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This review contains spoilers
Written by Dr Max Pemberton, this is an account of a year spent working as a doctor doing outreach work in the city. He was based in a medical centre, but also did a lot of work on the streets, looking after drug addicts, homeless people and people with mental health problems.
Dr. P is a kind, self-deprecating man, with a great sense of humour. His concern for his patients is impressive, although he is often ambivalent about them too, well at least the drug addicts. The choices they make are provocative - their lifestyles, the anti-social ways in which they finance their (incredibly expensive) habits and the frequent lying and self-delusion. For those with mental health problems he just feels compassion.
This book gives us privileged insights into the characters and lives of his patients. They become very real people to us, and over the course of the book we get a rounded picture of the problems and difficulties they face in their day to day lives. Some of these characters include Mr. Allsop who thinks he’s God, Fergal and Antony the heroin addicts who against all odds were coming clean, Rachael, the pregnant heroin and crack addict, and Janice, the middle-aged housewife addicted to painkillers. There are others too. Dr. P describes them and their situations with a mixture of insight, frustration and compassion. Also humour. There are episodes in this book which had me guffawing with laughter.
And here are extracts from the book I want to remember…… Not very nice ‘review’ fare, but the book taught me new things, and I want to note them down.
* ”In essence, two medications are available to prescribe for people addicted to heroin. The first is methadone, a bright green or blue liquid in the same class of drugs as heroin and morphine – the opiates. You take it every day as a substitute for heroin and its stops the physical cravings. Because it’s prescribed the dose is accurate, and can be increased if you need more to stop the cravings, or brought down over several months if you want to get off it altogether without the unpleasant withdrawl symptoms. The downside is that to start with you have to come every day to the clinic to have it, and for safety reasons can only have a weekly or fortnightly prescription once you’ve proved, through urine tests, that you’re not using heroin on top. Methadone doesn’t give you a buzz like heroin does; it just stops the withdrawl symptoms. Given that most people use drugs for the buzz, this rather spoils the fun.
The second option is buprenorphine, or Subutex. This little tablet is placed under the tongue and dissolves slowly. It, too, is an opiate and substitute for heroin, but the dose can be decreased over weeks, rather than the months it takes with methadone, so users are detoxed far quicker. This is great if you’re ready to be drug-free, not so good if you aren’t. It works by blocking the receptors on the cells in the body which the heroin latches on to, this providing the addition benefit of preventing any heroin you do take from working. It doesn’t work if you’re using more than a bag of heroin a day prior to starting on it. It’s also incredibly expensive and reserved for people who are adamant that they want to be drug free.”
*“There is a belief among addicts that residential rehab is the answer to all their problems. Patients often request it. In the private sector they will happily take your money and provide you with a nice, peaceful room offering a view of rolling countryside, but in the state sector a residential placement is hard to come by. Unusually for the NHS, this isn’t because of funding but because it isn’t that effective……Removing the person from temptation doesn’t address the underlying reason as to why they were using drugs…..”
*”Heroin is physically highly addictive; crack is not. But both drugs are addictive because of the psychological benefits they provide for the user: the sudden rush, the euphoria, the overwhelming, all-enveloping sense of anaesthesia from one’s life. It might sound heretical for me to say it, but if that’s what you’re looking for, then I’m afraid the drugs do work.”
*”The world of hard-core drug addiction is dark, seedy and hidden. …the general public have only a hazy awareness of what that world is really like; how these people long to be free of their addiction, hate themselves for what they do every day, and their bleak despair.”
*”Pharmacologically, morphine and heroin are the same drug, the only real difference being that morphine is given to you by a doctor and heroin by a drug-dealer.”
*”In many ways, crack is the poor man’s cocaine. They are chemically very similar, crack being a solid, smokable form of cocaine; the same drug for two very different social echelons. The effect of crack is more intense than that of cocaine, but very short-lived.”
*”As both (crack and cocaine) are stimulants …users often find themselves trying to take something to ‘mellow’ them and help them get to sleep: the stimulant properties last long after the buzz from the ‘high’. After crack or coke, a mug of Horlicks won’t help. Heroin, on the other hand, is a sedative and works wonders. But, unlike Horlicks, it brings with it physical dependency.”
*”For several years she had been taking an increasing number of over-the-counter painkillers. She was now consuming around six packets a day….She didn’t like to talk about her addiction and referred to it as her ‘silliness’….. However, when I sat down and worked out exactly how much codeine was in each tablet and the number she took each day, I was horrified to discover that she was taking the equivalent of a bag of heroin each day…..’I can’t be an addict’, she had said earnestly, only last week. ‘I pay my taxes and listen to Radio 2, for goodness’ sake’.”
*”Managing them (heroin addicts who are pregnant) was particularly difficult because by the time they presented at the clinic, it was not just they who were addicted to drugs but their unborn child. While an adult woman’s body is relatively resilient to the effects of heroin, the developing foetus’s is not. Using heroin during pregnancy increases the risk of premature birth, stillbirth and restricted growth.”
* “‘This is Anna’ said Flora…….I looked closely at her. She was limp and grey. She wasn’t responding. …..The nurse shook her head. ‘No, it’s OK, don’t worry. She’s just been given her morphine. Opiate babies aren’t very responsive.
The idea of given someone so small such noxious medication made me feel ill. ‘She started withdrawing a few days after she was born and then began having fits so we had to start her on it’, she continued. I remembered reading about it at medical school: it’s called Neo-natal Abstinence Syndrome and is common in babies born to mothers addicted to heroin or taking methadone….It came about because opiates cross the placenta, so the developing baby becomes addicted. When it is born, the opiates are not longer supplied by the mother’s body, so the baby goes into withdrawal.’”
Please don’t be swayed by the rather grim extracts above – the book is warm, funny and caring – as well as dealing with the more serious sides of addiction. It is also incredibly readable. I found it hard to put down. It opened my eyes to issues faced people on the edge of society, and I was left with admiration for the way the National Health Service here in the UK tries to help them with their problems – for their sakes and our sakes.
PS The title of the book seems completely irrelevant and unrelated to the book's content and direction. More suitable for an Enid Blyton story than the issues it actually deals with, in my humble opinion.