photos: Allan Fowler and Chereece Keewatin used the old methadone for years with good results. Today, however, both say the new formulation, Methadose, is sending them back to using heroin. Photos: Garth Mullins.

New methadone is failing the people it's designed to assist, says local researcher

Methadone is a medication prescribed to treat withdrawal and the various effects of addiction to heroin of other opiates—not lead people back to their use.

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A recent study found the new formulation of methadone, called Methadose, and the regime used to administer it are leading to withdrawal symptoms and heroin relapse among patients.The study, published in the Social Science and Medicine journal, found that the vast majority of study participants experienced heightened withdrawal symptoms about 14 to 16 hours after ingesting the new methadone. The old formulation had previously lasted at least 24 hours, until patients got their next daily dose.

These findings confirm a story I broke in Megaphone last year, citing the experiences of users, frontline workers and harm reduction advocates after provincial authorities forced more than 15,000 patients onto the new methadone and made substantial changes to the way it’s administered. Working with the BC Association of People on Methadone (BCAPOM), I witnessed the negative impacts of the new formulation from the start.

Methadone is a medication prescribed to treat withdrawal and the various effects of addiction to heroin of other opiates—not lead people back to their use.

“Within three days I was back to using heroin”

Allan Fowler started feeling bad just after he was switched to Methadose. He’d been on the old methadone for five years and had gotten clean. But “within three days I was back to using heroin, picking up Dillies [Dilaudid], morphine,” he said. Patients could count on the old methadone to work steadily until their next daily dose. But for Fowler, Methadose wasn’t lasting a full day. “Within 16 hours, I was getting really sick,” he said. “Then, 100 per cent relapse.”

Ryan McNeil heard the same thing from most of the 34 participants in his recent study of changes to Methadone Maintenance Treatment (MMT) in B.C.

McNeil is a postdoctoral research fellow with the Urban Health Research Initiative of the BC Centre for Excellence in HIV/AIDS. “The vast majority of people [we] spoke to talked about experiencing heightened withdrawal symptoms,” he says, “usually beginning within 14 to 16 hours after ingesting [new] methadone, as opposed to the day that it would have previously carried them.”

For 75 per cent of McNeil’s study participants, this caused problems.They “missed doses,” he says, and experienced “withdrawal symptoms that, in turn, led to increased injection opiate use, as well as the consumption of diverted [black market] methadone.”

Chereece Keewatin participated in McNeil’s study. “I’m happy there’s people out there that care enough to listen to us, to believe us,” she says of the study. As part of the BCAPOM, Keewatin became familiar with official indifference.

After 11 years on methadone, she says Methadose failed her. “I never used heroin for years and years on the other stuff [the old methadone formulation].”

But after the switch to Methadose came withdrawal and relapse: “I was really sad to go back to that stuff [heroin]. I thought [heroin addiction] was over.”

Keewatin is frustrated. “Why would they change something that is already working?” she says of officials in charge of MMT. “They’re not sick. They’re not the ones who are taking it.”

Hacking at liquid handcuffs

Patients have always been policed by the methadone system in B.C.

McNeil’s study found that the increasingly restrictive methadone regime further marginalizes an already vulnerable group. According to his report, it creates obstacles for patients with “insufficient resources (e.g., lack of transportation) or disruptions due to drug criminalization (e.g., arrest, detention) or housing instability (e.g., homelessness, eviction).”

One of those obstacles is that now people have to come to the pharmacy to access methadone. This policy change came in at the same time as the new methadone was introduced. Methadone deliveries enabled treatment for patients who couldn’t afford bus fare to and from a pharmacy every day.

Not being able to get to the pharmacy disrupts this treatment, and that can be devastating. One participant described the experience of getting sick after missing a dose as “heroin withdrawal times 10.” Having to drink the methadone every day under the watchful eye of a pharmacist, having to consent to regular urine testing, and frequent doctor visits is like a pair of “liquid handcuffs,” many patients say.

McNeil’s study suggests that the strict regime “operates as a form of biopower, regulating the bodies and lives of people on methadone.”

McNeil and his co-investigators also found that doctors were unlikely to adjust doses to compensate for withdrawal symptoms, leaving patients to devise their own solutions. Some bought additional methadone illegally on the street to“top up.” Others used heroin or various opiates to treat withdrawal symptoms.

Not just guinea pigs

For methadone patients, big changes can lead to big problems. This phenomenon has been documented for decades. In a 1992 study, researchers Steels, Hamilton, and McLean found “a decline in social stability and an increased use of non-prescribed drugs in some patients” when their methadone formulation was changed. Gourevitch and his colleagues noted the vulnerability of “those at risk for intolerance to the change” in a 1991 study.

These kinds of findings should have alerted officials to the fact that methadone patients are very sensitive to big changes. Regardless, B.C. authorities went ahead with what the McNeil study called a “natural experiment.”

Drug users on Vancouver’s Downtown Eastside are one of the most studied populations anywhere.

But often participants never know what happens to their data. The Vancouver Area Network of Drug Users’ (VANDU) volunteer coordinator and community organizer, Aiyanas Ormond, explained what VANDU asks before participating in any study: “Is this research going to actually support empowerment and social justice for people? Is it going to leave our movement stronger after the researcher is gone?” For his methadone study McNeil partnered with VANDU, giving the group a voice in the research process.

Cascading harms

When methadone treatment fails, it can mean a return to heroin, crime and the sex trade—what the McNeil study calls “cascading harms of MMT disruption.”

The study concludes that the MMT regime is too focused on “reforming ‘irresponsible drug users’ ...[and on the] ‘discipline’ of people on methadone.” In our conversation, McNeil kept strictly to his data. But, he reflected, “These changes have had such a devastating impact on people enrolled in methadone. It’s really sad.”

Last August, BCAPOM wrote to Terry Lake, B.C.’s Minister of Health, about the problems caused by the switch to Methadose. Minister Lake told a press conference that he would look into the situation.

An emailed statement from the Ministry of Health dismisses the McNeil study, saying it uses a small sample size. I asked about the impacts from Methadose. They wrote: “we have no scientific evidence of this effect.. we also have had no new complaints.” The ministry encourages patients to talk totheir doctors if they are having problems.

McNeil disputes the provincial government’s assertion of lack of evidence. “Formulation changes should be undertaken with awareness that the phenomenon of ‘change intolerance’ is well established in the academic literature,” he says.

McNeil points out that the study had reached a point of “data saturation” at 34 interviews. That is, a point in qualitative research where no new information is being revealed. Regardless, research continues: “We are currently analyzing data from our larger data sets to further understand these dynamics at the population-level,” McNeil says.

Study participant Chereece Keewatin was on the BCAPOM board when the group sent that letter to Minister Lake.

After being switched to Methadose, she started using heroin. Today, she says, “heroin is a totally different game. You gotta scrabble every day to pay for it.”

That scrabbling takes the time, energy and spirit that Keewatin would have spent on advocacy. She’s not optimistic the McNeil study will change things.

Doctors, patients, activists and researchers are all starting to point to the same set of negative impacts: last year’s radical changes to MMT are leading to serious problems among patients. It’s time for those in charge to start listening.

 

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  • Vlada Jekic
    commented 2020-10-18 07:38:25 -0700
    The brand name of Methadone produced in the same way as Methadose is not only inferior as a drug, the formulation is unstable, and the final product strength is different in my country for every batch. Every time when they manufacture new quantity strength of medication is different 10-50%. You can’t imagine how that influences on the life of patients. I live in Serbia and every 2 weeks I take a different dosage of Methadone. My prescribed dosage is 100mg, but for 2 weeks I will need to take 130mg to reach the same therapeutic effect as 100mg 14 days earlier. Then after a month of example and taking 130mg for more than 30 days when a new batch shows up maybe 100mg will be enough for me. That’s not possible to patients who use 130mg feel the same if take only 100mg except if the active substance is screwed up. That’s the reality of Methadone Substitution Treatment after the FDA give permission to Mallinckrodt to register well known inferior Formulation. They are banned 2-3 times and finally, they get permission to give danger, not effective, and drug full of side effects. I only could say Sexual Life in my country in East Europe was untouched decades before formulation is changed, no one complains about dosage, side effects or anything before Methadonse formulation is given to us. I’m walking dead. I can’t enjoy life, I can’t sleep, I didn’t sleep normal years. And I don’t want to poison myself with a bunch of pills only because pharmacists get permission to make crimes against people. I invest so much energy in recover after 12 years of heroin abuse, I felt normal 6 years, after that my life is not life anymore. It’s suffering and I can’t without opiate agonist. The best option would be with help of advocates and biochemists who will synthesis Methadone from scratch with Bockhmul Erhardt synthesis to compare on the court with Methadose giving the same dosage to 20 addicts. Who will take one-week Methadose and next week Methadone synthesis from scratch on the original way only for comparison? That would be the nail in the coffin to Methadose. That would be the biggest affair in the pharmaceutical industry and it’s not hard to trigger. There is more than enough independent chemists who suspect in pharmaceutical companies, Health Systems and they’re ethic and who will gladly to help and synthesis Methadone from zero, not to mix with finished components bought from China and India for the cheapest price. I lost faith in humans because of inferior Methadone formulation and nothing will change that.
  • Vlada Jekic
    commented 2020-10-18 07:26:16 -0700 · Flag
    Inferior Methadone invented under the same brand name but different formulation destroyed my life literary. Methadose is the biggest fraud in the world of pharmacology and many countries switch to Oral Morphine because of that. I only ask what happens with people who have no access to SROM Treatment and who used on regular Methadone. Everyone hit by inferior Methadone should give self objective to warn people about modern medications and vaccines and explain to them how many patients are victims of inferior substandard human drugs. Opiate Addicts on Substitution Treatment are the rear group of patients who will notice inferior drugs, 99% of other patients will feel nothing, only statistics and recovery will be far worse and they will not know why because they can’t feel the therapeutic process of their treatments. I can’t believe that Western Societies allow such pharmaceutical crimes and present self worse than III World Countries without laws and human rights. Methadose should be forbidden and the original Methadone formulation should be back. In my country, the brand name was not changed, the only formulation and no one has the right to say that different brand names force people to think that medication is different. Only worse scum in the Health System and the Pharmaceutical Industry is capable to do such things.
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