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.