MINISTER LOOKS AT WEANING PATIENTS OFF METHADONE

Minister John Curran wants evidence on whether patients manage to stave off addiction, reports Stephen O’Brien in The Times newspaper.

In Ireland, drug detox programmes for heroin addicts are to be overhauled in an attempt to reduce the death toll among former drug users and bring down the numbers who stay on methadone for years.

John Curran, Ireland’s minister for drugs strategy and community affairs, has asked the Health Service Executive and the National Advisory Committee on Drugs to review all methadone-maintenance programmes and report on how effectively they wean patients off the heroin substitute.

Of the 400 drug-related deaths each year, up to 60 occur among the 8,600 registered methadone users, prompting fears that they are not being steered off the laboratory drug and that many are combining it with illegal substances.

“I have a grave concern that people seem to be on methadone for an extended period of time,” said Curran. “I would like to see the hard evidence to show progression. I want to see an active methadone-reduction programme.”

GOOD vs BAD PRACTICE IN METHADONE MANAGEMENT

Curran said the HSE is developing an “overdose prevention strategy” to address the risk to methadone clients. Since becoming minister, he has met many former addicts who were on methadone maintenance for years.

While methadone helps heroin addicts stabilise their chaotic lifestyles, Curran believes this period of stabilisation must eventually be used to reduce the dosage to help former addicts progress to a drugs-free lifestyle.

Methadone, also known as physeptone, helps block withdrawal symptoms for someone coming off opiates. Properly supervised and managed methadone patients can reduce or stop their use of substances such as heroin.

Jack Wall, the Labour drugs spokesman, has challenged Curran about the death toll among those registered on state-run methadone programmes. Wall said he was concerned that some patients were getting supplies of the drug from a number of sources.

“If that is the case, instead of curing themselves, addicts are creating more problems for themselves and can become addicted to using methadone,” he said.

DRUG DEATHS

Curran confirmed that, out of 400 drug-related deaths in 2005, 60 people died while on methadone maintenance and the use of drugs with alcohol and other substances was a factor in many of the deaths.

The national drugs-related death index published by the Health Research Board last year showed 2,442 young people had died as a result of problem drug use between 1998 and 2005. Causes of death included overdoses, illnesses linked to hepatitis C and HIV infection, and trips and falls linked to incapacitation from drug use.

“When a person enters drug treatment they should have a realistic prospective of becoming drug-free,” said Curran. “We need to be much more proactive in exploring ways towards helping people to exit successfully from opiate substitution treatment, and this is something that I intend to pursue.”

He said drug users’ relatives also needed help in accepting and coping with the problem that had arisen within their family, and support to help their relative re-engage with society.

The minister said the national drugs strategy for 2009-2016, now nearing completion, would set demanding but achievable targets to tackle the problem of substance abuse in Ireland.

In Vienna last week, Curran signed a new UN political declaration on drugs that commits Ireland to closer co-operation in the international battle against the illicit drugs trade.

Comments

[Peter O'Loughlin]

This writer welcomes the news from Mr. Curran, but is baffled and disappointed as to how Mr. Curran is so ill and inaccurately misinformed at the true number of drug related deaths in the UK. If he wishes to avail himself of the vastly more accurate numbers of drug related deaths, I would refer him to the Office of National Statistics, where he will discover for himself in their Health Statistics Quarterly 39 that these avoidable deaths, nothwithstanding claims from the National Treatment Agency, to the contrary, are escalating, and that in 2007 alone, there were no less than 829 deaths attributed to heroin,329 attributed to methadone.

[Frugal Dougal]

I think it's important to remember that prescribed methodone - ie that taken by those it's prescribed for, not diverted - is a trade worth £17 million per year (according to NICE: http://www.nice.org.uk/nicemedia/pdf/TA114Niceguidance.pdf).

Theodore Dalrymple, a former prison doctor, makes very interesting points on the relation of heroin addiction to Methadone: http://www.spectator.co.uk/the-magazine/features/3212846/withdrawal-from-heroin-is-a-trivial-matter.thtml

[Steve Rolles]

Hes talking about Irish drug deaths not UK drug deaths. In the second sentence he is described as 'John Curran, Ireland’s minister for drugs' and the piece opens with the words 'In Ireland'.

[Steve Rolles]

just to repeat, as my post from 2 days ago doesnt seem to have appeared - his stats aren't wrong Peter, he is talking about Ireland not the UK, as is abundantly clear from the first two words of the article.

[Al C]

Having been a heroin addict for nearly 10 years and a methadone patient for a total of about 4 and a half years I think I may have some insight.
Anyone that wants a drug free life style can achieve it. Back-titration (weaning off)of methadone is easy and relatively comfortable. It should be accomplished slowly however. The longer a person has been using methadone, the slower they should detox.
The recommended rate of detox is about 5% of the total dose. A rate of twice that or, 10% is not uncommon. It should be noted that at very low doses that becomes impractical, even impossible. At a dose of 5 mg. lowering by 1 mg. gives a rate of 20% and from 2 mg. to 1 mg. is 100%. Because of the long half life of methadone, decreases of dose should occure at 12 to 15 day intervals and not faster.
I know, from personal experience that desire is key and, that a 12 step program such as AA or NA is essential to long term success. The addict should receive treatment and be educated as to addictive thinking and avoiding addictive behavior. Things like seeking drugs, cross addictions and the problems of using other drugs and medications.
Any heroin addict knows what 'dope sick' is. I assure the reader this will NOT be the case. Symptoms and discomfort are very minor. They will resemble minor allergy symptoms. A runny or stuffy nose, sneezing and some sleep problems may occure at very low doses.
I hope that this might be of help to anyone considering weaning off of methadone and, I wish you good luck in your endeavor. It is not difficult just, go slow.
Al C Portland Oregon, USA