Is methadone a bad way to treat heroin addicts?
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Is methadone a bad way to treat heroin addicts?
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Comedian Russell Brand has said that more should be done to decrease the number of recovering heroin addicts on methadone, and more time and funding should be put into abstinence based therapies for d
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Forums » Off duty » News & media » Is methadone a bad way to treat heroin addicts?
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Is methadone a bad way to treat heroin addicts?
posted at 13/8/2012 10:07 AM BST
on bmj.com
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First: 7/4/2011 Last: 24/5/2013 |
Comedian Russell Brand has said that more should be done to decrease the number of recovering heroin addicts on methadone, and more time and funding should be put into abstinence based therapies for drug addicts. To paraphrase him, methadone still creates a sense of dependency and does not tackle the reasons behind addiction. Methadone treatments cost the British taxpayers £3.6bn a year. Brand argues that whilst abstinence therapies are more expensive up front, that costs would be recouped by seeing a fall in crime and prison populations. Brand claims that addiction is caused by particular trigger points in an addicts life (parents' divorce, a death, sexual abuse etc) and that therapies and understanding why individuals use drugs in the first place and helping addicts to confront why they might have turned to drugs, is a more sustainable way of dealing with addiction. Is he right? Should more be done to promote abstinence based therapies? Is methadone prescribed too easily? http://www.guardian.co.uk/culture/2012/aug/12/russell-brand-methadone-treating-heroin-addicts |
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Re: Is methadone a bad way to treat heroin addicts?
posted at 13/8/2012 10:39 AM BST
on bmj.com
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Posts: 1271
First: 13/4/2010 Last: 23/5/2013 |
Hi Matthew - the only treatment for which a good solid evidence base exists is methadone maintenance therapy - it reduces crime, it reduces social dysfuntion and it reduces relapse rates compared to detox regimes. It's become fashionable to berate the use of methadone maintenance particulary in the right-wing press and amongst right-wing politicos but it flies in the face of the evidence - at least as far as i understand it (as always I am happy to change my views if anyone can come up with good solid evidence to the contrary - as opposed to childish moralising that is) |
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Re: Is methadone a bad way to treat heroin addicts?
posted at 13/8/2012 4:27 PM BST
on bmj.com
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Posts: 138
First: 25/5/2011 Last: 24/5/2013 |
Mr Brand has only made half an observation in my view. Addiction is often caused by an individual's decision to deal with life-stresses by opting for a strategy of substance usage and then indulging repeatedly in this strategy to the point of dependence. During this whole process the individual is either incapable of, or unwilling to confront the inadvisability of their course of action and then generate an alternative strategy. I also suspect that they enjoy some element of the experience in some way and so deliberately ignore the obvious evidence of the harm that they are doing themselves both physically and socially. There is thus little to praise in an addict's choices and equally little to suggest that once free of their self-imposed addiction that they will deal with the next of life's inevitable stresses in a different fashion or be particularly amenable to advice on trying alternative strategies. To get involved in heroin in the first place means commiting the criminal act of buying it from the criminal supplying it. It demonstrates that the user holds a very lax view of social norms and responsibilties and, in my experience, these people are very egocentric and directed to prioritise their needs far above anybody else's. I have seen them rob their siblings, parents and grandparents and then attempt to justify their actions in terms of what they needed. These observations I offer in order to explain why I would suggest that abstinence therapy may be an unreachable aspiration for the majority. However laudable it may be to espouse such beliefs, to then commit staff and resources to certain failure in the pursuit of the impossible would be an unforgivable error of putting naive hope in front of cruel experience. Methadone is a maintenance therapy, not a curative one. Far too many people, in my opinion, have been deliberately misled to regard this drug as a treatment that offers a ray of hope to a hapless recipient. My view is that it is mainly given to protect the rest of society from the rapacious and self-absorbed individuals who firstly choose to take so much heroin that they become addicted and then, remarkably, conciously decide to continue with it. By generally rendering themselves unemployable, their only means of paying for their drugs is through crime and then we all suffer. It was long amazing to me that all these "recovering heroin addicts" were unable to reduce their methadone dose by 1mg or 1ml daily per week towards zero in order to get "clean". In spite of this tiny incremental reducing option that they could ask for and be assisted with, many still continue with the same or indeed an increasing dose for several years. You might come to believe that something deep inside of them did not really want to recover - and I'ld suggest that you were right. We should view these people and their problems for what they truly are before either condemning them out of hand with no thought applied or treating them like fallen angels after too much. In then thinking about what to do with them, I would suggest methadone is the realistic compromise that we probably have to accept while heroin remains illegal in the UK. |
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Re: Is methadone a bad way to treat heroin addicts?
posted at 13/8/2012 4:39 PM BST
on bmj.com
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Posts: 2060
First: 12/3/2010 Last: 24/5/2013 |
This is someone called Russell Brand, whose only expertise in this subject is as a drug-user, and now abstainer, whose journey to the latter happened not to be with the use of methadone. He is also 'famous' for an abusive and invasive phone-call, 'live' on TV, to a blameless and well-known actor about his grand-daughter's alleged infidelities. Who, without wishing to denigrate anyone else's dress sense, thought it appropriate to appear before the Parliamentary Committee on drug abuse in a torn singlet. Whose contribution to world literature is entitled "My Booky-Wook". The man is a self-aggrandising poseur, with little or no talent for anything except self-promotion. We need not take him seriously. John |
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Re: Is methadone a bad way to treat heroin addicts?
posted at 13/8/2012 10:20 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
Taking methadone is not a cure for heroin, Oxycontin, hydrocodone or any other opioid or opiate addiction. In fact true freedom from drug addiction involves physical detoxification and a program that addresses the mental, emotional, social and spiritual aspects of drug addiction. Methadone has 3 times the half-life of most opiates including heroin, thus making it much harder to get off of if you were to get addicted to the Methadone, which doesn't take long. Its long half-life was its advantage in medical settings over other natural or synthetic opiates. The analgesic effects of methadone can last two to three times longer than other opiates. Because of its slow metabolic breakdown, it was later used to block or decrease the cravings and withdrawal symptoms from persons that were addicted to opiates generally and heroin in particular. In the 1960's the government sponsored clinical research to demonstrate the benefits of methadone administration as a substitute for heroin and from this research it was determined that methadone could be used as a substitute for heroin. |
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Re: Is methadone a bad way to treat heroin addicts?
posted at 14/8/2012 12:19 PM BST
on bmj.com
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Posts: 1181
First: 19/4/2010 Last: 23/5/2013 |
Mrs Dr Dundeechest works in a drug dependency service once a week. She feels that those on methadone fall into 2 camps - those now addicted to methodone, and those accepting the methadone, and continuing to take heroin/other opiates. She is fairly demoralised by it all, to be honest. I know there is an evidence base to show the reduction in crime, etc, but locally, at least, addicts are put on methadone, and left on it, with little or no attempt to bring the dose down, to get them off the drugs completely. It's only one piece in the jogsaw, and most of the pieces are lost forever down the back of the sofa...
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Re: Is methadone a bad way to treat heroin addicts?
posted at 14/8/2012 2:38 PM BST
on bmj.com
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Posts: 1271
First: 13/4/2010 Last: 23/5/2013 |
I hav to declare that I am GPwSI in drug and alcohol problems and deal with drug users not just in my own practice but for other practices in the locality. My experience is different from MrsDundee Chest. I have dealt with individuals in whom methadone maintenance has allowed them to hold down jobs, keep a roof over their heads, avoid family breakdown and, in one case, start up a succesful business. Sure they may be on it for 3 or 4 years but that has to be seen against a background of 10, 15 or 20 years of drug misuse and anything has got to be better than that. |
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Re: Is methadone a bad way to treat heroin addicts?
posted at 14/8/2012 4:04 PM BST
on bmj.com
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Posts: 1181
First: 19/4/2010 Last: 23/5/2013 |
In Response to Re: Is methadone a bad way to treat heroin addicts?: I hav to declare that I am GPwSI in drug and alcohol problems and deal with drug users not just in my own practice but for other practices in the locality. My experience is different from MrsDundee Chest. I have dealt with individuals in whom methadone maintenance has allowed them to hold down jobs, keep a roof over their heads, avoid family breakdown and, in one case, start up a succesful business. Sure they may be on it for 3 or 4 years but that has to be seen against a background of 10, 15 or 20 years of drug misuse and anything has got to be better than that. Posted by skyesteve I'm encouraged by your experience, Steve. I think Mrs DC feels that the initiation of methadone is an 'easy' step, not backed up by all the extra things like finding a job, support, weaning off etc. I think the population (meaning all durg addicts) is very heterogenous - as my wife says, noone ever woke up one morning and decided to be a drug addict - so a single solution such as methadone is unlikely to fix the population. Mrs DC would argue that the main issue is the inequality in health service provision for these patients, mainly due to stigma, and poor education of those supposedly giving the care. I try hard to treat all people with equity, particularly those from deprived areas, and not prejudge those with addiciton problems; but it's a challenge.
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Re: Is methadone a bad way to treat heroin addicts?
posted at 14/8/2012 4:09 PM BST
on bmj.com
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Posts: 1181
First: 19/4/2010 Last: 23/5/2013 |
One thing is for certain, Methadone is a better solution that Krocodil, the home cooked drug in Russia. Here's a video to explain it's effects: BE WARNED - THIS IS NOT A VERY NICE VIDEO, CONTAINS FULL NUDITY (NOT SEXUAL) AND SOME VERY DISTURBING SCENES, INCLUDING MINOR SURGERY. I CONSIDER IT SAFE FOR WORK AS IT IS A MEDICAL CONDITION, BUT IT IS NOT FOR THE SQUEAMISH.
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