Sunday, 19 December 2010

Treatment Options For Opiate Addicts

Realising you are addicted to anything is difficult and traumatic, admitting it to others is even harder.

I remember when it first dawned on me that the flu like symptoms I was getting when not using heroin were actually withdrawal symptoms!
I dealt with it by burying my head in the sand and taking more heroin....

It took a while until I was ready to actually deal with the situation and start looking for help.
I initially went to my GP and was prescribed methadone, a long acting opiate that's regularly used in the UK for heroin addicts.
I was fairly naive I guess, and didn't understand just how powerful a drug methadone is, typically heroin has a half life of around 1.5-7 hours, averaging at around 4, which means an average addict having to use at least twice a day, often more.
Methadone is designed to have a 15-60 hour half life, but it averages 22 which builds up in the body the longer you take it. There is a lot of variation person to person though and I  like many others found I had to split the dose over the day or I would be withdrawing by night time, this is one of the inherent problems of the 'one size fits all' treatment of addicts.
It's a myth that it gets into your bones, but it does sit in fat cells.

Methadone is the gold standard in opiate addiction treatment, even though it only has a 4% success rate!
It's cheap, can be prescribed by GP's without a home office license and gives users a chance to get they're lives together.

Methadone can also prescribed in an injectable form although it's rare now.

Newer drugs used in maintenance are subutex/buprenorphine/temgesic.
Buprenorphine is a partial antagonist as well as agonist, meaning it binds to the opiate receptors but also has a partial blocking effect meaning users can't get high if they take heroin (although many claim you can, especially on low doses)
It also means if buprenorphine is taken shortly after heroin the user will suffer precipitated withdrawals, the blocking effect will also render any opiates useless for around 24 hours, so trying to take heroin to stop the withdrawals will have no effect!

Back in the 80s diamorphine (pharmaceutical heroin) was prescribed to a small amount of addicts (notably at the stapleford clinic) and up until the late 90's private doctors would still prescribe too.

These are classed as 'out patient' or community treatment options and are usually combined with regular counselling.

Rehab is probably the most successful way to treat heroin addicts at the moment, although many people would argue otherwise.

There are different types of rehab and they vary enormously in length of treatment and philosophy.

If your lucky enough to be able to afford private treatment you can go for a three month stay at a beautiful retreat type centre that offers alternative therapies along side detoxification and counselling.
For most people though rehab means being admitted to an NHS style, two week, quick detox.
They provide varying levels of aftercare with most offering post detox rehabilitation in a halfway house or similar. (If you can get funding)

Most centers, private or not adhere to the NA philosophy of 'finding and giving in to your higher power'
In my opinion this is where a lot of them fall down, I don't believe in god, and as much as NA says otherwise it is the christian version of god they want you to accept.
I was brought up catholic, in catholic schools and had it rammed down my throat most of my childhood, maybe this is why I have such a problem with it.
It also seems a bit cultish, especially as during a detox you are so vulnerable, it always felt like they were trying to convert me whilst I was down and open to anything that might take the pain away..

There is no magic bullet for opiate withdrawal unfortunately..

When you get to rehab you will be seen by the doctor and given a full medical examination, they will look at your drug use and if your on methadone will reduce your dose over a period of a few days usually, way too fast for such a long acting opiate, the half life that has built up over years of methadone abuse means it takes WEEKS to leave the body and even when it has long term addicts will most likely suffer post acute withdrawal symptoms (PAWS)

Some centers use drugs like clonidine/lofexidine a blood pressure medication that reduces physical withdrawal symptoms, it unfortunately also makes you feel like your walking around in a space suit!

The better places will offer benzodiazepines to help take the edge off and to help you sleep, most wont medicate anything that will make you feel better though and tend instead to try and treat the symptoms.

These include quinine for cramps and restless leg syndrome, anti-diorreah meds, deep heat for aching muscles, lavender oil to help sleep, paracetamol and that's about it.

Unfortunately the only thing that will ever really get you through a detox is willpower, and that's something that cant be forced.

Other treatments include places like detox 5, that basically put you to sleep for 5 days while they pump you with naltrexlone to push the opiates out (and it costs a bloody fortune for the pleasure).
In Thailand you can go and stay with monks that physically purge you, and of course there's always ibogaine...!

I'm slightly biased but after numerous different treatments the only thing that has ever worked for me, withdrawal wise is ibogaine.

You can always try it Trainspotting stylee!
If your lucky enough to be able to beg borrow or steal some comfort meds (IE benzo's) or if your more organized, some dihydrocodeine so you can taper down this is probably your best shot.
The most difficult bit is cutting contact with using mates and most difficult of all, deleting all your dealers numbers and changing your phone number!
Not many people succeed doing it this way, like the film you will more often than not end up ripping the planks off the door and running out to score!

Willpower dear Watson..

Ultimately changing behaviours and habits is key to recovery, replacing the day to day grind of grafting for money, scoring and using is the biggest challenge and takes a lot of work, this is where long term rehabilitation has it's benefits.

Here are some of the main rehabs in the UK:

These two I've had personal experience with;

Clouds House, is a six week residential detox and rehab centre, its in Salisbury and is where most people from the south of the UK will be sent, I went there three times altogether and never completed for one reason or another, they offer opiate detoxification with Clonidine and it's philosophy is based on the Narcotics Anonymous 'abstinence' model.

City Roads is based in London and specialises in 'crisis intervention'.
They will take you on short notice if your in urgent need of detoxification. Stays are usually two weeks and they will organise three to six month residential or 'halfway house' type when you leave.

I haven't been to these centers;

Narcanon is based in Lea-On-Sea, it has a good reputation but they don't use prescribed medication to aid withdrawal, alcoholics will receive IV vitamins and all patients benefit from alternative therapies.
I thought Narcanon was based on Narcotics Anonymous but after more research it's a front for the church of Scientology! (See below) Which begs the question why is it called Narcanon?

EDIT: After a comment posted on here informing me that Narcanon is a Scientology based rehab I am adding this info too....
I didn't realise this, and I'm pretty shocked actually.. if you know anything about Scientology, other than that Tom Cruise is a member, it's that they use somewhat questionable tactics to get people into they're 'programme'.. They have a habit of exploiting the most vulnerable members of society and indoctrinating them into what basically amounts to a cult.. the biggest cult in the world!
So they are basically using a rehab as a front to induct new members! That's shocking! And immoral..!
I leave is to you to make your mind up on this one, but it's not somewhere I'd want to go!
In fact, the more I think and write about this the more angry I'm getting....

Charis is a London based rehab facility that offer long term support by using supported housing units and dorms for people that have been through detox.
I know people that have been there and it is apparently very good, residents start off sharing dorms and by adhering to the programme of group therapy and counselling gradually work they're way up to sole occupancy flats. They specialise in long-term recovery and the waiting list is very long.

Hope House uses a 12-step integrated abstinence-based model using a holistic approach recognising emotional, physical, educational and recreational needs. The project is women-only with an all-female staff team. Second stage treatment facilitates the transition back into the community. Provides a safe space - community living and peer support. Life skills are gained through participation in the running of the house and in decision making about domestic and community matters, resettlement and housing advice. Attendance at self-help groups - AA, NA. Day and aftercare programmes are provided upon completion of the residential programme.

It is possible to be detoxified as in in-patient in an NHS hospital type setting but the waiting list is very long and they have a reputation of not being particularly good.


Gledwood said...

Some of the crap I hear about methadone is unreal. That it "should" be doing this, "should" be doing that... On 80 or 90mg (I can't remember bc my dose has changed a lot) I could go 4 days on methadone. It was torture. I split the doses, which the clinic want to tell me is less effective bc people who split doese are more likely to complain it doesn't work. Under what logic precisely can a once a day dose be better. Obviously that is going to produce a huge peak and a huge trough! In hospitals for pain or coughing it's given ever 6-8 hours, to produce a stable level. DUR.
Anyway on this 80, 90mg after 4 days I have a lovely hit of IV brown and it goes WHOOSH in to fill all those gaps methadone has left untouched.
They want to believe using on top is just psychological. These are people who've never taken methadone. If it worked so very well then nearly ALL their clients wouldn't use ~ often very heavily ~ on top of it. There would be no point. But there's every point because one £5 hit on top of methadone makes you feel way better all day. That's a simple fact.
I always split my dose and just being 6 hours behind time today made me crave gear badly. I drank the juice and the craving went. So this rubbish about it working for ages and ages is just that, pure tripe.
The ONLY reason methadone is preferred, from what I can see, apart from cost and possibly the fact that it gives no high at all so you're making addicts suffer, is that it can be dosed once a day. Well unless they're insisting on supervised consumption then they can change the drug after that to something less awful.
I'm willing to take methadone now because I don't want gear. But I still think it's an expensive waste of time for most people. Expecting anyone to 1. come off heroin and 2. come off the needle is just too big a step for most people. On paper maybe not. The reality speaks for itself. Using using using on top.

PS I tried subutex but don't think I'd go on it again. Too much clarity. I don't like that. When I asked about Subutex+Valium the clinic said they'd "never heard that one before" (never heard the truth then!)

Sid said...

I totally agree mate, the people that prescribe it have no personal experience of taking methadone, or withdrawals... it's a two sided coin though, they give high doses in some places in America, and people say it holds them, but the thought of being on more than 60mls again scares the shit outta me!

I always split dosed, was the only way I could cope, and because I was usually working my gp gave me 2 week take outs, so i could always dose at home as soon as i woke up.. the difficult bit was when i started reducing, at 40 mls id do say 20 and 20 but when it got low.. its a nightmare... on 10mls id have to take more in the morning to get me through the day, so id do 7 and 3 for example... but then struggle sleeping...
The thing with reducing though.... as you know with opiates you need more as tolerance increases.. so your going in the opposite direction! I could literally go no faster than 1ml a week, and i'd feel that for a few days, stabalise then drop again. Thats why it took so bloody long..
Thing was I was so determined to get clean.. I wish I had that mind-set again now.

lucky said...

Hi Sid

seen your posts on BL and like your blog - can indentify with alot of your feelings (treatment talk lol)couple of things Narcanon is scientolgy centre and includes brainwashing - really.I spent 3 months ay Promis and put on 2 stone got a tan got cleam and felt gtreat....1 week later I was scoring again - trouble is i went in to try and save my marrige not for me to get of skag,I suppose i have accepted the fact that i will always take gear even if it is as now only once a week or so (huge debts, 2nd marrige long story...!)and stick to my now low dose script on 10mgs now.
GL in what ever you decide to do - but dont think too hard about it.
Gav (Blondin on BL)

Sid said...

Thanks for comments, nice to know people are actually reading and enjoying it!

I didn't know that about narcanon! Is it actually a scientology rehab!? That's REALLY scary!

Your so vulnerable when detoxing... I can see why they decided it's a good idea to set up a drug rehab!

I'll take the link down to it if that's the case!

It's a shitty life really isn't it!
Thanks for the support.. I hope you find what your looking for too man!