Friday, June 24, 2011

A Lesson on Methadone

On Monday, I shadowed an outreach worker who was meeting with a client just released from prison the previous week. There was a mix-up with his release, and he was sent out without his paperwork. This was a major problem as the client was a drug addict who used to do heroin. During his incaceration, he was sustained through a prescription for methadone (script). When we met with him, he had been without his script for 3 days, and he was anxious and unable to focus for very long. He was having a difficult time coping without his script. 

Prior to starting work at Thames Reach, I had never heard of methadone or Subutex. Once I started looking into methadone, I realized how prevalent it is - not just in the UK but throughout Canada as well.

Methadone is a synthetic opiate manufactured for medical use that has similar effects to heroin so it curbs withdrawal, reducing some of the more serious side effects and offers more more hygienic course of treating addiction. It is a sedative that depresses the nervous system, slowing down body functioning and reducing physical and psychological pain. It causes relaxation and detachment. Methadone does not deliver the same high and allows people to stabilize their lifestyle without experiencing withdrawal symptoms. That is not to say there aren't problems with heroin withdrawal symptoms, but it is much less severe. This form of opiate substitution therapy generally leads to a reduction in dosages until the user is off the drug completely.

I am not sure what I think of this type of treatment. I am in no way an expert in this field, and this is not so much an opinion as it is thinking out loud. I am not sure I understand using drugs to replace drugs as an effective practice, just because one is considered "less harmful" than another. From what I have learned, users sometimes stay on this form of treatment long-term, spanning decades. While I cannot begin to understand how difficult detox is, and how stopping heroin use can be debilitating, I do not see how a sustained script can be helpful in living a clean life.

As I began to learn more about this topic, articles were published about a report by The Centre for Policy Studies, a think-tank suggesting that Britain spends £730m a year on maintaining methadone addicts. Methadone prescriptions are part of harm reduction efforts, started in the late 1980s as a way to prevent the spread of HIV/Aids, and considered more of a concern than creating policy around drug misuse. However, since the release of this report, a bitter row surrounding the merits and consequences of heroin treatment has been brought to the forefront. I think there is a lot of different issues at stake, including how taxpayers feel at a time of recession, as well the impact on the drug industry if other forms of treatments take precedence, so I am sure this debate will continue.

It is interesting though that methadone is considered to be more of a normalizer than a narcotic, as users are able to function without impairment. However, from what I have seen from the client who was really anxious without his script, it does seem that there is a certain level of dependency on methadone for functioning. Is this that different than drug treatments for depression or anxiety? I'm not sure, if it helps someone function and maintain a healthier lifestyle, perhaps it is useful. On the other hand, would rehabilitation services that help users off drugs completely not be more beneficial? Surely, heroin created the problem and it was not necessarily a natural anxiousness that needs to be addressed but rather withdrawal. Of course, as with anything, a one-size-fits-all solution is not possible, but it is rather important to consider how beneficial drug policy is in helping addicts live a better life without costing others who have managed to steer clear.

Alcohol dependency is another aspect that I am learning a lot about, as it seems to be very closely linked to homelessness (though of course that is a generalization) and I will be posting about it soon. I am eager to understand the many aspects of policy that affect homelessness, even if not directly. Drug misuse, alcohol dependency and the welfare system all play such a pivotal role in this issue as street homelessness seems to be an amalgamation of factors and a very cyclical problem.

1 comment:

  1. Great post Mimosa,

    I have a very special place in my heart for the challenges faced by addicts and support worker who work with addicts. I am in this place at the moment: I do not really support methadone treatment as I feel that it can draw out the recovery process and perhaps inhibit it from ever happening. I also feel that an addict should experience the affects of the detox so that they are tuned in with what that they have put thier body through in the process of feeding thier addiction.

    Thats just my perspective!

    Leanne Price