The State is official opiate supplier to 10,000 people. Methadone stabilises, and sometimes even saves, the lives of heroin users, but many are in their second decade of dependency.
Darren Balfe reaches under the sink and takes out a cornflakes box. From it he produces a plastic bag containing a nearly empty plastic bottle with a green liquid at the bottom. “That’s one day’s dose,” he says. His girlfriend is playing with their baby in the next room. It’s a “takeaway”, which means that Balfe is trusted to receive a full week’s supply of methadone.
What does it taste like?
“Want to try it?” says Balfe.
I must look as if I’m considering it, because Balfe puts it back in the bag and laughs. A dose of methadone prescribed for a seasoned drug user, I’m later told by Dr Joe Barry, an HSE public-health specialist, could easily kill me.
“It tastes a bit like cough syrup,” says Balfe. When he drinks it he goes “from itchy, agitated and wanting, to feeling normal.” It does not, he says, make him high. For heroin users who want to straighten out, methadone maintenance is the only option widely available.
Balfe was first prescribed methadone 18 years ago. He is one of about 10,000 people for whom the State acts as an official opiate dealer. (There are another 10,000 or so heroin users not in the methadone system.) We’ve been prescribing methadone since the late 1980s.
Originally developed as an alternative to morphine in the 1930s by a German company, IG Farben, it wasn’t until the 1960s that Rockefeller University researchers Vincent Dole and Marie Nyswander pioneered its use to stop heroin withdrawal and block the heroin high. They argued that “the status of insulin for diabetes was comparable with methadone for heroin addiction”, says Shane Butler, who is associate professor of social work and social policy at Trinity College Dublin. In their view “you put heroin addicts on methadone and left them on it indefinitely”.
The idea of giving opiates to opiate addicts was then revolutionary, but around the world maintenance drugs now include methadone, morphine, buprenorphine and, in some countries, even heroin itself.
In Ireland, until the 1980s, we preferred the abstinence-based approach favoured by Narcotics Anonymous and referred to as the Minnesota Model. Methadone maintenance “would have been philosophically alien here” at that time, says Butler.
What changed in the 1980s was the spread of HIV. Methadone was “snuck in in a quite covert way, with little or no debate, not on the basis of any great liberalisation but as a purely pragmatic public-health thing,” says Butler. “This is a terrible thing to say, but as long as heroin addicts were only killing themselves there was a kind of public indifference.
Source: Patrick Freyne, Irish Times, 28/06/14
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