METHADONE: CURSE OR CURE?

You wouldn't know it by looking at the veins in his arms, but over a
10-year span, 37-year-old Adam injected himself with heroin,
morphine, cocaine and crystal methamphetamine.

There aren't any visible track marks left by the needles, he says,
because he wasn't a chronic user. Nonetheless, through those veins
once surged a number of illicit drugs he wanted to live without, yet couldn't.

Trying to get clean turned out to be a frustrating and drawn-out
battle for Adam.

"It was really difficult to live in that duality. I mean, my spirit
wanted to be clean, but my body and my head still wanted to be an
addict," says the Regina man, who does not want his real name published.

Almost every time he tried quitting, Adam says he would relapse,
which took a toll on his sense of worth. "I just felt that if I can't
get it together to stop doing what's killing me, then what can I do?"

Even overdosing on more than one occasion couldn't scare him into
sobriety. "I used (drugs) the moment I got out of the hospital," he admits.

Today, Adam is no longer a drug addict, and has been clean for nearly
a year. But to get to this point, Adam had no idea it would involve
quitting one of his treatments, which he says turned out to be just
another addiction.

It was the feeling, like a wave of warmth moving through the body,
which Adam says hooked him on the painkilling drug morphine shortly
after moving to Regina more than two years ago.

"It got me out of my skin. It kinda made everything seem like it was
okay. It was comforting."

Struggling with a drug addiction most of his life, he tried to lose
it by moving here from Vancouver when other treatments didn't work.
But the addiction followed him he started buying morphine on the
streets and using it illegally.

Desperately wanting to lose his addiction, he went in search of other
treatments. Aware that methadone was a popular treatment used to stop
the cravings for such opioids, he decided to give it a try.

However, only two months into the treatment, Adam says he wanted
nothing more than to get off it. "I was really dull on it ... There
was just no spark. I couldn't think very quickly. I didn't really
have any motivation or passion for anything, really. I had absolutely
no libido whatsoever. That was completely killed," says Adam, who
took methadone at the Harm Reduction Methadone Clinic in Regina in 2003.

"It's the purest form of slavery there is, really. I mean you're a
slave to it, because you had to go to the clinic in person on a daily
basis and get a dose. It made it hard for me to work certain jobs,"
he says. "If you miss a dose, you might be okay the next day, but
then you start to get sick," he continues, adding that he took
morphine to feel better after missing his methadone dose two times.

Although two other former drug addicts never took methadone
themselves, they agree with Adam's opinion. They all say the
treatments that worked for them made you "do the work" to reach sobriety.

Many intravenous drug users in Saskatchewan, trying to kick their
habit, take methadone. A synthetic opioid similar in effect to
morphine, it is used to treat addiction to opioids, including heroin,
codeine, morphine, Oxycontin, hydromorphone (Dilaudid) and meperidine
(Demerol). It prevents physical withdrawal and physical cravings for
opioids by blocking the effects of the addictive drugs. The effect of
methadone lasts for about 24 hours, thus requiring the addict to take
it on a daily basis, according to Saskatchewan's 2004
methadone-assisted recovery guidelines for addiction counsellors.

In other words, addicts are given a legal opioid in order to help
wean them off other illegal ones.

It is common for opioid withdrawal symptoms to occur within a few
hours after the last dose. During withdrawal, the individual
experiences the exact opposite of the drug effects, including
increased anxiety, pain, uneasiness and agitation. Since the effect
of methadone lasts for about a day, longer than the effects of other
opioids, addicts shouldn't experience physical cravings, according to
the methadone assisted recovery guidelines report.

The report also states that methadone-assisted recovery can be an
important harm-reduction strategy to prevent the transmission of HIV
and other blood-borne pathogens, while helping addicts reduce illicit
drug use, needle sharing and criminal activity associated with opioid use.

Sheila Moore, a nurse for Addiction Services at the Regina Qu'Appelle
Health Region, has handed out methadone from time to time at the Harm
Reduction Methadone Clinic.

"You're hoping that they'll just use one drug instead of a variety of
drugs," she says, adding there is a lot of criminal activity that
goes along with illegal drug use.

When someone wishes to go on methadone, Moore says they go to the
clinic and see a counsellor who asks them about their drug use and
criminal activity history. Then they see a physician who determines
whether or not they will take methadone, which is usually mixed with
lemonade or orange juice, she says.

Urine drug screens are conducted every two weeks to see if the
methadone has any effect or if the patient is taking any other
non-prescribed drugs.

"If you take methadone properly, if you're consistent with it, if the
dose is working well for you, lots of people have jobs, function
well, they get on with living. Their life is not revolved around
sticking something in their arm," Moore says.

Barry Partington, a relief pharmacist for R + C Drugs and the Harm
Reduction Methadone Clinic, mixes methadone and prepares doses for
the patients when he is called in. He says he thinks methadone helps
addicts control their withdrawal and function better.

One local addiction counsellor, who does not want his name published,
has a different opinion about a methadone user's ability to function well.

"I'm certain there are, out of the hundreds of people that are on
methadone, two or three that are doing that," says the counsellor,
who is a former drug addict himself.

"I actually have met a couple of people who are trying to keep their
lives in order and to decrease their methadone. So, there's a couple
that I know. So, the only thing I know is the people who are
successful on methadone are trying their darndest to get off it."

Some people take methadone their entire lives because it keeps them
stable and able to function well, while others try to wean themselves off it.

Speaking from experience, Adam says it was really hard to quit methadone.

"People end up staying on it for years at a time ... It's not really
much of a life either, there's not much freedom involved. I mean it's
really addiction in its purest form. I mean, it's like, here's a
substance that you're given under the guise that it's going to help
you with your quality of life, but it's the very substance that you
need on a daily basis or you can't function. I mean it's pretty much
the definition of addiction -- you can't function in your daily life
without it," he says.

"I think it's part of the problem with Western society in general.
It's like if you feel uncomfortable, just take a pill and you'll feel
better. And I think we're getting really lazy in that respect. You
need to do the work."

When Adam quit methadone, he asked the physician to take him off it
in two weeks, which was much quicker than recommended, he says.

"It was terrible ... But I just wanted off it," he says, describing
his withdrawal as a really bad flu.

"It was more intense than kicking morphine or heroin, because it's
long-lasting. I mean you can basically be over your dope sickness
from heroin or morphine within three or four days, five days tops.
And then you start feeling good again. Methadone took me three weeks.
I was kind of lethargic, achy and flu-like for a long time."

The number of people prescribed methadone in Canada has risen
significantly in recent years, according to the methadone-assisted
recovery guidelines report.

In Saskatchewan, there were less than 200 methadone clients in 1997
and more than 1,300 in 2003. Saskatchewan Health has encouraged the
development of guidelines and the adoption of best practices to
support the delivery of methadone-assisted recovery services.

From what Partington says he has seen over the last few years, there
has been an increase in the number of methadone clients coming to the
clinic. He says the clinic sees approximately 250 clients per day who
take their dose in front of a witness, and another 50 or so who take
their prescription home with the consent of a physician.

"The majority are addicted to morphine," he says.

Last August, the provincial government announced its three-year plan,
Project Hope, to prevent and treat substance abuse. The government
says it is committing $10 million for the plan, based on 15
recommendations contained in the report Healthy Choices in a Healthy
Community by Healthy Living Services Minister Graham Addley, who was
directed in January 2005 to review all substance abuse services.

The government says implementation of most of the community-based
services and some residential services are supposed to begin this
year and in 2007.

A 2002 Health Canada literature report indicates that methadone
treatment is effective in reducing opioid use and stimulant use,
including cocaine.

This wasn't the case for Adam, who continued using cocaine and
drinking alcohol throughout his methadone treatment.

"(Methadone) is really a central nervous system depressant, and so is
alcohol, and the danger with cocaine is that because you're already
sort of on a low level, kind of depressive state, you have a tendency
to want to do larger amounts of cocaine, which can stop your heart,"
he says, adding that most of the people he knows who have taken
methadone were also using cocaine.

Stu, a former drug user living in Regina, agrees with Adam about the
dangers of mixing methadone and cocaine.

"Methadone helps them get off the drug, right? OK, I'm all for that.
But what happens when they don't have a solid footing in their
recovery and they go back out there? Now all of a sudden, they've got
their former addiction that they're probably going to go back to,
they've got an addiction that's even stronger than heroin ... It's
extremely dangerous to be using coke and methadone."

Moore says the effectiveness of methadone depends on the person and
the choices they make.

"If they took their methadone and that's all they took, it would work
a lot better for them," she says.

The addiction counsellor says it's hard for addicts to take methadone
and refrain from using other illegal drugs at the same time.

"We deal with lots of people who come into detox because they're
trying to get off other drugs and they've been on the methadone
program for years. So, that tells me it isn't working ... If you give
me a drug to get me off drugs, I'm still taking a drug. I'm not
facing whatever it is that needs to be faced. I'm not working with
it," the counsellor says.

Moore says she hears quite a few people say that methadone is another
drug and another addiction, but she says it has its benefits.

"I hear that from a lot of health-care professionals too, who don't
have a lot of faith in it, you know, because (addicts) want that
methadone. But, you know, they're not sticking something in their
arm. There's so much hepatitis and HIV out there and it's dangerous.
So, maybe it is another drug. The harm-reduction drug works very
effectively for the majority of people," she says.

Addley's report points out that among the province's estimated 3,500
to 4,000 injection drug users, the risk of contracting and spreading
HIV and hepatitis C through needle sharing is significant.

Even though he says he never shared needles, Adam contracted
hepatitis C while he was using drugs in Vancouver. He says he assumes
it was by sharing water with an infected person.

Methadone may be successful in reducing injection drug use and the
spread of disease, but Adam, Stu and the addiction counsellor say
there are alternative recovery methods that worked for them,
including abstinence, group therapy and spirituality. They also say
that it was a long and difficult road to recovery.

Adam says he realized drugs could change his mood when he was
prescribed Ritalin at a young age. After that, he started to
experiment with codeine, marijuana and alcohol.

"It became a way of coping with an unhappy home life," says Adam, who
used to live with his mother and stepfather. "My parents had lots of
stuff around the house."

He also says he would isolate when he used drugs, which was very
risky, especially with heroin.

"It wasn't my idea of fun, for one thing. I just didn't associate it
with being a social thing. I mean I would be social in situations
like that, but I would hide the fact that I might have been stoned,"
he says, adding he hid his addiction because of the stigma attached to it.

When coming down off a high, Adam says he usually had suicidal thoughts.

He never tried to commit suicide but said: "I wrote a suicide note
one time and I read it the next morning when I sobered up, and it was
like the most pathetic thing I'd ever read in my life. It was awful.
So, that kinda stuck in my mind."

Right before he started putting more effort into getting sober, Adam
says he was in pretty bad shape. "It was destroying my life. I just
couldn't cope with anything," he says. "I was having a hard time
holding down a job. I couldn't maintain any relationships with
people. My health was suffering."

During that time, Adam describes himself as looking very gaunt and
pasty. "I just felt weak all the time."

He says he appreciated having the support of loved ones, but
ultimately, it was up to him to quit taking drugs.

"I've tried to stay sober for other people in the past, and it never works."

Stu, who was addicted to many drugs, including crack cocaine, heroin,
Valium, PCP, LSD, marijuana and alcohol, says he attributes his
recovery to abstinence and spirituality.

A few months ago, he volunteered at Pine Lodge Treatment Centre --
the same facility he says helped him get off drugs.

"It's my responsibility as a member of a 12-step program to carry the
message to people who are still suffering," he says. "One of the
things about addiction is it's a selfish disease. I mean, I took, I
took, that's all I did ... If (addicts) can learn from my mistakes,
then I'm really happy for them.

"If you wanna quit, then quit ... I think you need to feel the pain ."

It took the addiction counsellor a lot longer to quit, but he has
been clean for almost 17 years. He says he was a junkie in Vancouver
back in the '70s, but moved to Regina to find a new lifestyle in 1981.

However, his drug use didn't stop then.

"Mostly I was doing pretty good, but I woke up in the morning and I
would vomit blood, because I drank every day. And I would have a few
drinks to steady my nerves. I shook like a 90-year-old man. Then I'd
do a few lines of cocaine because I didn't want to be drunk when I
went to work. Then I'd put on my tie and go to work," he says of his
drug days. "The problem is, when you're in that drug culture, the
non-drug culture looks like Sunday school, and it's really scary. And
it isn't Sunday school.

"I'd like to get dramatic and say I got off heroin cold turkey, but
the reality is I got off heroin by staying drunk for an additional 10
years and doing lots of cocaine," he admits.

In the end, though, the counsellor says abstinence worked for him.

"You learn how to live without the drugs, and it's hard."