Day 12: Thursday, October 17 - Methadone Clinic

I woke up rested and excited because today I go to the Methadone Clinic in Dun Laoghaire.  I arrived at the bus stop promptly at 8:55 am.  I stood there waiting for an hour and fifteen minutes before I went back to Farmers because a bus never came:(  Well of course a bus never came - I was at the wrong bus stop....apparently their version and mine of up the street were very different.  Lesson learned - even though I looked up the bus stop the night before and planned what time to come, I should have made sure (since we are at an intersection) that up the street was what I thought.  Well luckily, they were so kind enough to drive me over to the clinic. :)

I arrived an hour late, but they said it was not a problem because I would still see everything I needed.  There were two chemists (pharmacists) in the pharmacy area, two physicians, nurses, security, and other personnel that if needed were 'linked' to the area.  The clinic is located on a nice street with many residents.  Due to this and a mutual agreement with the residents - the clinic can only have a maximum of 100 clients at a time.  Additionally, they can only be open until 1 pm.

They have a very good, established relationship with the 'Outreach Clinic' -- Let me explain what this is:
¬Outreach Clinic:  a clinic in Ireland that goes around to where the 'drug addicts' are and know them by 'gang' name or 'street name'.  They then educate them on how to properly inject the heroin.  They provide the street/drug users with fresh needles, citric acid, spoons, bands to tie around, and anything else they may need for a clean injection.  The purpose of this is to promote safety.  The drug users are going to use whether they have a clean needle or one that has been used by 100 different people -- which increases spread of disease and leads to infected abscesses!  So the outreach program establishes a trusting relationship with these people.  If someone does not show up to the clinic one day, the pharmacist (Diedra or Marie) call the outreach program tell them the person's name, and then the outreach program goes to their friends to make sure the patient is still okay and nothing is wrong!

So the way the clinic works:  the pharmacists see (almost) every patient every day!  They come in, and depending on their situation, the pharmacist asks them to do a breathalyzer test.  Their results determine their dose of methadone they can get for the day.  The legal limit in Dublin is 50 mg/100mL (vs. 80 mg/100mL in USA) - BUT if they blow >80, then they are only allowed half their methadone dose, and if they blow >150, then they cannot have their methadone at all.  This is purely from a safety perspective - if they have too much alcohol in their system, it is a CNS depressant and they risk depressing their CNS too much by having too high of methadone with a high blood alcohol.  You wouldn't believe the amount of patients who blew a 78-79

The clinic also supplies the patients with any medications related to their addiction.  For example, anti-depressants, some sleep aids, many people have liver failure - so they provide their edema medications, spironolactone, and any medication that is related to this as well.  Since many people have the liver failure, the clinic has a great relationship with the local transplant clinic.

The pharmacists see the patients every day - and at least more than the doctors.  The pharmacist knows every patient at the entire clinic by name & knows exactly what they've been up to!  Now this was seriously an incredible relationship.  I have never seen a more trusting and established relationship between a patient and pharmacist as this was!!!  This means they know the patients as well as they would know a close friend.  The clinic holds weekly staff meetings where it is pharmacist driven since they know the patients so well - they can speak to how they are doing.  Pharmacists are able and trained at this clinic to identify life-threatening situations to alert the appropriate people.  Additionally, they know if a person is not acting 'normal' to determine if they are using drugs again.

The clinic has drugs tests each time the patient comes in.  The patient is always tested for a methadone metabolite (many patients were dropping some methadone in their urine to beat the system - this ensures they are taking their medication) and always tests for opiates and benzos.  The heroin test is only done randomly.

It was such an interesting concept and experience to see!  Some patients depending on their progress can 'take away' medications and only come in 1-2 times per week.  If a patient does not come in to the clinic on their scheduled day, the pharmacist is who notifies the physician and reaches out to the outreach program.  The clinic clearly recognizes the value and importance of a pharmacist in the success of patient outcomes and it is truly a wonderful experience to even just observe!

After clinic hours, it was probably the most beautiful day ever and I went for a walk on the pier.  It was quite lovely and I just sat on the benches and devoured my lunch:)

When I went home to meet Cayla, we decided to stay in tonight - so I went to bed niceeee and early - 930pm, only to be woken by Cayla at 11pm screaming I hear something under your bed!!!!  In complete distress, we opened and took apart the bed & mattress - to find nothing -__-.  After all the anxiety, I could not sleep and just watched the clock tick to 3 am -when I finally moved to the couch!  Aye yi yi!

Tomorrow night - we go to Scotland =)


Irish Word of day:  Gone in the head = crazy person