Methadone forever? Lack of support for painkiller addicts draws concern
A doctor in Paradise says there's not enough support in Newfoundland and Labrador for people trying to kick their addiction to painkillers.
Since 2005, Dr. Jeff White has been prescribing methadone for people hooked on opiates such as oxycodone and morphine, and he has come to feel that patients need more than the two years that had been the original expectation for treatment.
"As I move along in my career and see people relapsing over and over and over again — obviously, in retrospect, those people should have stayed on it, " said White.
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"Studies have shown that the longer someone is on methadone, the better chance they have of recovery."
When the methadone maintenance program started more than a decade ago, White believed that people could be put on methadone for about two years, be weaned off and then they'd be drug free.
White says he's treated more than 1,000 people with methadone since then, and experience has shown him that two years is not nearly enough time to be on methadone.
"When I first started this in 2005, I said 'man I can use this drug and I can cure people within two years — get them their lives back, get them back into society, reduce the incarceration rate that this particular person can have after they've finished,'" White said in an interview.
"That hasn't worked out. There's no question it has not worked out."
Ron Fitzpatrick, who runs Turnings, a group that helps offenders transition back into society, knows a lot of people who are on the methadone maintenance program.
In fact, Fitzpatrick said he has seen many people who've been on methadone for more than 10 years, and he is concerned about the long-term health effects of being on a powerful synthetic painkiller for an extended period of time.
He says methadone users never look well. They are fatigued and can have sexual dysfunction. Fitzpatrick says another big problem is with their bowels.
"Extremely constipated. Not very — extremely," he said, describing the condition of some long-term users. "We've seen it getting worse and worse and worse."
Back in 2004, Fitzpatrick was a champion of the methadone program and pushed for it to be used in Newfoundland and Labrador to treat opiate addiction.
People are on it now 10 and 12 years, since we started. I just don't buy into that anymore.- Ron Fitzpatrick
Fitzpatrick says the idea was for people to be on methadone for a short period of time and then abstain from all drugs. But he's says that's not what's happening.
"The way it was set up to come off after say 18 to 24 months — people are on it now 10 and 12 years, since we started. I just don't buy into that anymore," he said.
"I don't like it, 'cause you're not helping anyone get off drugs. They are on a drug they're going to be on forever in that case."
An underground market
Fitzpatrick claims that some people on methadone also sell their take-home doses.
Once a patient has clean urine screenings and gains the trust of their physician and pharmacist they can be allowed up to six "carries" a week of methadone.
Fitzpatrick says he knows of some users who don't take all the methadone themselves, "You're selling the rest for like $80 or $100 a pop. We've seen people doing that."
The black market sale of methadone has led to overdoses and the deaths of two teenagers in the province.
Fitzpatrick worries that some methadone users are also abusing recreational drugs such as cocaine.
He says coke is more easily flushed from the body and less likely to show up in a urine screening.
Expensive needle habit
Cocaine is one drug that did show up in a urine screening of a methadone patient named Shawn.
Shawn, who didn't want his last name used, lives in St. John's and is in his late 20s.
He used to inject $100 worth of morphine a day, and is now on the methadone maintenance program, to try to get clean and turn his life around.
His recent slip-up means he's monitored more closely by his doctor. He's not allowed any take-home doses at this point, so he has to visit the pharmacy every day to get his liquid methadone.
Shawn says the hassle of being on methadone is worth it as he's determined to kick his morphine habit.
"I was sick all the time, pretty dependent on it. I needed to have at least $100 dollars a day to be [functional] so I realized then I had a problem."
Success rate has been low
He says it wasn't easy to get that kind of cash.
"Sometimes I'd end up stealing from people. I'd sell drugs — I'd do whatever it took to get the money," he explains.
Shawn says he's trying to make the methadone program work for him — to stay out of trouble — and have a relationship again with his young daughter.
Unfortunately for Shawn, the success rate for people who finish the methadone program here is low.
According to White, "the success rate is not great and I would estimate it to be roughly 20 per cent."
To improve that, White says it's better to keep people on methadone a lot longer than the recommended two years.
He says addicts should be treated like people who have chronic illness in that they may need to be on methadone for life, "just as people who are diabetic, who have heart disease, who have hypertension — once these people start medication they stay on it forever."
'Abstinence absolutely does not work'
White says many of his patients don't want to hear that, as they hope that methadone will be a short-term cure for their addiction.
But he says most struggle once they finish methadone.
"Abstinence absolutely does not work," he said.
White said when they get off methadone there's little help available in this province for people to stay clean.
"There's no doubt we need continuing support once these patients finish. Right at the moment that's lacking. Counselling is lacking," White said.
That's also bad news for Shawn, who wants to get into the addictions treatment centre in Corner Brook once he's weaned off methadone. "Spending some time in Humberwood. Thinking of going out there — spending a month or two," he tells me.
But the facility only has 11 treatment beds and four withdrawal management beds.
The current wait list is between 11 and 12 weeks.
White said with such little support available, it's probably best to keep users on methadone for an extended period of time. He said some patients refer to it as "liquid handcuffs."
It's a lesser of two evils- Dr. Jeff White
White said methadone maintenance reduces the harm to the user and to society. That's because the synthetic drug stays in their system for 24 hours so they don't have cravings.
"Would you rather be controlled on a medication that's quite cheap, you're looked after medically, you're monitored as opposed to your lives being corrupted with other drugs? It's a lesser of two evils," said White.
For the time being, Shawn's just happy that he has a chance to recover and to see his child again.
"Methadone's pretty much saving my life and having me there for my daughter soon so I'm very, very grateful for methadone."