Page 5 - TSAB Adult B FINAL (1)

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contact with offers of work. On one of these occasions this caused friction as Josh took money for a
job that he did not complete. Some contact with his sisters was asking for money and
accommodation. There were periodic messages that indicated that Josh was getting fed up with his
life. Josh indicated to professionals that he was estranged from his family.

5.4. Josh’s story from first admission to the date of the overdose that resulted in the brain injury
happened over 77 days as depicted below:

Table One: Map of Admissions

Phase One – July 2018- Day 36

5.5. Josh had been known to substance misuse services in Area A from the date of handover from the
previous provider in April 2018. Josh was seen for review on four occasions before his first hospital
admission. On three of these occasions he was noted to be injecting heroin, using needle exchanges
1
with use of cocaine on two of those occasions. He was also taking his prescribed methadone .

5.6. On day one, Josh called an ambulance as he was unwell. Josh reported that his insulin was out of date,
he was sleeping rough and drinking dirty water from an allotment. Josh identified that he was also
prescribed methadone for substance misuse. Josh was unkempt in appearance and admitted to
hospital for treatment.

5.7. During this admission Josh initially stated a clear intention that he wanted to die. Josh did not like his
life and had left his tenancy in Area A as he wanted to get away from drugs and the intimidation of the
dealers. Later Josh discussed goals that he wanted to achieve indicating that his intent to die was not
as significant as it had been. Josh was seen by the diabetic team and psychiatric liaison service. Josh

1 Methadone is a synthetic opioid drug that can be prescribed to treat chronic pain, but it is most commonly used in the
treatment of heroin and opiate drug withdrawal. When administered as part of a medical detox, methadone can help to reduce
the severity of symptoms associated with opiate withdrawal. As it produces effects similar to other opioids but without the
associated euphoria, it can be effectively used to help in the withdrawal from drugs such as heroin without experiencing the
unpleasant symptoms typically associated with detox.

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