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.