methadone doesn't work
Why the methadone doesn’t work.
Doling out methadone to heroin addicts has become a daily ritual for many pharmacies but the government needs to tackle the root causes of addiction.
A heroin addict in recovery takes their prescription methadone. Photograph: Danny Lawson.
The first task of the day in the pharmacy is to prepare the methadone, a little over a gallon this morning.
Its supervised daily consumption has been the mainstay of the harm reduction philosophy that has largely driven heroin addiction treatment for the past 20 years. Not all pharmacies supply methadone, but in those that do, the pharmacist sees addicts more regularly than any other health professional.
George, employed and drug-free for almost 10 years with her commitment to Narcotics Anonymous, still tells me of the conflicting emotions she felt as each day she stood in my busy pharmacy with her daughter in the pram, and consumed the sticky green methadone mixture, followed by a glass of water to help stop her teeth rotting from it, gradually reducing the dose.
Today, pharmacies have private rooms for such activities, but the daily grind continues. One inner-city pharmacy has even relocated to a former bank, and the walk-in vault is now the “drug cupboard” accommodating the quantity of methadone required.
Methadone is a highly addictive synthetic opiate, more addictive than heroin and harder to withdraw from, but it survives the digestive system and so does not need to be injected. Most addicts loathe it.
They call it green gunk and grimace as they swallow. All of today’s addicts have been coming to the pharmacy for months, some for years. And that’s the problem.
The Centre for Policy Studies thinktank has called methadone maintenance “nationalised drug dealing”.
Instead, it promotes recovery through residential detox and abstinence-based rehabilitation. But there are pitifully few rehabilitation beds available at “reasonable rates” of around £600 a week, and none in the NHS.
The National Treatment Agency for Substance Misuse (NTA) recognises that addicts have been parked on methadone for too long, and now promotes abstinence as the treatment goal, with time limits on the duration of methadone maintenance.
Jane, a drug therapist, shakes her head in disbelief at the new recovery targets and the lack of facilities and experienced staff to handle such a change. She and her colleagues worry about how the new emphasis on recovery – welcomed as it is – will affect the most vulnerable people, for whom harm reduction is fundamental. The cherry picking of new clients to attain NTA targets seems inevitable.
And what of those heroin addicts not in treatment? They visit me regularly for clean needles to inject filthy brown street heroin.
There is growing evidence to support treating these long-term relapsing addicts with pure heroin. A blueprint for the requisite regulatory changes has been created, but until the laws are changed they must remain thieves and prostitutes, rather than patients, victims of legalised social neglect.
The children of the addicts in my pharmacy today live in blighted social circumstances. Unless the fundamentals of social inequality are addressed, it is hard to see them having very different lives from their parents. Drugs may fuel addiction, but they don’t cause it. Those politicians who, in the face of all contrary evidence, stubbornly see the drugs as the problem are no less misguided than the addicts who see drugs as the solution.
By the end of the afternoon I have dispensed the gallon of methadone to 33 addicts and supplied three more with clean needles. They should all be back after the weekend.
• Peter Dawson is a locum pharmacist in West Yorkshire.