Kevin Flemen confronts a topic we all need to talk about.\r\nA few years ago, on a training course we started to discuss death. Surprisingly this wasn\u2019t on the drug-related deaths course, where such discussions could be expected to take place.\r\n\r\nThis was on an NPS course, and the conversation related to a worker struggling with a young person whose high-risk polydrug use and apparent unwillingness to take on board harm reduction measures left the worker desperately worried and stuck.\r\n\r\nWe discussed the idea of the young person writing a \u2018what if\u2026\u2019 letter to their parents. \u2018You think you are going to be OK,\u2019 the worker said. \u2018And hopefully you will be. But if something bad happened, maybe you might want to write a letter to your parents now. Just in case. You can leave it with me, so I could pass it on to them.\u2019\r\n\r\nFurther down the line, the worker got in touch saying that after having this discussion with the young person they came in two weeks later, saying that they hadn\u2019t used at all. The enormity of sitting down with a piece of paper saying \u2018Dear Mum and Dad, if you get this then\u2026\u2019 was, for this young person, a catalyst for change.\r\n\r\nWhile my initial interest in this may have started with discussions around risk and mortality as a part of motivation, it isn\u2019t now my primary interest. Instead it\u2019s the realisation that drugs workers should be discussing the risk (and ultimately the inevitability) of death far more than we do.\r\nDrugs work is fundamentally an optimistic occupation. It seeks to reduce harm, reverse overdoses, promote and achieve recovery, help people reach their turning point, to change and grow, to rise phoenix-like.\r\nBut people can, do and will die. Some very prematurely, some less so. In our optimism what discussions can, and should, we have with our clients about mortality? How do we balance these discussions (which could be considered pessimistic) with the need to inculcate our services with positive messages of hope?\r\n\r\nMany people who use drug services are isolated from family. They may not have close contact with ex-partners, their children, siblings or their own parents. Obviously this won\u2019t be true for all, but it\u2019s painfully true for some.\r\n\r\nThis isolation may be compounded by professional isolation \u2013 limited access to GP care, recurring episodes of homelessness, transience, periods of incarceration.\r\n\r\nGiven this personal and professional isolation, drugs workers can have a key role in representing a person\u2019s wishes and intent regarding end-of-life care and their death.\r\n\r\nFor example, has the person considered their wishes in terms of advance decisions (living wills)? If they\u2019d overdosed, been deprived of oxygen and could be maintained on a ventilator, what would they want? Has anyone asked them? Has it been recorded anywhere?\r\n\r\nBeyond these discussions, does the person want to write and lodge letters for estranged family or friends? Have they considered writing a will if they have possessions they wish to pass on? How do they want their funeral to be conducted?\r\n\r\nFor some people these conversations will be much more \u2018what if\u2026\u2019 They could take place with people who have significant risk of overdose, or who had recently experienced and survived an overdose.\r\n\r\nFor other people, with multiple, chronic and serious health problems the discussions may be less \u2018if\u2019 than \u2018when\u2019. We would have these conversations in elderly care settings. We would have them in cancer care and other serious illness contexts. We are starting to have the conversations with older dependent drinkers. But few agencies are having the conversations with older and at-risk drug users.\r\n\r\nIt\u2019s probably worth restating the dual nature of these conversations, and introducing a note of caution. They could on the one hand be a catalyst for change. But they can also form part of a package of care for a planned and dignified death, where the person\u2019s end-of-life wishes are known and can be respected. Workers engaging with such discussions should be clear in their own heads why they are having the discussion and the purpose of it.\r\n\r\n\r\n\r\n \r\n\r\nIn the relentlessly optimistic world of hope and recovery from addiction, such conversations may seem \u2013 literally \u2013 morbid. But they are long overdue and our reluctance to have them deprives drug users who die the dignity and rights we afford to other members of society.\r\n\r\n \r\n\r\nKFx workshops have moved online during the current lockdown. Email firstname.lastname@example.org for joining instructions.