HOPE FOR FREEDOM FROM 'LIQUID HANDCUFFS'

A funding boost has brought new hope for opioid addicts, writes YVONNE
MARTIN.

'Liquid handcuffs" is how Mary Smith describes the Christchurch methadone
programme and the constraints put on her life by a strict medication regime.

The 34-year-old Whitecliffs mother of three girls, is one of about 4045
people in Christchurch who are addicted to morphine-based drugs or opioids.

Experts estimate 1700 to 3400 addicts use illicit drugs bought on the
street. But Ms Smith is one of the 645 so-called "lucky" ones on the
methadone maintenance programme. Instead of paying for her $100-a-day drug
habit through prostitution, she receives controlled daily doses of methadone
from a pharmacy and two-day "takeaways" for weekends.

The liquid is bitter to swallow, says Ms Smith, and so is the regime she
must comply with to stay on the programme. More than 80 people on the
waiting list for treatment would eagerly trade places with her.

Ms Smith makes a 60km return journey each day from Whitecliffs to the city
to get 60mg of methadone. Petrol costs $120 a week, and is only partially
covered by a $46 disability allowance.

A proposed Christmas trip to Southland to see family had to be abandoned
this year when it became too complicated trying to find pharmacies that
would dispense methadone along her travel route, she says.

"It left no room for the unexpected like the car breaking down. It became
such a stressful endeavour that I gave up."

Ms Smith says the daily trip into town has also curtailed her ability to get
a job close to home. The earliest she can pick up her methadone in the city
is 8.30am and it would be near impossible to dash out for methadone during a
lunch hour. Taking methadone also brings Ms Smith out in sweats, which can
be a social cringe.

But despite the negatives, she admits she is better on the programme than
off it. Her daughters agree, it is the best thing that ever happened to
their mum. It has enabled her to kick prostitution, study law at university
and be a better parent.

"I'm much more stable. I have money to buy food and I'm able to concentrate
and study at varsity," says Ms Smith.

"And I'm able to be a proper parent to my children. They are my life."

Her experiences are reflected in a new study by Healthlink South's
alcohol-and-drug service acting clinical director Steve Duffy, which found
the benefits of the methadone programme far outstrip the negatives.

His work follows on from a high-profile study several years ago by
Christchurch clinical psychologist Simon Adamson of 60 addicts on the
programme's waiting list and how they paid for their habit.

Its most memorable finding, often used to back up calls for more funding for
programmes, was that addicts each stole $1100 a week to pay for their
illicit drugs.

The wait-list study also covered the day-to-day difficulties of those
queueing to get treatment: high cost of opioids, risky income sources, slum
housing, physical illness, stigmatisation, and low self-esteem.

Dr Duffy's study picks up where the last one left off, tracking 23 of those
addicts to see the difference the programme has made to their lives after
one year.

It found that crime rates among addicts plunged as they reduced their use of
intravenous opioids, while their general health and social functioning
improved. Nearly 70 per cent of patients reported that they had abstained
from "shooting up" in the month before they were questioned.

Cannabis use stayed the same. Most patients used cannabis more than once a
week. Dr Duffy says this was probably a reflection of their lifestyle. There
was a significant reduction in the use of sedatives, mainly benzodiazepines,
often used by addicts to reduce unpleasant symptoms when they are
withdrawing or short of opioids.

Alcohol consumption remained low, averaging less than once a week. Dr Duffy
says opioid and cannabis users often said they avoided drinking alcohol.

The big change was the impact on crime. Dr Duffy suggests that over all,
there was an 85 per cent drop in reported crime by those on treatment. Most
reported they were crime-free. Those still regularly into crime were drug
dealing or involved in fraud, rather than burglaries.

As well as reduced offending, patients led more stable lives, had more
personal support, less conflict, and less illness. They reported leaving
their old circle of drug-taking friends, but had difficulties establishing
new friends and relationships.

Rates of depression, very high in the waiting list study, had reduced
significantly since people had begun treatment, but were still higher than
in the general population.

While the results were encouraging, Dr Duffy admits the study has its
limits.

Patients who were doing well, with a regular address and phone number, were
easier to contact for the survey and more likely to be satisfied with their
treatment.

More women than men took part. There were no Maoris. More women used
prostitution as a source of income - which is not a criminal offence.
Increased numbers of women in the survey would show up in the results as
less offending, says Dr Duffy.

His results also mirrored those from a study of treatment by the Otago
methadone clinic released earlier this month. About 65 per cent of patients
stopped using illegal opioids and 90 per cent of those who had been sharing
needles and syringes quit the risky habit.

Almost one in three ceased to be beneficiaries and their rate of employment
and training doubled.

The Health Funding Authority spends $6.8 million a year on methadone
treatment - $1.3 million of that in Christchurch - and another $6 million to
$7 million on dispensing the drug. It has just boosted methadone funding for
the year 1999-2000 by $600,000, which will treat another 300 people
nationally.

Christchurch is getting $85,000 of that, boosting places on the programme to
665.

But it is like pouring money into a bottomless cup. The present waiting list
of 80 people - they wait about eight months - is not a true reflection of
the numbers wanting treatment, says Dr Duffy.

When new funding is announced, hopes rise and the size of the waiting list
grows.

When some people gain a position on the programme, their place on the
waiting list is quickly filled.

"It's a bit like drilling for oil," Dr Duffy said. "People keep seeping out
of the ground.

"I would say that there's a potential capacity for 50 to 100 per cent more
places to be filled."

Patients have been on Christchurch's programme for an average of three
years. Unlike clinics in the United States, it does not put pressure on
patients to withdraw from methadone.

Of those who do withdraw, it is not known how many stay off opioids.