methadone; cure or con?

One drug - a green liquid in a beaker - is an addictive opiate that takes users at least five weeks to come off. Another - a brown powder in a syringe - is an addictive opiate that takes users five days to come off. The liquid is methadone. The powder is heroin. One is legally prescribed by doctors. The other is illegally procured from dealers. What, they’re asking in Britain’s drugs capital, is the good of that?
By Mary Braid
Published: 19 July 2000


Alex Clark, a 38-year-old from Ruchazie, a run-down council estate on Glasgow’s east side, sits in Marco’s Gym and reels off a long list. They’re the names of neighbours and relatives, all smackheads, and all dead, ruined, or on the run. Alex’s cousin Danny, who has been on heroin since his teens, is the one on the run - somewhere in England, hiding from dealers to whom he owes money. In his case, flight was sensible. A few months back machete-wielding pushers put another cousin, Aldo, in the city’s Royal Infirmary for owing a few hundred pounds.
Alex Clark, a 38-year-old from Ruchazie, a run-down council estate on Glasgow’s east side, sits in Marco’s Gym and reels off a long list. They’re the names of neighbours and relatives, all smackheads, and all dead, ruined, or on the run. Alex’s cousin Danny, who has been on heroin since his teens, is the one on the run - somewhere in England, hiding from dealers to whom he owes money. In his case, flight was sensible. A few months back machete-wielding pushers put another cousin, Aldo, in the city’s Royal Infirmary for owing a few hundred pounds.
Meanwhile, Alex, after eight years on heroin, is seeking salvation through weights and stomach-wrenching sit-ups. It has been three months since he last shot up, and his abstinence has made his older brother Andrew, who is 39, proud. “What’s great is to see Alex with his two sons again, because for a while there he lost them,” says Andrew, whose skinny frame and hollow Celtic eyes are so similar to Alex’s that the brothers might be twins. “And it’s great to hear him laugh again. There’s not much laughing when you’re using.” Alex, still a little jittery, came off cold turkey, just as Andrew did two and a half years ago, following his own eight years on smack.
When it comes to kicking heroin, however, abstinence is not, generally, the Glasgow way. As in other parts of Britain, methadone, prescribed by GPs, is now the orthodox medical treatment for the 8,500 “jaggers” who have turned Glasgow into Europe’s heroin capital.
Widespread prescription of liquid methadone, taken orally as a heroin substitute, was introduced in the Eighties to curb the spread of HIV by needle-sharing addicts. But the strenuous promotion of methadone - an addictive opiate, just like heroin - as a medicine angered some communities, already drowning in drugs, and at least one in four Glasgow GPs still refuse to take part in the scheme. Methadone, none the less, has emerged as the treatment king.
Addicts, it seems, just can’t get enough. In 1992, there were just 140 Glaswegians on methadone prescription. Today, around 3,000 visit their chemist every day to swallow the sweetened green liquid provided by the state. There’s a waiting list to join the programme and Greater Glasgow Health Board has plans for further expansion. Last month a government drugs-advisory group held the Glasgow scheme up as a national model, after stricter supervision appeared to cut fatal methadone overdoses. This month, the first research into methadone in Glasgow sings its praises, claiming it reduces injecting, overdoses and crime.
Andrew Horne, of the Glasgow Drugs Crisis Centre, is among those who argue that methadone clearly reduces the harm heroin does, both to society and to the individual user. Dispensed in a non-injectable form, it is, he says, better for the health of addicts and also protects society from infection. “Methadone or heroin injected into the groin - which would you rather have?” he says.
Horne also argues that daily supervision of addicts on the methadone programme brings users into daily contact with services that can help them. There are no statistics to reveal how many addicts are helped by methadone to become drug-free. Horne says a large proportion of addicts simply grow out of opiate use, but he insists that the methadone programme does help significant numbers to kick their drug habit. “It is a stepping stone,” he says. “The best way to detox is to use a substitute drug and do it slowly.”
All of which would be dandy, except for critics’ claims that there is no evidence the opiate is actually doing what many presume to be its principal job: ie helping addicts to come off heroin and other drugs. Last year a record 152 people died from overdoses (mainly heroin) in the Strathclyde region, 52 more than the year before. Methadone, some warn, has now become just another dangerous drug swilling round a city infamous for “polydrug” misuse.
For their part, the Clark brothers hate methadone. Alex and Andrew’s brother-in-law, Davie, was prescribed it after five years of injecting heroin. It was supposed to ease his withdrawal and help him kick drugs. Ten years later, at the age of 33, he is still on methadone. It’s the same story, they say, with the rest of the old Ruchazie gang - at least for those who are still alive. Most have been on methadone prescription for years and - despite the scheme’s rules against using other drugs, enforced by urine testing - they continue to inject heroin and take other drugs.
The main difference between the opiates is that methadone, while it does not offer the intense high that heroin does, is longer-lasting. Addicts on the programme should not need to dose more than once a day, while heroin addicts come down much faster and need to “dose” at frequent intervals. But compared to heroin, they say, methadone is boring - a Volvo against the preferred Ferrari, and, therefore, treated just as a “top-up” to heroin.
“The health board would consider Davie a success story,” says Alex bitterly. “He does not inject or take other drugs. But he’s like a vegetable. He used to have a good head on him but now he just sits at home all day.”
Alex’s brother Andrew took methadone for four weeks when he broke with smack. “It did take away the aches and pains of withdrawal, but psychologically the benefits wore off in days - and coming off was worse than it was with heroin,” he says. It takes five days to come off heroin but five to 15 weeks to kick methadone, which is a consideration for addicts, with jail a constant occupational hazard.
Alex complains that drug centres never treat the individual addict but simply prescribe methadone to everyone. He relates how, three months ago, after 14 days without heroin, he went for medical help. “I wanted to stay off,” he recalls. “I had a house like the one in Trainspotting - there was nothing in it. A drugs counsellor took just 10 minutes to decide methadone was for me, though I told her I was already detoxed.”
Despite Davie’s experience, Alex admits he was tempted: “By then I was gasping for anything.” So he went along to his local methadone group. “There were 15 of them there, all slumped forward,” he says, now laughing. “I was introduced and - shit! - I realised I knew most of them.”
Alex made his excuses and left and finally gave into Andrew’s pleas that he join Calton Athletic Recovery Group, a hard-line abstinence group based in Denniston, in Glasgow’s East End, which was famous for a while as the technical adviser to the film of Trainspotting. Calton, which is bitterly critical of the methadone programme and currently embroiled in a funding row, is where Andrew came off, and where Alex is now trying to kick his habit. Some days are hard, but it was peer pressure, Alex says, which sucked him in in the first place. Now another peer group, he believes, can help rescue him.
Calton offers football, half-marathons, daily work-outs, and group-therapy sessions. Its controversial director, Davie Bryce - who is a hero to his fans and a bloody-minded svengali to his critics - believes exercise stimulates endorphins suppressed by years of addiction. As Bryce, a former heroin addict himself like everyone at Calton, earthily explains: “You don’t get better sitting on your arse.”
Calton is supportive, but tough. And Bryce, in track suit and trainers, is scathing of the suited professionals who blame addiction on poverty, giving addicts too many places to hide. Calton’s mantra is individual responsibility. “I used to blame social conditions and Thatcherism,” says Bryce. “I blamed everything and everyone, bar drugs.”
The health board, and a host of Glasgow drug centres, claim methadone helps addicts, as well as society, by stabilising them until they feel able to tackle dependence. But Calton bans all drugs - prescribed or otherwise - including alcohol. To Bryce, prescribing methadone makes as much sense as switching an alcoholic from whisky to gin.
“Methadone is not a treatment,” he says angrily. “It is a method of social control, introduced to contain HIV infection.” During the Aids panic, he says, the authorities had to reach the drug-taking population and methadone was the carrot that lured addicts in. Bryce reluctantly allows that methadone might have a very short-term application, if addicts moved off it before dependence set in. “But it’s not used as a means of getting people into detox,” he argues. Another Glasgow drugs counsellor, who does not want to be named, agrees. “You get these reports about methadone working miracles, but I don’t know anyone it has helped come off. Its an inexpensive way for the health board to look like it’s actually doing something. And no one takes the board on now because we all rely on it for funds.”
The study into methadone’s effect on the behaviour of Glasgow addicts - co-authored by Dr Laurence Gruer, public health consultant and the driving force behind Glasgow’s methadone programme - makes no assessment of methadone as an addiction-busting drug. Gruer’s fellow co-author Sharon Hutchison, of the Scottish Centre for Infection and Environmental Health, says that a drug-free life is the long-term goal of methadone programmes. But the study only covered addicts’ first 12 months on methadone - too soon, apparently, to expect long-term heroin users to become drug-free. But the question arises: if methadone brings such dramatic improvements to addicts’ lives, why are so many of them still relying on it, years after their first prescription?
Professor Neil McKeganey, of Glasgow University’s Centre for Drug Misuse Research, does not argue with the social benefits of methadone in curbing infection and crime. A £3m methadone programme looks good value when set against the £194m of goods that Glasgow addicts steal annually to fund their habits. It is generally accepted that given free methadone, addicts do steal less.
“But the big question has to be what effect, if any, is methadone having on heroin addiction,” says McKeganey. “And the truth is we don’t have any evidence either way.” McKeganey says that when psychiatrists were responsible for the care of heroin addicts - before Aids arrived and public health and infectious diseases consultants took over - they were largely sceptical about methadone as a treatment, as countries including France remain today.
McKeganey agrees that short-term use of methadone might stabilise an addict. “But stability is not an end in itself,” he warns. “Methadone should be the point from which other things take place and that’s not happening in Glasgow.”
From his own interviews with addicts, he believes that for some, the opiate may create an even stronger dependence than heroin. Professor Russell Newcombe, a drugs lecturer at Liverpool John Moores University, argues that because of the longer withdrawal period, methadone may, in fact, extend addictions by years. Yet there are no studies into the long-term effects of the drug.
Meanwhile Calton’s members believe that, secretly, the health board has given up on addicts, convinced they cannot be saved, or that saving them would cost too much. Janis, who is 29, finally came off heroin five years ago. “I had sold everything,” she says. “I slept rough on the streets. Eventually I joined a methadone programme, lying that I wanted to kick heroin just so I could get more drugs.” It was a year before a urine test revealed she was still using heroin and other narcotics.
“My habit just got bigger and my life got out of control,” she says. “I thought the only way you got out was to die. That was all I was seeing around me.” Bryce laughs that the health authority likes schemes that are “non-directive and non-judgmental” when directive and judgemental are just what addicts need.
“I wanted someone to tell me how to get off and stay off, ” remembers Janis. “I didn’t want someone to ask me what I wanted to do. How would I have known, the mess I was in?” Fundamentally, she says, she needed role models to show what was possible. That finally happened when she saw a Calton presentation in prison.
Janis, understandably, wants more abstinence schemes. But even drugs counsellors who support methadone projects, warn that Glasgow’s expanding scheme is facing problems because of scarce long-term rehabilitation programmes. “We have them on methadone but we can’t get them off,” says one drugs-project manager who prefers anonymity because he, like most others, relies on health-board funds.
Alex, meanwhile, struggles on with the daily sit-ups at Marco’s Gym. “I worried at first that it was all too late to get clean,” he says. “But I believe now that had I gone on methadone I would be sitting in the house just like [my brother-in-law] Davie.”
http://news.independent.co.uk/health/article266397.ece