Mr M is a 28-year-old white British man who lives on his own. He is currently unemployed and is on state benefits.
Mr M was first seen in our drug service in late 2003, following a referral from Probation. He was soon placed on a Drug Testing and Treatment Order (DTTO). At initial assessment, he reported a 2-year history of crack cocaine misuse and a 4-year history of heroin dependence. He had started using cocaine in his mid-to-late teens, then went on to use ecstasy and a few years later had become dependent on heroin. He was smoking between one and two bags (0.2–0.4 g) of heroin and £10–20 worth of cocaine a day. At that assessment, he said he had never injected any drug. He denied alcohol misuse. He had been in prison several times, all for drug-related offences. He gave no history of comorbid medical or psychiatric disorders. He was living on his own, having separated from his partner and 3-year-old daughter.
Mr M derives from a family of three; he has two younger sisters. There is no family history of substance use disorders. He is closer to his father than his mother. His mother has a history of depression and epilepsy but there is no other family history of mental health or chronic medical problems.
He was born and raised locally, attended normal mainstream schools and left school with a few GCSEs. He has worked sporadically since leaving school, as a labourer and mechanic. He has committed various acquisitive offences to finance his drug use.
The following section is a summary of Mr M's treatment episodes with our service. Since 2003, Mr M has been in treatment with our service for his heroin dependence. This has been punctuated by episodes of non-engagement and spells in prison. In the past 6 years or so, he has been on substitute opiates – oral methadone (in doses of up to 70 ml/day) and sublingual buprenorphine up to 8 mg/day. As he himself puts it, he has had ‘his good times and bad’. ‘Good times’ refer to spells when he has managed to remain ‘clean’ of all illicit psychoactive substances, and be on only prescribed opiate substitute medication. ‘Bad times’ refer to when he has either ‘dropped out’ of treatment and has used heroin and crack chaotically, or when he has been in treatment but still used heroin ‘on top’ of the prescribed substitute. When he has been ‘stable’ on methadone/buprenorphine, he has successfully held down jobs and has established good interpersonal relationships with his family. During the chaotic periods of his life, he has returned to daily injecting of heroin and crack and regular offending. He has served ‘more than fifteen prison sentences’ and has spent ‘over seven years inside’. Apart from the above-mentioned pharmacological interventions, his treatment package has always consisted of one-to-one psychological input from his key worker and further support to address his social needs. During his treatment episodes, he has been in treatment voluntarily and under court orders (such as DTTO and DRRs (Drug Rehabilitation Requirement)), with neither achieving consistently successful outcomes. He has also had numerous detoxification attempts, which again have been successful in the very short term but only for him to relapse back soon into regular heroin use.
Current/present situation
Mr M is currently on buprenorphine 8 mg daily. He has been doing well over the past few weeks and has not misused any heroin or cocaine. He is attending college and is also seeking employment. He is living on his own and is single. He is engaging well with his drug worker-provided psychological treatment sessions. He appears highly motivated and insightful to address his drug use and lead a ‘normal’ life.
Patient perspective
Given below are Mr M's reflections on being prescribed take home naloxone and having used it in an overdose situation to save a life.
“I feel it's [take home naloxone] a good thing that you can have with you to help others. Like in case of any emergency, like if one of your friends is overdosing, it's great to have it. It helps; it helped me in my situation. And the training and all that was very good as well, recovery position and all that. It made me more confident, I think.
And having someone ‘go over’ [overdosing] in front of you ain't that unusual in our world. It happens all the time. Not all of us know what to do then. Some just leave, because they panic and don't want to get into trouble. Some may call an ambulance and wait. Previously when I've been in overdose situations like, I just put them in recovery position and phoned the ambulance, then I basically kept checking on them to make sure that they were still breathing.
But it was different this time. OK, well I was sitting in my flat about 10.30 at night and my friend S came to see me and he said to run down to the flat because he thought his friend had overdosed. So I ran down to the 5th floor of my block of flats and found this lad turning blue like. I put him in the recovery position and I ran straight back upstairs, grabbed the naloxone and ran back to his flat. I pulled his trouser bottom down and stuck it in his backside and gave him the injection. When I was doing that I got my mate to call the ambulance. After about two minutes, he started going back to a normal colour and started stirring. Then he woke up and started having withdrawal symptoms, like. By then the ambulance came and took him to hospital.
I think if I hadn't done the training with naloxone, I would have panicked and not known what to do. Just having the knowledge and naloxone was a great help. I would get anybody to do it, I would. Having the naloxone with me, gave me a sense of responsibility I think. I had to do something and I knew what to do. I did not panic at all. In fact, I even managed to calm my mate down, who was getting all stressed. Yes, that's all I think. I don't know what else to say or what more I felt. It felt great, saving a life”.
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