nta on methadone

[saramcgrail]

Paul Hayes’ views on the role of methadone in drug rehabilitation
06 November 2008

(This article appears in Community Care Magazine 06/11/08)

When I first started working with drug users thirty years ago, abstinence was the only treatment in town. The only options were rehab or methadone on a brief, reducing, script. Most of the users I knew quickly dropped out, or were kicked out, either for misbehaving in rehab or using in the clinic. In addition, levels of relapse after completion were high; so many individuals voted with their feet - choosing not to enter the system at all.

Following the advent of cheap, smoke-able heroin in the 1980s, drug misuse escalated drastically, plunging the abstinence-based system into crisis. The Advisory Council on the Misuse of Drugs persuaded the then Conservative government to focus on harm reduction in order to encourage treatment take-up and retention. This succeeded in holding down levels of HIV infection, and Labour built on it through significant additional investment with the explicit aim of using the treatment system to reduce crime. Hence what we have today – more than 200,000 in treatment, low waiting times, high levels of retention, increasing numbers completing, improvements in health, and reductions in crime.

Compared to 1978 - or even 2001 – the modern treatment system is very successful, and we should all be proud of it. However, it remains a job only half-done.

As critics of current policy point out, most drug users enter treatment wanting to leave as quickly as it is safe to do so. Too often the system is not ambitious enough on their behalf. The NTA is now addressing this under the new Drug Strategy.

As I see it, the problem with methadone (the standard treatment for opiate addiction) is not that it doesn’t work, but that it works too well. Stability, improved health and reduced crime are necessary steps on the road to recovery and a drug-free life, but not the destination.
 
We need to balance the risk of relapse if people attempt abstinence, against the risk of inappropriately thwarting their ambition to become drug-free. The NTA believes in a balanced treatment system, in which a range of options are available from which users benefit at different points in their lives.

That means methadone is appropriate to start the process of getting heroin users off drugs. We make no apologies for that: NICE recommends it. It also means psychosocial interventions, so-called talking therapies, are on the menu, together with detoxification, offered in the community as much as in a residential setting. An increasing variety of other non-medical help and support is there too. And abstinence-focussed treatment is suitable for some, when they are ready to take advantage of it, and clinicians judge it will work.

Our aim is to get drug users into treatment in order that they come off drugs. Some people are in treatment for a long time before they get to that point, but that must not make us complacent. To help users go beyond the stability that the script can establish, and embark on meaningful change, is difficult, demanding, skilled work. Not all drug systems are commissioned to deliver it, and not all practitioners can. Nevertheless, our challenge is to address the ambitions of clients in the future.

[will-c]

Sometimes I think the world is still viewed as being square when it comes to drug treatment and final destinations.

A few things jumped out at me when I read the above statement by Mr Hayes; firstly why is it when talking about Methadone we get the word problem thrown in, when looking for problems with methadone I always find what comes next is a moral opinion rather than a statistical stand point. What would be so wrong with him saying according to the vast amount of research we have undertook we have yet found no clear problems with long term methadone use as all major complications are, results of under prescribing or innappropraite prescribing regimes. What the statement stinks of is a clear stand point allowing for him to duck out of any criticism from the right wingers while trying to appease the lefties. I say that but in reality I have never been that clever about what a leftie and rightie is. Something to do with the Daily Mail versus the Guardian.

Short term treatment makes me wonder why the bench mark for treatment is set at 12 weeks.

The risk of relapse is always going to be there, for those people like myself who prefer not to be on a daily prescription, its the reality of trying to give something or someone up; we still kind of love despite the/ir over bearing demands on us.

Why does the ulitmate destination always have to be getting people into treatment to get them off drugs, I dont think people are being failed when it is clearly recognised for this person or group of people life long prescribing would best meet their personality and needs. I personally feel the system if over burdened with people more suited to be prescribed soley by their GP with or without the added support or interference by community drug services, leaving drug treatment to those people who desire and want psycho social interventions.

[purplehearts]

i think there are going to be moves back towards abstinence based treatment in the future especially if we have a tory government. theres been loads of quotes from government ministers lately about how methadone prescribing is 'out of control'.
in cardiff one of the main prescribing agencies, dip, has changed from prescribing maintenence scripts to now they just do 12 week detoxes on methadone linctus (the brown stuff). so that means people who go through the criminal justice system will be put into 'treatment' only to end up on their own with no script after 12 weeks. also id like to point out the highest rate of fatal overdose is among people coming off a methadone script so i think they should tread very carefully before pulling people off scripts. in my town, people whove beent hrough probation (DTO) when theyve come to the end of their order they go straight to DIP and get pulled off the methadone on a 12 week detox. so they manage to achieve stability and then just have it pulled away from them. makes me angry!

[will-c]

Its rediculous, so many lifes wasted for the price of a sound bite.

They can try going down the abstinance route its a bit like the recession actually as, many will say its already here...

targets targets targets....

[purplehearts]

thats right yes these often thoughtless populist 'soundbites' have the potential to destroy lives. apparently, when the cameras are off, most MPs and senior police actually believe in decriminilisation of all drugs, but when the cameras are on, they say the complete opposite. its like a competition to see who can be harshest on drug users.
i completely argee as well, that gettting people into treatment with the aim of getting them off drugs altogether isnt suitable for everyone, and is often setting people up to fail.  only you know when and if you are ready to come off drugs altogether, and being forced into treatment will inevitably have a negative outcome if you arent ready.
i saw it all the time when i was working in homeless services. the aim was always to get users off drugs. i worked in a night shelter which was for people sleeping rough and with multiple support needs and heavy long term drug and alcohol problems. the night shelter was just open in the nights to provide people with a hot meal and a roof over the heads. people who refused to go into hostels were often happy to stay here because there was no pressure, no allocated support worker, and using drugs was tolerated. however, the maximum length of stay here was 6 weeks. after this,
people were moved into 'dry houses' and second stage rehabs. people didnt want this and wernt ready for it! inevitably, they would carry on using and it was just a matter of time before they got evicted an ended up back on the streets again.  why cant we give practical help to street homeless which isnt conditional on them completely chaning their lives?
and why is being on methadone long-term seen as being a failure??
ive been on methadone for years, but i believe i am a suc ess story. i used to be a heavy intravenous chaotic drug user, doing all sorts to fund my habit, ive also had a history of mental health problems,  now i am a responsible parent of two, i dont use anything at all  other than my script and i now have a settled, organised life with my family and am completely healthy and happy. everytime i have tried reducing the cravinngs come back, its like fighting a losing battle, and i know if i was to come off methadone, relapsing would be just a matter of time. so what is so wrong with me staying on methadone?
sorry for the rant but i feel strongly about this!