Ireland Drug Czar Condemns Long-Term Methadone Maintenance

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Published: 30th March 2009
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The Obama administration and all state legislatures could learn a lesson from Ireland, where John Curran, Ireland's minister for drugs strategy, has called for a review of methadone addiction, and how effective methadone programs actually are at getting people drug-free.

Ireland's Minister of State, John Curran, wants the country's national health service to overhaul methadone replacement therapy programs to reduce the death toll among former heroin users, and reduce the numbers who stay on methadone for years without ever being placed on methadone detox and rehab to recover drug-free lives.

Methadone helps block withdrawal symptoms for someone coming off opiates, and is usually used to help addicts reduce or stop their use of substances such as heroin. Unfortunately, methadone is just as addictive as heroin, and methadone detox can be even more difficult than withdrawing from heroin.

"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 program."

But reducing the dosage of methadone in a taper-off program is almost impossible, because withdrawal symptoms are immediate and severe. Methadone detox is a ferocious experience, which few ever complete. One source claims the actual rate of full recovery among Ireland's registered methadone users is less than 3 percent.

Methadone detox is so difficult, in fact, that most methadone detox facilities refuse to treat addicts on any but the lowest of maintenance doses. Yet because long-term users take more and more as time progresses, most people on methadone replacement therapy are routinely taking 3, 4 or even 5 times the acceptable dosages for most methadone detox programs, effectively removing any hope for a drug-free future.

Here in the U.S., methadone replacement for opiate addiction is a multi-million-dollar industry that is getting almost no one off drugs in the long term. Thousands of addicts are still on methadone after many years, all people who could potentially recover their lives through methadone detox and rehab programs if these were made widely available. The new administration in Washington could learn a thing or two by paying attention to what's being planned in Ireland.

Nearly 20 percent of all drug-related deaths in Ireland come from among the 8,600 registered methadone users. Thousands of former heroin and other opiate addicts on the country's methadone programs are not being steered off the drug into methadone detox and rehab. And many are combining it with illegal substances, say critics of the programs, which is what leads to most overdose deaths.

Curran said the health service 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, he added.

While methadone helps heroin addicts stabilize their "chaotic lifestyles", Curran says he believes that this period must eventually be used to reduce the dosage to help former addicts progress to a drugs-free lifestyle.

"When a person enters drug treatment they should have a realistic prospective of becoming drug-free," Curran said. "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 Ireland's new national drugs strategy would set demanding but achievable targets to tackle the problem of substance abuse in Ireland.

Here in the U.S., there are a few methadone detox clinics that do accept high-dose methadone patients, and achieve excellent end-results while helping patients avoid the worst of withdrawal symptoms.

Steve Hayes, clinical director at Novus Medical Detox in Pasco County, Florida, said his clinic offers such a program. Hayes explained that a workable methadone detox must take into account everyone's unique DNA and metabolism, unique health situation, and personal and private issues, along with 24/7 medical supervision.

"Cookie-cutter detox programs, and taper-off-on-your-own programs, don't even begin to deal with these important aspects of methadone detox," Hayes said. "Such programs have a high rate of failure, and frequent reversion to methadone addiction," he added.

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