Monday, January 18, 2010

The Methadone Programme

Last year I wrote to each of the 21 DHBs and the Ministry of Health asking questions about the Methadone Programme under the Official Information Act. Over the years I have sent requests to various Ministries but none that I can recall to the Ministry of Health. The nature of the response itself was interesting.

A number of DHBs rang me obviously curious to know why I was curious to know. One woman was quite hostile, demanding indignantly, "Who are you?". An interested individual I answered. Another Doctor had a long conversation with me because, I think, he thought I was an ACT MP (this didn't become apparent until the end of our conversation or I would have put him right.) He was very forthcoming and told me how, for example, before they had been able to resolve waiting lists in his region, he believed women had deliberately become pregnant to get on the scheme. But the waiting lists were no longer a problem. Some areas however were still struggling because there was a shortage of or no pharmacies prepared to dispense to methadone patients.

Anyway it was quite clear that my request was provoking a mixed reaction. It must have been raised at a general MOH/DHB meeting and it was decided that the MOH would make a response on behalf of all DHBs. However, by this stage some of the DHBs had been good enough to compile an individual response. The variation between them, and the fact that the DHBs had no protocol for dealing with a request of this nature, is, as I said, interesting of itself.

For instance I asked how many patients had dependent children. All bar one response declined an answer citing either a lack of information or privacy. The DHB that did provide an answer said 85 percent of their methadone patients had dependent children.

I asked about the duration of stay on the methadone programme. The umbrella response from the MOH said that the information wasn't readily available "..but of those clients seen by methadone services in 2007/08, 3244 (81%) were seen for at least a year."

But I received more fulsome information from individual DHBs including;

The current average duration on the programme is 6 years which is the same as five years ago.

49.9 months currently and 28.5 months five years ago.

The average duration of patients on the programme is estimated at 5 years.

There are still some patients receiving the methadone since the programme started in ___ in 1995.

The MOH said they could not provide average duration. However when I asked how many people had used the programme since inception they answered that in the period 1 July 2001 to December 31 2008 the number was 8,887 nationally. As the number was 4,437 in 2007/08 a high turnover is not indicated. In fact in the calendar year 2008 517 people started on the programme and 300 left.

2 DHBs would only respond to certain questions if I paid. One estimated 40 hours at $76 per hour to answer 7 out of the 10 questions I asked. The other, 34 hours at $76 per hour. One said it would take 4 hours to calculate the cost of treating patients whereas all the other respondents, including the MOH, were able to provide an answer at no cost.

3 DHBs provided answers to 7-8 questions but they weren't necessarily the same ones. None of these mentioned charging.

All up there wasn't a single question that either one of the individual DHBs or the MOH didn't answer.

Which begs some questions; Why such a patchy response? Is information in certain areas only available to the wealthy? Isn't the OIA supposed guard against this very thing?

Some DHBs made a real attempt to supply the information. Others did not.

What did I learn?

*That, as I expected, the methadone programme is more about maintenance than rehabilitation. Of those who left the programme (300) 3 overdosed, 39 died, 39 left involuntarily and 219 left voluntarily. If we assumed that anyone who managed to wean themselves off methadone is in the 'voluntarily left' group, then the success rate in terms of rehabilitation is not high. 5% percent at the most.

*That if the one response I got regarding patients having dependent children is representative, the percentage is high.

*That the costs of administering the programme are climbing inexplicably. It rose by 52 percent between 2007/08 and 2001/02 whereas the numbers were relatively stable.

*That there is nothing remarkable about the ethnic make-up of patients which roughly matches the general population.

*That very few patients (1 percent) are under 20. Amazingly 17 are over 65.

If it was my call I would not dispense with the programme. It gives heroin addicts a chance to normalise (eg avoid crime, hold down a job, parent) or even recover. But the actual cost of methadone is next to nothing and some scrutiny into why it is costing $14 million to primarily maintain rather than cure addicts wouldn't go amiss. It's not unlike the welfare system really. Best of intentions gone awry. More dependence instead of less.

But I will conclude with my own bottom line in this area. If women are on the programme they should also have to use long-acting contraception as a condition of their admission. It could easily be administered as part of the clinic treatment. Babies being born addicts courtesy of the taxpayer weighs very heavily on my mind. There is an opportunity to discourage this from happening and strongly incentivise female addicts to get clean. It may be that some clinics already unofficially encourage female patients in this direction. I don't know.


Anonymous said...

I have a couple of friends working in the field of mental health. On more than one occassion I have wondered if the inmates have taken over the asylum?

These friends care for some patients who are on the methadone programme and they sssure me its about control not cure.

At the same time my "friends" take a cocktail of prescription medicines to help them deal with their own demons.

I sit back, observe and pour myself another drink.


Oswald Bastable said...

That brings back memories of doing the methodone escort every morning- down to medical to get a little cup of smiles.

Then make them sit in a holding cell for 20 minutes, lest they regurgitate it back at the wing and sell it...

Macdoctor said...

I have yet to see a patient come off the methadone program, but, like you, I think it is better than taking heroin and morphine.

Unfortunately a good proportion of patients obviously still access herion and morphine from time to time.

MikeE said...

Like Macdoctor I know someone on the programme, I doubt she will ever get off it - but her quality of life is greatly improved (as is her families, who she was stealing off, and causing all sorts of trauma for) since being on it.

She finally has a job, responsibility and is looking at finishing her degree (which she dropped out of due to heroin dependency) - I very much doubt she would have been able to do this without access.

One more reason why I think the war on drugs is a faliure, and drug issues should be dealt with as a health issue, rather than a law and order issue. Any other drug and she would have been locked up, at least with this one, she has an opportunity to control dependency (and hopefully one day overcome it)

brian_smaller said...

Oswald - I have seen them outside a chemist sticking their fingers down their throats and throwing up into a plastic bag. At the time I wondered whay three people were vomiting into the same bag. A friend with a son on the methadone program told me about the 'saving it up for later' thing. Yeech!

Anonymous said...

The person MikeE describes is a very rare individual indeed. The majority of those on the methadone program depend on benefits from cradle to grave. I have dispensed methadone for over 20 years and the number of "clients" who have improved thier lifestyles I can count on one hand. It is a rort of the highest order keeping otherwise unemployable doctors, nurses, and councillors in a job.
Read Theodore Dalyrymples book "Romancing Opiates", everything in it correlates extremely well with what I have witnessed. Lindsay email me at if you would like a first hand account of my experiences. Incidentally the pharmacy gets a dispensing fee of $7 a day 365 days of the year for dispensing to these clients, yes $2555 pa per person. Some days its money for jam and others you earn every penny.
Murray M

Julia said...

Hi Lindsay, I spent a considerable amount of my life researching the same questions you raise here. Wonder if you have come across my book 'The Spell of Morpheus', in which I attempt to make sense of a very complex issue. Be happy to forward you a copy or meet with you when next in Wellington.
Julia Sutherland, Tauranga

Lindsay Mitchell said...

Julia, Send me an e-mail

I cannot find an address for you

Anonymous said...

i am a 36yr old female who has bn on the methadone 4 17yrs.i am single,stable and do nt hav children.about 65% of methadne female patients have children,they r all healthy.howevr it dpendsn the patients stability as 2 weathr they r bougt up wel.i stayon the programe bcoz as long as im n it,i am unable 2 use opiates,i do nt feel any drug like efect frm my dose.i also stay n programe becoz i am gvn no suport to come of.4 me the programe works bt is nothn more than a antidepresent is 2 the depresd.longterm maintanance.i have hep c and in taranaki most oldr iv users have it.we r lucky we were pikd 4 interferon trials sum 15yrs ago.thanx

Anonymous said...

re.lastnites post..i must say that only the women i hav had experiences with have had healthy these poor babys r born in2 a luckydip as 2 how bad they withdrawl,they r gvn tiny doses of stil i wil nevr get the sound of a methadne babys cry out of my head.a high pitchd scream of physical need.i cn nt hav children,nothn to do with my addictn,bt if i could i WOULD NEVER HAV A METHADONE BABY.sum methadone mums wil say,'my baby didn withdrawl"that is the EXCEPTION,NT THE RULE. i feel womyn n methadone should b placd n cntraceptive,for as lng as n methadone.n if they wnt a baby they should show it by withdrawing of methadone.which we r gvn litle help 2 do thus my being n methadone so long.i was told 2yrs,and then they would countme dwn WITHOUT my known.only 2 b told 2odd yrs l8r that2 count me off blindly was against my rights.the staf at a n d dnt wnt us of,4 if we came off,they may nt be needd.i sadly do nt c myself ever beingoff methadone.i am stable,ilicit drug free,and have nt like so many bn ravishd by the drug n2 a toothles gaunt etc addict.u would nt gues im on it unles u were very i am the exception nt the rule.the sale of methadone n the st is so ryff we have addicts going n theprograme and the only drug they r addictd 2 is methadone! methadone works bt if thngs were changd around would work so much beter.

Lindsay Mitchell said...

Anon, Really appreciate your comments. You've been on the programme almost half of your life.

I've only known one Methadone mum firsthand and her perenting was mostly impaired by being very sleepy during the day. Don't know how she coped. But then her troublesome partner lived only a few doors away and despite having a protection order out against him was fairly involved with the child I think.

Hope you get something good out of life to counter-balance the addiction. At 36 your only a baby!

Anonymous said...

thanx for ur 36 i am just a i cn only ask if im a baby now wot was i when at 14 i was introducd 2 iv drugs,at 16 my partner gave me hep c and a ravaging drug habit then he wnt 2 jail 4 armd robery.leavn me 2 options i stil am nt over.i tried rehab bt endd up n rules my life.i yearn 2 travel bt where would i find a have a b.a in socialwork,bt became so unhapy n the few placements a methadne addictd social worker may legaly sure u r thnkn "if u wntd 2,u could come of ths drug" bt what if there is even a 1%chance i succumed n went bk n st drugs n st life..i could nt do that 2 me or my lvd ths "baby" has much life n lv 2 gv.n should the hep c nt kil me i intend 2 live life 2 fulest..take care

Lindsay Mitchell said...

Truthfully, I never thought about whether you could kick it if you really wanted it. And I didn't mean to sound patronising by describing you as a "baby". It's just that 36 is so young. Know it now instead of waiting until you are in your 60s and 70s looking back. But from your latest comment, it sounds like you do.