...I decided to look into rehab options. I met with my CAU key worker, explained that I wanted to get off the methadone as I wasn't using heroin anymore, and go to a rehab, I was told in no uncertain terms that she thought I wasn't ready for rehab and the local authority wouldn't be funding it.
As it happens that was probably for the best as I found a rehab myself, funded by housing benefit in Cardiff, that had a place for me. So I left hospital and went straight into LivingStones Rehab. I wanted to discuss reducing my methadone, so at this point I went to see my key worker again, really chuffed to be able to give my first negative urine sample(negative for heroin), She said that's great but I'd like to increase your methadone dose, just in case. I couldn't believe it, why raise it? I'd stopped taking heroin, was in a stable environment, with support and they wanted to raise my dose? After a lengthy discussion, she agreed to not increasing it but would have none of it when it came to talk of reducing it.
So I decided to write my own reduction plan, as I was on weekly pickup it was possible for me to measure it myself and discard the remainder. I decided on 10% drops every week, until I was completely off it. I let my key worker know my plan, accepted the flack she gave me and got on with it.
Every time I went in for an appointment after that I ended up being chastised for reducing myself,it was going smoothly but she still wouldn't agree to reducing as I wanted and would only drop it to the level I was on that day, so by the next week I was having to measure it and throw away the excess again. No matter what I said or how I explained it, the CAU would not reduce it for me, worse than that they put every barrier possible in front of me. This went on for months, in fact it wasn't until I was on 8ml/day that they realised I was serious about coming off methadone for good and actually started to reduce it for me when I asked.
Friday, June 20, 2008
Kicking methadone in the U.K.
A great story of recovery and the professionals who didn't believe that it was possible. We get calls from people with the same experience here in the U.S., they want to get off methadone and the clinic treats it as noncompliance. They often feel that their only options are to get back on heroin or con a doctor into an opiate prescription, switch to the heroin or opiate Rx, and then detox themselves from the heroin or Rx opiates.
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I believe firmly that any patient who wishes to taper off should be allowed to do so and supported thoroughly in their efforts by their counselors/key workers/doctors. That being said, I also think the patient needs to be informed of the pros and cons or risks inherent in what they are doping, as well. The relapse rate for those leaving MMT is high--about 90% relapse within a year of leaving treatment.
Also, many patients get on MMT and then within a few weeks or a few months, decide they are "dured" and ready to be done with this costly and over regualted treatment, and tell their workers that they want off and they want off NOW. While this is their right, the drug worker owes it to the patient to explain the facts to them, and to let them know that chances of success are much higher of they institute a taper after 2-3 years of stability on MMT (i.e., no illicit drug use, stable family life, gainful emplyment, etc), and that they taper slowly, all the way down to 1mg.
This is often seen by patients eager to be free of the clinic scene as an attempt to keep them "hooked" and keep getting their money. While this may at times be the case--there are unscrupulous practitioners in all areas of medicine--in many cases it is simply the best medical advice based on what we currently know about MMT and relapse.
If, after being informed of this, the patient wishes to continue with a rapid taper, or a too-soon one, they should be supported, and it should be made clear that IF they should fail, they can return to treatment and try a slower taper or whatever they wish to do. The clinic does not "own" the patient--it is the patient's right to do what they wish regarding their health, and it is the clinician's job to provide factual information, expert opinions, and support for the patient's ultimate decision.
However, just because someone is told by a clinic worker that the relapse rate is high or they are tapering too soon/too fast and should wait awhile, and then the person continues with their rapid taper, etc and is successful, does not mean that the clinic was wrong. They have a duty to tell the patient what the odds are--and any decent practitioner will rejoice to see a patient beat those odds--but they still have a duty to provide the facts and the risks to the patient.
We wouldn't be shunning this clinic if it were a health clinic or a mental health clinic.
If a patient with depression or epilepsy JUST started to do well on medication and their healthcare providers where weary of them coming off that medication--would we expect any less than what this clinic did?
Opiate addiction is a disease-why do we insist on treating it differently than any other disease?
If you have a guy that has been eating twinkies and downing 20 cokes a day and he gets diabetes--which medication then helps control....would it be a great idea to take him off the medication as soon as his glucose levels level off? Even if the guy had his diet under control for a few months, can the doctor be sure this man will continue to stay on the diet>? Without the medication, would the man be doing so well?
How can we possibly say addiction is a disease (a fact--no sense trying to debate it) and then say we want to treat the people with it differently than we do other patients?
I am thrilled for anyone that is able to control their illness without meds...but I can't imagine why we would consider it a tragedy for the patient to be told the ODDS that it will stay that way.
Personally, I think it's more of a tragedy when someone is encouraged and goaded into tapering before they should.
Also, exactly how long has the poster been off methadone without relapse? A successful "detox" is great--but it means nothing if the guy relapses a year from now.
To the second commenter, you'd be correct if MMT was the only effective treatment for opiate addiction. Professionals who treat their patients with this approach is exactly what troubles me.
Your depression and type 2 diabetes examples only reinforce the point. There are several treatments for depression, some involve medication, others do not (CBT & ECT, for example). I'm no expert on type 2 diabetes, but my understanding is that it is generally first treated with behavior and lifestyle changes, and they might be able to discontinue medication once they are stabilized.
No one here is talking about goading anyone. We're talking about people who have been on methadone and decide that they want to get off it. It's no different than a patient with another illness deciding that a treatment is presenting quality of life problems and that they would like to try another option. This is done every day. The difference is that most treatments are much easier than methadone to walk away from. Methadone patients are at the mercy of the professionals they are working with.
I'm not suggesting that methadone should be abolished, but it should be one option in a menu of options. Our small community has hundreds of recovering opiate addicts who were told by professionals that their only hope. They're in stable, drug-free recovery today.
As an old NA t-shirt said, "The lie is exposed, we can recover!"
I believe I remember seeing a post or profile that says he's been clean for 3 years.
What's your point? That opiate addicts can't get well? And, if they are doing well, you're still right because they're doomed to relapse?
But just because one person "can recover" through NA, does not mean that everyone can. If a person were able to get off injectable insulin and then said "The lie is exposed! We Don't NEED insulin! We CAN recover!" and then all insulin dependent patients decided to throw away their insulin and live "drug free"--what would happen?
No one is saying that these people should not be permitted to try abstinence if they so choose--that is their right. It's the way you are presenting it that troubles me. Methadone is presented as not really being "well" or in "recovery", and MMT patients presented as sad, depressed victims of the industry, fooled into believing the "lie" that they need medication.
Yes, it is true that not all diabetics need insulin. I often use that analogy myself. Some diabetics are able to control their disease by diet and exercise alone. Others require oral medications. Still others require injectable insulin. And others still, may not do well even with insulin--they are termed "brittle diabetics". Insulin helps them, but does not fully control the disease.
Now, compare this to opiate addicts. Some can control their symptoms with therapy, counseling, biofeedback, group support, accupuncture, etc. Others may require Buprenorphins--a partial agonist. Still others may require methadone--a full agonist. And some may not do well even on methadone, though it may improve their situation to some extent.
In both these scenarios, a patient may move back and forth as time goes on. Someone in early stages of addiction may do well with abstinence based treatment at first. But then, if they relapse and use for many years, they may require more intensive treatment or medication. Similarly, a person may require methadone for a time, and then be able to taper off and do well on abstinence, even though they were not able to do so before.
My point is that all types of treatment should be available, and patients should receive unbiased advice from counselors--too many of whom recommend only what worked for THEM (if they are in recovery) instead of providing a broad range of choices. In the USA, 97% of treatment centers offer only 12 step treatment, despite the very low success rate, especially for opiate addicts, and people who relapse or who do not accept this form of treatment (which is really NOT treatment at all, but a support group) are simply sent back again and again and again, very seldom being given any other options. This is just as wrong, IMO, as providing everyone with methadone and only methadone.
We're in agreement that addicts should be offered a complete spectrum of high quality options.
I'd point out that this post was never about 12-step oriented treatment. It was about a guy who's treatment provider refused to cooperate with his wish to taper off methadone.
You bristled at this guy's story. Why?
I've got no problem with methadone being offered as one option in a continuum, but if a patient decides that they want detox, the professionals have an ethical obligation to help them taper. Too many professionals believe that opiate addicts are incapable of drug-free recovery and discourage it or refuse to cooperate.
We're in agreement that one danger with recovering practitioners is that they impose their own recovery path on their clients. This should be dealt with in supervision, if they can't overcome it, they should be counseled out of the field. The same applies to any practitioner who believe addicts are incapable of drug-free recovery.
97%? Are you considering any treatment program that ever makes a 12 step referral a "12 step treatment program", or was that hyperbole?
No, not at all. In fact, if a treatment program feels that a 12 step program would be a good "fit" for the patient they are obligated to make that referral, IMO. What I meant was that 97% of the treatment centers in the USA use the 12 step model exclusively. For example, a typical center might hand the incoming patient a copy of the Big Book and tell them to keep it by their side and read it every day and that they will be quizzed on their knowledge of the steps. (often you must memorize them). Then, the patient goes to various groups, most of which have a 12 step theme (i.e., step 1, making amends, getting a sponsor, etc). Usually, 12 step members will come in each evening to "bring a meeting", or the staff will take patients out to attend an area 12 step meeting. And usually patients must get a sponsor and work steps 1-5 before they can be discharged. The entire center is usually saturated with 12 step material, 12 step literature, 12 step banners and signs, 12 step lingo, and 12 step based counselors who believe it is the ONLY way to recover. Then, the court system will often require anyone with any kind of a drug or alcohol related charge to attend mandatory meetings of a 12 step group, several times a week, for the term of their probation. No other options, such as SOS, Lifering, Methadone or Buprenorphins treatment, are generally allowed. As I may have mentioned, I went through 13 abstinence based treatment centers, relapsing after each one, and was never advised to do anything except try the 12 steps again, and maybe pray harder this time. No one ever suggested any other options to me.
So, it sounds to me like the UK has an issue with everyone being bundled off to methadone treatment and pushed to stay on it against their will, and the USA has a problem with everyone being pushed to make it in abstinence based 12 step treatment, with other options very seldome being suggested or offered. Neither is the right way to go.
Ideally, a treatment cener should do an individual, THOROUGH assesment of the patient--history, physical, what has helped or not helped in the past, belief system, resources and referrals needed, dual diagnosis issues, etc. Then the patient should be offered all their options, with expert advice and guidance so they can make an EDUCATED choice--but this guidance must be based on FACTS, not personal prejudices, as it so often is.
I agree that if a person, having been told the risks and benefits, wants to get off methadone--no matter if it is "too soon" or the clinician feels they are "not ready" or whatever, they have done their job by giving them the facts and they then owe it to the patient to assist them in meeting their goal and giving them the best chance of success within the parameters of what the patient is willing to do. Anything less turns the clinician into a jailkeeper with the keys to the patient's rights in his hand. If the pt. wants off methadone, that is their right. Conversely, if a patient wants to remain ON methadone for a period of time longer than the clinician feels is best, that too should be the patient's right, and if the patient is in abstinence based treatment and wishes to try medication assisted treatment, they too should be allowed that choice. Do you agree?
All clients should be offered a complete continuum of options.
Locally, I can't imagine someone not getting medication for as long as they wish. There are no methadone detox programs, they're all maintenance. Bupe is widely prescribed on a maintenance basis.
I wouldn't want to tell a prescribing doc that they have to prescribe in a manner that conflicts with their professional judgment. However, given that there are so many providers willing to offer maintenance, they should offer a referral.
I agree.
Thanks for an interesting discussion!
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