Methadone withdrawals...

I wake up, bleary eyed and dis-orientated, frustration bubbles through my veins as sleep has evaded me for what seems like the whole night. My legs feel like two logs after an eternity of unsolicited movement, twitching and kicking repeatedly and I smell like a chemical soaked rag. Anger erupts into a flurry of violence as I try to beat my addiction into submission, after punching myself on the temple, I'm seeing stars.

Eyes closed the water pounds away at my body; my mind meanwhile is frantically searching for peace. A peace that will only come with total exhaustion, and so not really peace but more like unconsciousness. I know searching is useless but I have little control of that part of me, instead I attempt to wash the stench from me - soap, rinse, soap, rinse, soap, rinse. I notice that I have goosebumps all over me still, the heat of the water has no effect on that symptom.

I lie back on the bed, my body, for the moment, feels rather numb. The heat helping to ease the cramps, but my mind still is a tightly wound spring. I start to drift into blackness, noticing as I do so the soap hasn't helped - I still smell like roadkill. All I want is to sleep - to simply not be, anymore.

Twice in my life I've had to stop using methadone without the luxury of reducing slowly. Compared to a heroin detox it isn't as violent but for me it was far, far longer lasting. Something else I noticed too was that even if I had a hit of smack I still didn't feel 100%, they may both be opiates but they affect me slightly differently. Only methadone would get rid of all the withdrawal symptoms. This told me that I wasn't a heroin addict, I wasn't even an opiate addict but rather a methadone addict. Other opiates might help a bit but not even dia-morphine would sort the withdrawals out completely - only methadone would do that now.

But far better than methadone for sorting out withdrawals, is time (and time, goes by, so slowly, and time, can do so much) but enough of the Righteous Bros! I wanted to write about this subject today as I believe it's important to remind ourselves of our past, the good, the bad and the ugly.

NTA's annual figures

I've been following with interest the debate that has followed since the release of the NTA's annual figures. Mark Easton, the BBC's home editor has reported on what he, like many others, sees as the farce that the NTA is trying to sell.

The NTA's figures concentrate on having 202,000 people in treatment last year but the people that left treatment drug-free was a bit lower - 7,324! I notice that they aren't shouting about that one! The NTA's focus is on getting people into treatment, that much is obvious, but for only a short time - 12 weeks. I say this because they have targets of 'retention in treatment' in which the box is ticked once people have lasted 12 weeks. But they don't have any targets for people leaving treatment drug-free! How can this be?

It seems to me that it's because the NTA aren't interested in getting people out the other side of treatment drug-free but rather more interested in getting people in for 12 weeks and job done! They don't care whether or not the service user achieves abstinence but rather that they are retained in treatment. The reason? So the public will think they're doing a good job and sleep safely in their beds tonight.

They do this by refusing point-blank to reduce the amount of methadone an individual will be receiving. It doesn't matter whether that person is stable, giving clear urine tests and meeting every demand they have. They will not reduce that methadone or send you to rehab, because they are scared to death that people will achieve a stable drug-free recovery and that will put them out of a job. The whole system stinks and people are starting to realise that, the charade is coming to an end. As the saying goes - you can't fool all the people all the time!

Millions upon millions are being wasted because the NTA won't admit they are wrong and change direction to focus on recovery and the things that will aid recovery, and not just keep on with their present tack of treatment for treatments sake, which, as their figures show, isn't actually helping many people to achieve drug-free lives. My fear is that when the public, as a whole, realise this there will be such a outrage at the wasted money that the drug and alcohol field's budget will be slashed and we'll be lucky to help many people at all.

The black or white approach to treatment

I read with interest the story highlighted on today's Daily Dose - 'Tackling substance abuse in families'. Bruce Thomson starts by saying-

"Debate regarding the most appropriate ways to help people to get off drugs has resulted in what often seem to be polarised positions in favour of either methadone prescribing or abstinence-based interventions."

This has long been the case in the substance misuse field - why it is so I'm not sure, as it is a pointless debate with both sides losing out. In my opinion the "extras" that usually come with abstinence based programs, i.e. counselling, fellowship groups, reflection/meditation groups, one to one/group therapy etc, are what make the difference. 

Why aren't all of these "extra" interventions offered with methadone maintenance or reduction prescribing? I don't see any reasons why they couldn't fit together, in fact, I've worked in a project myself that offered this kind of methadone prescribing service, which was then reduced leading to abstinence as the final goal - with good success rates I'd like to add. To my knowledge this project is the only one of it's kind. It could work just as well with methadone maintenance for those wanting that.

I'd like to see the whole range of interventions being offered to prospective clients with a kind of self-selection (with professional guidance) of the particular services they'd like to have in their recovery program, kind of like choosing what subjects to take for your GCSE's! This way service users aren't being forced into doing something that they don't need just to get the services that will help them. Of course for this to happen there would need to be co-operation between different services throughout treatment, all governed by a new kind of direct access free service, doing the initial assessment, referrals and overseeing/supporting the clients throughout the whole process including the aftercare.

That would be my 'perfect world' answer to substance misuse! No black or white but black AND white - I think I'd call it 'The zebra intervention'!

My experience of methadone reduction

When I went to my first appointment at the CAU (Community Addiction Unit) in Cardiff and asked for help in stopping using heroin and crack cocaine, I was told that they could give me methadone for the heroin addiction and there wasn't anything they could do for the crack habit. So I went on to methadone, starting at 20ml/day.

I told them that I was injecting a lot of heroin ( 1-2 grams/day), so would that amount of methadone be enough for me? I was then advised to 'top up with heroin' until the methadone had gone up to a high enough dose to hold me on it's own, and then to gradually reduce my heroin use. The problem was I couldn't control the amount of heroin I used, that depended solely on the amount of money I had, and nothing else! So I ended up on 120ml/day of methadone and I was still using the same amount, if not more, of heroin. I'd gone in with 2 addictions and come out with 3, in a right daze - basically I was up the creek without a paddle!

When push came to shove and I ended up in hospital, with an unconnected injury, for 8 months, I decided to look into rehab options. I met with my CAU key worker, explained that I wanted to get off the methadone as I wasn't using heroin anymore, and go to a rehab, I was told in no uncertain terms that she thought I wasn't ready for rehab and the local authority wouldn't be funding it.

As it happens that was probably for the best as I found a rehab myself, funded by housing benefit in Cardiff, that had a place for me. So I left hospital and went straight into LivingStones Rehab. I wanted to discuss reducing my methadone, so at this point I went to see my key worker again, really chuffed to be able to give my first negative urine sample(negative for heroin), She said that's great but I'd like to increase your methadone dose, just in case. I couldn't believe it, why raise it? I'd stopped taking heroin, was in a stable environment, with support and they wanted to raise my dose? After a lengthy discussion, she agreed to not increasing it but would have none of it when it came to talk of reducing it.

So I decided to write my own reduction plan, as I was on weekly pickup it was possible for me to measure it myself and discard the remainder. I decided on 10% drops every week, until I was completely off it. I let my key worker know my plan, accepted the flack she gave me and got on with it.

Every time I went in for an appointment after that I ended up being chastised for reducing myself,it was going smoothly but she still wouldn't agree to reducing as I wanted and would only drop it to the level I was on that day, so by the next week I was having to measure it and throw away the excess again. No matter what I said or how I explained it, the CAU would not reduce it for me, worse than that they put every barrier possible in front of me. This went on for months, in fact it wasn't until I was on 8ml/day that they realised I was serious about coming off methadone for good and actually started to reduce it for me when I asked.

At a time when I was taking huge steps forward the CAU were trying to drag me back at every opportunity, that was how it felt to me. I'd go as far to say they made it a lot harder than it could of been, it was only because I was so certain that I was making the right decision did I continue it alone. I didn't want to have to argue my point and defend my position at every appointment, I wanted supporting in what I was doing. It was my decision to reduce and it was a decision I didn't make lightly. But I was forced to fight a pitched battle all the way through my reduction.

It took me just over 5 months to get off 120ml/day of methadone, the sweating went on a lot longer but has also improved vastly! But there is one thing I'd like to know - Why was there so much opposition from the CAU to me coming off methadone? I have my own ideas about that but if there's anyone else out there who can help me understand this, then please let me know!

I'd like to add that I know the way the CAU acted was obviously in accordance with the directives passed down to them, and weren't local decisions. So the real question is - Why is it this way?

Keep taking the medicine???

I've just read The Guardian article highlighted on Daily Dose, in which the head of the National Treatment Agency, Paul Hayes, dismisses 'ideologues' who claim his organisation's addiction programmes aren't working. Well I for one agree with him, his organisation's addiction programmes most definitely are working, They've managed to give everyone who walked in to a treatment centre and asked for help to stop using drugs another addiction, methadone. The reasons? It's cheap, it keeps the people on it subdued and they hope it'll lower the crime rate.

Paul also says that the evidence for maintenance prescribing is clear and robust, "There are 130% more people in treatment than when we started [in 2001], rather than half the people dropping out because treatment isn't of good quality."

Clear and robust??? If you were drugged up to the eye balls on 100, 150 or 250ml of methadone a day, would you be able to drop out of treatment? What about your methadone addiction? It is only the methadone that locks people in treatment, most never escape the trap.

Why are the NTA giving this message? The message should be - 

"IT IS POSSIBLE TO OVERCOME ADDICTION AND LIVE A PRODUCTIVE, JOY FULL LIFE!!"

Recovery is where it is, not treatment for treatment's sake. The power of community, that's how we're going to sort out the shit-pit, this country's become. The Recovery Movement is gathering pace.

It's time to dust your boots off and get stuck in, before it's too late.

Methadone time limit??

One of Scotland's leading authorities on drug treatment, released a statement yesterday calling for a time limit on substitute methadone prescribing for heroin addicts. Neil McKeganey, Professor of Drugs Misuse Research at Glasgow University, said that methadone treatment should only be available for a short time, suggesting that 2 years is long enough for anyone to overcome their addiction problems before becoming drug free.

He said: "There is no question that methadone has a role to play in assisting addicts to become drug-free but we have far too many addicts on it for far too long, many of whom are continuing to use illegal drugs alongside their methadone," he said.

"I am not saying we should not have methadone but what I am saying is people should be on it for a modest period of time and moved on to a drug-free programme. If it's not time limited, they remain on it for far too long and I do not think we should have addicts on methadone for more than two years."

In my opinion, it is a vast generalisation to say that everyone with an addiction problem should be drug free within 2 years. It should be treated on a case by case basis, some may need methadone or another kind of substitute treatment (yes there is more than one kind) for a lot longer than the next man/women.

In my personal experience of treatment and recovery, I eventually realised that it was essential I be in control of my treatment, in both increasing and decreasing the dosage and also the time scale, (I'll be talking more about this in the near future). I was certainly a lot more successful in my recovery when I was given responsibility in making my own decisions, with medical guidance of course, than when it was forced upon me.

In a previous posting, I've talked about how I've experienced methadone being used in the wrong way, but implementing a blanket ruling such as a time limit is totally the wrong way of addressing this problem. There isn't a quick fix (no pun intended!) for solving the issue of addiction and recovery in our society. It's going to take a whole new treatment/recovery ethos, with 'client led' at the top of the list.

The Wired In 'Way Forward'

Wired In's strategy was launched today on Daily Dose and I for one think it's bang on! Drug and alcohol services out there should be offering a service based on 'recovery' not simply treatment for treatment's sake.

In an earlier blog I spoke of my experiences of community based drug services in my local area, and how once I was on Methadone my key worker thought her job was done, she couldn't even remember my name without looking on her folder. For people to succeed in obtaining lasting recovery, they need a strong relationship with their worker/s which is led by the client themselves. Without this it becomes very hard to make any meaningful, lasting changes to their lives. 

I'd like to stress I'm not saying all the doctors, CPN's or key-workers I've ever been with, have been of no help to me, because that simply wouldn't be true, my current GP is excellent and I know there are many other excellent workers out there.But, we need more of them and if your in a 'caring job' and aren't enjoying it or you've lost your enthusiasm, then get out, do something else, something that will fulfill you.

The current 'containment' strategy in operation, at prescribing services up and down the country isn't working. Yes substitute prescribing has it's place, but it's not the magical answer to everything.