Methadone: cure or curse? Special investigation

“I knew I was a junkie when I started on methadone” – With over 22,000 people in Scotland prescribed the drug in the battle against heroin addiction, is it working? Matt Coyle investigates.

IT is first thing on a cold Monday morning outside a chemist in Glasgow’s East End. Fidgety, gaunt looking figures are waiting for one thing – their methadone fix. As in pharmacies across the city, and country, the little bottles of luminous green liquid will be handed out to tide addicts over for another day and stave off destructive cravings for heroin.

This strange, sad ritual seems like blessed relief for many heroin addicts across the country. The chaos of life on the lethal Class A drug is written across the faces of those limping through the door on heavy legs; heard all too often in the tragic stories of looming prison sentences and death riddled through the family tree – overdosing parents, brothers, sisters and cousins.

Among the thousands of gaunt, despairing addicts standing outside Glasgow chemists on a daily basis is the son of Jim Doherty.

The 63-year-old has four sons, two of whom are chronic drug addicts and have been on the methadone programme for the past four years. Between them, the ”methadone success stories” - as their father ironically refers to them - they have racked up more than 100 convictions and when they are not in prison, they still use heroin.

”You see isolated incidents of people doing well on methadone but they are very few and far between. The main problem is that it is dispensed and then they are simply flung out with no help or monitoring, and with nobody asking what’s happening to them,” Jim says solemnly.

“The final straw came after my son told his GP he was going on a week’s holiday with me and his mother. He was prescribed a week’s supply of methadone which he swallowed in one dose, before mugging an elderly friend of the family. It was a highly embarrassing and completely shameful incident,” he says.

“Me and my younger two sons went out to look for him and I honestly would’ve murdered him if the police hadn’t got to him first.

”When you discover your kids are addicts, you start off trying to save them, end up wanting to murder them, and in between you wish you were dead.”

Figures drop

There are around 15,000 heroin addicts in Glasgow with 4,000 of those being prescribed methadone. But the number of addicts on the methadone programme in Glasgow is down significantly, by 40% over the last five years, figures reveal.

The statistics, obtained exclusively by the Cardonald Courier through a Freedom of Information request, show that in 2007 there were just over 5,300 addicts being prescribed methadone by their GPs in Glasgow. That number has fallen significantly since then to 3,800 in the last year.

Andrew Johnson, of the Drug and Alcohol Misuse Research centre at the University of the West of Scotland, said the decrease may be attributed to a growing stigma among heroin addicts towards the methadone programme.

“The number of addicts, although still extremely high, actually wanting to get on the programme is decreasing and, as part of my personal research through speaking to addicts, is rather surprisingly because of a change in the attitude of addicts towards methadone,” he explained.

“There is a sort of stigma starting to develop among addicts with regards to the methadone programme, the reasons I am not yet completely sure of but many of those I spoke to, and this quote stood out to me, said: ‘I knew I was a junkie when I started on methadone’.”

Methadone is said to provide a more stable substitute to heroin, but withdrawing from methadone, however, is not much easier. In fact, unless addicts have a long-term, carefully planned and monitored detox, the effects of giving up are likely to be even more severe. Astonishingly, just three percent of all addicts on the methadone programme in Scotland become drug after three years on the heroin substitute.

Substitute?

Ingrid Curran, an addiction worker whose son, James, died from a methadone overdose in 1994 at the age of 23, shares Jim’s views on methadone. She has formed a help group in Johnstone and asserts that the heroin substitute has destroyed more people than it has helped in the past 17 years.

”As far as I’m concerned it is like saying to somebody who’s drinking a bottle of whisky a day that it’s ok to drink a bottle of gin instead,” she says frustratedly.

However despite the two parents’ scathing criticisms of methadone and the way it is administered in Scotland today, many of those hooked on smack see the green liquid as their only way off the destructive path heroin has taken them down.

Bobby-Joe Brown, now 41, admits to throwing away much of his life to hard drugs. A drug overdose killed his dad. His only “clean” period since his teenage years came during a jail term. Drugs are his life. And could well be his death. But he is determined to use methadone treatment to get completely clean. However this has turned out to be a prolonged and painful struggle and Bobby-Joe has found himself in a state of despair on many occasions.

“When I went to see about methadone, I was told there was a waiting list,” he said. “I said, ‘How long?’ The woman said, ‘How long is a piece of string?’ “I’ve been in a desperate state and I think methadone is the only thing that’s going to stabilize me.”

Others across Scotland have been told they face a painful wait of up to six months.

“I broke down in tears in the clinic. I think they felt sorry for me. Getting on it has given me just that wee bit of hope. I know I need to use methadone to start getting away from drugs. I know it’s not something you want to be on for years,” he said.

He has been spending £80 to £100 a week on heroin, but like many addicts, he is not a complete stranger to methadone. There is a prominent street trade in the substance, with heroin users often dabbling in the substance to “top-up” after injecting themselves with their hit of smack. A daily dose of 100ml goes for around £10 on the street corner.

Money, however, is not often the main motivator of those involved in the methadone black-market. Dealers are users; users are dealers.

“One lassie said she could, if I wanted, hold some in her mouth for me until she came out the clinic and then spit it into mine. That goes on too I’m afraid,” Bobby-Joe continues.

For critics, this is one of the plainest examples highlighting the side-effects of Scotland’s dependence on methadone as its core means of coping with the plight of heroin.

Patchy provision in Glasgow and elsewhere in the country may mean frustratingly long waiting lists, as the number coming forward for the methadone programme continue. But some believe this level of demand only indicates the dreadful triumph of the opiate.

Doubt

Best estimates suggest Scotland has around 55,000 – 60,000 heroin addicts with around 22,000 of those are on methadone at any one time. Professor Neil McKeganey, one of the country’s leading drug experts and one of the UK’s leading researchers on methadone, is shocked that a treatment “of uncertain benefit” is the default prescription of health professionals.

“Virtually everyone getting treatment is being prescribed methadone. Whether the Scottish Government likes to admit it or not, we do have a one-size-fits-all treatment, which is our national methadone programme. The notion that we have individualised packages of care to meet individualised circumstances is a complete and utter myth. The Scottish Government has overseen a situation where more than 22,000 people are prescribed methadone, but they have no clear strategy as to how to get them off it,” he says.

Prof McKeganey’s research questions the validity of claims that methadone provides a much more stable, crime-free existence as it provides a regular, free hit for addicts, removing the need for criminal activity such as theft and house-breaking. But more than half of methadone users he surveyed continue to dabble, and in the process destroy themselves, by using it alongside street drugs. He also estimated the rate of Scots becoming drug-free after three years on methadone to be desperately low – around three per cent.

“It remains a complete mystery as to just how long people are on it,” he says.

“The majority of people are combining it with other illegal drugs and are placing themselves at very high risk of overdose. It does not appear to be having the major crime reduction its proponents claimed it would have. It’s easy to say it stabilizes lives, but where’s the evidence?”