Column

A brief encounter with distrust

Rosa Hudson, healthmatters’ doctor at large, reports from the front line

John Owen Jones was squeezed into my fully booked Monday evening surgery in a five minute ‘quickie’ slot. One partner was ill and a locum had seen him that morning. He said he was using heroin and wanted temazepam capsules and dihydrocodeine tablets to help him cut down. He had registered as a temporary patient. Our locum, knowing practice policy, had told him we would have to check with his usual GP and the Home Office before prescribing anything.

Attempts to contact his usual doctor had failed, but the doctor’s receptionist told us he was ‘one of a number of addicts for whom the doctor prescribed temazepam and dihydrocodeine’. John had given us a local address saying that he had moved in with his girlfriend, a patient who has not so far come to our attention as an addict. The address was in ‘heroin valley’, a close notorious for heroin dealing and use.

John asked me to refer him to the Drug Dependency Unit (DDU). This, at least, was hopeful, though there is a six week waiting list and they, like us, will prescribe nothing but methadone linctus. Temazepam is widely injected by addicts locally causing much mental distress and horrendous abscesses and blood clots at injection sites. This and dihydrocodeine fetch a good price on the street.

I wasn’t prepared to give him what he wanted. We negotiated a deal: he gives a supervised urine sample for drug screening and comes back in two days with his girlfriend. We will check with the Home Office and his GP, and if his story holds water we will prescribe methadone then. Meanwhile I will write to the DDU.

He was angry. I said: ‘This is a good deal — either take it, or don’t bother coming back’. Part of me hoped he would just go away but part of me didn’t. Because I want to help, I’d like to be there for him on the day he decides he really has had enough.

He left only after an aggressive 15 minute tirade. ‘What am I going to do tonight? You don’t care about me.’ But he did give a urine sample — a hopeful sign. He’s due back in two days.

I finished surgery over an hour late. I was upset for all those waiting, but how could I explain? ‘An emergency came up’ — it sounds a bit weak.

Recently the practice discussed feelings aroused by ‘no trust’ situations. General practice is built on trust, understanding and communication. But even if I liked John, I still couldn’t trust him. In some ways it’s easier to have a business-like relationship with addicts I don’t like.

If John does go to the DDU he’ll be in contact with people who can help him more than I can. One day, as with any tobacco or alcohol addict, he may decide ‘now I really am going to change’. But who knows how, where or when?

I fear I’m in for a stormy time with John. I lie awake long after midnight thinking about our brief encounter. Can I continue to negotiate with him — at least until he gets to the DDU? So much for a five minute ‘quickie’ slot…