Maximize positive methadone maintenance outcomes

Whenever I'm asked what I think about methadone, I always say "it saved my life".  That's quite a claim, but it's true.  Before going on methadone, I had a heroin/morphine habit that was getting way out of control and I was clearly heading for jail or worse.  So I went on methadone maintenance as the only way of avoiding a catastrophe I knew was coming real soon.  And it worked!  I was able to stabilize on methadone and my life immediately started improving.

Methadone isn't some kind of magic drug.  It doesn't automatically save one's life.  In fact it took me four attempts at methadone before I got it right.  The first three times I really had no idea what I was doing.  I pretty much just looked at methadone as a back up dose of dope which I could count on to keep me from going cold turkey in hard times. The first three times my fridge filled up with bottles of methadone I didn't drink and I kept on using dope from the streets.  As year's went by, my street habit kept getting worse, my life got more desperate and crazy, I kept risking OD, HIV and Hep C, and I got deeper into crime to feed my habit.

Eventually things got so bad, and I got so fed up with all the bullshit, that I decided to go on methadone one more time.  But this time was different.  This time I was determined to do the program correctly for my own sake.  I knew methadone maintenance was my only hope and that I knew I could only succeed if I did the program right.  Experience had taught me what I needed to do - take every dose of methadone, don't take anything else from the street, and stay away from people and situations which would put me at risk of using.   The forth time I was totally committed to doing methadone right, and so that's what I did.   And it worked!

Methadone maintenance does work.  You just have to do it properly and really stick to a maintenance program and then methadone will assist you in getting control back in your life.  Unfortunately not everyone who goes on methadone understands this.  They don't realize it isn't just the methadone, but its their overall behaviour which determines whether methadone maintenance works.  Nothing improves simply because you take methadone.  Things only improve when you work the program properly along with taking methadone.

It takes some knowledge to understand how to successfully do a methadone maintenance program.  Unfortunately many clinics fall short in assisting their clients in this regard.  Many clinics fail to establish good support and education programs for their clients and therefore they don't help to maximize successful outcomes for people.  I think this lack of good supportive programming is scandalous.   After all, drug addiction is a life and death situation and successful methadone maintenance can actually save lives.

Canada needs to establish a country-wide set of regulations governing methadone clinics whereby good supportive education and counseling must be provided to clients on an ongoing basis.  Too often clinics are merely methadone providers and they lack any semblance of socially supportive programs.  They give out methadone but they don't give clients assistance understanding and managing what methadone maintenance is all about.  As such, they really drop the ball for the people they should be helping.  

Clinics should be required to provide quality supportive programs for their clients.   One aspect of such programs must be peer-based support.  Clinics should be required to hire people on methadone maintenance to serve as guidance peers.  Such individuals possess the knowledge and are the example of what successful methadone maintenance can be.  Hiring such role models to oversee the social side of a clinic's methadone maintenance therapy would properly augment well-trained physicians and nurses who handle the medical and prescribing side of the therapy.

Another problem with far too many current clinics is the absence of clear regulations governing how clients can expect to be treated.  There is far too much arbitrary treatment of clients and this leads to confusion, demoralization, and ultimately, rejection of methadone maintenance therapy.  It is unacceptable that clients quit methadone maintenance because of improper or arbitrary treatment by clinic staff.  At present most clients are powerless in seeking redress when they feel they are not being treated fairly.  This too is something lacking in the current methadone clinic system in Canada.  Clients need to have clear channels of grievance regarding a treatment which is so essential to their current and future well-being.

The arbitrary nature of clinic policies due to a lack of clear national standards, and the absence of clear grievance procedures, go hand in hand as something which must clearly be addressed in order to make methadone maintenance more effective in Canada.  Clients should have the right to expect proper treatment at any clinic in Canada, and they should be able to seek redress if they feel their treatment by clinic staff is not up to standards.   It should never happen that clients choose to stop methadone maintenance therapy do to ill treatment by clinic staff, or a sense of futility with regard to changing ill treatment.  But all too often clients are leaving treatment for precisely those reasons.  That is the system failing people who desperately need the system to work properly.

Lastly, I want to emphasize something I came to realize.  It wasn't methadone which saved my life, but in actuality, it was maintenance which was the key.  The fact that I was legally provided with a daily dose of an opiate drug provided me with the maintenance I needed.   There is too much emphasis on methadone when in fact it is opiate maintenance which is the crucial thing.  Morphine, heroin, oxycontin, or dilaudid could similarly provide maintenance.  Each and every opiate-based drug has somewhat unique characteristics, but ultimately the fact that they are opiate-based means that any one of them can serve as a maintenance therapy drug.  The fact that methadone is the only opiate-based drug permitted for maintenance is yet another arbitrary thing about the current maintenance therapy system in Canada.

Ideally one day there will be a range of opiate drugs available for maintenance therapy in Canada because the more that the possibility of maintenance becomes attractive to the widest number of individuals the better it will work for all.  But for now methadone is what we've got and as such it behooves all of us who seek survival for junkies in Canada to try and make the methadone system be as good as it can be.   For as we know we can't always get what we want, but by improving what is, we just might find, we get what we need.

Brent Taylor
Coordinator
UNDUN - Unified Networkers of Drug Users Nationally
http://www.undun.org
undun@sympatico.ca