It’s three in the morning—hours before Jeff Louden will get his next daily dose of methadone. But the nausea and sweats have already set in. He’s in opiate withdrawal and to stave off the sickness, he’s been using heroin.

Last February, Louden and the rest of B.C.’s more than 15,000 methadone patients were switched onto a new formulation of the medication used to treat opiate addiction (I reported on this in Megaphone in January). Some are now saying that this new medication, called Methadose, is not as strong as the old methadone formulation. And it’s leaving some, like Louden, spiraling into withdrawal, and then using heroin—or Oxycontin, Fentanyl or other opiates—to make up the shortfall. Methadose is leading some back to habits they have spent years fighting.

There is lots of talk about the new, weaker methadone among members of the BC Association of People on Methadone (BCAPOM). The group’s meetings can be raucous—but no more so than Question Period in the House of Commons. People are passionate and informed about changes to their treatment regimes.

As the meeting recesses for a smoke break, the group’s vice president, Laura Shaver, tells me that after being heroin-free for three years, she started using again. It happened soon after she was switched onto Methadose. “It doesn’t have legs,” she says of the new medication. “[Methadone] used to hold me no problem. But now I wake up at seven in the morning, feeling fevery and sick.”

Laura is describing the beginning of opiate withdrawal. It starts with restlessness, the sweats, anxiety and nausea, but can quickly move on to vomiting, diarrhea, muscle spasms, bone pain, increased blood pressure, faster heart rate, depression and even suicide. The daily ingestion of methadone is supposed to prevent all this and end the cycle of opiate highs and lows. But for some, Methadose is not lasting the full 24 hours. Withdrawal symptoms return before the next dose and patients become vulnerable to relapse.

Laura is very matter-of-fact when advocating for methadone patients. But as she shows me two new injection sites on her arm, the words catch in her throat. After long years away from heroin, it is clearly a real blow to find herself using again. And she’s not alone.

“Methadone used to hold me for up to 72 hours”

Charlie Boyle, BCAPOM’s treasurer, tells me that “[Methadone] used to hold me for up to 72 hours. Now I feel sick by midnight.”

After the smoke break, the meeting resumes and one by one, people start to disclose that they too have been relapsing into heroin use, after being switched to Methadose. The room falls into a silent, morose reflection on the return of old demons. But soon, the mood turns to frustration and anger. The group was suspicious of the changes to the methadone program, made ostensibly to standardize the dispensing of methadone and to prevent diversion.

Methadose doesn’t last as long as methadone, say one-quarter of patients

A few weeks after Methadose hit pharmacies across BC in February, I rode along to a meeting between a couple members of BCAPOM and the regulatory bodies in charge of the Methadone Maintenance Treatment (MMT) Program. We sat around a boardroom table in the offices of the College of Pharmacists of BC. A plate of sandwiches and a big pot of coffee were offered—along with a large bottle of Methadose. A glass of the medication was poured out and passed around. The various professionals took a sip, like a wine tasting.

The Methadose being served was “inert,” there was no active medication in the glass. The sample allowed the professionals to find out what it tasted like—gasoline.

Laura and the crew from BCAPOM told officials that they were finding that Methadose is not strong enough. Initially this was met with skepticism.

However, a methadone-prescribing doctor that I spoke to, under condition of anonymity, said that 25 per cent of her patients are now reporting the same thing: Methadose does not last as long as the old methadone.

I contacted the College of Pharmacists of BC. Spokesperson Mykle Ludvigsen believes there’s something to all of this. He told me that the College is looking into the issue with the manufacturer, Mallinckrodt Pharmaceuticals. In an email, Ludvigsen said that the college received “some information from the manufacturer stating that they have had cases where patients have perceived (or reported) that their dose is not holding during the transition from one product to another, even in cases where there was no concentration change.”

I wanted to ask if all methadone doctors have been advised of this issue, but the College of Physicians and Surgeons of BC did not return my inquiry by deadline.

The methadone-prescribing doctor I spoke with is now raising patients’ dosages to try to compensate. These are patients that had been stable and off street drugs for years, she said. But not all doctors are so accommodating.

As a last resort, topping up Methadose with heroin

Louden has been on methadone for nine years. He’s having the same problem, but his doctor won’t adjust his dose.

“The new juice is garbage,” he says. “It comes on hard and fast, then dies quick.” Louden goes to the pharmacy to take his Methadose at around 10 a.m. every day. But he’s starting to feel the effects of opiate withdrawal in the middle of the night. At 3 a.m. of the morning we spoke, he was awake, sweating with “the spider [of withdrawal] crawling up and down my spine.”

“Without methadone,” Louden says, “I’d be back to robbing banks.” But now, to avoid getting sick, Louden is topping up his doses with heroin, which he has long struggled to stay away from. “I don’t wanna be a pin cushion,” he says.

Patients, doctors, regulators and the pharmaceutical manufacturer all know there’s something going on here. I asked Louden what he’d like to tell those in charge: “I don’t take this stuff (methadone) for fun, I don’t take it to get high,” he says.

“Just give me the old stuff back.”

Garth Mullins is a writer, activist and award-winning broadcaster living in East Vancouver. Follow him on Twitter @garthmullins.