again, we see how important important it is that treatment is person-centered.

Part 1
Part 2

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