Walking proof that methadone is failing after 20 years in treatment
by Kathy Gyngell on Friday, 19 February 2010 10:04
If further proof were needed of the government's failed 'methadone prescribing to reduce re offending' strategy then it was given in a Scottish Court last week.
The presiding judge had had enough. He stopped the 20 year long methadone script of the offender in the dock before him who, despite it, had failed to turn up for his less than stringent community sentence order. The judge refused to accept the doctor's sick note for anxiety excuse. What infuriated the judge was that despite methadone from boyhood (age 16 he'd been put on it) a cost of some £20,000, the man had neither quit his 20 year heroin habit nor halted his re offending.
The story prompted Professor Neil McKeganey, Scotland's leading drug misuse expert, to launch a fresh attack on Scotland's methadone programme and to demand, once again, a review of exactly how many people have been on the stuff and for how long. He is now calling for the imposition of a two year limit to any individual's methadone prescribing,
Not radical enough? Maybe not. But the reality for any incoming responsible Minister or Government is just how deeply this misconceived harm reduction theory has penetrated the health and justice system, not just in Scotland but England and Wales too. Changing policy, Neil once said, will be like turning round a super tanker. You only have to look at the official state of denial and disinterest, whether with regard to the prison prescribing explosion, to infant methadone deaths or to adolescent prescribing, to see how hard it will be to shift the focus of policy and practice to one that challenges behaviour, insists on freedom from drugs and supports rehabilitation.
Tragically, the government is so confident in the benefits of methadone prescribing that it has extended it to prisons. The hyperbolically entitled Integrated Drug Treatment Strategy - methadone or subutex prescribing to anyone else - was imposed on the estate by the Department of Health and PCTs from without. It bi-passed consultation with individual prison governors. It went ahead despite the variable, mainly inadequate assessment and referral services that surely should have been its prerequisite. IDTS was rolled out with apparent disregard for the lists of reservations about its safe or appropriate 'implementation' set out in the government's own evaluation of the first 30 odd prisons engulfed. Nor did those who masterminded the strategy predict its implications for those prisoners desirous of 'clean time' and drug free areas or access one of the very few abstinence programmes.
The result has been, as David Burrowes MP pointed out in his letter in The Times, the creation of more state induced addicts, in fact a 67% increase just last year on 'methadone maintenance'. That and semantically disguised 'stabilisation' or maintenance as detoxification gives the dismal reality that Mark Johnson, the remarkable author of Wasted, an ex offender, recovered addict and founder of www.uservoice.org. described so powerfully in his column the day before (The Guardian 16.12.09). The sight of addicts lining up outside the prison dispensary for their drugs... 'a slow shuffling queue in the rain' was, he said, 'one of the saddest and most shameful' he had witnessed in the prison estate. A treatment policy that keeps drug-addicted people on controlled methadone, he went on, is one to which 'recovering addicts who have made the long journey to successful living are bitterly opposed'.
This was however to bear no weight with Paul Hayes, the National Treatment Agency boss. His foray into the field of 'pro-prison methadone' public relations followed Mark's second article on the subject.
He claimed that 'user voices' have been heard and they weren't Mark's - they were the 198 of them organised into taking a class action against the Home Office because methadone had not been on tap for the duration of their sojourn inside. Mr Hayes's 'culture of complaint' choice of defence was deeply ironical, for many believe that it was the fear of further such litigation, rather than concern for the public good, that has driven the IDTS policy in the first place.
For the Home Office's capitulation and payment of a substantial out of court settlement hardly represented a Martin Luther King moment. Even if Professor Stimson is correct in his report that some prisoners have been 'forced' off methadone, which simply means not being given it, this hardly makes methadone 'best practice' as he claims, nor does it justify its mass prescription and the changing of the prison culture that inevitably follows. This defence of the 'human rights' of a few has been eclipsed by what has become a human wrong for the many.
For, along with fears about offenders overdosing on release, this is responsible for Mark's queue of shuffling prisoners. And it is brings us back full circle to the judge. For the received wisdom, that he was brave enough to break cover from, is that addicts have to be protected against themselves at all costs, at all times however determined their own risk taking behaviour and whatever the implications for themselves or other. Nowhere more so is this belief found than in the need to prevent overdose on release - the other justification for prison prescribing. Yet two fascinating pieces of research indicate that the judge's instinct and common sense was backed by fact. Whatever is done to protect addicts from themselves, however much or little we retox prisoners on release, may make little difference. One study pierces the theory all together: "The hypothesis that after liberation, individuals typically soon relapse to heroin use and fatally overdose due to reduced tolerance is not, supported"
The second of these studies suggests that these best of intended interventions may be quite futile for "when the risk period analysed includes both time spent in prison and the post-release period, the risk of fatal overdose is not found to differ from other periods outside prison".
Neither study is to be found in the current drug policy evidence base bible.
The First Stage of the Evaluation of IDTS, Prison, Health Care Staff and Primary Care Trusts Perception of Implementing IDTS in the First Wave of Prisons, Prison Health Research January 2008 (Centre for Suicide Prevention, The University of Manchester)
http://www.timesonline.co.uk/tol/news/uk/health/article716535.ece
Fatal Drug Overdose After Liberation From Prison: A Retrospective Study of Female Ex-Prisoners from Strathclyde Region (Scotland) David Shewan a; Richard Hammersley b; John Oliver c; Sandy Macpherson a
Addiction Research & Theory, Volume 8, Issue 3 June 2000 , pages 267 - 278
The contribution of imprisonment and release to fatal overdose among a cohort of Norwegian drug abusers; Ellen J. Amundsen a; Knut Boe Kielland b; Ragnar Kristoffersen Addiction Research & Theory 30 April 2009
Comments
Within my 16 years of addiction i have been in and out of rehab twice, prison a few times and homeless many times, when i finally founhd a place that would allow me precribing on a daily basis for as long as i felt i needed it, it was the best thing that could have happened to me, I had experienced the inhumane 'treatment' in prison of being left without any medicaiton in a very unwell state for weeks and had also experienced a reducing medication regime in which i had to be off the methadone in 3 weeks, how the hell did they expect a 16 year addiction to be addressed in 3 weeks, without any other pshycosocial treatments to go with it. So, the day i started on my maintenence script was the day my life re started, i got my daugher back, i got a qualification in Youth and Community Work, i started my own charity, Oxfordshire User Team. All under the watchful eye of loacl services who were full of staff and volunteers who quoted "she shouldnt be in that job, shes still a smack head", oohh how lealousy rears its ugly head ast the best of times, ensuring that they are giving me the gumption to show that that i work a damn site hardeer thatn they do and yes i do deserve this job as much as any one else. Try telling my daughter whose now 19 and seen what being on a maintence script did to me that im still a junkie, my youngest daughter who is 4 knows me as me, not a junkie, she sees no drugs, sees no violence, does not have to see me committing crime, like my older daughter did before i became stable on this medication. Her mum is normal. Ive achieved so much in my life since i was put on this prescription, it has made me a normal, achieving, functioning, tax paying citizen. If my prescription was taken away id go private, simple, P.s the reason crime is going up in Scotland is due to people like Kathy thinking they know whats best and whipping prescribing away, get a habit kathy, do an inhumane detox and then come back and report on it, then you may be reporting something that we can relate to, in fact here in Oxon we are ensuring that the Conservatives do not get 1 vote off any homeless person or drug user, if david cameron had advisors with the views like yours, my god this country is in trouble, you have no idea what would happen, until you have experience, stop talking from your inexperienced mind and get a reality check. i tried to detox off my presciption last year, it resulted in the most destabling 6 months of my life, i could not funciton as i had not received any phycological treatments at all to get to the root of my addiciton,so it was never going to work. If i was you Kathy, id spend my time moaning about the lack of that type of treatment, that is the aim of HR prescribing, you are on the script whilst you undertake 'talking therapies', its the lack of this to aqccompany the prescrbing that is the problem, if this was widley available and of a good sdtandard, many more people wodul be willing to come off their presciptions, most re not as they know aht will happen if they do, they will relapse after, for some, being on a script and clean of street drugs for many, many years.
Please, please look at the bigger picture, try talking to people who are acually benefitting from this treatment before slating it, or, you could try addciiotnj yourself, then see how hard it is to get out of with people like you demonising users at every chance you get.
People do use heroin on top and commit crimes on methadone but if they are denied methadone they are unlikely to stop committing crimes and miraculously stop needing drugs.It is addictive. By proposing such draconian changes you risk forfieting the right to a normal life for thousands of people who have functioning family lives because of substitute prescribing. If methadone is prescribed properly, people should not use on top. You can put sanctions in place but there has to be an alternative way of life available. Scotland was one of the first countries in Europe to deindustrialise. It has lost most of its industry and generations of people in the Lothians have had no work or expectation of work. Drug use thrives in situations of deprivation and worklessness. Telling people to stop taking drugs and get on their bikes is not the answer. Rather than locating the blame for social problems with the poor you should find ways of addressing the endemic issues of poverty and deprivation.
Although you make some valid points around how treatment was delivered before methadone maintainence i am confused as to what the rest of your post is reffering to. It appears and this is only an observation, you have some form of problem with view points that do not fall in line with your own, to suggest someone gets a habit to know what it is you are talking about is ludicrous and lacks taste as well as proffesionalism. If as you suggest you have been bullied by an entire treatment system and its volunteers you should as a memember of a user team have raised this issue with your local DAAT, if have done what was their response have they brushed it under the carpet? did you allow that? finnaly i want to ask who is it in Oxon that is making sure that vulnerable adults such as the homeless and drug users dont vote conservative? is it you, the DAAT the user team, surely it is the clients choice?
The Gyngell Gal is right to draw attention to yet more proof of the failure of methadone.
But the problem is not lack of proof, it is lack of action.
And for those who value their methadone scrip there is another way out of opiate addiction.
For the total of what it costs the taxpayer every three years - to keep the average methadone user in their daily supplies and in Job Seeker Allowance, Housing Benefit, Income Support, Child Support, health treatment and in many cases policing, court hearings, prison, probationary costs and the acquisative crime many (according to the BIG ISSUE) still commit to fund their continuing usage of heroin - 69% of them can be brought to a recovered condition.
By "recovered" is meant a permanent return to the natural state of relaxed abstinence into which 99% of our population is born, and this can be achieved in around 22 weeks of residential Rehabilitation Training.
Proof is that this form of recovery has been delivered for 44 years and is now in 47 countries and 154 recovery training centres (including prison units), but as it is not "treatment" and so does not generate sales or profit for the massive psycho-pharmaceutical fraternity, it gets ridiculed and side-lined by those whose livelihood depends on "habit management" with addictive substances.
What we need is a National Addiction Recovery Agency to replace the NTA and its prescription pushing.
AFTER 24 YEARS OF USING OPIATES IVE TRIED A.A.,ACCPUNTURE,N.A.,RELIGION,2.5 YEARS IN 3 TREATMENT CENTERS,TRYING TO STOP ON MY OWN,HOW TO GET SOBER WITHOUT 12-STEPS,JUDDAS THADDUS PROGRAM,PDAP IN TEXAS ETC.....I JUST COULD NOT STAY CLEAN,MAYBE 3 WEEKS OR 2 MONTHS,9 MONTHS 1 TIME.I NEVER FELT RIGHT.SOMEBODY SUGGESTED "METHADONE".THE VERY FIRST DOSE I HAD, COMPLETLY CHANGED MY LIFE!9 YEARS LATER,LIFE IS GOOD.BEEN CLEAN FOR 9 YEARS,IM RESPONSIBLE,HONEST,WORK WELL AND HELP OTHERS.I RAISE NEWFOUNDLANDS AND ENJOY LIFES REWARDS.AT ONE TIME I BELIEVED THAT YOU CANNOT GET CLEAN WITHOUT 12-STEPS,THATS HOW THIS PROGRAM IS DESIGNED.MY POINT BEING:PEOPLE GET CLEAN FROM MANY DIFFERENT MODALITIES.METHADONE IS WHAT WORKED FOR ME.I WORK VERY HARD AT TRYING TO EDUCATE OTHERS ABOUT THE TRUTH OF METHADONE AND NOT ALL THE MYTHS.JUST ONE VIEWPOINT AMOUNG MANY.
Firstly, "Dr" is right--methadone in the UK is inappropriately prescribed in doses that are less than half of the average needed dose by most patients. The avg. dose needed to control withdrawals is 80-120mgs--additionally, doses of approx. 80mgs and above block the effects of other opiates so that it would be pointless to use heroin on top of their dose--yet the average UK dose is 30-40mgs. When you give pts an inadequate dose, there is no way to determine how "effective" the medication is. In the USA, where doses are within the average range, the rate of illicit drug use is far far lower than in the UK.
Secondly, the press and much of the UK seems to have little conception of how MMT works and what the goal of treatment is. Due to oftentimes permanent changes in the brain chemistry of the long term opiate user. they may no longer be able to produce endorphins (natural opiates), no matter how long they are abstinent and how much counseling and rehab they get. This leaves them severely depressed, anxious, anhedonic (unable to feel pleasure), physically exhausted, etc and this condition does not improve with time in those with permanent damage. Methadone replaces not the drug of abuse, but the missing endorphins--enabling the patient to feel normal and go about their daily life. THAT is the goal of treatment--not to be "drug free"--after all, many many people require daily medication for a variety of chronic physical and mental ailments--but to be free of drug ABUSE and able to live a productive, law abiding life.
The recent "study" purportedly showing only 3% succeeding in MMT was misleading in the extreme, considering that anyone who was still on methadone after 3 years
no matter how well they might be doing, was considered a "treatment failure". Someone like myself, for example--I am a 45 year old married mother of 3, with a college degree, living on my own home. I work full time and pay my own bills and my own treatment costs, in full. I volunteer in my community, pay my taxes, attend church, administer several educational websites, sit on three national Board of Directors and am a productive citizen. This has been the case for the past six years, since I got on MMT. Prior to that I spent twenty years addicted to prescription opiates, and cycled through 13 abstinence based rehabs, thousands of 12 step meetings, psychotherapy and counseling, antidepressants, cognitive therapy, therapeutic communities, you name it I did it in my quest to get better. I did everything I was asked and more. None of it worked. I needed MEDICAL treatment for what was a MEDICAL problem with my brain chemistry. As soon as I got it, my life improved 100%.
It saddens me horribly to see so much misinformation and ignorance surrounding MMT in the UK, even among professionals in the field who truly ought to know better. In the USA, where abstinence based rehabs are the norm, not the exception, methadone is far and away the most successful treatment method available. This could be true in the UK as well, if people were properly dosed and not made to feel that by being on methadone they are simply "continuing their addiction". There is a BIG difference between physical dependence and addiction. Methadone patients who take their meds as prescribed and are not abusing other drugs cannot be said to be "addicted" to methadone, as addiction involves a behavioral component that is not being displayed in stable, compliant patients.
HI I DONT THINK THESE POLITITIONS REALISE FOR ONE MIN WHAT WOULD HAPPEN IF YOU STARTED TAKILNG PEOPLES SCRIPTS AWAY I AM A 29 YEAR OLD MAN AND FROM THE AGE OF 16 WAS ADDICTED TO HEROIN AND FROM THE AGE OF 16 I WOULD BE VERY LUCKY IF I HAD BEEN OUT OF PRISON FOR A TOTAL OF SIX MONTHS THEN IN 2008 I WAS DUE FOR RELEASE ONCE AGAIN I WAS SICK CONSTANT IN AND OUT OF PRISON LIKE OUT 1 DAY THEN BACK IN SO I ARRANGED TO SEE THE DOCTOR AND OTHER AGENCY IN PRISON AND THEY EVENTUALY LOOKED AT MY RECORD I HAVE BEEN IN 3 DIFFERENT REHABS AND I EVEN TRYED A CHRISTIAN ONE BUT NOTHING WORKED ANYWAY THE PRISON AGREED TO START ME ON METHADONE AND SIX WEEKS LATTER I WAS RELEASED AND FROM THE DAY I WAS PUT ON METHADON I HAVE NEVER TOUCHED HEROIN AGAIN BUT I DO KNOW THERE IS PEOPLE WHO DO USE ON TOP AND ME PERSONALY I DONT SEE THE POINT IT IS STUPID BUT I THINK INSTEAD OF TAAKING EVERYONES PRESCRIPTION AWAY WHY DONT THE GOVERMENT TAKE MEASURES TO STOP THE PEOPLE WHO ARE USING ONTOP OF THERE PRESCRIPTION 1 IDEA I HAVE IS AND NOT ALL ADDICTS WILL AGREE BUT I SAY PUT THEM ON A SCRIPT AND WHEN THEY GO TO JAIL IF THEY DO IT IS OBVIOUSLY NOT WORKING SO SHOULD THEY COMMIT CRIME THEN LET THEM SWEAT IT OUT IN JAIL ATLEAST THEN YOU ARE NOT MESSING UP THE LIFES OF PEOPLE WHO IT DOES WORK FOR IT MAKES SENCE AND I WOULD GARENTEE THEY WOULD GIVE UP THE CRIME RATHER THAN THERE METHADONE SO WOULD HAVE TO GIVE UP THE HEROIN OR IF YOU DO JUST STOP PRESCRIBING METH AND TAKE EVERYONE OF IT EVERYONE WILL ULTOMATELY TURN TO CRIME AND OUR JAILS WILL BE FULL EVEN MORE A CANT SEE HOW DOING THIS TO PEOPLE THAT IT WORKS FOR IS FAIR SO COME ON MR CAMERON PLEASE DONT WRECK MY LIFE AGAIN ALSO WHILST I HAVE BEEN ON MY METHADONE I HAVE BEEN WORKING THROUG MY PROBLEMS AND GETTING TO THE BOTTOM OF WHY I STARTED USING DRUGS IN THE FIRST PLACE THIS WOULD NOT BE POSSIBLE ON A 3MOUNTH DETOX NEVER MIND A 3 WEEK 1
Actually "anonymous", there are many cases of people dying from opiate withdrawals, just that it doesn't get recorded on the death certificate as such, but rather as a heart attack.
It is true that death during withdrawal is very unlikely for any young [18-35] year old addict, but it is well recognised by medical literature that death during withdrawal is likely for the aged or chronically sick, especially those with cardiac conditions.
Sadly it seems that Kathy Gyngell, and her cohort Deidre Boyd et al at Addiction today, are either unaware, or choose to ignore the fact that harm reduction policies were introduced because precisely the same policies they wish to inflict on society were tried in the 1980's, with the result of an unprecedented rise in the level of heroin addiction to epidemic proportions, and the shame of Edinburgh becoming the HiV infection capital of Europe.
Once again it seems like another generation is due to be sacrificed between the twin evils of a prohibitionist drug policy, and restrictive, limited addiction treatment policy, simply so that misinformed individuals can inflict their myopic ideology on the rest of society.
I am quite certain the one group of people who will not be complaining at this deeply harmful change in policy will be the drug dealers. After all, they can look forward to vastly increased sales of heroin when methadone provision is time-limited.
Prisoners released with a methadone script will be able to get it honoured and continued by drugs agencies, and so the cycle continues, in a sort of vast corporate Münchausen's syndrome by proxy.
People on Methadone are, among other things, terrified of discontinuing it because of the longer withdrawals - if this is an urban legend, it's firmly rooted in fact. And what doesn't help is the withdrawal scene in Trainspotting, which is a very good representation of alcohol withdrawals, but nothing like the heroin ones.
And what's it all for? There is no recorded case of anybody dying from heroin withdrawals. As you say, former addcits who have completed the long, hard journey to recovery are dead-set against Methadone. But one thing is clear about this government: money talks, and Methadone generates huge amounts of money.