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This summer, at the age of 78, Margarete Sharp retired from a groundbreaking career nursing drug misusers. Janet Snell asks her what she learned
Theories and models for the best way of treating people who misuse drugs come and go, but when you have worked in the field for 45 years, you have pretty much seen it all.
In 1967 Margarete Sharp became the first nurse to work in one of this country's early drug clinics at what is now University College Hospital, London. The mother of two small children, and from a comfortable background, little did she know it would become her life's work, and that nine-hour shifts would be a daily reality right up to the age of 78. She finally retired this summer after a career that spanned cleaning abscesses on infected injection sites to serving as the only nurse on the Home Office advisory council on the misuse of drugs.
Awarded an MBE in 1983, she had a drug clinic named after her (the Margarete Centre near Euston in London) and became a much-loved figure among her clients from the back streets of King's Cross, who referred to her as 'Sister Sharp'.
Ms Sharp, who trained as a general nurse at Paddington General Hospital in London, began her passage into the specialty when she was in her early thirties. She was taking a break from nursing and working in one of her husband's chain of pharmacies when she was asked to work at a new drug clinic in central London being set up by two psychiatrists.
'My children were in nursery and I had an au pair so I thought "why not?". The job was practical. I had to clear up after the misusers who had been injecting. No cleaner would do it - there was blood everywhere. Then I cleaned their abscesses, treated their cellulitis and taught them about hygiene and nutrition.'
Ms Sharp believes the rapid growth in the number of people addicted to drugs in the late 1960s was caused by the increased availability of drugs and their glamorisation of drug taking - she says the Beatles had a lot to answer for.
In 1970 the clinic was moved to the National Temperance Hospital in Camden. The prevailing attitude at the time was that drug misuse was a self-inflicted illness, and misusers were shunned, she says.
'They were covered in abscesses and barbiturate burns but they had no GP and A&E didn't want them, so they depended on me. Sometimes it took me an hour to do one person's dressings because they were injecting into so many sites.'
Ms Sharp says she went into drugs work 'full of ignorance'. 'I thought I could cure the them. How wrong I was.'
In the early 1970s the clinic's approach changed with the arrival of consultant Martin Mitcheson, a pioneer who believed the accepted practice of prescribing heroin and cocaine did not work.
The theory was that if misusers had their drugs they would be able to hold down a job or go to college. But most clients took their prescribed heroin then went out and bought more, she says.
Dr Mitcheson set up a three-year randomised trial in which one group was given heroin and another methadone, and he stopped prescribing heroin for new patients.
'At first we gave them injectable methadone and then the oral kind that is still used now. It stopped them feeling sick but it doesn't give them the buzz that heroin does.'
The clinic's change in approach prompted an outcry from the misusers, and the team faced the wrath of colleagues who saw a sharp rise in their caseload. But Dr Mitcheson stuck to his guns and when the trial was over he prescribed only methadone.
'Our view was that drug dependency was a social problem, not just a medical problem, so we wanted social workers and psychologists and more nurses on the team.
'We asked members of the community to be buddies to our clients to help them get into education or work.'
Meanwhile heroin was becoming more available, dropping in price from £360 for one gram of 5 per cent purity to £80 a gram for 35-40 per cent purity. Then, in the mid 1980s, HIV/AIDs became a problem in the UK and the concept of 'harm minimisation' became the priority. 'We pleaded with the clients not to use anyone else's needles.'
In 1985 Ms Sharp helped set up a drop-in clinic for homeless people. It became a forerunner to many future services that would emerge in the UK.
'Looking back we were tough with patients, but I think we provided a service that, at that time, was fantastic.'
Risk of violence
The work was rewarding but often hard and sometimes dangerous. On one occasion a man just out of prison who arrived for a one-to-one session pulled a sword out of his briefcase and held it to Ms Sharp's throat. 'He demanded heroin and I said no. Luckily he put the sword down and I was able to leave the room.'
The incident led to Ms Sharp deciding to become a magistrate, a position she held for 28 years.
'Drug treatment is difficult but it can work. When we started all those years ago, Dr Mitcheson believed in abstinence with support. Now we have just changed the words - patients have become clients and abstinence is now called recovery. I do believe in abstinence. You need to be drug free to start growing emotionally.'
Ms Sharp says she was often frustrated by patients who could not see their own potential.
'You have to remember it is not you who gets them off drugs - you guide them so they can do it themselves. Staff who don't grasp that usually end up burning out.'
Feature | Nursing Standard | November 7 | vol 27 no 10
Pioneering nurse Margarete Sharp worked in one of the country's first clinics for people who misuse drugs. After 45 years in the field, she is convinced that, with the right level of support from nurses, social workers and doctors, drug treatment can work.