Saturday, October 30, 2010

MMT Program Campaign Proposals

This posting is my completed campaign for proposed changes to The Methadone Maintenance Treatment program. 

I am not pro or anti Methadone, I acknowledge The Methadone Maintenance Treatment program does have a place and purpose in our society for persons with drug addictions.   However, I am very uncomfortable and concerned with certain aspects of The Methadone Maintenance programs current operating format.   The existing program format must be restructured to put more emphasis on achieving an end result for the participant, not just maintenance.   Participants shouldn't have to, or be permitted to exist on this program for years.   These participants, just end up 'Methadone Junkies' who see no way out of the program, and without a timeframe, plan, or encouragement, why most stay on it for many years.

Addiction research and studies confirm that Methadone is highly addictive and one of the hardest drugs to withdraw from, with body tolerance to Methadone being higher and cravings stronger than Heroin.   Addiction professionals also confirm this is the reason why participants tend to 'Poly-abuse' or 'Top-up' with other substances while attempting to reduce their daily dose of Methadone.   Apparently it is quite common, and why drug abuse within this treatment program is a major problem.   To give drug addicts a more highly addictive drug than the one they were probably using, begs questioning, and why the treatment, maintenance and dependency of Methadone needs to be seriously investigated.

The Methadone mixture was originally mixed with a syrup so it couldn't be injected, but the mixture was altered and the sryup was removed towards the end of the 1990's.   The Methadone mixture could, and was used by most participants intravenously from then on.   Addiction professionals within The Methadone Maintenance program acknowledges the mixture being changed did promote the intravenous use of Methadone.   Participants on, and entering this program are mainly intravenous drug users, so why have a treatment program that almost encourages the addict to continue with their intravenous habit, also begs questioning.   A Methadone mixture that cannot be used intravenously urgently needs to be investigated and introduced back into this treatment program.

Very random urine and periodic blood testing should be a perquisite of The Methadone Maintenance
 program.   This would help to solve the drug abuse problem that widely exists with participants on the program.   Urine only detects some substances, whereas blood testing could detect all substances in the system.   It is necessary that the drug testing be very random, as addicts are knowledgeable enough to work their drug abuse around the testing that presently operates.   It is simply not random enough and allows too many loopholes.   The current guidelines, I believe, also need to be more rigid and participants held accountable for their actions.   The privilege of participants having take home doses of Methadone is one area of accountability that seriously needs to be reviewed.

Most addicts entering The Methadone Maintenance program are burdened with psychological problems, they suffer low self esteem, and have self worth issues, which are not professionally addressed at all within this treatment program.   All these psychological issues become a bigger burden and are accentuated with becoming addicted to Methadone.   I think that addiction professionals within this treatment program has lost sight of the fact that drug addiction is a mental and spiritual problem, as well as a physical problem.   In other words, you cannot heal the body without healing the mind as well.   Community Alcohol & Drug Services caseworkers are the only link these program participants have, and very few of these caseworkers are qualified addiction counsellors.   So regular professional counselling for participants must become a top priority within this treatment program.

I propose a time frame of 3 - 5 years be introduced for all participants to withdraw off Methadone and exit the program.   In that time, with regular therapy, constructive support and encouragement, partial Methadone withdrawal could be safely achieved under the current guidelines.   The final and tricky withdrawal phase of 3 - 6 months could be safely accomplished within a residential rehabilitation facility.

If the Opioid Substitution Practice Guidelines were changed to accommodate all these new measures, then all, including participants already on the program, would have to abide by them.

Admittedly an increase in funding would be required in the first 2 - 3 years to intially phase these new measures in - especially for the extra residential rehabilitation facilities, the cost of blood testing, and professional counsellors.   The long term monetary savings of funds allocated to Addiction Services, with not having participants on The Methadone Maintenance Treatment program for years, would be extremely beneficial and worthwhile, making this a very practical, sustainable solution.

I am aware of what the view point will be towards my proposals and suggestions from professionals within Addiction Services.   I am also knowledgeable enough to realise some years ago, when the program originally started, that timeframes for participants were attempted and weren't successful, with addicts having to enter back into The Methadone Maintenance program.

T say " it's been tried and it doesn't work" is a cop out to me, that was some years ago.   I know what is required and how difficult it is for participants to withdraw from Methadone, and any attempt will never be successful without a new approach.   The Methadone Maintenance program has been operating for some thirty years or so.   It has become bigger, with more persons entering, but certainly not better, or even worthwhile anymore.   A huge amount of Government health funding goes towards this particular treatment program.   So for future benefits The Methadone Maintenance program must be streamlined for success, not just sustainability.

I don't have a crystal ball in front of me, I just know from my own experience with Shane on this Methadone Maintenance program for 14 years, that this treatment program and the services that exist around it, or lack of them, seriously require attention.

The Methadone Maintenance Treatment program operates world wide.   However, programs in other countries are structured and operated differently to the MMT program in New Zealand.   With funding and duration of treatment for overseas program being the major difference to our MMT program here in New Zealand.

Government Health Officials and Addiction professionals attend world wide Drug Addiction Treatment conferences annually.   One would assume then with all this new knowledge and expertise that firstly, the MMT program in New Zealand would have improved after 30 years, and secondly, that the success rate for complete Methadone withdrawal would be higher than the 2% figure quoted in 2007/08.

The Methadone Maintenance program funding figure for 2008/09 was $13.6 million dollars, with approximately 4600 persons enrolled nationally in the program that same year.   The funding that keeps this treatment program operating, is in reality taxpayers money, that is something none of us should loose sight of.


                                                     End Of Campaign

Shane's 14 years on The Methadone Maintenance program, his drug abuse, and drug addiction was summarized into 2 pages and included with this campaign.   The following list is to whom the campaign has been forwarded out to.

                                                        Members Of Parliment

Mr John Key -  Prime Minister                                   
Mr Bill English -    Deputy Prime Minister
Hon Tony Ryall -  Minister of Health                          
Hon Jonathan Coleman -  Ass Minister of Health
Mr Russel Norman -  Minister Health/well being         
Ms Tariana Turia -  Ass Minister of Health
Ms Heather Roy - Ass Minister of Health                   
Ms Ruth Dyson - Spokesperson.  Labout Party      
Mr Lian Galloway - Spokesperson. Labour Party       
Mr Keven Hague - Spokesperson. Green Party
Ms Sue Kedgley -  Spokesperson. Green Party          
Mr Phil Goff - Opp. Leader Labour Party
Ms Annette King -  Opp. Deputy Leader. Labour Party

                                                      District Health Boards

Mr Brian Rousseau -  chief executive.  Southern DHB
Mr John Peters -  chief executive.   Nelson/Marlborough  DHB
Mr David Meates  -  chief executive.  Canterbury  DHB
Dr Kevin Snee  -  chief executive.   Hawkes Bay  DHB
Mr Craig Climo  -  chief executive.   Waikato  DHB
Mr Phil Cammish  -  chief executive.  Bay of Plenty  DHB
Mr Garry Smith  -  chief executive.   Auckland  DHB
Mr Dave Davies  -  chief executive.  Waitemata  DHB

                                      Community Alcohol & Drug Services

Dr Murray Hunt  -  Medical Director  CADS  Hamilton
Mr Robert Steenhuisen  -  Regional Manager  CADS  Auckland
MS Clarissa Brodrick  -  Manager  CADS  Auckland
Mr Louis Miller  -  Manager of Alcohol & Drug Services.  Blenheim
Dr Alfred Dell'Ario  -  Clinical Director of Alcohol & Drug Services.  Canterbury
The Manager.   CADS  Wellington
Mr Rob Warriner -  chief executive.  Walsh Trust
Mr Tim Harding  - chief executive.   Care NZ


Mr Paul Holmes  -  TV and Radio Host
Mr Leighton Smith  -   Radio Host
Ms Bernadette Courtney  -  editor.  The Dominion Post Newspaper
Mr Andrew Holden  -  editor.   The Christchurch Press
Mr Tim Murphy  -  editor.    The New Zealand Herald  -  weekday edition
Mr David Hastings  -  deputy editor.   The New Zealand Herald  - weekday edition
Mr Bryce Johns  -  editor.  The New Zealand Herald  -  Sunday edition
Mr Jonathan Milne  -  deputy editor.   The New Zealand Herald  -  Sunday edition

Hopefully there maybe a reasonably positive response to my Methadone Maintenance Program campaign this time around.   I do need readers and followers of my blog to get behind this campaign, especially those in New Zealand.    Persons wishing to support my campaign can do so through my email address.
 I will be loading a normal posting on my blog in few days time.


Monday, October 25, 2010

Valium & Methadone Binge

My husband, Shane and eldest son were very keen hunters, and every year around April they all went on their annual hunting trip.   For the past 5 years they had flown in and out of the Ureweras by helicopter from a base in Rotorua for their 5 days of hunting.   The men camped in the bush and stalked deer and wild pigs.   This hunting trip was booked and planned months ahead, and it was something all three men looked forward to and really enjoyed.   Shane even had to apply to CADS weeks prior to this trip for the extra take home doses of Methadone to take with him.   Guns and hunting safety were always a top priority, and my husband had brought both boys up to appreciate this rule, so it was the one time of the year that for 5 days Shane remained in control and didn't abuse his Methadone or other drugs.

The 2003 hunting trip was upon us and the men were departing early hours of the Saturday morning.   It was arranged that our eldest son would head over to Te Puru on the Friday to sort and assemble all the hunting and camping gear ready for departure.   We arrived home from our work in Pukekohe that Friday night about 6.30pm to find our eldest frustrated and upset over the state Shane was in.   He said Shane was drugged up to the eyeballs, and he'd been like that since his arrival early that afternoon.   Our eldest had managed to establish that Shane had purchased Valium tablets from an acquaintance while in Thames that morning collecting his Methadone.   However, he was unsure how many Shane had purchased or taken.   In that moment all the excitement of the hunting trip was lost.

Shane being a bit drugged up wasn't unusual under normal circumstances, but it certainly was prior to a hunting trip, so at first I thought maybe my eldest was being over dramatic about the situation.   But, hell no he wasn't dramatizing at all, and barging into Shane's bedroom confirmed this.   Shane was indeed extremely drugged, in fact it's the worst drugged induced state in 9 years I'd ever seen him in.   Shane was sitting on his bed with this horrible vacant, dazed look about him.   A syringe and 2 empty dose bottles of Methadone were found, which I immediately disposed of, but no valium tablets were located in his bedroom.   His kit for hunting had been packed days before but that was all unpacked, and there were cloths strewn all round his bedroom.

I was livid, absolutely furious with him, not because of the hunting trip, but because he'd blatantly risked his life by abusing all that in one day.   You see, Shane would've drunk Fridays dose of Methadone at the pharmacy, then he'd been given 5 days supply of Methadone to take hunting.   It was obvious that out of this supply Shane had also shot-up another 2 doses of Methadone that day, plus whatever Valium pills he'd acquired as well.   Honestly I felt like slapping him, but he was that drugged up he probably wouldn't have felt it anyway.   It's just unbelievable, and never ceases to amaze me how a drug addict's body copes with all those drugs in the system, and all in one day.   However, that's how most addict's do unintentionally overdose, because they are always prepared to push the limits of what, and how much they've taken on previous occasions, and that's what's really frightening about loving a drug addict, never knowing if that one day of over indulgence, is going to be that one time to many.

All we could do at that time was to get Shane a bit mobile and keep him occupied, hoping that the effect's of the drugs would eventually wear off.   By 11pm that night Shane's drugged stupor had slightly improved, well, at least he was coherant and conversant.   Up to this point I'd contained my anger, but all this fury and fear welled up inside me and I exploded, ripping into him about his over indulgence that day, saying  " how dare you put yourself at risk like that, you're a bloody asshole Shane.  What if dad and I had come home and found you dead, you never think about that do you? with you're  bloody drug taking."   The barrage continued and I told him I knew about the Valium tablets he'd brought, and that he'd also shot-up an extra 2 doses of his Methadone as well.   Shane admitted to purchasing 10 Valium tablets, but he had no recollection of using the extra Methadone.   The usual apologies, sorrow and guilt followed and Shane promised to sort his 'shit' out and not to abuse like that again.   "You better sort you're 'shit' out Shane I said, or else, cause I'm not going to keep doing this drug stuff with you year after year".   Famous last words of mine, and one's that were to be repeated many, many more times over the next few years.   But there was one day I really did mean it.

There are a large group of drugs which in medical terms, are referred to as Benzodiazepines.   Some of the most commonly abused are:  Valium, Diazepam, Temazepam and Lorazepams.   The opiate based prescription medications that are abused and highly sought after by addict's are:  Morphine and Tramadol.   All these pills are listed as controlled drugs, therefore prescription only medications.   Naturally, failure to obtain any prescription drug via a general practitioner, the addict can purchase some of these medications through drug dealers.   Prescription medications are usually abused because they are easier to obtain than illegal, intravenous drugs and a lot less expensive.   Therefore, prescription medications are inclined to be seriously abused by Methadone participants for 'topping-up' due to their availability and cost.   Anyone of these drugs, if overly abused with Methadone, alcohol or other intravenous drugs, can have serious consequences.

My husband and eldest insisted on Shane still being included in on the hunting trip, it takes a day to set up their camp site so they wouldn't be going hunting until the Sunday, and they felt Shane would be fine by then.   Thank god for that, because incidents and row's with Shane used to leave me feeling quite emotionally drained, so putting some space between us was always good medicine for me.   The hunters returned 5 days later, this time minus a deer or pig, but never the less, fun and male bonding was had by all.   Shane went on this hunting trip with 2 doses of Methadone down remember, which meant he had to go 2 seperate days in the bush without his Methadone.   But even this didn't dampen his enthusiasm, my husband stated that although Shane appeared unwell on these days, he never once grumbled or complained about it, he just got on with the hunting schedule.

This fearful over indulgence incident in 2003 was just the tip of the ice-berg, drug binging sessions and Shane putting himself at risk became a nightmare.   But in 2004-05 I invested in a computer and this changed my perspective of Shane's drug addiction and how I dealt with the abuse.   My campaign re: The Methadone Maintenance program is ready to be forwarded out.   I will put my completed campaign format on as an extra posting in a few days time, so my readers are aware of what has been sent out.

Sunday, October 17, 2010

All Good Things Come To An End

In mid 97 Shane moved out of our flat and into his own rural accommodation on the outskirts of Pukekohe.   The flat on the property was always intended as a seperate living space for my husband and I, which Shane was aware of, hence why this move after eighteen months took place.   Shane's earnings were moderately high because of the shift work, but his expenditure which was presumably on drugs reflected this, so I hoped that this move with paying more rent may help to at least curb his drug abuse.

Shane's addiction had remained the same, some weeks were reasonably good, and others weren't, depending on whatever drug or pill he was using to top up with.   The more I tried to understand Shane's drug addiction, the more it grated on me.   He'd had this drugged look or appearance almost since being on the program, and that I'd semi adjusted to, but not the 'nodding-off' or 'blobbing' part of of his drugged behaviour.   Shane could 'nod-off' while eating a meal, rolling a smoke or in conversation, it was brief and only lasted a few seconds, then he'd come to and carry on eating his meal or whatever like nothing had happened.   Shane was totally unware he'd 'nodded-off', but it was really quite bizaar and distrubing to witness.   I'd questioned this part of Shane's behaviour at our meeting with CADS, but this question was also brushed off without explanation.

To keep some form of normality in life you have to try and ignore some of what goes on with a drug addicted loved one, or you'd go 'nuts' if you didn't.   But there were times that Shane's drug abuse and drug habits really did piss me off, and that was usually acknowledged and most times vented to Shane.   I'd got to the impatient, irritable stage of Shane's addiction and treatment, and I used to hound him about the program and his withdrawal rate off the Methadone.   So at this point, I think Shane and I were more than ready to put some space between us, well, for a while anyway.

Shane's visits to us were quite frequent, and in the first year or so of his move he seemed to be managing ok.   I still prodded him on visits about his treatment progress and Methadone withdrawal, but got very little information from him in return.   The break of not having Shane's addiction constantly in my life was good and it revitalized my spirit and emotional well being.   Our break though came to an abrupt end in late 99, Shane had a car accident going to his afternoon shift.   He lost control of his vehicle swerving to miss a goat on the road that had broken loose.   Thankfully, he wasn't badly injured and no other vehicle was involved, but his car was a write off and he'd let the car insurance lapse.   Shane couldn't get transport to work from his rural accommodation, so he moved into the flat with my husband and I, and signed his rural rental over to a friend.   There was plenty of room in the main house but Shane didn't want to encroach on our daughter and family.   The car accident was just the start, there was more upheaval to come as in early 2000 Shane also lost his job.

However, Shane wasn't terminated, he was deemed mentally unfit for work by his CADS doctor, and this wasn't a surprise to those around Shane.   Apparently, on two previous occasions Shane's demeanour at work had been questioned, and he'd also taken an extended lunch break without authority for a caseworker appointment.   Shane disclosed his recent entry into The Methadone program at a meeting with management and severe restrictions were imposed on him to retain his job.   Shane was searched, urine tested and examined by on-site medical staff before commencing his work duties, which was understandable from an employers perspective, but it was embarrassing and it became mentally stressful for Shane.   Up to this point, drugged or otherwise, Shane's work record of nearly 5 years was clean, and he was known to be a diligent, safe, hard worker.   His drug addiction had escalated though over that 5 years, so I guess Shane was lucky to have retained his job that long.   Fortunately for us, his stress levels did slowly abate with not having to deal with the pressure of his employment.   So with that chapter of employment closed, I wondered what the next chapter or phase of Shane's addiction might bring.

My saving grace in times of turmoil were my grandchildren, Shane's usually was drugs, but this time there was a lady in the back round showing interest in Shane.   Shane however, was very wary about relationships with his addiction.   He'd stated way back in 94 that drugs had ruined the few relationships he'd attempted to have, which he said was fortunate because he certainly didn't want, or plan to put his 'shitty' drugged life on a wife and kids.   At times I felt sad that Shane only had the love of his family in his life, and not the love of a good woman.   Which was a shame because he was a really nice, respectful guy, whom had good values in life, and he was wonderfully patient and loving with his little neices and nephew, so there was no doubt he would make an excellent father as well.   Even so, I was thankful that I didn't have the added burden and worry of a wife and grandchildren regarding Shane's drug addiction.

In mid 2000 our daughter and her husband brought our share of the proerty out, and my husband and I relocated to Te Puru, a lovely sea-side settlement along the coast of Thames.   Te Puru was only 1 hours travelling distance to Pukekohe, so we both retained our employment obligations in Pukekohe with our move.   Shane stayed and resided with our eldest son in Pukekohe, and he eventually did acknowledge this ladies intentions, and after much discussions with her regarding his addiction, they attempted a relationship and Shane moved into her home.   However, the relationship only lasted about 1 year, so Shane's reluctance and intincts about love and addiction proved to be correct, and love and women while addicted was never to be approached by Shane again.  

In May 2000 Shane moved in with us at Te Puru, his case file was transferred to the Thames CADS clnic, and he was enrolled with a Thames pharmacy for his Methadone.   Shane's abuse of other substances with the Methadone had always been a worry, but from here on, his drug abuse went to another level, it was to become very dangerous and destructive.   But on the 21st of June 2002 and within weeks of Shane's arrival a huge weather bomb hit along the Thames coast line and surrounding areas, and our property along with hundreds of others was completely destroyed by the flood that followed.   Many homes including ours were deemed uninhabitable, and we lived in a motel with Shane for 4 months while our home was being repaired.   The intial first 2 weeks after the flood my husband and I were very fragile, and Shane was to be our saviour at that time.   He showed empathy and understanding of our feelings, and it was his positive and helpful attitude that kept us grounded in those early weeks.   So Shane can certainly step up and be relied upon when needed.   His drug addiction at that time became secondary to our own problems and flood dilemma.

I soon established the reason for Shane's pattern of Methadone withdrawal and why it had fluctuated over the years, with the rate decreasing then increasing.   Negative urines are a sign of drug abuse and a participants instability, and CADS deem this to be because their daily dose of Methadone is to low.   The participant is notified of negative urine results, at this point a meeting with their CADS caseworker and CADS doctor is initiated, and the participant is ecouraged to increase their daily dose of Methadone.   The participants Methadone take-home privilege is also revoked for 2 - 3 weeks upon a negative urine result.

The Methadone programs protocol for withdrawal certainly requires reviewing.   Drug abuse is a major problem with withdrawal, however, participants withdrawing off Methadone shouldn't be permitted or encouraged to increase their dose.   A proposal will be forwarded with my campaign suggesting a time frame of 3 - 5 years be introduced for all participants to withdraw off Methadone and exit the program.   In that time, with regular therapy, constructive support and encouragement, partial Methadone withdrawal could be safely achieved under the present guidelines.   The final and tricky withdrawal phase of 3 - 6 months could be safely accomplished within a residential rehabilitation facility.

I do appreciate the comments that have come through so far from followers regards my postings.   If my story about Shane's drug addiction and Methadone helps just one person then telling it has been worthwhile.   I am hoping to have my campaign and proposals regarding The Methadone Maintenance program ready to be forwarded to the NZ Government, Addiction Professionals and the appropriate District Health Board Officials in the very near future.  I will keep you posted on the progress of my campaign further down the track.  See you all next week with another posting.

Friday, October 8, 2010

No Change, But Still Employed

This update is being posted earlier than usual, as I'm going to be away for a few days.

In 96 we moved to Pukekohe, a suburb about 15kms away and brought a large 5 bedroom property with our daughter and her husband.   The property also had a roomy one bedroom self contained detached flat on it, which we decided to rent to Shane.   This living arrangement gave him independence and responsibility for his own life.   Shane worked rotating weekly shifts of day, afternoon and nights, with 3 days off in between these shifts.   So with my part time job, there were days when he was afternoon and nights that I didn't see him.   But his addiction status and abuse of other substances hadn't changed, that was for sure.   He lived and breathed Methadone and the program, in fact his whole life revolved around it.   Ther were times we all worried, and wondered about his employment.   But he was still employed, so we guessed he must be ok at work.

Shane tended to be slightly worse on Methadone pick-up days, and maybe using an extra dose of Methadone was our explanation, and injecting his Methadone dose was also strongly suspected.   I did question Shane about his take home doses, and also if he was using the Methadone intravenously.   Of course, he denied both scenario's, especially using the Methadone intravenously, curtly informing me the Methadone was mixed with a syrup, therefore, it couldn't be injected.   No matter how hard I tried, gaining any sort of admission from Shane about anything was never accomplished, he always had an answer, just not an honest one.

Addiction had taught Shane, like most addicts to be very skilled and clever at manipulating situations and people, me included, this ability is a valuable survival technique to them, and one they never loose touch with.   Discussions with Shane at the time of disclosure allowed me some insight into the mind and life of an addict.   Shane stated then that all addicts do hold themselves responsible for being addicts, but none ever contemplate losing control when they originally start using drugs.   That an addict will do whatever it takes in their quest for drugs - they will lie, cheat, deceive and even steal from family and friends.   Shane wasn't proud having to admit these traits, it's just how it has to be to satisfy the craving for drugs, that's all.   So acknowledging and recognizing some of these traits in my addict son wasn't difficult, but actually accepting them was, and I didn't for sometime.

However, Shane didn't ever steal from us, and he always paid his flat rent etc on time.   Even the years he resided with us in our home and was on the unemployment benefit, he fronted up with his board every week, so Shane did retain some pride in himself by paying his way.   But knowing and even understanding all this didn't help, emotions can still run deep when dealing with an addicted loved one, anger, and frustration being two of them.   You soon learn to pick your battles and move on, or you wouldn't survive emotionally.   Having the gift of four beautiful grandchildren, and two of them at that time living on the same property was a wonderful distraction for me, and they did ease the stress of Shane addiction.

Inquiries at the time did reveal Shane was correct about the mixture, however, the Methadone mixture was altered towards the end of the 90's, and it could and was used intravenously by all, not just Shane on the program from that time on, that I did verify.   The Methadone mixture being alterted, I presumed to be a cost effective issue, maybe the syrup became to expensive.   Using the Methadone intravenously instead of orally was preferred by participants because it prompted a faster, more effective solution for uncomfortable withdrawal symptoms.   It kind of defeats the purpose though, of a 'harm reduction' treatment program, HIV and Hepatitis C, needle sharing and all that.   Oh! I forgot, of course they do have needle exchange programs operating, but not through out NZ, only in some larger centres of NZ, but the cost of a syringe is only $3.00 at a pharmacy.   Addiction professionals within The Methadone Maintenance program acknowledges the mixture being changed did promote the intavenous use of Methadone.   Participants on, and entering this program are mainly intavenous drug users, so why have a treatment program that almost encourages the addict to continue their intavenous habit, begs questioning as well.

Shane's CADS caseworker appointments were 3 monthly, and his urine testing was done in conjunction with this visit at the clnic.   This was the only time for years that Shane attended a CADS clinic, and he received notification of appointment about 2 weeks in advance, so I guess that could be presumed random.   There was a 2-3 year period though that Shane went to a Diagnostic laboratory, not the CADS clnic for urine testing.   I don't really know why, Shane didn't eleborate when asked.

Shane had various CADS caseworkers over the years, and very few of them, in fact only 2 were certified addiction counsellors, so Shane received very little if any psychological counselling over that 14 years on the program.   Most addicts entering The Methadone Maintenance program are burdened with psychological problems, they suffer low self esteem, and have self worth issues, which aren't professionally addressed at all within this treatment program.   All these psychological issues become a bigger burden, and are accentuated with becoming addicted to Methadone.   I think this treatment program has lost sight of the fact that addiction is a mental and spiritual problem, as well as a physical problem.   In other words, you can't heal the body without healing the mind as well.   So professional counselling for participants must become a top priority within this treatment program, and this is another aspect of my campaign.

In a future posting I will put forward a detailed plan outlining how these changes and new measures to The Methadone Maintenance programs NZ operation can be financially achieved, and also with only a minimal short term increase to the present Government funding schedule   The priority and importance of this campaign will be to indicate that the programs present format and it's operational services do need restructuring to premote a safer, higher success rate for participants in treatment.   This treatment programs future long term goal has to be improved to encourage and promote abstinence not just maintenance.

Thought I would give you all a break and make this posting a bit shorter.   Catch you all next week with an update.

Monday, October 4, 2010

Drug Abuse. Ignorance Is Bliss

Shane wasn't gainfully employed when he entered The Methadone Maintenance program.   This was probably just as well, as for the first month on the program he was required to attend the Auckland city CADS clinic daily to consume his dose of Methadone.   This was an 80km round trip from Papakura, where we resided.   I don't know how other new entrants work that around a job unless they live and work in the city.   Then after this month Shane was assigned a CADS caseworker in Papatoetoe, and he was enrolled with a pharmacy in Papakura to consume his daily dose of Methadone.   After a probationary period of 3 months, Shane was then progressed onto what's called Methadone pick-ups, or take home doses.   Now, this stage meant Shane only had to attend the pharmacy 3 days a week to consume his Methadone, and the pharmacist distributed the extra doses of Methadone for Shane to take home.   Shane was to consume these doses at home on the days not attending the pharmacy.

Even though the information stated Methadone had proven to be a very effective treatment for drug addiction, Shane taking it was a dilemma I mentally fought with for sometime.   Shane positivity reigned supreme though in those early months, and he even obtained employment, which boosted his morale even further.   His progress and the program were frequently discussed, and at this stage his goal seemed achievable.   However, all that started to change about 1 1/2 years into the program.   Shane became aloof and a bit sullen, and he wasn't as conversant about his progress, just stating he was sorting it out.   At times his demeanour and erratic behaviour indicated to us all there was some form of drug use going on other than Methadone.   But knowing he was being urine tested and he still had the privilege of take home doses of Methadone made our observations and concerns somewhat puzzling.

Shane was obviously experiencing problems within his treatment, but it was difficult to know exactly what to do about it.   After much contemplation, contacting Shane's caseworker about our concerns was decided.   But I was informed due to the privacy act, Shane's treatment couldn't really be discussed.   However, she assured me that random urine tests was done on a regular basis, and no illecit drug use had been detected regarding Shane.   She felt our confusion and concerns were possibly due to our lack of knowledge and understanding of Methadone and the program, so an appointment was made with CADS clinic Papatoetoe, which my husband, daughter and myself attended.   Although we were treated with respect, the two professionals handling our meeting were definite in their views of the program and the drug Methadone.   They completely dismissed our concerns of possible drug use and Shane being different on Methadone.   These caseworkers felt we were all reading to much into Shane's behaviour and such because he was on Methadone, that was their theory and answer to our concerns.   I left the clinic that day distraught, angry and totally peeved that I'd been treated like an over dramatic mother, whom didn't know her son, drugs or their affects.   So early on in treatment Community Alcohol & Drug services were made aware of Shane's possible drug abuse problem on the program.   With Shane's assurances and, now CADS we had no alternative other than to accept the program and move on with our own lives.

I loved Shane to bits regardless of his addiction, but my emotional journey from that point on with him, as a mother, constantly altered and, it was a cross I found difficult to bear sometimes.   From day one, Shane was always loving, respectful and very appreciative of our love and support, so he definitely was worth the effort.   The sadness, anger, frustration and fear that swept in and out of my life with his addiction though, did periodically test my strengths and challenge my spirit, but never deterred my hopes, dreams and aspirations of one day having my son drug free.

The program protocol does require all pariticipants on the program to be closely monitored with random urine tests for illicit drug use, and to have regular appointments with their CADS caseworker.   The take home doses of Methadone are a privilege, and the CADS caseworkers have the power to revoke or review this privilege at any time, if a participants progress becomes unstable or he/she has any negative urine results.   Well, Shane's and others drug abuse certainly validates that this part of  The Methadone Maintenance program protocol definitely requires attention and changes.   My campaign proposal and approach to the drug abuse problem that exists within the program is as follows:

Why do program participants abuse drugs, and why don't they get kicked off the program if they do? is probably what your are all thinking.   Well firstly, addiction research and studies do confirm the addictive nature of Methadone, and addiction professionals also confirm this is the reason why participants tend to 'poly-abuse' or 'top-up' with other substances while attempting to reduce their daily dose of Methadone, apparently it's quite common, and obviously quite acceptable within the program.   To give addicts a more highly addictive drug than the drug they were probably using, begs questioning anyway.   To help combat the drug abuse problem  in the program, recommended changes to The Methadone Maintenance program protocol are:    Very random urine and blood testing should be a perquisite of the program.   This would help solve some of the drug abuse that widely exists on the program.   Urine only detects some substances, whereas blood testing would detect all substances in the system.   It is necessary the drug testing be very random, as addicts are knowledgeable enough to work their abuse around the testing that presently exists.   It's simply not random enough and allows to many loopholes.   The current guidelines, I believe, need to be more rigid and paricipants held accountable for their actions.   If the Opioid Substitution Treatment Guidelines were changed to accommodate these measures then all, including the participants already on the program, would have to abide by them.

Now, why they don't get removed from the program is:    It has been established that immediate Methadone withdrawal can have serious consequences.   So removing a participant from the program would require them to be admitted into a detoxification unit or rehabilitation facility to safely withdraw off the Methadone.   We simply don't have enough Addiction rehabilitation and detoxification centres operating in NZ, and only a few of these centres cater for Methadone withdrawal.   This is a funding issue and another aspect of my camaign, which I will address at a later date.   Some participants daily dosage of Methadone are well over 100mgs, the recommended safe withdrawal rate is 2 - 5mgs weekly, however, if in a safe enviroment maybe 10mgs weekly, even so, withdrawing down from that amount would require sometime in rehabilitation.   So the program has no alternative other than to keep feeding them their Methadone, and  why once in, it takes a long time to get out.

Shane's abuse of other drugs may not have become so destructive, and life threatening, if The Methadone Maintenance program had these measures, with consequences already in place.   This isn't the first campaign that I have attempted to put forward for changes within The Methadone Maintenance program, two other campaigns to the NZ Government and health Officials over the years have failed to achieve a satisfactory result.

Shane, like all on the program has to take some responsibility for his addiction escalating over the years, but I certainly hold this program and it's operating services responsible as well.   Persons entering this program are usually at a desperate stage in their addiction, and this program offers them a drug they don't have to source themselves, and the bonus is, it's free.   Now, maybe I'm being cynical but, believe me, this is exactly how most addicts see this program.   They also all accept, once on the program, there is really no way off it.   The term 'liquid handcuffs' is used to describe their daily dose of Methadone, because that's what it feels like to them.

I do read and really appreciate your comments, and will always endeavour to answer questions, either through a posting or directly.   A comment regarding cost of Shane's treatment is:     The funding figure obtained for The Methadone Maintenance program 2008-2009 was $13.6 million, with 4600 persons enrolled that year in the program.   That's what this program is costing the NZ Government, or you the taxpayer.   Individual costs are:   Approximately $5000 for program, and $2200 pharmacy dispensing costs per year.   Shane's 14 years on the program equates to approx. $100.000, a lot of money for a treatment that doesn't really solve drug addiction.  
Oops!! sorry done it again, this posting bit longer than aticipated. Will continue on next week.

Drug Abuse. Ignorance Is Bliss.

Drug Abuse. Ignorance Is Bliss.

Drug Abuse. Ignorance Is Bliss.