Methadone users ‘actively discouraged’ from becoming drug-free

Methadone users who wish to become drug free are being discouraged by doctors, who are often more interested in increasing patients’ doses, a new study claims.

Those prescribed methadone to help them stay off heroin describe themselves as “lifers” bound in “liquid handcuffs” which prevents them from becoming drug-free.

According to the study, which was carried out by Trinity College academics and published in the International Journal of Drug Policy, users view methadone as a "ball and chain" and doctors rarely assist in helping patients come off the drug.

"Those who aspired to reducing their daily methadone dose or becoming drug free reported not merely that they were not assisted in striving towards these goals, but that clinicians did not permit them to discuss such an aspiration," authors Paula Mayock and Shane Butler wrote.

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The authors conducted in-depth interviews with 25 long-term recipients of Methadone Maintenance Therapy (MMT), 16 of whom had been on methadone for more than 20 years.

Indefinite MMT, along with needle exchanges and other harm reduction initiatives, was introduced in Ireland in the late 1980s to combat the heroin epidemic which had taken hold in urban areas.

There are about 10,000 people on MMT in Ireland, including a large portion who have been taking the drug for many years.

Although recent drug policy documents use language such as “pathways” and “progression” to a drug-free lifestyle, many MMT recipients who took part in the study felt methadone left them “trapped in a cycle that did not lead to progress or change”.

‘Held hostage’

The majority of participants felt MMT had a positive impact on their lives in at least one respect, including increased stability, the opportunity to rebuild family relationships and less contact with the criminal justice system as they did not have to steal to feed their addiction.

But this was almost always juxtaposed with the feeling that MMT prevented users from moving forward.

One of the participants, identified as Dillon, said MMT stalled but did not fix the problem.

“It’s only just keeping it at a certain stage, it’s not getting any better, you know what I mean. I just feel like [methadone] is holding everyone.”

A woman identified as Yvonne said methadone represents “a ball and chain. Liquid handcuffs we like to call it. To me it represents stagnant, no change”.

“Bernie” described being “held hostage by this green substance” which made her feel like the Tin Man from the Wizard of Oz. “Like the Tin Man has to take his oil before he starts his day.”

Dose reduction

Most participants entered MMT in the belief they would eventually come off the drug. However, they learned this aspiration was “strongly discouraged”.

“Not once have I heard a doctor encourage me to come off methadone. Even when I was wanting to come off I was actually told that I couldn’t,” said Dillon.

Some participants described asking for a reduction in their daily dose, however requests were refused without a discussion of pros and cons, the authors said.

“Indeed, a large number of participants were critical of what they described as regular offers on the part of their prescribing physicians to have their daily dose increased but with no mention or discussion of a dose reduction.”

The authors concluded a new, more realistic policy is “urgently needed” to help MMT users towards an improved quality of life.