Editor’s Note: Today closes out our series on methadone by guest Grey Ryder, the pen name of a methadone activist and patient who blogs at aboutmethadone.com. Following on his overview of the drug’s history and discussion of its benefits, this piece looks at recent attempts to make access to methadone maintenance more difficult and costly in the name of “morality.”
Methadone’s success in reducing the harmful effects and behaviors associated with heroin addiction have led to its status as the “gold standard” in opiate addiction treatment. Despite the phenomenal success of methadone, and its proven track record over the past fifty years, it has made its share of enemies. Methadone’s foes, once a small group of people primarily concerned with keeping clinics out of their neighborhoods, have coalesced in to a major movement. They have allied with legislators to enact laws that are posing a very real threat to addiction treatment in this country.
“Disgusting and immoral” was how Senator John McCain described methadone in 1998. He was seeking support for his “Addiction Free Treatment Act” which would, among other things, cut off Medicaid payments for methadone after six months of treatment. His wife, Cindy, is an addict herself: she stole the painkillers she was addicted to from her own medical organization. McCain’s bill (which never became law) was followed by then New York Mayor Rudolph Giuliani’s own crusade against methadone. Giuliani vowed to shut down New York’s methadone clinics, again describing the treatment as “immoral,” before finally reversing himself in the face of overwhelming criticism.
Methadone opponents across the country are ready to clamp down on treatment. Many methadone patients – perhaps the majority – are poor and on Medicaid. States have begun to target this population by cutting off tax dollars for their treatment.
It is true that methadone deaths have risen exponentially over the past several years, due to a massive increase in pain relief prescriptions.Opponents of methadone treatment are blaming the increase in deaths on methadone clinics, when the majority of the dead are being prescribed methadone for pain. Even though the clinics account for a very, very small percentage of these deaths, opponents call for legislation to stop “diversion” at clinics. Diversion occurs when a patient gives their methadone to another person. Legislation seeks to stop this mostly imagined threat by restricting the “take home” doses clinics give their patients.
In the initial stages of methadone treatment for addiction, a patient must report to the clinic every day. Making the patient attend the clinic daily imposes structure on his life, and it allows the staff to monitor the patient closely.
As patients spend more time in treatment with negative drug tests, they slowly earn take-home doses. This allows them to continue treatment without having to come to the clinic every day. Take-home doses are a valuable tool; not only are they a carrot to encourage patients to stay drug free, they improve a patient’s employment and family situations by not leashing her to the clinic every day. Federal regulations give patients the ability to earn up to twenty-eight take-home doses every month after three drug-free years in treatment.
Some states are doing all they can to eliminate take home doses for patients. Proposed legislation eliminates this small perk, requiring clinics to be open three hundred sixty-five days per year, seven days a week. Even on Christmas morning, recovering addicts must report to the clinic because the state cannot trust them with even one take home dose.
The laws that pose the greatest threat are those that cut off methadone treatment after a set period of time. In Pennsylvania, there is a proposed law that directs the Health and Welfare office to stop payments for methadone after one year. Maine seeks to set the limit at two years. These time limits were arbitrarily set with no regard to addiction science. Since the vast majority of these patients cannot afford to pay for methadone treatment, which can cost upwards of four hundred dollars a month, these laws effectively end treatment for thousands of patients.
The effects of this, on both the individual and the state, will be nothing short of disastrous. Officials fear that the vast majority of people who suddenly stop methadone treatment will turn backto illegal drugs and crime. Even methadone patients who have been stabilized on methadone for a number of years, changed their life habits, and tapered off the drug very slowly still relapse in incredibly high numbers. It’s unclear what outcome these bills’ authors have in mind for the patients who will suddenly see their treatment terminated. Nearly all of these patients will return to a life of illegal drugs, prostitution and property crime. Because methadone can change your tolerance to heroin, huge numbers of people will overdose. It’s possible that the architects of these bills gave no thought to the patients who will lose treatment. A more cynical interpretation is that the politicians know exactly what will happen – a return to narcotic abuse, with all the ancillary horrors that accompany it – and simply don’t care.
(www.davidrochkind.com)
Although these bills are being sold as a way to save the states money, this will actually create an enormous financial burden. Those who turn back to drugs will, if they’re lucky, end up in state treatment beds. Inpatient rehabilitation costs many times what methadone does. More likely, the prisons will swell as these patients return to a life of crime. Methadone treatment costs about $12-$14 per day; the average cost to clothe, house and pay the medical bills for a prisoner is about $80 per day.
One major problem is the public’s perception of methadone. Most people view it, and drug abuse in general, so negatively that these bills have a great deal of public support. Cutting treatment will cost states many times more in increased health and incarceration costs, not to mention the social costs of thousands of addicts returning to opiate abuse. Conservatives have methadone treatment in a death grip, and it doesn’t look like they’ll be letting up any time soon.
If this was such a great system why not extend it to nicotine addicts?
We really know how to drive up costs in the name of a false morality to basicall protect cigarettes from the competition- the public health be damned.
We have plenty of experience of methadone in the UK. It is not anything like capable of stopping the use of street drugs alongside the methadone. It is emphatically NOT a cure for opiate addiction. How could it be? It may have a use in the initial treatment of a chaotic addict but that is it.
In Scotland there have been more deaths recently from (legal) methadone than from (illegal) heroin. Addict surveys have shown that most addicts, the overwhelming number, want to help to get free of their addiction, they do not want being kept addicted by their clinician. The only people served by keeping people addicted are the treatment agency and the pharmaceutical suppliers.
The immorality in “parking” addicts on methadone stems from the obvious, cure is possible.
For any other disease, failing to treat it properly and cure, if that is possible(and it is), would be a public scandal and a contravention of the hyppocratic oath..
A very interesting post, Grey Rider.
The UK is currently the site of a strident populist discourse in which methadone treatment is represented as a state-sponsored addiction, on which individuals are ‘parked’ against their wills and left to rot on sink estates. As has been so often the case historically, methadone is the drug being made to operate as a metonym for everything that political and social commentators feel is wrong with society, particularly but not entirely those on the political right.
Amongst a number of heroin users which I cannot pretend to quantify, methadone functions as an existential alibi. After all, people are not held at gunpoint and forced to consume methadone. Addiction is a cultural site that illustrates the non-unitary character of human subjectivity: many people both really want to stop and really want to carry on taking heroin. I realise that there are manifold influences that detract from that sense of agency required to decide: ‘I am not going to consume this drug anymore.’ Nonetheless, as a generality, the point holds.
The complaint of these individuals that they want to be ‘cured’ or ‘drug-free’ but are instead merely ‘parked’ on methadone is then utilised by an anti-methadone lobby which appears to be gaining the hegemonic position here, thanks largely to the support it receives from sections of the press and a number of Conservative politicians, in addition to one or two figures from popular culture such as Russell Brand.
What is curious -or perhaps isn’t- is the ahistorical nature of the position. ‘Recovery’, which in this context means zero use of any illicit drugs, is presented as something entirely new. As though, until now, nobody has ever thought of getting heroin addicts to stop consuming heroin. Instead, they have been sedated with it by the louche liberal left (or, in Russia, by profiteering western pharmaceutical companies)- so goes the narrative, at least implicitly. In the UK, in fact, maintenance with methadone is comparatively recent. The old British System permitted heroin to be used on an ongoing basis in certain cases, while methadone maintenance has only been used systematically and on a broad scale since the 1990s. In the 1980s, if one attended the state treatment system, one was provided with a rapidly reducing dose of methadone and strenuous attempts at compulsion toward abstinence. What developed was generally known by both the addicts and the drugs workers- amongst whom relationships were generally conflicted and demoralised from both perspectives- as the ‘revolving door syndrome’. People undertook ‘reduction cures’, went back to full time street heroin use, and then returned to treatment when the regulations permitted or when they ran out of sufficient money and health to get out there and score.
If the hard line elements of the recovery movement achieve their goal of shifting policies away from recourse to methadone, not matter what the wishes of the clients/patients may be, we will see a return to this kind of situation. What is needed, of course, is a more pragmatic approach where those using the treatment system can obtain the specific type of services that they need, as determined in a therapeutic alliance with their physician and arrived at in the context of a democratic and participatory institutional ethic.
Simples.
Yet such a remote possibility in the UK and, I gather, in the US.
“Strident populist discourse”.
Humbug and twice humbug. The UK debate has been going on largely among those concerned with drug policy and with treatment. It has hardly touched popular discourse. The “hard line” of which you seem to complain is a hard line FOR recovery, not just against methadone.
What we had in the UK was a NTA (National Treatment Agency) achieving no more than accidental success in getting addicts free of addiction. I wrote about this in the Guardian “Comment is Free” section some time ago. I did that because it was necessary to change the terms of the debate. .
The terms of debate in the UK HAVE been changed. Get over it.
What we had was a developing situation where the rich (who could afford proper support and treatment) could get re-hab and become drug free, but the poor were indeed “parked” and left on methadone, sometimes for years.
This was an unsustainable and immoral public policy and a national disgrace. Addicts are people, they deserve better. We have a human duty to help as many as possible to become drug free.