Treatment for addicts, malpractice or not?

Treatment for addicts, malpractice or not?

David and Joyce Djaelani Gordon, Directors, Yayasan Harapan Permata Hati Kita, Ciawi

Recently The Jakarta Post ran an article titled "If doctors hurt but not heal: It's malpractice."

As regards the detoxification and treatment of addicts at the present time, there are those whose methods and conduct -- if reviewed by a board of inquiry -- could be considered as malpractice.

Most of this article, however, is not specifically directed at malpractice but addresses medical common sense, while encouraging better approaches to detoxification and recovery, adding stratagem to harm reduction, and sensitizing professionals. In this case, it means that hospitals, institutions and those in the medical and therapeutic fields, and communities must learn more about intervention, detoxification, drug abuse, the world of drug addiction and addicts, HIV/AIDS and Hepatitis C.

The grounds for allegations of malpractice concerning the detoxification, treatment and recovery processes generally concern the discovery of facts that some "professional or institution" is knowingly making the same mistakes over and over again with patients (and their families) by using incorrect and or incomplete procedures and methods.

Malpractice includes imparting false information and advice for reasons of ignorance, arrogance or inadequate knowledge -- overmedicating a patient during the detoxification process; continuing to prescribe medication on an ongoing basis for patients without employing a proper system of evaluation, monitoring, and therapy; or using "the addicted and recovery community" to enhance one's personal wealth and status.

The foundation of all medical practice is helping others, and assisting those who are sick and suffering towards healing. In recovery from drug abuse or addiction, detoxification constitutes the first part of the recovery process only. A true "recovery" means physical, mental, emotional and spiritual recovery. Medical common sense also recognizes that there are four stages that encompass the process of treatment and recovery.

Controversy mostly concerns what is meant by proper and improper methods and treatments in the detoxification process. Yet for most drug abusers and addicts, "detoxification" is far easier and safer than most realize.

When the symptoms of the abuser or addict are treated through the detoxification process, the generally used method is "the standard medical model", meaning a heavily medicated detoxification process. It means they treat the symptoms of withdrawal with heavy medication, while mostly neglecting to treat the mental, emotional and spiritual individuality of the abuser, the person within.

Therefore, they only address the first stage detoxification, the physical portion of recovery. One stage recovery, detoxification only, is rarely successful.

At Yayasan Kita, for instance, we have always used a natural method of detoxification. Over 250 mostly young males and females have successfully completed the detoxification process with no adverse side or after affects. Only a tiny bit of medication is used and vitamins for withdrawals, and only when necessary.

Detoxification from putaw (heroin) and shabu-shabu (crystal methamphetamine) is relatively uncomplicated when individuals or institutions understand the detoxification procedure, understand the addict and addiction, and realize most of those seeking detoxification are young people who are easily assisted through the detoxification process. After three to six days, the most difficult part of withdrawal (sakaw) is over with.

The mental cravings of second stage recovery are far more difficult to deal with than the detoxification withdrawal pains and discomforts of first stage recovery. Furthermore, it is not the getting-off drugs that is considered the main problem in the recovery process. The more difficult problem is staying off drugs!

It is malpractice today for a recovery facility or center, hospital or other body to treat any drug abuser or addict for anything related to detoxification, recovery or general health issues without providing testing for HIV/AIDS and Hepatitis C, as well as quality information regarding these two highly prevalent diseases. This is especially true if the drug abuser is an IDU (injecting drug user).

HIV/AIDS and Hepatitis C are both raging throughout the addicted community. If drug abusers or addicts are treated by professionals for anything related to drug abuse today, they should be given factual information about drug abuse and the viruses, and provided with harm and risk reduction counseling along with referrals for ongoing support and assistance, and given the option (a suggested must) of being tested for the viruses.

Testing must be carried out with the full understanding of why they need to be tested. Written consent from the drug abuser, guardian, or family member is also essential. With blood testing, information, counseling, consent and confidentially are always primary factors.

At any point when and where addicts and their families show up for help, professionals must give responsible information and assistance. Qualified professionals realize most addicts relapse after intervention and treatment, usually several times or more, and by not providing accurate information on how to avoid HIV and Hepatitis C today can mean sending addicts home unprepared and open to infection with a life threatening or deadly virus.

The foundation of Harm Reduction is based upon personal involvement, giving quality time and information, and caring. Harm Reduction as regards the drug-abuse community means focused education, ongoing counseling, outreach into the community, confronting human rights issues, family counseling and involvement, self-support groups, treatment and hospitalization, and directly addressing HIV/AIDS and Hepatitis C.

Harm Reduction realizes that without knowing they may be infected with HIV/AIDS and/or Hepatitis C after treatment, when they return home they often return to their "old ways and patterns of life (relapse)", thus continuing to spread the viruses further into the drug-abuse community and general population.

Harm Reduction methods are responsible and sensible methods that intervene and build bridges of learning, action, and protection for almost everyone in the war against drug abuse and the viruses.

Sensitizing the professional (centers and institutions) means a conscious elevation of maturity, sense of responsibility and integrity in facing both a national crisis and a human crisis.

Today there are three to four million addicts throughout the country. Many are beginning to seek help for detoxification and treatment. As professionals, we cannot truly help if we do not fully understand addicts and addiction, the recovery process, the viruses, or exploit these people for personal gain or fame. We cannot help very much if we only see a person as a drug abuser, thereby forgetting that he or she is someone's child, our brother or sister, a member of our own family.