First in a three-part series examining the effectiveness of the province's methadone treatment program for drug addictions
The first time J.J. tried to detox, he thought he was going to die.
"The sickness is probably comparable to somebody's last few days of cancer," he says, describing constant diarrhea, vomiting, muscle aches, joint pains and cravings.
As he came off heroin in the Vancouver Harbour Light, J.J. didn't know he'd start using again.
And again.
People don't die from coming off opiates like heroin, OxyContin and morphine, but most addicts will tell you that they want to.
The success rate of detoxification is low, but in the past few years there's been another option for addicts in this province - methadone.
But even methadone advocates will say it doesn't work for everyone and it can have serious side effects.
Used properly, it can help some people change their lives.
This time around, J.J. is using methadone.
"It's not the magic cure. There's a whole lot of other shit (you've) got to deal with. And I'm one of the lucky ones," he says, looking down at his two-year-old son playing with colouring books on the floor of the St. John's apartment, where the boy lives with his mother.
After getting clean and clear of the heroin he'd gotten hooked on in jail in British Columbia, J.J. came back to his home province to attend college in Labrador.
When his father died, and he and his girlfriend broke up, he got back on the drugs. This time it was OxyContin.
He went to a doctor while he was in St. John's for his father's funeral and said he was trying to get weaned off the drugs.
At the height of the OxyContin crisis, J.J. was prescribed seven tablets of OxyContin a day.
His sister did the same and was prescribed 12 tablets a day, J.J. says.
The high from OxyContin is exactly the same as from heroin, he says.
But once he started methadone, even when J.J. tried to get high, he felt nothing.
"It blocks the buzz completely."
Now J.J. has started weaning off the methadone, a milligram a week. He has 39 mg to go.
He cares for his son regularly and is looking for work for the first time in years.
"It's a nuisance to me now, but I don't want to rush getting off it," he says.
"Once I get off methadone I know I can get a buzz off Oxy again. ... You do Oxy two, three days in a row and you'll be hooked."
For years, the addictions treatment program in St. John's had treated people for alcohol, marijuana and cocaine additions.
Then the first OxyContin junkies walked through the doors.
Barry Hewitt, the head of addictions services, says things changed in the capital city when OxyContin appeared here earlier this decade.
Treatment at the recovery centre changes shortly after.
The addicts came from everywhere, Hewitt recalls.
Some of them had legitimate pain and were prescribed OxyContin and became dependent on it. Others were buying it on the street.
By the time the OxyContin task force sent out its final report in 2004, Hewitt and others working at the Pleasantville recovery centre had gone from seeing the odd narcotics addict to more than 100 within two years.
That number didn't include addicts still on the street who weren't looking for help.
"One person actually brought in a picture of himself and said, 'This is who I want to be again.'" Hewitt says.
Prostitution, thefts and armed robberies were on the rise.
Residential and commercial break and enters were up roughly 30 per cent in 2004 over 2003, and armed robberies doubled.
Then, in 2005, an explosive story broke about a St. John's physician, Dr. Sean Buckingham, who had been prescribing drugs in exchange for sex.
Suddenly, "OxyCodone," "needle exchange," and "detox" became household words in what had been thought to be a relatively crime-free, drug-free city.
Five of the 50 recommendations of the OxyContin task force were related to using methadone to treat OxyContin addiction.
Today, methadone is prescribed and distributed by a handful of doctors and pharmacists specially trained in the use of the drug for about 600 addicts across the province.
There is no average addict, Hewitt says, but many of the people he sees are young men who have been using for five or six years.
The waitlist at the treatment centre has more than 60 names on it, and there are waitlists at doctors' offices as well.
Methadone, a synthetic opiate, was created to battle heroin addiction in veterans of the Second World War, who became addicted when heroin was used as a pain-management alternative to morphine.
The breakthrough with methadone was that it gave relief to those going through the sickness of withdrawal and also blocked receptors for opiates, meaning that users couldn't get high from other opiates when they were taking the drug.
Users can, however, still get high from some drugs, like cocaine and marijuana.
Experts say another benefit of methadone is that a person isn't impaired when taking it. That's why it's regularly prescribed to people who are suffering from chronic pain.
Advocates for the use of methadone say it's a proven way for addicts to "get their heads straight," and stabilize their lives.
Then the weaning process begins.
"We don't tell a person how long they should be on methadone. A person decides for themselves how long they want to be on (it)," Hewitt says.
"It's only when they get down to the lower doses ... that's when the scary part kicks in. That's when some of the triggers happen and the anxiety comes up. That's when you need the most resources."
Hewitt says frankly, as long as people are seeing the benefits of methadone, he doesn't care if they stay on it for life, though that doesn't happen often.
And no wonder. People don't want to have to visit a pharmacy every day of their lives. They want to be able to travel or move without the hassle of having to have prescriptions transferred and finding new doctors and pharmacists and building relationships with them.
"It's not an option for everyone because you've got to be committed and it regulates your life," Hewitt says of methadone treatment, adding that it's difficult to maintain it in rural areas.
In some parts of the province there are no doctors prescribing methadone, while in other parts there are no pharmacies selling it, meaning some people have to travel for one or the other.
The success rate of methadone treatment is boosted greatly when counselling is a part of the program.
It was a particular problem with the program - a lack of doctors and pharmacies treating addicts in St. John's - that got Dr. Jeff White involved.
White was looking for a new focus for his career when he read a story in The Telegram about a couple who'd had their child removed from their care because of their addictions. The couple said they wanted to get off OxyContin and they had to move to central Newfoundland for methadone treatment.
White knew no one in St. John's was prescribing the drug and decided to get training through Health Canada.
"I thought this might be an interesting sideline at the time, but it certainly blossomed into a busier practice than I'd expected," White says.
About 70 per cent of his patients - 300 people - are on methadone.
He'd like to see more doctors and pharmacists taking part in the program.
"I think what deters the other doctors is the clientele. ... The training is not difficult, it's not long."
People are in need of help, he says.
And though OxyContin is still on the street, White says he hears regularly that methadone's out there too.
Most of the addicts who come to him now say they've tried methadone before.
It's actually cheaper than OxyContin on the street, White says.
And though the methadone program in this province is one of the strongest compared to others in North America and the U.K., some things are still lacking.
FAST FACTS
All about Methadone
Methadone was developed in Germany as a substitute for morphine.
In the 1960s, researchers in the United States used methadone to help some veterans kick the heroin habit they developed in lieu of taking morphine during the Second World War.
Further research by Canadian doctors helped create the first methadone maintenance treatment program in British Columbia in 1963.
Methadone is one of two drugs regularly prescribed to deal with addicts' cravings.
National guidelines for prescribing methadone were introduced in 1972.
Source: Health Canada
METHADONE BY THE NUMBERS
Pro Semibold Cond>$7-$10 the cost of a single dose of methadone.
Pro Semibold Cond>$50 the cost of a single 80-milligram tablet of OxyContin on the street.
Pro Semibold Cond>46 Number of community pharmacies in the province permitted to distribute methadone, not including the methadone program or hospital pharmacies.
Pro Semibold Cond>60-100 number of milligrams of methadone addicts tend to start on.
Pro Semibold Cond>124 the number of people in the methadone treatment program.
Pro Semibold Cond>64 the number of people waiting to get into the program.
Pro Semibold Cond>592 the number of people in the province prescribed methadone as of Oct. 15.
Pro Semibold Cond>550 the number of estimated injection drug users in this province in 2007.
Pro Semibold Cond>6,000 the number of clean needles provided through the needle-exchange program through the AIDS Committee of NL in 2006.
Pro Semibold Cond>$625,000 the annual budget of the methadone treatment program, which goes to salaries, medical supplies, office supplies and groceries (fruit and coffee for staff and addicts).
amorrissey@thetelegram.com
Saturday: Part 2: The controversy.
Is methadone good medicine or just another opiate for addicts?
.jpg){kind=small}
.jpg){kind=small}
