Tuesday, October 25, 2011

Go on - say something!

I guess after nearly 40 posts, it seems appropriate to address the issue of the 'loud mouth'. Of course, this blog has received its fair share of condescending swipes, so the call is being put out there for those who can cover the issues better (it wouldn't take much, after all) to please post links to your marvellous efforts in the comments section.

Sometimes the silent among us are holding onto a deep, deep wisdom - but often it's a simple case of the person having nothing of worth to contribute, fear of speaking out or an unwillingness to disclose true feelings on a subject due to the meagre value or offensive nature of their content.

Go on - if you're such a worthy judge on matters of importance and those who choose to make public comment, show us all how brilliant you really are!

Wednesday, October 19, 2011

Anex Bulletin - September 2011

The latest Anex Bulletin has published a piece about people on opiate pharmacotherapy programs and this blog thought it best to respond:

This blog has just been forwarded sections of the latest Anex Bulletin and it finds the inclusion of a couple of 'top 10' lists very offensive, especially in light of the trajectory of the illicit drug discourse in this country; not to mention the practice of gross simplification, pioneered and perpetuated by the commercial media, that the articles draw inspiration from. For what they are worth, here are our thoughts on the methadone list:

Methadone Appointment Excuses

-      Dodgy excuses are provided in ALL areas of life, by ALL people – this is common knowledge and any teacher, boss or lecturer will make this clear. Also, in this context, a discriminatory, unfair and inhumane legislative and policy framework means that those people who are targeted are too often left in desperate situations that require wrangling to get out of – and yes, sometimes the truth needs to be stretched, as it is in innumerable other situations, such as parking fines, sick leave, tax evasion, drink driving etc. etc. etc. This is clearly an example of ‘kicking people whilst they are down’ and exploiting the behaviour of marginalised people who are actually exhibiting very human attributes that are not unusual given the circumstances involved. Instead of focussing on the far more pressing concern of a discriminatory, unfair and inhumane system, Anex has instead scored cheap ‘laughs’ with excuses that not only DO NOT represent everyone who is prescribed methadone, but the excuses listed are new to me – I have never, in reality, heard of anyone using any of these excuses. As far as I am concerned, the list is a complete fabrication and is in no way the “retorts of an old hand”.

-      We now have evidence that stigma has negative effects on people’s health and stereotyping has been a ‘thorn in the side’ of the harm reduction sector since the beginning – this list flies completely in the face of the harm reduction ethos that has been developed under extremely difficult conditions over many years, including the soul-destroying but invaluable labour that drug users have undertaken. 

So let’s have a look at the actual list:

#1) There is nothing remarkable about this first excuse – that is, it bears no specific relation to the OST program. This is a mistake that could be made by anyone, in any situation, attempting to obtain something. However, by using such a ubiquitous example in this context, the implication is that methadone users are dim and conniving (and delusional in their ability to be conniving), possessing poor memories that are unable to recall the other occasions when the excuse was used. Furthermore, the extraordinary nature of the lives we lead, drug user or not, means that it is entirely feasible that a person may indeed have attended their mother’s funeral, even though it was used falsely on prior occasions, so this possibility needs to be considered and, given the sensitivity of the matter if the person’s mother had passed away, due sympathy provided.

#2) This one doesn’t actually make any sense whatsoever, as it is entirely reasonable that the door would be unlocked as it was only on this most recent occasion that the person realised that he/she didn’t have keys and therefore did not wish to leave the house unlocked. That is, either the person had accidentally left the house unlocked on the prior occasion or the person had only popped out for a brief while and had deliberately left the house unlocked due to not having keys – the house being unlocked on this previous occasion actually has no direct relationship to the person’s current predicament in which he/she feels unable to leave the house unlocked. However, the implication inherent to the list is that the person has been caught out with a glaring inconsistency that again shows how dim-witted the ‘perpetrator’ is. Furthermore, the person might then need to explain that circumstances have changed since his/her discovery that his/her keys are missing and it is therefore necessary to remain in the house (e.g. an expensive item is now present in the house, or the person fears that someone has actually stolen the keys and is looking to break in). It is worth pointing out that if the prescriber didn’t treat the consultation like a police interrogation in the first place and actually treated the person with dignity and respect, then maybe such details would emerge more easily and terse questions wouldn’t need to be asked.  

#3) Again, the most extraordinary things happen in life all of the time – this series of events is actually entirely possible. Apart from anything else, number 3 is not actually funny or humorous in any way and is just an example of how cringe-worthy the author of the piece really is.

#4) Not only is this excuse not funny, but what kind of worker would respond in such a nasty and sarcastic manner??? When treating a person respectfully, one doesn’t use offensive humour – this is a no-brainer, yeah? One would simply ask how much the school uniform is, or some other relevant question. The ‘worker’ in this situation deserves a verbal warning for such shoddy, harmful practice. Furthermore, why is it an issue that the person has only one child? Without further detail, this point is irrelevant – what is relevant is the cost of the uniform, the income of the person and what their weekly/fortnightly budget is. Again, the author proves her/himself to be the dim-witted, mediocre one.

#5) Again, I’m unclear as to why this is such a stand-out example of ‘client’ manipulation – there is a myriad of circumstances that could contribute to the person’s inability to traverse the city in just under 3 hours and a proficient worker would respectfully negotiate a solution with the person based on their individual situation. The message that really needs to get out there is the critical importance of working with each individual’s particular circumstances – not the insulting and outrageous garbage that occurs in this piece. This is also another example of bland, poorly-constructed ‘humour’.

#6) Yet again, why is this so outlandish? Anyone who has worked with illicit drug use for any length of time with half a brain in their head knows that the most extraordinary things happen to people. Read any edition of a Drug User Organisation magazine and this will become very clear. The salient matter that needs to be conveyed to workers is that people who use drugs are not all compulsive liars and that it is vital to develop respectful relationships so that genuine interactions can occur. If the OST dynamic could be along these lines, then not only would people on the program feel more comfortable to speak openly, but the atmosphere of suspicion and ‘us versus them’ would also dissipate. But alas, Anex has instead chosen to exploit this woeful state-of-affairs.

#7) See point #6).

#8) Big deal! So the person has slipped up in this scenario – who really cares? We are dealing with a ‘War on Drugs’, a continuing hep C epidemic, a worldwide HIV pandemic, fatal overdoses, amputations, endocarditis, imprisonment  etc. etc. and this is cause, instead, for an article revealing the inconsistencies of the perennially devious junky??? Furthermore, the policy and practice regarding takeaway doses verges on ludicrous and the persistent poverty that people endure is fair reason for the selling-on of doses – if people resort to this kind of dialogue then an ethical organisation would be seeking to find out what leads people in this direction. I guess Anex feels that it is more appropriate to have a cheap ‘laugh’ at the expense of the disadvantaged.      

#9) Maybe I am just cognitively compromised, but I fail to see the direct relationship between the fact that the person walked into the prescriber’s room and the issue of takeaway doses based upon the person’s statement that “I can’t walk”. The fair thing to do in this situation would be to find out exactly what the person means by this statement. Often, especially for marginalised people and people who have difficulties with open communication, statements need to be picked apart to find out what is actually going on. And in actual fact, over many years of working in this area, I have seen too much harm caused by workers and clinicians jumping to conclusions, being presumptuous and not adequately listening – these are the most important concerns that should be relayed to Bulletin readers.

#10) Ahh.., unless the prescriber also has a degree in veterinary science, what right does he/she have to dispute this statement? Also, can someone please explain to me, in a sector pushed for resources, what the great value is of going to the trouble of writing and then publishing an interaction about a person’s sick dog???  Is it just me, or should people be using their time far more constructively???

The opiate pharmacotherapy system in Australia is incredibly dysfunctional and to then publish a list that reads like tabloid journalism or the blog of an ignorant userphobe is nothing short of disgusting and potentially cause for litigation, as occurred in Ireland and more recently with Victoria’s Andrew Bolt.