PRESCRIPTION ADDICTION

Elliott Corley remembers the first few days of withdrawal and shudders to
recall how he was unable to make it to the bathroom.

His aching body was bound to the floor, bound to its pain, to the aches in
his tired bones and relentless cramps in his stomach.

For hours, he struggled to make the short walk from the bed to the
bathroom. In that first week, he spent an afternoon in his sweat-soaked
bed, beside a puddle of his own vomit. He was too sore to clean it up.

For 14 nights, the agony kept him awake. By then, he was seeing
things-headless people and flying objects.

Six months without methadone and he still could not rest through the night.
Even nightmares would be better than the aggravating sleeplessness.

"I didn't want to do methadone," he says in an interview at a dimly lit
coffee shop. "I had a healthy fear of it."

In 2001, methadone, the synthetic opiate used as an alternative to heroin,
was the most prescribed drug in B.C. In Ontario, by contrast, it's the
third most prescribed.

According to provincial statistics, there were a million claims for
methadone prescriptions, while Tylenol 3 prescriptions, in second place,
came to about half that number.

Over the past decade, the number of British Columbians taking prescribed
methadone has increased from about 1,000 to almost 6,000.

Methadone maintenance, used by doctors to treat heroin addicts since the
1960s, is steadily becoming a one-size-fits-all form of treatment, sparking
criticism that other options are not being adequately explored.

"We have more methadone per capita that anywhere else in Canada," says John
Turvey, a former heroin user who pioneered Vancouver's needle exchange and
now serves as executive director of Downtown Eastside Youth Activities Society.

As of May 2001, methadone drug and dispensing costs in the region were more
than $40 million a year, according to a methadone report prepared for
Vancouver Coastal Health Authority by consultant Therese Turner.

That doesn't include another $4 million a year spent on urine testing to
monitor usage.

Created by German chemists during World War II, when the country's opium
supply was cut off, methadone acts in a similar way to opiates but is
structurally different.

It metabolizes in the liver and is stored there and released to the
bloodstream as needed.

It's possible to overdose if other opiates are added to the active
methadone. Methadone is as physically addictive as any opiate; in fact,
many users claim the withdrawal process is significantly more intense than
with heroin, as Elliott Corley discovered.

The rise in methadone prescription in B.C. can be in attributed to the rise
in HIV/AIDS, an epidemic among intravenous drug users in the Downtown
Eastside of Vancouver that began in the 1990s.

The provincial and city governments could no longer turn away from the
effects of drug addiction, which had plagued the area for so long.

Thus was born the "four pillars" strategy, a more pragmatic and
comprehensive approach to dealing with drug addiction through prevention,
harm reduction, treatment and enforcement.

The strategy was adapted from the Swiss model, which sought to decrease the
crime and health costs of illicit drugs.

In 1997, the authorization process for methadone was handed to the
provinces, which meant doctors no longer had to go through the long and
arduous process of obtaining patient approval through Health Canada. The
new authorization process also removed the limit on the number of methadone
patients doctors could have, and eliminated the requirement to release
information about patients to the federal government.

However, many people working in addiction treatment say this is precisely
the problem-government is making methadone more accessible, but not
abstinence-based programs.

Methadone wasn't always the first choice, says Turvey-addicts used to be
required to have some experience with abstinence-based treatment programs.

If they were continuously unsuccessful, then methadone would be prescribed.
Those restrictions have since fallen by the wayside.

"We see more and more young people on it, so people who haven't been able
to access treatment are placed into drug substitution therapy," Turvey
says. "My alcohol and drug workers are seeing more people that have real
difficulties getting off."

As a result of the increased support for methadone maintenance, the city is
losing treatment beds, says Turvey, a former "baby addict" who started
using heroin at 13.

Turvey doesn't deny methadone is effective for some people, but says since
most drug users are poly-drug users, they're likely to be on cocaine or
amphetamines at the same time as methadone.

Provincial Health Officer Dr. Perry Kendall says in some cases-although
it's rare-illicit drug use drops for patients on methadone maintenance.
Kendall insists methadone is an excellent alternative to heroin because it
does not need to be injected, so the risk of spreading disease is decreased.

It's prescribed, so there is less stigma and the quality and purity is
known, and users don't have to ingest it more than once a day, as can be
the case with heroin. It does not induce the euphoria heroin does but it
blocks the withdrawal symptoms.

Methadone maintenance only fails when people come off too quickly or if
they are given an insufficient dosage, says Kendall, who sees what's called
pharmaceutical therapy as the future of addiction treatment, although as
yet, there is no universal replacement for cocaine.

The first encounter Corley had with methadone was on the street, not in a
clinic.

"I ran into some street people and I was looking for drugs and all my
dealers were out and they were trying to phone around and find some dope,"
he recalls. "They couldn't, but they had methadone and they were like,
'Want to buy this?'"

It was a methadone prescription bottle, with a doctor's name on the bottle.
Corley says he and his girlfriend called the doctor and made an appointment
to get on methadone.

Corley had tried abstinence-based programs several times before without
success. However, his former girlfriend had only tried to get clean once.

Neither of them had any problems obtaining methadone, even Corley's
ex-girlfriend, who had barely been using heroin for more than a couple of
years.

At the Community Health Centre, a methadone clinic on Commercial Drive and
11th Avenue, Corley was asked if he had ever attended a Narcotics Anonymous
meeting. He told them he had but they didn't work. He had to do a physical
and fill out a form. Corley says the doctor gave him someone else' s
prescription that hadn't been picked up before his application was approved
by the College of Physicians and Surgeons, administrators of B.C.'s
methadone program.

For harm reduction supporters like Ann Livingston, project coordinator for
the Vancouver Area Network of Drug Users (VANDU), Corley's easy access to
methadone was a victory.

Livingston is one of a number of people, including some in the medical
community, who want to see restrictions on methadone maintenance therapy
abolished. Livingston wants addicts to have quick access to small dose or
low-threshold methadone without the usual paperwork and prescriptions, to
avoid painful opiate withdrawal.

Lack of low-threshold methadone, she says, often forces opiate addicts to
partake in illegal and dangerous activities, such as using dirty needles.

Livingston, who also supports prescription heroin in some cases, argues the
College of Physicians and Surgeons should spend more time talking to
addicts about how they can best be served with methadone therapy.

With characteristic passion, Livingston says doctors and administrators at
the College "have their heads up their asses," when it comes to knowing how
to treat opiate users. She believes the current system keeps drug users in
a chemical prison because they are forced to go through the medical system
to acquire methadone.

For Chuck Parker, a long-time former heroin user, methadone has been a godsend.

"I was able to stabilize my lifestyle," Parker says with a smile.

It's a sunny afternoon and the third meeting of the recently re-formed B.C.
Association of People on Methadone, which Parker is facilitating. (The
group foundered last year, when VANDU president Dean Wilson stepped down as
chair, but later regrouped.)

A pharmacist from Gastown Pharmacy talks to the group of about 22 men and
women about methadone. The pharmacist answers questions that are often
painfully basic, despite the fact all the methadone users are supposed to
have seen a doctor.

The users receive a $3 stipend from VANDU for showing up, but seem
motivated less by money than the desire to meet others in the same
situation. It's an affectionate group, although someone will occasionally
yell at the others to shut up when they ask questions at the same time.
They speak openly about their concerns, like whether or not they should
take calcium supplements, and the potentially harmful effect methadone may
have on the liver. The talk is on recovery and health, until one man
quietly asks another if he wants to go halves on some crack.

Vickie Engdahl is the clinical director of Turning Point, a drug and
alcohol recovery house that advocates abstinence-based recovery.

She believes methadone maintenance is the wrong solution for drug addiction
and offers drug users nothing but a life sentence.

She sees it simply as a case of one drug replacing another, and argues that
methadone maintenance does not cure the psychological and emotional effects
of long-term drug use. (Dr. Kendall says the ideal situation for a heroin
addict combines counselling and methadone, which is why the province wants
methadone patients to be able to access residential care at places like
Turning Point.)

Engdahl is battling the provincial government because she refuses to accept
methadone patients. She says it compromises the safety of clients coming
off methadone. "We have a man that came in after a four year [methadone]
habit," Engdahl says. "If there was someone there on methadone he wouldn't
have felt safe. Because there was no methadone on the property, he felt it
was the safest place he could be."

Because of that commitment to abstinence, she says, Turning Point has had
its provincial funding cut to less than half of its original contract.
"We've got people who are not even heroin addicts that are getting
methadone to sell for cocaine or to increase their coke high," Engdahl
says. "The methadone clinic here in Richmond is one of the easiest places
to score drugs."

Two weeks after beginning his horrendous withdrawal process at home, Corley
ended up in Turning Point recovery house.

While he was there, his withdrawal symptoms were still so bad that at one
point, he called a drug dealer, just to end the pain. He says he is
grateful the dealer didn't answer.

Corley only stopped using heroin and cocaine for about a week after he went
on methadone, then began using all three. Most of the time, he would go for
his methadone in the morning and use heroin at night.

Despite the fact that he was still using illicit drugs, Corley was able to
get "carries," methadone he could take home, within a month of being on the
program. The entire 10-month period that Corley was on methadone, he claims
never to have been given a urine test. He says he was able to get around it.

Daniel Roitberg, clinical director of the methadone clinic where Corley
went and a former heroin user who's been drug-free for 21 years, expects
many of his clients to continue using heroin for the initial period on
methadone.

As for the horrible withdrawal associated with methadone, Roitberg argues
it's probably less intense than that associated with heroin, although
methadone withdrawal lasts longer. Roitberg suggests that drug users taper
off to reduce the effects, but Engdahl counters that the very essence of
addiction is the inability to taper off drugs.

Roitberg insists his clinic gives urine tests on average at least once a
month. He says new patients usually meet with him for a half-hour
counseling session before they see a doctor, although Corley says he dealt
with the clinic's nurse, and was not given the option to see a counsellor.

Roitberg says he does everything he can to dissuade those using methadone
from selling it on the street. "We're really ethical here, to the point
where we lose clients at times because they can go other places and get
carries right away," says Roitberg, adding that on a daily basis he meets
with methadone patients whose lives have been positively changed by the drug.

"We monitor things really closely. We've got two doctors that are on the
opiate committee at the College. We want to carry a strong message about
what we are here for, what this is really about, so if somebody isn't
clean, they are not going to get carries."

The one thing almost everyone from Roitberg to Engdahl to Turvey agrees
with is that more treatment must be made available for drug users. There
are just not enough treatment beds for drug users, whether in detox or in
residential treatment.

"In some cases, [methadone] is the only...option available. Doctors will
say, 'Here we'll put you on methadone,' so all of a sudden you've got a 17
or a 19-year-old young person, who has never been in treatment, never in
recovery," Turvey says. "They really don't understand their addiction at
all and then they are on a drug maintenance program. Now it's not that they
shouldn't be; it's just that maybe a few kicks at the treatment can prior
to that are in order."