Who is Yoshi? We'll just say that this young French physician is specialised in addictology. As for the rest, it doesn't matter what his name is as long as his voice is heard loud and clear.
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The atmosphere is intimate, we are on a first-name basis. The discussion flows peacefully, the carers explain, the users tell their stories. The common thread is Yoshi's questions, which are precise and never directed, and his desire to understand and to help others understand. The name "Parcours Stup" is a playful twist of "parcours" (the french word for course or lesson) and "stup", a shortened version used in France for stupéfiants ("drugs" in french); while also referring to "ParcoursSup", a web platform that allows prospective French students to choose their academic studies.
On Parcours Stup1, we talk about individuals and drugs, lives and substances, physiological effects and treatment. It is a podcast where all voices are equal and are addressed to both caregivers and substance users.
One question I am often asked is about anonymity. Is it really necessary? Unfortunately, I think it is. In any case, this point is very important for me and for my guests, including the carers. Anonymity allows us to speak freely about an area that is still sensitive.
I try to preserve this anonymity at all costs, but it has its limits. Addictology is a rather small world, you have to be careful. In my region, there are only a few young addictologists and our careers still depend on our hierarchies, which are sometimes resistant to new or dissonant voices. Recently, one of us had the opportunity to speak in the media about a new type of behaviour. It was made clear to her that this was not desirable, that informing could "encourage consumption".
"It was the connection I made with health professionals that allowed me to believe in it and get through it." These are the words of Sandra Pinel, a formerly addicted nurse who testified in the seventh episode of Parcours Stup. This is what I am trying to do with the podcast: To show the raw reality of addiction, in all its facets, so that health professionals from all walks of life and drug users have a common culture and language. It's up to me to translate into non-medical language if necessary. When a CNRS researcher explains the impact of alcohol or opioids on the intestines and mentions "coprostasis", I translate it as "stuck poo". It is important that we are all clear on the subject of the discussion, and this avoids unnecessary complexity in a trivial subject.
Sandra Pinel also mentioned the creativity of the physicians who had followed her, who were always ready to try something else to help her to explore other avenues. Addictology is a specialty where you have to be inventive, so why not the podcast? I also recommend listening to the excellent podcast Substance, created by journalist Benjamin Billot and focused on users. Parcours Stup is different because it is a cross-section of addictions.
Although I often go out into the field, I have a great ignorance of the daily life of drug users. Nor can I put myself in their shoes. For other pathologies, such as cancer for example, it happens that carers, who are themselves ill, talk about it. This is still taboo in addictology, Sandra's case is an exception. Physicians in particular do not talk openly about their addictions. I hope that the anonymity offered by Parcours Stup will give them the opportunity to do so.
Our specialty is young and fragile, even miserable. This is all the more regrettable because in addictology, clichés are tenacious and perceptions are fixed. The empowerment of patients that is emerging in other specialties - this pivotal cultural moment when patients take ownership of their care plans - will be all the more difficult in addictology because patients have difficulty expressing themselves and are stuck in the negative representations of which they are victims.
I am told that my speech is politicised. This is true. Addictology is unfortunately a militant specialty. From the moment that this specialty is not allowed in certain countries, I consider that I am doing a militant act every time I walk through the door of the hospital.
In Bali, practising my profession is punishable by death. In Russia, it doesn't really exist. One in three Russians dies from the consequences of alcohol. Addictology is a public health issue in this country, yet the authorities are opposed to the practice of this specialty. For example, after the annexation of Crimea by Russia, access to methadone was banned and stocks were burnt. International drug users associations estimate that several hundred people have died because of lack of access to care.2 With this podcast, I choose to give a voice to those who do not have it, who hide because they are pointed at, denigrated and dehumanised.
When I have students in medicine or nursing, they imagine that our patients are dangerous or violent people. Except that we hardly ever have them in the ward. It's probably the same proportion as in the general population. At the end of the course, the students often say to me: "I understand them now, these people have difficult life paths, and drug use is only one of their problems". This is exactly the case. Addiction is often not their main problem, it is a co-morbidity. Their problem is a traumatic life course that has never been taken care of, it's finding a flat, it's paying the rent. If we solve that, we can more easily solve the problem of dependency.
On Parcours Stup, there was a special episode dedicated to medical students. I wanted to understand their perception of addiction. The guests were fifth-year students, interns, etc. What emerged from their testimonies is that addictology is overhauled during medical studies and is mainly dealt with by psychiatrists. Students find it very difficult to get a clear picture of this specialty. They also describe a hospital environment that is toxicophobic, with a caricatured vision in which addicted patients are renamed "lying patients".
In fact, addictology is essentially social and community medicine. It is also the only specialty in which we find ourselves at 3pm in a squalid squat behind a FNAC (large multi-media store in France) to try and get in touch with a patient who has broken away from care. We're in the field, we're in the city, we're looking at it and what's really going on. This is what my mentors and my patients have taught me and what I want to pass on to others.
In the fifth episode, I explained that a person who plans to do the "mule" should never take laxatives because they make the stool acidic and increase the risk of exploding "fingers" (the fingers of latex gloves filled with cocaine and ingested). 5 to 10 grams of the substance released into the body means excruciating pain and rapid death. An emergency physician contacted me and said, "I've done this before, prescribing laxatives to a mule. I realise I could have killed them. So I ran your podcast, there were at least ten people who broke out in a cold sweat." Another acquaintance who works in an emergency room near an airport tells me that they have posted "Don't give laxatives to mules" with the source "Parcours Stup". To me this is a nice recognition.
Originally, the "aim" of Parcours Stup was the small addictology community, whether professionals or users. But I have had enthusiastic feedback from colleagues in other fields and I realise that the podcast can be useful to them. For example, the first episode describes in fifteen minutes a typical consultation in addictology.
Then, over the course of the episodes, we provide knowledge on pathophysiology, substances, etc. The idea is to provide a better understanding of the problem. The idea is to be both very precise and very concrete.
I have read that toxicophobia concerns "only" 20% of health professionals. However, the 80% of "well-intentioned" carers sometimes lack the keys to fine-tune their treatment. This includes me. This is why I try to invite a concerned person to each episode. Parcours Stups can be a good toolkit, whether in terms of knowledge about products and their effects, documentary resources on care structures, etc. By recommending this podcast to a patient, a physician shows that he or she is not accusatory but has a real desire to understand the patient. It is also a way of explaining the diversity of the care on offer but also its limitations, such as the lack of places.
It is thanks to Twitter, a network on which I can also express myself anonymously, that I was able to launch Parcours Stup and find an audience. Twitter allows me to interact with physicians who would otherwise only have seen me from afar, at conferences. These connections are invaluable to me, especially as I am not planning a career in hospitals. Parcours Stup allows me to find my place in a non-university network, with people who share my approach to addictology.
At the beginning, I thought I would do about ten episodes. The ninth, on eating disorders, has just been put online. With the special edition, I'm now at ten episodes. And I'm very keen to continue the adventure. Two themes are close to my heart, but they require a lot of work beforehand because the literature on them is very fragmented and the debate can be divisive. In preparing them, I will learn a lot. First, there is cannabis. I am less familiar with the issues surrounding this substance because my specialty is heroin. The other subject I really want to deal with is that of women addicts.
Over the years I have tried several formats. The first episode was fifteen minutes long because I was afraid it would be too long. Now I know that an episode can easily last an hour. At first I was alone, then I had one or two guests and I also tested the "round table" format. Two people participate on a recurring basis in Parcours Stup - a user and a general practitioner - and I appreciate what we have built. I can't see myself hosting the podcast alone any more and I would love to see all future podcasts done with three people.
I am certain that the user's voice is as important as mine. What I would like is that after each episode of Parcours Stup we both have the feeling that we have understood something and created a link. And I would also like to learn from the listeners. That's why I invite everyone who wants to share their experiences in the comments on the podcast episodes. The classic pyramid scheme of teaching - as practised during medical studies - clearly shows its limits. I think that all means are good to increase knowledge sharing and I hope that Parcours Stup is one of them.
1. Parcours Stup
2. Slate - "Annexation Symptoms: Russian rule has cut Crimea's drug addicts off from the treatments they depend on, with sometimes deadly results" (22 May 2017)