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.


  1. I am a recovered heroin addict, who was on methadone for a number of years. I am clean for over 4 years, and I have a few words to say about methadone.

    Methadone is good IN THEORY but it is the practices that are lacking. The theory behind it is that they give you this substitute, so you are not copping on the streets and do not have cravings. The next step, to start working on your life with the help of intense counselling. Once your life is back together, you will not want to use and mess up this good thing you have built. The problem is that clinics do not provide counselling, addressing addiction issues. They do not teach recovery, but instead take money and keep them strung on legal dope. Methadone clinics in the States are very profitable. Why would they want to improve these lives enough to get them off methadone, and in turn lose 80 bucks a month?

    I did not realize this until I had been completely clean for quite some time. Before that, I thought methadone was a very viable option for an addict. At times, I felt like methadone was the only way I would ever be "clean." I was convinced that I would take methadone for life. Many of these greedy clinics would reinforce this idea,they compared methadone to insulin and addicts to diabetics.

    But, what methadone does not do is break that cycle of addiction. You still wake up every day, and the first thing you think about is methadone (dope). The last thing you think about before you go to bed, is methadone. Your life is still revolving around drugs, only now they are legal drugs and you are on the clinics schedule. Even with buprenorhine, the first thing you do when you get up, is think about getting your fix. When I finally broke the cycle, I experienced a freedom I had not known in years. Before long, my life was not consumed with drugs;they were not even a part of it. It was only then, that I was really clean.

    Now, I want to add that I am not opposed to methadone. I think it is a great starting point. When I was in active addiction, methadone was the only option for me. I would have NEVER considered another option. You meet other addicts at the clinic. But let's face it, without the proper counselling,these are not addicts in recovery. They are addicts on methadone. In the early stages of recovery, methadone is a good option. At first, getting clean is too scary and really hard. I wish it were more of a short term solution than a long term one. I think methadone clinics should be required to provide counselling, and clients should be required to go to several counselling sessions a week. And if you don't comply, you are kicked off (this would work well with free programs.) I think if addicts had to work for the methadone, they would take their recovery more seriously. And if clinics were able to provide better care.But, it again comes down to money. Intense counselling is expensive, just look at how expensive rehab is. Also, using a blood test to detect drug use is VERY expensive. Most clinics are unable, or unwilling to afford much more than urine testing. Blood testing requires a phlebotomist, or other professional who can draw the blood. Also, it requires a more careful handing of the blood. Then, it requires a more specialized process to check the blood for drugs. It would be great in theory, but I do not think it is cost effective.
    But, at least for me, I now see a lot of problems with it. My mind was still altered with methadone, and my need for it still ruled my life. The schedule of the clinic ruled my life, and I just had to break that addictive cycle to truly be free. I am truly free and also happier than I ever imagined. Check out my blog.

  2. My comment had to be edited by half because it was too long! I was on a rant, I guess. If you have any questions about methadone from the opinion of a recovered addict, feel free to email me. I discuss it on my blog very briefly. An old post called "Problems with Treatment" talks about it.

  3. Thanks for the blog post and to BMelonsLemonade for sharing your story. I completely agree with you on counseling being mandatory with methadone.

    Someone I love is on it, has been for years and as far as I know, they have no real plans to get off of it.

    They do not attend meetings, have a sponsor, follow a routine, etc and have relapsed several times while on methadone. They are subject to random urine test but there has to be a way around that because they haven't failed a single one even though they have told us they used within that time frame.

    I do not have an opinion on it either whether methadone is right or wrong, I just know that they are not a "sober", loving life person with it. They seem apathetic, tired and "dopey".

    As it has been over 5 years with them on methadone, I worry of the long term effects and can no longer tell if they have relapsed or just taken a dose of their "medicine".

  4. i always said about and to my daughter. you are not clean, you are on methadone. you traded ONE letter of the alphabet. now, instead of getting up and stressing over getting doPe you get up and stress about getting doSe.

    still addicted. still having your life totally revolve around do_e.

  5. Thank you all for your comments,your views and personal experiences with Methadone are informative and very much appreciated. Although Methadone programs are operated differently all over the world, the same co-dependency problems that exist within it are the same everywhere. Methadone participants keep this program operating, and a lot of people in jobs, so maybe that's why persons on it aren't encouraged to come off Methadone. To Bmelonslemonade. Could you please post your blog address, I would love to read it.

  6. My blog is called "Hashish Dreams and Heroin Nightmares."


  7. Let me repost that link...


  8. methadone. definitely a two-edged sword. My son was on it for almost 3 years. Initially, it did help to get him out of crisis mode. He got a job, though had trouble keeping it. I did appreciate the counseling he got, it was good. And yet, I agree with what someone said earlier, their life still revolves around drugs. It reinforces addictive behavior. As my son reduced his does, the symptoms became so uncomfortable that he started injecting his 'take-homes'. He supplemented with other drugs. And he used someone else's urine to pass his UAs. Maybe it's a help for a short, transition period, but a straight-up recovery program dedicated to sobriety must be the goal. Trust your hunches, Mom.