Source: Halifax Daily News
Contact: letters@hfxnews.com

New drug, new life

Methadone program offers addicts the chance to escape the vicious
cycle of chasing the next high

By SHAUNE MacKINLAY The Daily News

ESSIE HICKEY WAS an impressionable 17yearold from a nice family when
she first put a needle in her arm. It was more about fitting in and
impressing a man she had a crush on than it was about getting high,
she says.

"As soon as I did use, I was in the clique," says the Halifax woman.

Hickey was 37 20 years older than she was when she first felt that
rush through her veins when she got serious about quitting. Her
answer was methadone, another opiate. But this drug came from the
provincial Health Department's Drug Dependency Services.

At 43, she leads a relatively normal life, far removed from the days
of living to feed her addiction.

While she was shooting up with intravenous drugs, Hickey dreamed of
being a teacher, getting married, having children. But after two years
at Saint Mary's University she dropped out.

`Chasing the drug'

As long as I quit using by the time I'm 25, she told herself, I can
still make something of my life. At 25 and still shooting up with
heroin, morphine, or whatever opiate she could get her hands on, she
decided 30 wouldn't be too late.

In those years, she managed to hold down waitressing jobs but spent
her hours off "chasing the drug."

Another hit

She didn't resort to some of the more common ways to get money,
prostitution and shoplifting, but she did the driving for people
willing to rip off stores to get things they could sell or trade for
drugs.

"I would go home and get sleep and I'd get up early and rush in town,
drive people around, make some money, get a pill to go to work, get to
work, and as soon as I have enough tips to get another pill I'd call
somebody like a cabdriver that ... would deliver the pills," she says.

At the end of the night she'd have enough money for another hit before
heading home to sleep.

Mornings were the worst. She would wake up sick, an early sign of
withdrawal, then scramble to find some drugs before she went to work.

Whenever she came down, the guilt about what she had done to the
people she cared about rushed in as fast as the body aches, sweats and
chills of physical withdrawal.

"As long as you are high, you can deal with those things," she says.

Now she starts her day with a methadone and Tang drink to keep her
physical addiction to other drugs at bay. Hickey does the rest.

Methadone works basically the same as any other narcotic drug, says
Dr. John Fraser of Halifax's North End Community Health Centre.

Longterm IV drug users have long since stopped getting high, he says,
but they have a physical addiction to the drug.

"The reason why they need their opiate is so they don't get sick from
withdrawal,'' he says.

Methadone is just as addictive as other opiates, but it allows drug
users to function normally. Because it is longlasting, it can be
taken once a day, freeing the user from what Hickey calls "chasing the
drug."

"Basically you can live a normal life. It doesn't affect your body in
any significantly negative way,'' Fraser says.

Most metro opiate addicts use prescription painkillers such as MS
Contin a form of morphine and dilaudids, says Shaun Black,
supervisor of pharmacology programs for Drug Dependency Services. They
come in pill forms, but are broken down and injected. Heroin is out
there, but only in small quantities, he says.

To ensure the powdered methadone won't be injected, it's dissolved in
water or Tang by a pharmacist. Getting rid of the needle reduces the
risk of transmitting the AIDS virus and hepatitis through dirty
needles.

"It's a harmreduction approach to look at minimizing or reducing the
harms, not necessarily with the drug, with the method of use, the
injection," Black says.

Hickey spends her days working at Mainline needle exchange in
Halifax's north end, seeing drug abuse from the other side of the
counter. She is also chairwoman of the Community Methadone Advisory
Committee.

`Blank piece of paper'

The committee was created to respond to a lack of programs for opiate
addicts like Hickey. Drug users, former users, methadone users, First
Nations representatives, the AIDS Coalition, health professionals, and
Drug Dependency, were included in the development of metro's community
methadone program.

"We started with a blank piece of paper and made a program," says
Hickey.

Black says the old methadone program's underlying theme was
abstinence. It was thought that if a user could substitute methadone
for another opiate they should then progress to being drugfree, he
says.

Drug Dependency first began a trial methadone program in 1990. Hickey
was one of the participants, but was kicked out when it was discovered
she had shot up.

The lack of tolerance for transgressions was only one of the program's
shortcomings. The methadone could only be accessed through Drug
Dependency at the Nova Scotia Hospital site so for some users that
meant trips to Dartmouth every three to four days.

Black said the pilot project didn't achieve the expected results.
After six months, no one wanted to get off the methadone, he says, so
the program was extended.

In June 1992, a threeyear methadone pilot program was launched.

Only one drug free

"We thought over a period of time anyone entering the program would be
off methadone by the end of it,'' Black says.

At the end of three years, only one of 26 participants was drugfree.

"Written that way it does not appear to be a success, but if you
reword it and say there were a tremendous amount of people who had one
or two or three years with no positive urines, no criminal activity,
then you have positives.

"From an abstinence point of view we didn't gain that success; but
from a harm reduction, quality of life, decrease in criminal activity
(point of view), tremendous gains,'' Black says.

Hickey, and others like her, were no longer seen as a failure for not
kicking methadone.

If the program was to work on a broader, permanent basis, it had to
attract pharmacists and doctors in the community, Black says.

Two years after the community advisory committee was set up, the new
methadone program started accepting clients.

"This is a first time it's been open and they haven't set a limit on
the number of people they'll take or anything," Hickey says.

There are now about 44 people in the program, but Black says as many
as 90 have requested assessment.

"It's just the difference between night and day between someone on
methadone and someone who's actively doing a drug on the street;
you're able to eat, you're able to look at your life, you're able to
do things you weren't able to do before. The quality of life; there's
no comparison between the two.'' Black says.

Participants must be on IV drugs for more than a year, and have
usually tried other methods of quitting. After a 28day assessment
period at Drug Dependency they are stabilized on methadone, but time
is also spent on drug education and prevention.

Most people have to make other major changes in their life, Hickey
says, sometimes breaking ties with other users, joining a support
group, or going to church.

"A lot of people are dealing with a lot of issues that happened prior
to their using or during their using. You do a lot of things while
you're abusing that you probably thought you would never have done in
your life.

"It can overwhelm you sometimes, and it's enough to take people back
because they just can't deal with it," she says.

Fraser has 10 patients on methadone.

"There are people I see now who are working and who are in stable
relationships with kids," he says.

Despite its successes, the program is not without problems.

Doctors must obtain a special licence to prescribe methadone. Fewer
than 10 have, Hickey says. Unless the numbers increase, addicts who
meet all the criteria for the program won't be able to find doctors,
she says.

Side effects

And there's the cost. Hickey pays $4 for each dose of methadone, which
would be covered if she were on welfare or could get a job with a drug
plan.

Then there's the methadone itself. Although longterm side effects are
few, the drug causes rapid weight gain Hickey's weight shot from a
toothin 114 pounds to 175. Even though the drug has freed her from
the emotional turmoil of using, Hickey says it has flattened her
feelings.

"I don't ever have a hearty, hearty laugh and it takes a major thing
for me to cry," she says.

Black says sweats and decreased sexual libido are also possible.

Hickey has mended fences with family and lives with the man she's been
with for seven years. Life is good, but there are still times when she
thinks about what she lost to drugs.

"I sometimes think it hasn't really hit me yet, but I have no kids. I
think sometime that's going to hit me," she says.