CRACKING THE METHADONE MYTH

Breaking free from the shackles of drug addiction

He was a healthy, hardworking stiff with a house almost paid for, perfect
credit and a solid job, but within six months, it was all gone. Now, $15,000
in debt, he's jobless and homeless.

To endure excruciating pain from injuries suffered in a 1995 motorcycle
accident, he was prescribed Percocet, a narcotic painkiller, so he could
work. Soon he was buying it on the street, swallowing handfuls at a time.
Then a friend suggested injecting Dilaudid, a synthetic heroin -- "the
Cadillac of drugs" -- and he started shooting up, eventually, three times a
day.

"I lost my interest in women. Heroin was all the sex I needed. When I
scored my drugs, it was like foreplay. Mixing it was intercourse. Then I
whacked it -- orgasm. It was heaven. For the next six hours, I'd smoke
cigarettes and watch TV."

But over time, the highs diminish, the afterglow fades and the light
ultimately dims and dies out. You don't get the same rush. You can't even
get high anymore. All you can seem to do is keep the dope sickness at bay,
he says.

Today, after a history of hassles at his last job by his union about using
methadone to kick his $150-a-day habit, six failed cold-turkey attempts,
with two break-and-enter charges pending and the prospect of going to jail,
Johnny is back on methadone, convinced it is his only salvation.

Methadone is a long-acting narcotic developed by the Nazis and originally
called "Adolphosine."

In 1964, two American doctors, husband and wife Vincent Dole and Marie
Nyswander, found oral doses of methadone helped opiate addicts break their
addiction by eliminating their cravings and normalizing their physiological
functioning.

Methadone, a clear liquid, produces no high. When mixed with orange juice
and taken orally once a day, it relieves withdrawal symptoms and reduces
cravings. Many use it safely their whole lives.

"There's a lot of misinformation and mythology about methadone and heroin,"
explains Dr. Bobby Esbin, a family practitioner with a special interest in
methadone maintenance and counselling to help people overcome opiate
addiction.

Many people believe prescribing methadone is substituting one addiction for
another. Not true. He stresses with professional help, family involvement
and exposure to positive role models, methadone is simply an adjunct, a
therapeutic tool to help people break free from the shackles of addiction.

"In detox or in jail, they'll dry out. In a 28-day rehab program, they deal
with the physical aspect of their dependency, but not the psychological
addiction," says Esbin. "The first thing some do when leaving rehab is score
more drugs."

Johnny has no alternative. "For me, it's either death or methadone.
Otherwise, I'll end up killing myself," says the 31-year-old Oshawa factory
worker, desperate to regain his dignity and rebuild the life his addiction
has annihilated.

Heroin belongs to a family of drugs called opiates, which are all refined
from raw opium. Opiates mimic the brain's natural pain-relieving,
euphoria-producing endorphins. Other opiates include prescription drugs --
morphine, Percocet, Tylenol 1, 2 or 3, even cough syrups with codeine -- all
true narcotics.

A survey of 25,000 U.S. households found 2% of men and 1% of women had used
opiates at least once, but only 0.2% were currently dependent, says Dr.
David Marsh, clinical director for addictions at the Addiction Research
Foundation (ARF) division of the Centre for Addiction and Mental Health.

Increasingly a drug of choice, popularized by the "heroin chic" of high
fashion and heroin-addicted pop icons like Courtney Love and the late Kurt
Cobain, today's Ontario population of 20,000 opiate users (15,000 in
Toronto) is heterogeneous, from every socioeconomic, racial and educational
sphere of society -- university graduate students, Bay Street lawyers,
nurses and high school dropouts, says Marsh.

"In most countries, 0.2% of the population is currently dependent on
opiates. The number is increasing. More heroin of higher purity is being
seized by police and its price is down on the street," he says.

American statistics show the number of 12- to 17-year-old heroin users is
higher than has ever been because heroin on the street is so pure. About 30
years ago, when it was only 10% pure, people injected because they got a
better bang for their buck. Now, at 40% to 45% purity, they need less to get
the same bang, so many are smoking or snorting it.

Another myth, stresses Marsh, is that with one hit of heroin, you're
automatically physically dependent. Cancer patients given narcotics for pain
don't become addicted.

Larry Corea, program co-ordinator of addiction treatment at Parkdale
Community Health Centre, defines addiction as "a chronic relapsing
condition. The first time people use heroin, they usually get sick and
vomit. After a few times, they can become dependent and go through
withdrawal if they don't have it."

A complex interplay of the psychological and neurochemical, "addiction is
the craving, the looking for the drugs," says Dr. Harold Kalant, professor
of pharmacology at U of T. "It's the fundamental problem. Physical
dependency is a sign of an adaptive change in the brain. With repeated
exposure to drugs, you develop a tolerance and must use increasing amounts."

Once addicted, you use compulsively, you lose control of your use and you
use in spite of adverse consequences.

The other component of addiction is withdrawal, the roller-coaster on which
it traps the addict. When heroin wears off, violent cravings begin. Off
heroin, you go into withdrawal.

"Your hair's on fire," recalls ex-junkie Jeff Ostofsky, 41, shuddering. He
had an 18-year drug habit and is now maintained on methadone. He works at
the City of Toronto's Methadone Works program he co-created, where he's an
activist, advocating for addicts on methadone.

"Withdrawal is like the worst case of flu you can imagine,with diarrhea,
puking, joint pain. You can't walk up stairs. Then there's the crippling
dark depression that comes with it."

Physically hyper, curious, a self-described risk-taker, Ostofsky started
using pot and hash at 13, then acid. At 18, a close friend turned him on to
heroin. Snorting it at first, it wasn't long before he was shooting up
whenever he could.

"I wasn't physically addicted for the first four years. Heroin was hard to
get. Gradually, I used more frequently and, in between, took prescription
painkillers like Percodan."

Between bartending and working as a roadie with rock bands, Ostofsky battled
his $150-a-day habit, injecting heroin two to three times a day. "I would
have used four to six times, if I could have afforded it," he admits.

Wait-listed for methadone, he tried detox and 28-day rehab. Nothing worked.
By 1993, desperate to get off his merry-go-round, Ostofsky holed up at his
sister's in Newmarket to go cold turkey. After two days, "I walked three
miles with the intention of robbing a drug store," he says. "But I
couldn't."

Instead, he went to the Queen-Dufferin Medical Centre, where he was told it
would take three months to get on methadone. "I told them my wife was about
to give birth. They made me bring her in, and by Monday, I was on the
program."

When his son was born 10 days late, Ostofsky was feeling stable and
motivated. "I never had a moment's discomfort on methadone, but I still
crave. You can never forget how good it feels."

Historically, opium addiction wasn't a major social problem or even illegal
until the turn of the century. Heroin was refined in Germany in 1898, so
named for the heroic feelings of invulnerability and self-esteem it gives
the user.

Society's attitudes towards drugs and alcohol gradually changed by the early
1900s, explains Dr. Mark Latowsky, a family practitioner and addictions
specialist, who ran ARF's methadone program from 1992. He now works for
First Step Medical Clinics, four private methadone clinics in Greater
Toronto.

"At that time, moral reformers spearheaded a temperance movement to prohibit
alcohol consumption within society. Demon drugs, including alcohol, were
bad, viewed as the cause of all societal ills. Negative social values were
attached to deviant behaviours. The solution? Prohibition, punishment,
incarceration or abstinence," he says.

Drug use was criminalized and even with Dole and Nyswander's 1964 discovery
that addiction is a medical metabolic disease, these legal, social, moral
and political attitudes stuck. Research continues to prove opiate addiction
causes physiological changes in the brain. Now methadone maintenance to
treat this disease of the brain is compared to insulin in controlling
diabetes.

"Goals in treatment are shifting from abstinence and punishment to
normalization of function and better quality of life," Latowsky says. On
methadone, addicts reduce heroin use, curtail their criminal behaviour and
minimize their risk of HIV, hepatitis C infection and overdose. They can
work. Even if they occasionally use, they reduce the potential for harming
themselves and society at large.

Harm reduction This goal of "harm reduction" is a range of interventions
aimed at "decreasing the costs to the person addicted and to society,"says
Marsh. But, certainly with only 4,000 or 20% of Ontario addicts on
methadone, it is by no means a panacea.

"It's a management strategy for life," says Corea. "You build an individual
treatment plan for the long term where you substitute a long-acting opiate
for a short-acting one."

Still, methadone isn't for everyone. U.S. journalist Susan Gordon Lydon
chronicles her 25-year drug habit in Take The Long Way Home -- Memoirs Of A
Survivor (HarperSanFrancisco, 1993) and violently opposes it.

Vicious stigma "It enables some people to live a semi-normal life, but I
tried methadone and I think it is a heavy addiction, an evil drug," she
says. "Using it, you're very far from clean."

In 1986, after years of prostitution, crime, even prison, she went into
detox, followed by a two-year residential rehab program at Boston's Women,
Inc. "Women need a different kind of treatment model because they have
different issues."

Still, a vicious stigma remains for some methadone patients: "If I go to
emergency with an injury, I can't tell anyone I'm on methadone or I'll be
denied pain medication because of the prejudice," says Ostofsky. "Even
12-step programs, like Narcotics Anonymous, reject you."

"For someone on heroin, his next injection could be his last. He's a walking
time bomb," says

Ingested raw opium "Prescribing methadone forces addicts to hook into the
real world. It's Life 101, where they must keep doctor's appointments, go to
the pharmacy daily, give urine samples. It forces them to structure their
lives, but they must also open their lives to scrutiny, confront their
demons. They need a lifestyle transplant -- skills, jobs, self-esteem,
respect."

"It's been a constant battle with fatigue," Anne admits. "But I never
thought of opium again, or wanted it, or desired it. I just needed help to
get off it. Now, I've never felt better."

In 1996, with a new, pragmatic set of guidelines, Ontario made methadone
maintenance more accessible to hundreds of desperate opiate addicts on long
waiting lists.

Meanwhile, Komal Khosla, who trained as a pharmacist in a Boston veterans'
hospital, was working in a downtown Toronto pharmacy that dispensed
methadone. He didn't like what he saw and began devising a new approach to
methadone.

Today, he's senior vice-president of First Step Medical Clinics, with 20
doctors assessing and counselling 600 patients annually. He's committed to
providing quality support by building trust and treating them with dignity.

"But we have to convince people addicts are worth saving and that it's
cost-effective," he stresses.

A New York survey found the annual cost to maintain an opiate addict
untreated on the street was $43,000; in jail, $11,000; and on methadone
maintenance treatment, $2,400.

"We get no government funding for counselling patients like publicly funded
institutions," says Khosla.

Humane weapon Norman Panzica of the Council on Drug Abuse says, "Being an
addict shouldn't be a crime in Canada, yet too many addicts are treated like
criminals by people who might help them, like some professionals they come
in contact with. Sad, but true."

Latowsky adds: "It's well accepted many of the social problems of addiction
stem from criminal laws. Addiction isn't a moral problem."

"I have a medical condition for which I take medication," Ostofsky says. But
experts agree methadone is not the whole answer. It is, however, an
effective, humane weapon in the fight to relieve the suffering of addicts
and those around them.

For help, call the A-R-F Assessment Service at 416 595-6128.

For Anne, a 38-year-old single mother requesting anonymity, methadone has
helped her beat her five-year addiction to raw opium, which she'd ingest
twice daily, in pinhead-sized pieces with a cup of tea. "It gave me energy
and endurance," she says.

In a few weeks, this university-educated financial consultant from an
upper-middle class Toronto home will be beating the odds, as she tapers off
methadone, becoming totally drug-free.

But it's been no cake-walk. Last January, she dreaded her $300-a-week habit
was getting out of control. "I was afraid things would fall apart. I didn't
know about methadone. ARF told me there was nothing for me, that opium
didn't apply."

By August, frantic after numerous doctors refused to see her, she heard
about Esbin, who saw her immediately and assessed her. Four days later, he
started her on methadone and has been counselling her every week.

Checked-by: Don Beck