"Methadone Maintenance - a Saviour for the Family or a Trap?"

Methadone In Ireland
Aisling Group Nationwide (Ireland) is national organisation in Ireland. Founded 18 years ago in response to the growing problem drug/alcohol problems. Some of its roles include running drug/ alcohol abuse prevention programmes for adults/parents nationwide.
We establish drug free policies with sports organisations, schools and the community.
Being involved in sport myself and working with representative teams I could see that just playing sport was not enough. We also needed to have policies in place, which made it a safe place for children to be. This included guidelines for trainers and managers also, such as no underage drinking and how we might address the risk of young people using drugs such as cannabis during their time with the organisation. Bradan Foundation, founded 5 years ago, is an abstinence based therapeutic recovery programme. This is the only such program in the North East of Ireland. Bradan means salmon in Irish language. Chosen because Salmon swim upstream against the current to get back to their source. For many of the people who attend us they have a battle against the bureaucracy and lack of services as well as their addictions to get back to having the lives they deserve drug free. We believe that behaviours are learned by people to meet their needs in life and can be unlearned and other more healthy ones developed. Families and friends are also facilitated in this programme. Those around a drug/user are affected by the situation. The mother/ father who worry continually what will happen to their child when they are using drugs.
There is disruption in the home and police may be involved. Drug abuse started in Dublin in the late 1960s. In the 1980 saw a great increase in the availability of heroin and the numbers addicted rose rapidly. Young people travelled between Dublin, London and Amsterdam (Netherlands) As the problem increased in the mid '80's decreases in funding threatened the survival of the few recovery facilities available. As the problem increased efforts were made to impose medical control. Public protests eventually brought about new community responses to the problems.

• Ireland has one of the highest levels of drug and alcohol abuse in young people in Europe (ESPAD report (1995,2001)
• It has one of the highest levels of drug-related deaths in Europe (Irish Health (2003)
• Over 80% of intravenous users in Dublin have Hepatitis C. (Drug Treatment Board (2003)
• 90% of drug users who overdosed bad more than one drug in their system. (EU report) According to EU report also bad one of the highest rates of HIV and Hepatitis C in Europe.
• Substance worth 50Omillion Euro seized in Dublin, 13th May, to be used in production of ecstasy. Came from China and was being returned through Ireland to Holland.

Mary's Story
Mary started using alcohol and cannabis at 13. She lived with her parents and siblings. At age 15 she found it difficult to concentrate in school and she felt stupid and dropped out. She was unaware of the effects cannabis has on the brain. Her parents did not know she was using drugs. She eventually smoked heroin. After age 16 she was injecting heroin. She had only drug using friends, no job and not in education. There were lots of arguments at home now and her behaviour changed. She was stealing money at home and also prostituted herself for money. She had withdrawal symptoms without heroin and felt very sick most of the time. Eventually she was told about a clinic for drug users. She went there at age 18 and was introduced to the doctor. The doctor took her drug using history. Inquiring also about the amount of heroin she used. She was requested to give 3 positive for opiates (heroin) urine tests before being put on methadone. This she did over 3 days. She still had heroin in her system when put on to methadone. Mary was pregnant and so did not have to wait long for methadone maintenance. They put her on 40 mils per day. At age 18 her weekly routine was as follows:
Mondays, Wednesdays and Fridays before 1600 hours, attend the clinic where she would give a urine test. Every day of the week (7 days) go to a clinic and drink her 40 mils of methadone.
It was 35-minute drive to the clinic and 35 mins home. Time driving was 1 hour and 10 minutes depending on traffic. She met a counsellor once every month. This was for a short session.
Mary gave birth to her child. The doctor suggested she should now increase her dose to approx. 80 mils. To 'stablise' her. She refused the increase.
One other girl that she befriended, was heavily pregnant and on 120mils of methadone per day. Her baby bad withdrawal symptoms e.g. pain and sickness. The baby was detoxified through medication, which is called 'Baby methadone' by drug users.
Eventually Mary asked to be detoxified off methadone. She bad initially felt calm when using methadone hut now began to feel that she was actually numbing herself. She was not experiencing her feelings clearly.
They detoxified her over a period of months. No suggestions were made to her about where to go following detoxification or where to get help such as a follow up drug free programme.
She started to use heroin again. They detoxified her two more times over a period of months. She still was not referred to any recovery programme. She eventually used heroin again. Following this they would not take her back and she was left to take care of herself. Mary requested help from them again and was put on a waiting list for methadone. This lasted for 2 years. During this time she continued to use heroin. She went to the management of the clinic and threatened to go to the media and the y then put her back on to methadone. Mary attended the clinic every day for methadone. After approximately 3 months on methadone she was given 'take home' packs of methadone. This consisted of enough for 2 days and then increased to 3 days and so on. Indeed this practice is one of the reasons why methadone is now for sale on the streets illegally. It costs approx. 20 Euro per bottle. Mary overdosed on methadone. She took her normal dose and the take home pack covering 3 days. She wanted to take her own life. She was feeling very depressed and had feelings of hopelessness. She was not told that there were alternatives such as abstinence-based programmes following detoxification. Drug free recovery was not mentioned. She did not feel that her self-efficacy was supported. Or that she could do more than continue on drugs.
She stayed in hospital for a number of days and was then released back to her methadone programme.
Mary and her husband and child moved to another area in a rural part of Ireland. She continued on her methadone programme with virtually no counselling. She asked once again to be detoxified and this was done. Her husband heard about our centre and also met a former drug user who had attended our programme. Mary requested to come for counselling. This happened immediately. She was assessed and then began attending daily for group therapy and counselling in a drug free environment. In this setting people address issues, which may relate to their childhood, their feelings, thoughts and emotions. They eventually go back into education or employment.
She has now through her own determination survived both her addiction and the lack of services to help her. There are many more stories like this. One boy was left on methadone maintenance while using 5 other illegal substances. The Health Department was aware that he was doing this. Many others have discovered they can use heroin at one point during the week and it will not show in their tests.

• In Ireland a child as young as 13 has been given methadone maintenance. We find that methadone has be come the first option given to opiate users. People are now addicted to methadone and less are coming off drugs. They are called 'Government Junkies' by their own words. They see the Government now as their supplier rather than depending solely on their street heroin dealer. Many on methadone are also using other drugs such as benzodiazepan, which is a prescription drug. In fact many of the drug related deaths have included benzodiazepan (sleeping tablets).
• In Australia cases are now coming to light where people have taken legal action in relation to their consequences following methadone use. One person has received a couple of million dollars. It is a matter of time before it happens in Ireland.
• "Methadone, the drug widely used in drug treatment centres to treat heroin addicts, stimulates HIV infection of human immune cells studied in cell cultures”, according to immunology researchers from The Children's Hospital of Philadelphia. Perhaps we need to research alternatives.
• Many on methadone maintenance are driving cars which is drug driving. So others are now at risk on the roads. This is also true of Australia where one person was obtaining a false medical report in order to drive his truck. The legalisation of drugs movement has also noted that by softening people's attitudes to drugs in the community via methadone maintenance, it may be possible to achieve full legalisation of drugs. At a conference in the European Parliament members of the anti-prohibition that continuing to push the idea of needle exchanges, methadone maintenance would help with their task.

Present situation in Ireland
There is now widespread abuse of benzodiazepan tablets. A European report showed that 90% of drug users who overdosed bad more than one drug in their system. Including methadone.

Pharmacist

• "Almost one third of pharmacists participating in methadone treatment programmes for drug-addicts have been verbally abused. 18% have been threatened or intimidated in last 12 months. 7% are victims armed robberies" (Survey Irish Pharmaceutical Union (2004)
• IPU also raised concerns over the “CHAOTIC MANAGEMENT' of the Dept. of Health as far back as September 2002. Nothing was done.
• The IPU found over 40% of pharmacists involved in the program do so despite complaints from neighbouring businesses, residents and other patients.
• 31% feel their patients are unstable (not 'stabilised') which means on more than one drug.

Services
200 to 300 residential and day programme (drug free) places are available in the country. 30 detoxification residential beds. 7,000 on methadone maintenance in the city of Dublin. Population 1.5 million. 50 methadone clinics approx. in the city alone. 1 residential programme for under 18s nationally. Drug use and crime is linked. It is seen as a medical problem and thus medicated and therefore doctors make attempt at control.
Drug Free Recovery Costs Less Than Methadone Clinic Treatment
"On the other hand, those who try to be come addiction free may access one of the few private/voluntary, drug free treatment centres.
Here, the full cost of a place is 50,000 Euro per place, per annum, 34,000 less than a methadone clinic place. In the private clinic, the addicted person is striving towards independence rather than dependence; self-control not imposed control; real change not drug substitution.
The benefit to the addicted person's physical health is obvious. They have stopped using toxic substances, so their health can recover. The beneficial effect on their families, due to the greater sense of responsibility for themselves and for others, is striking. The possibility of a productive life is greatly increased.

Cost Comparison
The cost of the service in a private residential program in the year 2002 was 6,880 Euro per 6-week programme. A further 800 Euro is paid for aftercare of a two-year period, bringing the total cost to the service user to 7,680 Euro.
This figure is very close to the cost to the State of 7,400 Euro per person per annum engaged with the methadone services. At this point it is important to emphasise that 60% of the private centre patients manage to stay drug free for two years and longer after treatment.
There are no statistics on how many methadone users ever becomes drug free.
Detoxification costs also have to be added to the cost of treatment. Residential medical detoxification is expensive and is generally administered over a three-week period at present. These facilities are needed to support drug free treatment and also to reduce drug dependency. They are used prior to drug free treatment hut are also used in methadone maintenance for 're-stabilisation'. The benefits of detoxification are maximised to those who continue on to drug free treatment and aftercare/rehabilitation programmes. In the long term, drug free recovery is cost effective, even taking into account relapse and the rehabilitation needs of people in early recovery. However, these drug free services have been starved of funds, while methadone maintenance, once hailed as the cheap alternative, is now proving to be maro expensive in financial terms alone." (Working Group on Addiction Spoke Ireland (2004) A New Initiative Is Needed For Under 20s.)
It is important that young people are helped to grow to their full potential.

Under 20s
Maintaining under 20s on methadone does not support their development. Their confidence and self-efficacy is not supported. They are stuck in a situation with a serious lack of services to help them improve their situations.
Very few actually stabilise - Many young people use other drugs as well as methadone. When they are collecting their methadone doses young people meet other drug users. Parents agree and sign permission for methadone for children. At that point they are usually desperate for help and see this as the only option. It is possible to help young people come off all drugs if the resources are made available. This requires political will and strong leadership.
We must decide if we want our children to use drugs or not. If not then we must put in the effort and financial support for services to help them grow to their full potential drug free. It is an achievable goal. Prevention of drug/ alcohol abuse training, which includes parents, adults, and youth leaders, must be run in conjunction with youth programmes.
We must move away from the idea that we can do nothing to prevent abuse. Drug free services that help those addicted must be available. It is their right to have the opportunity to take control of their lives.

"Note: What drug free means"

The description "drug free”, "all drug free', "completely drug free"
Are used in my report to describe, recovery/rehabilitation from the use of ALL mood-altering drugs. We see drug free treatment as the essential objective of all drug services for under 20s especially.
In doing this, we are being explicit and emphasise our meaning so that readers are not confused by the current practice of describing people dependent on the addictive opiate, methadone, as being drug free. "Treatment" similarly is likely to me an substituting methadone for heroin, and supplying injecting equipment to clients. "Recovery" usually now means methadone maintenance, NOT RECOVERY FROM ALL MOOD ALTERING DRUGS.
"Prevention" means mainly harm reduction: free needles and methadone.

Treatment for recovery
Drug Free treatment is effective
Foundations of a successful service for under 20s
There has been virtually no planning or delivery of drug free recovery services for under 20s. This includes a failure to provide any day or residential recovery service that would enable a drug/alcohol troubled young person to continue education as a participant and then to resume schooling at the end of the programme.
There is a need for drug free recovery facilities for this age group and not methadone maintenance.
It must be emphasized that instead of encouraging adolescents, who bad succumbed to our society's alcohol/drug environment, to seek entry to the scarce recovery facilities that are available, they have been frustrated and impeded, particularly by refusal of access to detoxification.
Instead of being a motivator and facilitator of addicted young people towards healthy normal, and recovery where needed, our drug services have imposed an almost total dependence on the substitute addictive drug methadone on addicted young people. Dublin, for example, now has a methadone dependent population of 7,000. One relatively recent residential programme that caters for under 188 remains the only facility available in the country.
To provide a successful drug free recovery oriented service for under 20s we must first replace the current climate of hopelessness with an environment where there is a real expectation of recovery. Every aspect of this approach should convey a belief in the capacity of the addicted young person to recover. Drug free treatment programmes should be located in premises that are entirely drug free and not used for methadone maintenance.
(Otherwise there is the temptation to use methadone or other drugs)
Adolescents at this most vulnerable and critical developmental phase of growing towards maturity and responsible independence should not be prescribed methadone or any sedating/mood altering drug except in short-term detoxification. Unfortunately, methadone maintenance, not drug free programmes, is the purpose of Government policy

Counselling For Recovery
To provide a minimal but effective service that would be available to parents of adolescents in trouble with alcohol and drugs we need the services of counsellors who are trained in motivational counselling and other front line recovery (drug free) strategies and have the interest and talent for this work.
Currently this type of professional service is mainly provided by voluntary organizations. We need a great many more. In understanding the particular dilemma of heroin-addicted adolescents and their families, it is vital that we understand the reality and the consequences of the methadone maintenance only policy. So dominant is this policy within the drug services that many people working in this service are not aware that recovery to a drug free life is feasible without methadone and should be an option for under 20s. Drug free recovery must be our priority for under 20s. Successful counselling, with family involvement, should lead to services, day and residential that enable the youth to recover. But before that can happen he or she needs to be come drug free and this means obtaining detoxification, with family involvement, and a program me laying the foundations for participation in a drug free rehabilitation afterwards.

Detoxification Places urgently needed!
To assist addicted young people to undertake the process of recovery that requires participation in a drug free rehabilitation programme, day or residential, he or she must be come drug free first. An adequate supply of detoxification places is both vital and urgent for adolescents addicted to drugs. A special unit is required to detoxify under 20s.
The number of detoxifications unwisely undertaken in the homes of distraught families, and self-detoxifications, probably exceed the number of detoxifications available with appropriate medical supervision. Medical and other supports are usually necessary as detoxification is difficult and even dangerous, and ideally should be carried out on an in-patient basis.
Those who are abusing alcohol/ other drugs, hut who are not yet physically dependent could be treated as outpatients, with good family support and counseling, for both.
Many approaches to detoxification are available that do not have the disadvantages of methadone, which is the most commonly used drug for detoxification, and treating opiate abuse in Ireland."(Working Group On Addiction (2004) (Other drugs such as Naltrexone-non opiate) could be used.
It is only when young people are drug free can we help them with the underlying issues around their drug use.
We have dealt with a significant number who have previously been sexually abused and physically abused. Of course that is not everyone hut it does show that maintaining them on methadone does not help them deal with these very painful experiences and to continue on with their lives.
Under article 33 of the UN conventions on the rights of the child, young people are entitled to have services provided which help them come off ALL psychotropic substances.
If they are not provided, does that mean there is a case against a Government for failing to carry out what the y have signed up to?

FINALLY
'Prevention is better than cure'
We need to put in the resources at the earlier points in order to reduce the demand for drugs/alcohol.
The fight against drug/alcohol dependence will be won in the ordinary homes of our countries.
Parents and relevant others have the power to influence in a positive way. We must help them achieve that.
When we buy a car we get a manual. Have a baby and you get nothing.
So we need to support each other in our communities to take care of the future of our nations (our youth).

 
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