Methadone has saved countless people from destructive heroin addiction. But the treatment, an opioid-substitution therapy, has a dark side. Patients call it “liquid handcuffs” because it chains recipients to a pharmacy they must visit every day, sometimes for decades. And after addicts transition from heroin, many find it even more difficult to get off of methadone.
At a coffee shop on Main Street, Laura Shaver, a spokesperson for the B.C. Association of People on Methadone, told the Georgia Straight that patients have long asked for other options.
“I’ve been on methadone now for 13 years,” she said. “I’m only 36 years old, so that’s quite a long time. And if I would have known then what I know now, I would have stayed on heroin and had somebody detox me off of it.”
B.C. methadone patients may soon have the alternatives they have been waiting for.
Vancouver Coastal Health (VCH) is in the early stages of a review that could significantly change how the province treats people addicted to heroin and other opioids.
In a telephone interview, Dr. Evan Wood, VCH medical director for addiction services, said the regional health authority is drafting new guidelines that could expand the number of pharmaceutical therapies available to help people kick harmful opioids.
“There are a whole range of approaches that can be applied, and that is really what is needed in British Columbia,” Wood said. “Coastal Health is presently developing a guideline for the treatment of opioid addiction that articulates these different strategies and when they should be employed.”
According to a May 2014 B.C. government report, in 2012-13 there were 14,833 patients enrolled in the province’s methadone-maintenance treatment program and 1,482 patients receiving Suboxone (the trade name for buprenorphine-naloxone, which became available in B.C. in 2010). A January 2015 report states methadone cost the province $43.7 million last year, making it the second-largest expense for the PharmaCare program.
In the past, Wood has criticized the province for failing to invest in alternatives when methadone’s deficiencies are so widely known. (The Toronto-based Centre for Addiction and Mental Health notes that some doctors regard methadone as a treatment that continues indefinitely, going so far as to compare it to insulin for diabetes.) Now, he said, the province has assigned representatives to participate in VCH’s review, and the team is already in the preliminary stages of assessing other drugs that could be more effective and involve fewer side effects.
For example, Wood continued, a slow-release oral morphine is presently the subject of clinical trials. There is also extended-release naltrexone, which, he noted, shows special promise because it is administered only once a month, whereas methadone must be ingested daily.
“There actually are solutions to these challenges, but it is going to require a broader focus than simply focusing on methadone,” Wood said.
How the province rolls out any proposed reforms is yet to be determined, he cautioned. But Wood said one option is to begin offering alternative treatments through VCH services in Vancouver, then to expand those deemed beneficial throughout the rest of the province. Wood added that he is optimistic the review will be completed before the end of 2015.
The Ministry of Health did not respond to repeated requests for an interview.
Dr. Eugenia Oviedo-Joekes is an assistant professor at UBC and research scientist with Providence Health Care. She told the Straight it is about time the province dropped its reluctance to embrace alternatives.
“If methadone is not working well for you, let’s try Suboxone,” she said. “Maybe somebody who doesn’t like methadone will do well on morphine. But we don’t have these things here. We say, ‘You should stop using [heroin] and you should take whatever I give you.’ ”
Back on Main Street, Shaver was critical of a recent government review of the methadone-maintenance program that largely confined its analysis to payment issues. (The result of that process takes effect on June 1. On that date, all of B.C.’s more than 1,280 pharmacies licensed to dispense methadone must re-enroll with the provincial PharmaCare program and start adhering to tighter rules around billing and record-keeping. According to a May 7 government release, the province intends to refuse re-enrollment to 46 Lower Mainland pharmacies it has judged problematic.)
Shaver called that review a missed opportunity. She said it should have looked at how the program could be revised to improve the lives of patients.
“What affects us is the way that people treat us in the pharmacy,” she said. Shaver listed a number of small changes she argued could make big differences. For example, patients could be offered more privacy when they are forced to consume methadone inside the pharmacy where they receive the drug.
“Methadone does save a lot of lives,” Shaver said. “But we need to think of other options.”