From: (Ian Wardle) Subject: Re: Heroin Addiction Date: 1995/10/13 newsgroups: alt.drugs,alt.drugs.hard METHADONE: FRIEND OR FOE? There have been many changes in the worlds of drug users and drugs agencies over the last sixteen years. Before 1979, people who injected seriously addictive drugs like heroin were a tiny minority. They posed no serious social problems to society at large. Unless you had a heroin addict in your immediate family or friendship networks then heroin addiction was of no concern to you. Then in 1979 and the early 1980`s British cities and towns were suddenly awash with cheap brown heroin. Drug services were swamped by working class heroin users who, in the eyes of many of the carers, were seen as streetÐwise and potentially dangerous. They were completely unlike the rather quaint old school of, largely middleÐclass, heroin addicts. In short, these new heroin users were perceived as a threat. The new heroin users were attracted to Ð and got stuck in Ð heroin use for several reasons. The drug was available at a price they could afford. It could be used in a more culturally acceptable form. That is it could be smoked. As their habits developed many of the new heroin smokers began to inject for reasons of cost. Many also became 'addicted' to the active 'taking care of Business' lifestyle. It takes an awful lot of ingenuity to get the money together every day for a `brown` (heroin) habit. This lifestyle slotted so perfectly into the vacuum created by mass unemployment that the new heroin users soon found 'getting off' much easier than 'staying off'. Without something to fill the unemployment vacuum heroin habits come back again and again and again. Each habit needs feeding. As each habit deepens the doors of the prisons begin to creek open. As the addict takes more and more risks to get the money to get the gear prison comes closer and closer. Before the ready availability of methadone became the standard form of `treatment` for heroin addiction, spells in prison were the only interruptions to these risky and busy drug centred lifestyles. Then HIV and AIDS appeared and "flexible prescribing" was adopted as a way of making, maintaining and maximising contact with heroin addicts. Access to the heroin substitute methadone is now well established in many areas. Methadone gives many people with heroin habits options. These options are held dear by many who regard methadone as something that keeps them out of prison and out of debt. Methadone is also a very attractive option for those responsible for caring for heroin addicts. Dishing out methadone to heroin addicts is not a very difficult job. It`s just like working in an off licence or a bar dishing out cheap lager to alcoholics. In fact, it's probably easier than that and it certainly pays a whole lot better than working behind a bar. A few drugs workers get paid nearly £30,000 per year for dishing out methadone. Working behind a bar for 40 hours a week will get you no more than £6,000 per year. So, being involved in the methadone business is a profitable place to be at the twilight of the 20th Century. Of all the different kinds of substance abusers to work with heroin addicts are a dream. People with experience of working with a wide variety of substance abusers will almost always agree that they would prefer to work with heroin addicts. Provided the services are in a position to dish out the methadone then most heroin addicts will be, or will at least pretend to be, ever so grateful. One long term heroin injector, who also uses crack cocaine, commented on how ridiculous it is that he has to pretend to be grateful for his daily ration of 50mg of methadone linctus that he only uses when he can`t get hold of any heroin and/or crack cocaine to inject. What he really wants is injectable heroin but he doesn`t dare to ask in case he might appear ungrateful for the linctus: "You know how it is, they think they are helping me, and they are in a way, and they`re nice people I don`t want to come across like a greedy, ungrateful bastard...but it`s crazy really". However, we know of one long term methadone user who has built a successful career in drugs research who swears by methadone. For him, methadone is a drug that gives `stability`. This stability has been essential in combining a long term opiate addiction with a professional career. There is a growing and worrying trend in the contemporary British `hard` drugs scene. In the USA they have long recognised a phenomenon that, was summed up in a 1960`s academic paper as: `Methadone, Wine and Welfare`. This refers to the situation where large numbers of people are socially dependent on handouts from the state (`welfare` or social security payments) and physically and psychologically dependent on both opiates (methadone) and alcohol to get through every miserable day. This is starting to happen in Britain. Combinations of depressant drugs such as methadone, benzodiazepines (e.g. temazepam and diazepam) and alcohol are being used by an increasing number of people just to get through each day and each night. This is especially true of people who are homeless and trying to survive on the streets or in abysmal temporary accommodation. But! There are other people who use heroin who think that methadone is the pits. These people regard methadone as poison that is peddled by the state to keep heroin users away from their real drug of choice heroin (`Diamorphine Hydrochloride`). In the `antiÐmethadone` camp are heroin users who see the widespread distribution of methadone as a clear piece of social control. These people argue that the stateÐsponsored methadone peddlers do not give a damn about the welfare of individual heroin users. The `antiÐmethadone lobby argue that the stateÐsponsored methadone peddlers are concerned about two things only: 1. That heroin injectors do not infect their sons and daughters with HIV. 2. That heroin injectors keep their grubby hands off their videos and their car cassettes. The `antiÐmethadone` lobby then splits into two camps. The first camp (which contains a lot of current heroin users) would like to see heroin users being given their drug of choice Ð Diamorphine Hydrochloride. One vocal member of this camp claims that the state and its doctors are responsible for poisoning and killing more heroin users with methadone than all the illegal brown street heroin dealers put together. These people claim that methadone is both more addictive and more `toxic` (or poisonous) than real heroin. The second camp (which contains a lot of exÐheroin users) would like to see heroin users and addicts being given all the support they need to get off and stay off heroin. These people have a highly moral attitude to drugs. They are very `anti` drug. These people see drugs like heroin as a manifesation of modern evil and have been instrumental in stopping the availability of methadone in some British cities. So, both the `proÐmethadone` lobby and the `antiÐmethadone` contain a motley collection of unlikely bedfellows. For the heroin user the choice is now there. Do you want methadone or don`t you? Mark Gilman for LIfeline Manchester. u.k. e-mail-drughelp@lifeline.demon.co.uk ==================================================================== From: a@b.c (Bayer Baby) Subject: Re: Heroin Addiction Date: 1995/10/18 newsgroups: alt.drugs,alt.drugs.hard In article <30838766.3B1D@support.nl>, Babalon wrote: >Ian Wardle wrote: > >> METHADONE: FRIEND OR FOE? > In this post you have enumerated a number of the reasons why people are so confused about methadone and why it's developed such a bad reputation, Scumbag providers take note: Methadone maintenance is _not_ intended to be a protracted detox. It's supposed to last as long as the patient wants. If the patients wants to stay on for the rest of their life, fine...if they want to try and detox after a couple of months, fine (though they should be warned of the odds of success..). The methadone maintenance dose is supposed to be adequate for the patient's needs. People are most successful (as measured by physical health, absence of other drug use, personal satisfaction, etc) on doses of _at least_ 60mg/day, generally between 80-120 milligrams per day. If the patient wants less methadone, they should receive less (most classic MMT programs will not allow lower doses if the patient is using illicit opioids as well...this "low threshold" option should be considered for patients who want/need it...but NO classic MMTP would kick a patient out of treatment for continued use of ANY drug). Patients with normal metabolisms who are on stable doses (whether 10mg/day or 1000mg/day) _do not_ feel any "high" from the methadone and are indistinguishable from non-methadone users (as measured by reaction times, psych tests, appearance, etc). There are numerous well-known public figures maintained on methadone. You'd never know it... Methadone maintenance _is not_ supposed to be used as a method of social or behavioral control. The patient should receive their medication no matter what other choices they make in their lives. (again, classic programs may deny continued treatment to those who persist in actions which are medically contraindicated by their methadone treatment, but classic MMTPs will go no farther in using methadone as leverage to control their patients' behavior) Finally, the last complaint you make, the two year waiting list, is obviously not a problem with MMT but with LACK of MMT. This is of course an outrage. The medication costs pennies, the ancilliary "services" and "counseling" might be good options to offer, but they are not necessary for the dramatic benefits provided by the medical treatment that is MMT. In short, all the problems and complaints you've mentioned (which mirror the usual complaints made "about" MMT) are problems with PERVERTED MMT, not classic MMT as developed by Drs. Dole and Nyswander in 1964. Admittedly, classic MMT is practiced in fewer and fewer programs each year, and even these programs fall short for many reasons, both imposed by regulation and brought about from within. We fiends MUST learn enough of the facts to make a distinction between the progressive, humane, and SUCCESSFUL treatment modality known as methadone maintenance treatment, and the perverted varieties masquerading as same...perversions which have brought about the terrible image of MMT held by so many of our brothers and sisters (not to mention the public and press, who would likely not understand even if it were practiced as it once was...). If MMT was offered as it's supposed to be, would it be for every fiend? No. If it were expanded to included a variety of flexible uses of methadone like low threshold programs would it be for every fiend? No. There are clearly many who would for some period or always disdain long acting oral opioids, even as a supplement to their heroin or whatever. But our lives and society's experience of us would be DRAMATICALLY improved. This is beyond questioning by anyone who knows the facts. I can only hope that some of those who read this will take the time to do the research and come to see through some of the myths and misunderstandings which surround MMT, even if you choose never to let the juice pass your lips. And for those who are simply turned off by the tone I often take in these posts, I hope that you will understand that those of us who owe our lives and well being to opioid maintenance in general and methadone maintenance in particular, are surrounded by a sea of misunderstanding and misplaced anger, (and suffering, which could be so easily relieved had our medication not been so perverted, repressed and misunderstood) which threatens continually to drown us or at very least drive us mad with the fallacious basis of it all. It becomes a full time job just attempting to partially stem the tide... enough