Methadone isn’t the problem or the only solution

jm03505

The latest figures for drug related deaths in Scotland make for grim reading.  In 2012, 581 people died from taking drugs (other than alcohol and tobacco).   Staggeringly, the most deadly drug isn’t heroin but methadone, a drug often prescribed to help users kick their heroin habits.

Let’s be clear before we begin, the response from the media to methadone has been nothing short of total nonsense, as usual.  Consistently screaming out against rational debate is what our papers do best, not least when drug policy is being discussed. Last year, the Daily Record gleefully branded the Scottish Government, “The biggest drug dealer in Scotland.”  A few basic points, as the people who run the health service in Scotland, I’d like to hope that headline is true – I’d like to hope the government distributes more drugs than wee Davey fae downstairs.  We can argue about a culture increasingly moving towards the medicalisation of everything, but I doubt the Daily Record will be standing at the bedsides of those receiving other potentially life saving treatments, in order to brand our nurses and doctors “drug dealers.”

jm03501

Bullshit like this helps absolutely no-one

It’s not the case that vast numbers of people die solely as a result of taking methadone. The number of deaths in which methadone was the only substance found was just 12.  Lest we forget, methadone helps many people to get clean in the long run.   It’s perhaps not even that surprising that the sole drug of choice used by the state to deal with those at the sharp end of heroin addiction is present in the systems of those same people when they die.  But the fact that we refuse to consider the idea that different strategies might work for different people and refuse to properly research and fund alternatives to methadone replacement means we’ll simply never know if we can prevent more people dying.

Just days after the figures for drug-related deaths were released, a report by a panel of experts commissioned by the Scottish Government concluded that the continuation of methadone substitution programs had a “strong evidence base”, albeit as part of a much broader strategy of community and residential rehab.  There are other questions which are always ignored: can’t we just do what you used to do and make clean, pharmaceutical diamorphine (i..e heroin) available on prescription to remove the street dealers from the equation?  What about abstinence based strategies?  What about newer approaches like Ibogaine? There is little or no “strong evidence base” for any of these strategies because we never properly fund and research them.  When heroin was available on prescription on a large scale, as was the case until the 60s, we had a handful of heroin users in Scotland.  Now we are in a situation where many users became addicted to a cocktail of substances, some available on the streets and some prescribed.  It’s not working or at the very least, it’s not working as well as it could be for everyone.

The inconvenient truth buried in all this is that heroin isn’t particularly dangerous if made in the lab and dispensed in the chemists, yet backstreet “heroin” kills hundreds of Scots every year.  Amazingly, some doctors do have the ability to prescribe heroin to addicts, but the lack of a clear national plan and properly funded research means most won’t touch it.  There may also be the acute fear that the likes of the Record may come after them if one of their patients, who may already be dicing with death on a daily basis, was to die whilst on a heroin prescription.  Their faces may be adorning tabloids as they are branded “the biggest drug dealer in Scotland.“ The war against science and those who practice it may be having very real consequences for people lives. Current guidance specifies that heroin can only be considered as a last resort.  For hundreds of users last year, we’re already too late, past the last resort.  Since it stopped being state policy, every report on heroin use contains a few lines saying we should research it or think about or some general “could do more” platitude.  But we never do more.

jm03504

In the olden days, pharmacists prescribed heroin to what few addicts there were

There will always be those who shout “why should I pay for this?”  That ignores the fact that our society already pays too high a price for our failure to act.  Heroin can be produced very cheaply on a large scale by the health service if need be, much more cheaply than is currently the case.  The NHS is put under unnecessary strain precisely because they do not control the distribution of what is sold as “heroin“, they merely have to mitigate the effects.  More broadly of course, if heroin was made available on prescription, crime associated with its use would greatly diminish.   People already pay the price of getting mugged in the street or having their houses broken into by those desperate to find the money to pay the criminals who peddle dirty smack.

Increasingly, other drugs are being suggested as possible solutions.  Ibogaine, a substance found in plants and most commonly used in Gabon, is a powerful hallucinogen that has been used with some success in the UK, leading many to ask if we should be investing in more research.  There is a powerful documentary looking at one Glasgow man’s experience of using Ibogaine to deal with his addiction available here.  The plant works by blocking receptors in the brain which trigger cravings, diminishing or irradicating the symptoms of withdrawal.  Unlike methadone, Ibogaine is not addictive, indeed many describe the experience as deeply unpleasant and even traumatic.  There is some suggestion that the trip many experience could itself help deal with some of the underlying reasons for their addiction; there’s much anecdotal chat of users understanding themselves or their lives better or coming to terms with traumatic events which may have been triggers for their addictions.  Without research, it’s impossible to tell if there is any basis for these claims and they are therefore easy to write off as the ramblings of a bunch of people high on the drugs.  There may be resistance to Ibogaine amongst the pharmaceutical giants due to it being a naturally occurring substance and thus more difficult to patent and control distribution. It’s always worth remembering just how many people make money out of heroin addiction.  Whilst giving hallucinogens to our citizens to get them off heroin will not please some tabloid journalists, we need to remember that this is not about people’s opinions, it’s about people’s lives.

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Ibogaine could be extracted from plants and used to deal with a variety of addictions

It would be churlish of me not to mention the positives of abstinence based strategies for some people.  This is not an ideological question but a purely practical one.  The clear flaw in any approach which focuses solely on abstinence demonstrates exactly why no one strategy will ever have total success.  Completely removing access to drugs from users for a period will prevent that person from using… for that period. However, time and again users are simply thrown back into the same environment in which their addictions started.  Abstinence based treatment cannot often break habitual drug use because the habits which form around drugs are more hard-wired.  We can all go on holiday for 2 weeks and lie on a beach, that doesn’t mean we’ll all be rushing to lie the streets of Glasgow on a pissing wet day.  Often users are simply removed from their communities, placed in more comfortable environment without access to drugs for a wee while and then plonked right back where they started.

If there is to be any hope we can do better in future, we first need to sideline the screaming tabloid editors and say we aren’t scared of science and we aren’t scared of being branded junkies because we want to save lives.  Scotland has an opportunity to abandon the war on science and on drugs policy experts pursued by successive Westminster governments.  For a change, I’m not about to descend into discussion about how independence is a panacea.  The SNP have shown precious little leadership on theses issues and that’s just not good enough.  We need to make clear what kind of framework we want Scotland to have. Will drugs policy be governed by science and evidence, or by the tabloids?  Will we pursue the kind of witch hunts against scientists like David Nutt, undertaken by Labour and the Tories down South? There is certainly much more the Scottish Government could be doing and with powers over health, housing and policing there is an urgent need for a more holistic and rational approach. There is also no doubt that giving Scotland the ultimate power to determine the legal status of drugs would be an important step on the way towards an evidence based drugs policy.

jm03502

David Nutt pissed off the entire political class with troublesome facts

We cannot continue to allow so many to die while so much bollocks is talked by scaremongers.  An approach which allowed for abstinence, methadone replacement, heroin on prescription and a whole other range of options must surely be on the agenda.   We need to put scientists, health and social care professions and most importantly users themselves ahead of ideology or party politics.  We need to declare heroin and methadone deaths a national health emergency and properly contextualise heroin within our society – to look at the link to homelessness and deprivation and spend money building houses instead of jailing users.  We need to offer those who would only benefit from a clean break that opportunity, safe in the knowledge that they won’t just be thrown back into environments where drug use flourishes.  We need to break the grip of criminals and gangsters on heroin distribution and put it back on the NHS.  We need to give a generation of users something better to do than just sitting at home taking smack.  That’s about a lot more than what treatment people receive for a physical dependency.

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Further reading:
Mephedrone: Then and Meow
It’s called “ecstasy” for a reason
Calling Time on Dodgy Pills

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One response to “Methadone isn’t the problem or the only solution

  1. Why not also mention drugs like Buprenorphine (Seen by this commenter under the brand name Suboxone)? I’ve watched several of my friends go from an addiction to Dilaudid (Hydromorphone) to clean with the help of this amazing new(er) treatment. Unlike Ibogaine, it’s legality is far less questionable, though I agree that Ibogaine holds amazing potential for rehabilitation.

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