From: (Ian Wardle) Subject: methadone,class and "Methateenies" Date: 1995/10/17 newsgroups: alt.drugs.hard The clear social contract that is happening in the U.K. between working class (read; unemployed) heroin users and methadone programme providers is as follows: "Look we know you're up to no good...no way can you afford your heroin habit on social security payments...so here's what we'll do - we'll give you as much methadone as you can swallow - in return all we ask is that you leave our houses, cars and shops alone - is it a deal?" For most chaotic amd impoverished opiate users of course it is a deal. High dose methadone maintenance is a real option for those who are not ready to stop using but have realised that they are on a fast track to prison if they carry on "grafting" (being criminally active) for street drugs. Who can argue against more options (like high dose methadone maintenance) for drug users? At Lifeline we have no problems in giving support to policy plans for more methadone whilst at the same time warning drug users about the reality of a life shackled to the ball and chain of methadone maintenance. After all, its all about choice though isn't it? Since the late 1970'S we have seen the 'normalisation' of three key social phenomena: unemployment; criminality and drug use. As unemployment has risen and become endemic so have spiralling crime rates and drug problems. In 1994 unemployment in the U.K. is endemic, crime rates continue to soar and people with serious drug problems are responsible for large amounts of the acquisitive crimes that afflict the people of the U.K. In the 1990's drug problems have moved beyond the relatively narrow spheres of health and 'social work' with individual drug users. Particular kinds of drug use are now a major driving force behind the increase in acquisitive crimes. Responding to the heroin problem in the U.K. now requires joint efforts between the local government, the Police and the health and welfare authorities. These responses need to be informed by a rigorous critical analysis of the nature of the heroin problem. The major task that faces cities like Manchester U.K. in the coming years is how to manage that significant minority of problem drug users who live their lives against the backdrop of unemployment and all the other features of multiple deprivation. We are already seeing significant numbers of people who are using both licit and illicit supplies of opiates (methadone/heroin) in conjunction with alcohol and, increasingly, crack cocaine. This cocktail of the dispossessed poses some serious problems of management for the city of Manchester. By prescribing drugs like methadone the city may be able to retain a degree of control over some people's drug using habits. Left 'unmanaged' these people will be solely reliant upon illicit supplies. This reliance will then require them to obtain large amounts of income from acquisitive crimes. Private residents and businesses in the city will be the victims of these crimes and the quality of life in cities like Manchester will suffer accordingly. BUT! What about the young (e.g. 14 to 21 year olds) working class, heroin users that are starting to trickle in asking for methadone? What do we do with these "Methateenies"? It sure feels wrong to be consigning them to long term methadone programmes. ==================================================================== From: a@b.c (Bayer Baby) Subject: Re: methadone,class and "Methateenies" Date: 1995/10/18 newsgroups: alt.drugs.hard In article , drughelp@lifeline.demon.co.uk (Ian Wardle) wrote: >The clear social contract that is happening in the U.K. between working >class (read; unemployed) heroin users and methadone programme providers is >as follows: > >"Look we know you're up to no good...no way can you afford your heroin >habit on social security payments...so here's what we'll do - we'll give >you as much methadone as you can swallow - in return all we ask is that you >leave our houses, cars and shops alone - is it a deal?" > >For most chaotic amd impoverished opiate users of course it is a deal. > >High dose methadone maintenance is a real option for those who are not >ready to stop using but have realised that they are on a fast track to >prison if they carry on "grafting" (being criminally active) for street >drugs. > You are addressing much broader issues than simple opioid dependence. Are these important issues that need addressing? Absolutely. Are they issues which factor in the policies of drug "treatment" providers, ie methadone programs, and in the policies of the governments and regulatory agencies which oversee them? Absolutely? Are these socio-economic issues factors in the development of opioid (and/or other drug) dependence for many individuals? Absolutely. Do I personally believe that these issues should be addressed by certain agencies involved in 'drug treatment' for _some_ patients? Absolutely. All this having been said, there are a few basics that should be understood about methadone maintenance treatment: Classic, "Dole-Nyswander" methadone maintenance treatment was designed for a very specific population: persons who had been physically dependent on opioids for a prolonged period of time, who had attempted and failed repeatedly to break this dependence. The impetus for classic MMT was the realization, as true today as it was in 1964, that their was no treatment modality which could prevent the vast majority of such persons from returning to opioid use once detoxed. Although the theoretical basis of classic MMT holds that such persons have long term, perhaps irreversible damage to their bodies' own opioid systems (either acquired through prolonged use of exogenous opioids or possibly congenital), and while there is an ever increasing amount of data supporting this hypothesis, the statistical likelihood of chronic is in itself the basis for MMT. MMT began as an attempt to reverse US prohibition policy and emulate the "British system" of maintenance prescribing of heroin or other short acting opioids. During experiments with methadone, a long acting opioid which provides the brain relatively stable levels of the desired opioid when administered orally, it was found that 1) Most patients who desired to live a drug-free lifesyle functioned much better on oral methadone than on injected short acting opioids (short acting opioids were NOT tested orally, it must be admitted). 2) That providing the patients doses sufficient to saturate the (then only hypothesized, now demonstrated to exist) brain's opioid receptors both provided a near total relief of opioid craving and a cessation of "tolerance-swings", and protected the patient from the effects of other opioids, thus assisting the patient in the psychological side of stabilization. Damn I'm tired...let me try and cut to the chase... For the original target population, oral methadone maintenance at blockade doses (80-120mg on average/day) is a uniquely effective means of removing the _problems_ associated with opioid dependence- both illicit opioid dependence under prohibition, and even hypothetical unprohibited short-acting opioid dependence. (Not to say that people can not be functional while dependent on short acting opioids, simply that classic MMT significantly eases the reapproximation of a non-opioid-dependent life). In other words, I'm on classic MMT, I feel nothing...I am indistinguishable from non-dependent persons by any measure but blood 'toxicology'. MMT does not address any of the socio-economic problems that I might have, but it is not designed to. It is meant to be a _medical_ treatment for a _medical_ condition which has social consequences...tremendous consequences under prohibition, far lesser but still significant (for those who wish their consciousness to be unaltered) consequences without prohibition. That the treatment of the medical condition would have social consequences deemed desirable was a major reason why MMT gained acceptance in the late 1960s, but it had _nothing_ to do with the intentions of its originators. Classic MMT is a _normalizer_, but it is not a panacea. Those who have or would use classic MMT as a means of social control should be called to task. Classic MMT has been perverted by politicians and by profiteers, and exists in its original and intended form increasingly rarely. Drs Dole and Nyswander envisioned 'clinics' as a mere stepping stone, as a means of assisting people for whom opioid dependence had brought socio-economic isolation. For those for whom socio-economic isolation had brought opioid dependence, classic MMT was seen as treating the physical problem, but the other, causative factors were seen as another issue. In the Great Society intoxication of the times, the physicians bought into the game run by the social workers, and the two set up shop under one roof. Drs Dole and Nyswander envisioned opioid dependent persons being treated by private physicians, for their opioid dependence alone. Were we to achieve that vision the majority of these threads would not exist. Christ...in my attempt to be comprehensive I've gone on typing while my brain goes to REM... Long and the short: Opioid maintenance is the best, most effective, most humane approach to long-term opioid dependence. Classic oral blockade dose methadone is the best form of maintenance for most long term users who no longer want to chase the nod. Shorter acting opioid maintenance or low dose methadone maintenance may be the better option for those who still want to nod. While there certainly are many reasons why people become opioid dependent, most long term opioid dependent persons have a medical need for which there is no known treatment besides opioid maintenance. Shorter term o.d. persons may have a much better chance of abstaining, but there is no evidence that methadone maintenance worsens their chances of eventual abstainence (there is evidence that it is the _cycling_ of opioid blood levels that does the damage...not their mere presence). Although continued use of short acting opioids may further damage the users opioid system, there is no question that the user's life under prohibition is more dangerous. Hence maintenance is indicated for "incorrigible" shorter term users as well as long term. For these 'novice' users, low dose methadone or short acting opioid maintenance may be preferred in an attempt to keep the person from turning to non-opioid (and more damaging) substances. Any and all attempt to enact social control through medicine is contemptible. Social service agencies should network with medical drug treatment providers, and vice versa, but the two should be entirely distinct as a matter of ethics. Give the kiddies their juice...they might stay alive long enough to make a difference in the social side... anyone who stayed with this one deserves a medal...but I didn't callous my fingers not to post it, so... >Who can argue against more options (like high dose methadone maintenance) >for drug users? > >At Lifeline we have no problems in giving support to policy plans for more >methadone whilst at the same time warning drug users about the reality of a >life shackled to the ball and chain of methadone maintenance. > The methadone is freedom...not a ball and chain. The methadone PROGRAMS are the ball and chain... We fiends forged our own balls and chains (if you buy free will...) when we picked up the spike...after that the only enslavers are those who would deny us our medication or attempt to control us with it...