Wednesday, June 9, 2010

Methadone Maintenance Therapy and Cocaine Abuse

Methadone Maintenance Therapy is specific for addressing opiate dependence. The principal opiate dependence is IV Heroin use but Methadone Maintenance Therapy will work therapeutically with other opiate abuse, such as morphine or oxycontin.

Commonly though patients who are opiate dependent are also using cocaine.

When I asked Dr. G. Horvath who prescribes and teaches methadone maintenance therapy at Doc Side Medical Clinic in Vancouver, how he would assess cocaine use in a person who on methadone was opiate free except for methadone but continued to abuse cocaine, he responded with these clinical gems:

"I'd ask them if they were using it IV or snorting it. I'd ask if they were 'chasing it' or only using it if offered. I'd record the amount and how they used it. I'd record if they were using it all night or just using it in passing. I would ask them how much they were spending and where the money was coming from and if they were not having to resort to crime to pay for it. All these would indicate a move in a positive direction."

The College of Physicians and Surgeons of BC handbook summarizes Treatment Outcomes as:

  1. Reduced or discontinued use of heroin and other intravenous drug use
  2. Reduced or discontinued use of other mood-altering drugs
  3. Reduced criminal activity
  4. Improved physical and mental health
  5. Improved stable living situation
  6. Improved social and personal relationships
  7. Improved vocational and employment opportunities.

So many of the patients who come to methadone treatment are at the very end of their rope. Some indeed are literally suicidal. They have often tried and failed at a variety of recovery alternatives including detox, treatment centres, recovery houses, and 12 step programs. Methadone is rarely the first alternative though it can be for the pure heroin addict. For the polysubstance dependent person it's not uncommon that they've also been in jails and psychiatric wards where as many as 50% of admissions or incarcerations are related to drug abuse.

"Ideally we'd like an overnight cure but the reality is that it's usually a slow process."

How to measure this progress is what clinicians like Dr. Horvath are keenly interested in.

As one Vancouver East Side nurse recently said, "We're all working in Harm Reduction here but we have to ensure that we really are reducing harm for the clients. In my work I've seen that the really down and out sometimes take 5 years of this kind of care before the real improvements are readily apparent."

It's the cocaine, especially crack, that slows this progress. Researchers are indeed looking at a cocaine alternative that would work as methadone does for heroin addicts but so far there's no such solution. More often than not, thankfully, once the opiate dependence is addressed with methadone the other addictions can begin to be addressed.

"I'm moving out of this neighbourhood. Off the heroin I have a hope of kicking everything else. I wouldn't do the cocaine but down here there's always someone pushing it or just offering it."

As another East End street nurse said,"It's not the addicts that are the real problem, it's the pushers. They're the predators and the addicts are usually just the prey. It's the Vancouver Police that have to deal with them. We're just here for the victims.'

A long time recovered addict likes to say, "I didn't set out as a teen ager with the idea I'd grow up and become a heroin addict. It doesn't work that way. " It's simply not a career choice. It quickly can become one as the disease takes over. First it's fun, then it's fun and trouble and then it's just trouble. The more addictive the substance the faster the downhill progress can be.


robert said...

getting out of the environment is the first big step

Aim said...

Very very insightful!