MEMORANDUM 52
Submitted by Tony Ralls
METHADONE—THE CURE THAT KILLS
1. INTRODUCTION
I started to inject soon after hitting the Soho
drug scene in the early 1960s. I was a young teenager and quickly
became addicted first to methadrine (a powerful stimulant which
came in ampoules) and later physeptone an opiate-based drug which
also came in ampoules which I used to as an aid to the "comedown"
off stimulants. I was offered treatment for my addiction from
Doctors Chappel and Grey who had brought methadone to the UK in
1969, and so registered at the Worlds End Treatment Centre in
Kings Road, Chelsea. I had never previously overdosed but once
I begun treatment with methadone, overdosing became a regular
occurrence. Bottles of methadone were given out containing supplies
for a week or more, the methadone itself, as today, looked like
cough linctus. I saw many of my fellow addicts die of overdoses
from prescribed methadone, mainly through combining it with other
drugs or alcohol, we were not fully aware of the lethality of
the drug due to a lack of information. I also exchanged my addiction
from my previous drugs to methadone. I came off drugs in 1970
through the love and support of committed Christians.
2. THE DRUG
Methadone, although chemically unlike morphine
or heroin, produces many of the same effects and has been used
for the treatment of narcotic addiction in the UK over the last
three to four decades. The effects of methadone are longer lasting
than those of morphine-based drugs, up to 24 hours, so permitting
administration only once a day in heroin detoxification and maintenance
programs, tolerance and dependence always develops. Some say withdrawals
develop more slowly and are less severe than heroin but are more
prolonged. Others involved in drug treatment say that one of the
problems with methadone has been that it is as addictive as heroin
and the withdrawals as bad or even worse than heroin, as an ex-methadone
addict I would agree with this opinion. Methadone has also been
widely prescribed to people with Hepatitis, which is a common
condition amongst drug addicts despite the fact that it is known
that in it's usual linctus form it is toxic to the liver. Matthew
Dolan the author of "The Hepatitis C Handbook" gives
the opinion that, "The continued prescription of methadone
linctus to HCV+ addicts would seem to have been unnecessarily
punitive and ethically questionable."
3. PRESCRIBING
In Britain, any medical practitioner can, at
present, prescribe methadone for opioid dependence; Drug projects
have, however, been the main source for prescriptions. Patients
often consume their methadone at home rather than under direct
clinical supervision, compared to other countries there is minimal
central regulation of methadone maintenance programs, and prescribing
practices are not uniform. Guidelines do exist but are not being
effectively enforced or adhered to. According to the Home Office
"Drug Misuse and the Environment" document: "There
has been an extraordinary growth in drug projects and much of
what they are doing remains hidden. More information is needed
about the processes and experiences with a view to establishing
what is good practice."
Methadone has been actively promoted as the
only real answer to heroin addiction. The Methadone Alliance is
a powerful body that has pursued this course. I believe however
that it is unacceptable that a drug that has killed so many non-drug
users continued to be prescribed freely over such a long period
of time. There are many examples of the fact that there has always
been an overspill of prescribed methadone into society with tragic
consequences.
4. METHADONE
OVERDOSES
"According to the DEA, "methadone
is frequently encountered on the illicit market and is annually
associated with a large number of overdose deaths in the US This
narcotic is associated with a number of toxic side effects and
is reported by medical examiners to be among the top 10 drugs
associated with drug-related deaths in the US"
It is important to note however that there is
no illegal production of this drug in the USA or UK. All methadone
at street level has come from a drug unit or a GP.
This is one example showing that decriminalisation
of drugs does not reduce the danger to the community in any way.
I became an addict through buying drugs that had been prescribed
to someone else. The stark fact is that prescribed drugs are killing
as many, in most case, even more, people than illicit drugs. I
quote from an article in the "Big Issue": In an expose
feature in The Big Issue by Lucy Johnston, (April 15-21, 1996),
a strong warning was given concerning methadone.
"Home Office figures show that the number
of methadone addicts has increased from 5,000 in 1990 to nearly
16,000 in 1994. This means that the widespread availability of
methadone, has produced, rather than prevented a whole new generation
of addicts".
The article also set out the many dangers of
methadone as a potential killer rather than a cure, I quote: "Despite
the fact that adulterated street heroin had many more users, Methadone
is killing more people. Between 1982 and 1992, deaths by methadone
poisoning increased by 710 per cent from 16 deaths to 131. According
to Government figures this meant in 1992 the drug accounted for
approximately four times more deaths than heroin per 10,000 users."
Information from the National Statistics Office, (autumn 1998,
Population Trends between 1982-6) states there has been:
"A significant increase in drug-related
deaths amongst men aged 15-44 years in all regions, half the drug
related deaths are attributed to opiates. Over the five-year period
there were nearly twice as many deaths mentioning methadone as
heroin.
5. THE ADDICT
A letter to the British Medical Journal (Volume
315, 6 September 1997) from A M Daniels, a Consultant Psychiatrist
associated with the National Poisons Information Centre states:
"Many that take Methadone lie about their consumption and
sell a proportion of their prescription on the black market. As
little as 30mg may be fatal in those who have no tolerance for
opiates according to Toxbase, Edinburgh Poisons Information Service
1994. No one dies of heroin withdrawal, whereas 90 people died
of methadone poisoning in Manchester between 1985-1994".
Many users store their methadone in baby bottles
because of the measurements on the side; this has led to some
appalling deaths of children. In a 1996 Spring edition of the
"Big Issue" an article on methadone stated that: "In
1993 a study in Liverpool found that 42 children were hospitalised
as a result of accidental overdosing. Two of these died. In one
case in 1995 a coroner in Stockport found a baby had died because
his stepfather had measured out his methadone in the baby's cup
and hadn't rinsed it out afterwards.
I have personally known responsible addicts
use methadone to withdraw from heroin and on a minimal dose build
a new life free of the drug culture but I must say these in my
experience have been the exception rather than the rule.
6. EDUCATION
Although attracting considerable media and political
interest, deaths from drugs such as ecstasy and cocaine account
for less deaths than methadone among both young men and women,
yet there is much literature available seeking to warn young people
about these drugs.
On contacting the National Drug Help Line and
other national drug information bodies and examining their booklets
and leaflets, I found no information warning young people, or
parents, about the dangers of methadone. The two most recent guides
put out by the Health Education Authority are "The Score—Facts
about Drugs" and "A Parents Guide to Drugs and Alcohol".
Whilst both are expensive full colour productions there is no
mention of methadone either in classification as defined by law
or in the general presentation of all the other drugs, although
there is always a mention of caffeine. In my research, I could
only find one drug group call "HIT" who have any material
relating to this drug, this is a postcard size card warning about
methadone.
My question is that if Drug Action Teams bring
together all those working in this sector why is it that the deaths
of so many appear to have gone unnoticed and why have children
not been warned through the years? The LEA Drug advisor has a
responsibility to advise schools concerning their drug policy,
they meet regularly with their opposite numbers in the treatment
field. This is where the lines have become blurred and why harm
reduction has been applied not only to addicts in treatment but
to education in schools with disastrous results making many drug
education lessons drug promotion lessons but that is another subject.
CONCLUSION
I was a drug addict for seven years and have
been involved in all areas of the drug culture for the past 32
years. I have lectured in rehabs and schools, worked in prisons,
written widely on the subject of addiction, but most of all fought
a running battle through most of those years with "drug experts"
in the areas of treatment and education. At present I am working
with addicts at street level in Cornwall. All have seen many friends
die through methadone many also have Hepatitis and recognise that
methadone with its toxic side effects are bad for the liver. All
know where to buy it on the black market. Even though Sebutex
is being introduced as a new drug for treatment of heroin addicts
many are resistant to this new drug most are so addicted to Methadone
they cannot imagine life without it, it is also interesting to
note Sebutex is also an opiate, yet again addiction is being treated
with an addictive drug.
I contend methadone has certainly not been proven
to be the answer to opiate addiction. What I know has happened
is that one addiction has been exchanged for another and along
with this countless innocents have died, I therefore can only
question this policy, how it came to be in place and was pursued
for such a long period of time.
August 2001
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