‘Methadone is a noose around my neck’

08/03/2010

Scotland now has 22,000 addicts on the heroin substitute. Is it working... or a costly mistake?

by Adam Forrest


Stand outside the chemist on Portland Road in Kilmarnock first thing on a weekday morning and you’ll find fidgety addicts waiting to get inside for their methadone fix. As in pharmacies across the country, the little bottles of luminous green liquid will be handed out to tide users over for another day – to keep them from having more damaging cravings for heroin.

At Allies, a nearby homeless charity in the Ayrshire town, this strange, sad ritual seems like blessed relief. The chaos of life on smack is written across the faces of those limping in out of the cold; heard in the tragic stories of looming prison sentences, prostitution and death riddled through the family tree – overdosing parents, brothers, sisters, cousins.

Devoted managers Sandra Day and Maggie Green, who provide support, advice and three hot meals a day for anybody who wants it at Allies, have been pestering NHS and council-run clinics to put willing clients on methadone substitution programmes. 

Day, also a part-time nurse, says the recent spate of deaths due to anthrax-contaminated heroin (10 in Scotland so far) has given some addicts the impetus to try the substitute that is designed to regulate their health long enough for gradual withdrawal and complete recovery. “A lot of people are scared of using heroin but they haven’t been able to get on the methadone programme,” she says. “We had one person who said if he couldn’t get on it, he would kill himself. We know of someone who put a brick through a window because there was a better chance of getting methadone in prison.

“People need a lot of back up and support to start recovery, and it doesn’t seem that there are enough people to cover all the cases.”
Bobby-Joe Brown, now 29, admits to wasting much of his life on hard drugs. An overdose killed his dad. His only ‘straight’ period since boyhood came during a stint in jail. He is determined to use methadone treatment to get completely clean while his lively personality is still intact.

“When I went to see about methadone, I was told there was a waiting list,” he says. “I said, ‘How long?’ The woman said, ‘How long is a piece of string?’ I’ve been in a desperate state and I think methadone is the only thing that’s going to stabilize me.”

Others in Kilmarnock have been told they face waiting up to six months. Brown feels fortunate to have been told his treatment will begin soon.

“I broke down in tears in the clinic. I think they felt sorry for me Getting on it has given me just that wee bit of hope. I know I need to use methadone to start getting away from drugs. I know it’s not something you want to be on for years,” he says.
Brown has been spending £80 to £100 a week on heroin, but like many addicts, he is not a complete stranger to methadone.

There is a lively street trade in the substance – a daily dose of 100ml can go for £10. Profit, however, is not often the main motivator of those involved in the methadone circuit. Dealers are users; users are dealers. A ‘buddy’ system often develops as addicts pair up protectively to share or exchange whatever dose either can get their hands on.

“One lassie said she could, if I wanted, hold some in her mouth for me until she came out the clinic and then spit it into mine,” reveals Brown. “That goes on too I’m afraid.”  For critics, this is one of the examples that highlights the limitations of Scotland’s dependence on methadone as the central means of coping with the country’s ongoing heroin crisis.

Patchy provision in Ayrshire and elsewhere in the country may mean frustratingly long waiting lists, as the number coming forward for the methadone programme continues to grow. But some believe this level of demand only indicates the awesome, dreadful triumph of the opiate.

Best estimates suggest Scotland has around 52,000 heroin addicts – roughly 22,000 of those are on methadone at any one time. Professor Neil McKeganey, of Glasgow University, is one of the UK’s leading researchers on methadone and is shocked that a treatment “of uncertain benefit” is the default prescription of health professionals.  

“Virtually everyone getting treatment is being prescribed methadone,” he says. “Whether the Scottish Government likes to admit it or not, we do have a one-size-fits-all treatment, which is our national methadone programme. The notion that we have individualised packages of care to meet individualised circumstances is a complete and utter myth. The Scottish Government has overseen a situation where more than 22,000 people are prescribed methadone, but they have no clear strategy as to how to get them off it.”

Prof McKeganey’s research questions the validity of claims that methadone provides a much more stable, crime-free existence, since more than half of methadone users he surveyed continue to dabble, or destroy themselves, by using it alongside street drugs. He also estimates the rate of Scots becoming drug-free after three years on methadone to be depressingly low – around three per cent.
“It remains a complete mystery as to just how long people are on it,” he says.

“The majority of people are combining it with other illegal drugs and are placing themselves at very high risk of overdose. It does not appear to be having the major crime reduction its proponents claimed it would have. It’s easy to say it stabilizes lives, but where’s the evidence?”

The cost of keeping so many on methadone indefinitely continues to rise. The prescription programme costs almost £17m a year (almost doubling in cost over the past five years), more than half Scotland’s annual £31.5m budget to tackle drug abuse. There is also the physical cost for those looking for the exit route. The nature of methadone’s slow-burning release means withdrawal symptoms, the agonising aches and sickness, can take weeks to lift.

One addict at Allies describes methadone as “a noose around your neck… it’s hell trying to come off it”. Another, Roberta McClung, says she has been taking methadone for 10 years and knows people who have committed suicide after stopping too suddenly and returning to heroin. Yet McClung, 41, does see a new dawn. A long period of relative contentment means she has been able to gradually reduce her methadone dose by a few millilitres each week. She’s looking forward to coming off it entirely in just a few weeks’ time.

 “I’m a bit nervous that maybe I don’t feel quite ready yet, but I think I’m at the end of a process of getting myself together. It’s taken a long time to do, but I really have learned how to live day-to-day life again.” McClung credits the support of the homeless charity for her progress, rather than the addiction clinic, which she describes as little more than a prescription service. “They’re not concerned about your life; they don’t have time to act as counsellors because of all the people they have to deal with,” she says.

For David Cairns, methadone programme manager for the NHS and council-run Glasgow Addiction Services, cases like this show recovery is possible with patience and support for addicts as they deal with a myriad of long-standing problems.

Cairns questions Prof McKeganey’s desire for a two-year time limit to be placed on each methadone course. “A lot of addicts are coming from generations of unemployment or deprivation or addiction,”   he says.

“In many cases we’re not trying to get them back to a golden age in their lives, but helping to build lives for the first time. Methadone is the best evidence-based treatment in helping people recover. They may be less visible, but there are thousands of people thriving on methadone – many are able to lead productive and satisfying lives.”

In a quiet corner of Bearsden, one woman is helping addicts quit cold turkey. Maxie Richards, a devout Christian, has for two decades been taking in hard drug users as guests in her home for however long it takes to turn them around. “You just need to care about people – to take an interest in their lives. I can get them drug-free in a week, but they need support for a long time after,” she says.

She loathes methadone, and has watched the treatment’s rise with despair. “It’s sedation, it’s not a treatment, not a cure,” she sighs. “What right-minded nation would do this to people? I fear for Scotland. People are coming here in complete despair after years on methadone. They’re unhappy, they need to come off it, but clinics just up the dose. It makes me so upset to see a generation left without hope like this.”

Graeme Devlin, a 29 year old who has spent the last eight years on methadone, says the “sky is brighter and clearer” since his 10-day detox in Richard’s home. Devlin admits he often connived to get more than his recommended dose of methadone, to use or sell.
“I’d go to the doctor, kid on I was going to Manchester, and get three big bottles. They’re handing it out like any other medicine. I despise the stuff now. It should be banned,” he insists.

Yet charities such as The Maxie Richards Foundation, which also runs a residential retreat in the Argyll village of Tighnabruaich, can only do so much. Detox rehabilitation is expensive. The average weekly cost of putting someone up in a private facility in Scotland ranges from £310 up to £425.

The Scottish Tories have continued to back Prof McKeganey’s calls for a much greater slice of treatment funding to be spent on drug-free rehab, but those in NHS and council-run services say it is unrealistic to expect tens of thousands of people to be catered for this way.  “It’s easy to talk about residential rehabilitation, but the resources are not there,” says David Cairns in Glasgow.

“It can be an excellent tool for people who aren’t functioning in the community and are ready for something else, but we have to use it discriminately. Not everyone is ready for it or feels confident enough to take up a place on such a programme.”

The treatment manager believes Glasgow is leading the way with seven community rehabilitation programmes across the city, where those on methadone can drop in for counselling, group therapy and job training.

Everyone involved in the debate surrounding Scotland’s dependence on methadone seems to agree that developing a more personalised care is the ideal. No one wants to see prescriptions handed over without determined efforts toward full recovery. Yet we have legalised a widespread addiction to which there is no easy or inexpensive way out.

“What would happen if you just stopped the methadone programme?” asks Cairns.
 
“How many would revert back to heroin? How much crime would there be? There is far too much emphasis on limitations on methadone and too little focus on what it does do successfully.”

For more information about drug treatment programmes in your area call 0800 587 5879 or go to www.scottishdrugservices.com