People on long-term methadone maintenance treatment feel trapped, stigmatised and have “exceptionally low” levels of social reintegration, even a decade after coming off heroin, a landmark study published on Monday finds.
It says recovering heroin addicts need more than to be “managed” by addiction services and the wider health service also has responsibilities to them in assisting their recovery.
Just Maintaining the Status Quo?, published by Dún Laoghaire-Rathdown Drug and Alcohol Taskforce, finds that initially methadone treatment brings stability to heroin users' lives. One participant said it had "saved" his life.
Methadone, also known as Physeptone, is a synthetic liquid opiate prescribed to heroin addicts to help them stop using. It can be dispensed by a pharmacist, GP or at a clinic. In theory the dosage can be reduced over time, enabling the addict to get “clean”. In practice, however, many remain on methadone for many years.
Twenty-five people, with an average age of 43, were interviewed for the study. All were in the Dún Laoghaire/Rathdown area and had been on methadone for at least 10 years. The average age they had started taking illegal drugs at was 14, while the average age they began using heroin was 19.
“Ambivalence was a core, cross-cutting theme ... While treatment benefits were reported, a complex constellation of negative experiences were recounted,” the report reads.
Many said the hold that methadone had on them mirrored heroin addiction.
“Respondents routinely used terms such as ‘lifer’, ‘hostage’ or ‘liquid handcuffs’ to convey the routine.”
No control
Many felt they had no say over their treatment and reported feeling that all they were being offered was methadone, with little or no focus on their mental health, education, housing or employment.
For many, methadone maintenance “was perceived as thwarting ... recovery goals, not simply because of the ‘bind’ ... but also because treatment was focused primarily on the administration of [methadone] and not on their broader health and social care needs”.
The report said stigma often hindered participants’ sense that they could get work.
A woman in her 40s, said: “You feel you can’t get a job. Like what if your job starts at 9 o’clock and you haven’t got your Phy in you ... What if they ask for a medical? ...Who wants to employ someone who is on methadone?”
Relatively few reported they had “good” friends with whom they interacted regularly.
“Participants’ social circles tended to be extremely limited and most had few, if any, dependable or trusted people in their lives.”
Almost all reported serious chronic and acute illnesses, including liver cirrhosis, thyroid disease, respiratory, renal and coronary diseases and all but one reported mental health issues. Almost half (12) had no contact with any service beyond the maintenance programme. Seven of the nine women had no additional support services.
