I’ve been addicted for six years, and the fall-back NHS treatment isn’t working.
(All photos courtesy of the author)
I’m a 26-year-old undergraduate studying towards a degree working with children and young people. In many ways I’m your typical mature student, juggling the usual uni stuff – severe deadline anxiety, the crushing realisation that student finance won’t actually finance all that much – with hobbies, housework and children. However, there’s one thing that sets me apart from the majority: for six years I’ve been struggling to beat a heroin addiction, something I’ve managed to keep relatively separate from all the other aspects of my life.
I would argue the myth that a heroin addict is constantly chasing their first high isn’t true. If the masses really were constantly failing to reach that desired level of intoxication, surely more would quit, and sooner? As an addict, I’d contend that people just tailor the amount of drugs they take to match their increasing tolerance. For instance, although my tolerance has reached a point of stability, I now need to take more than I used to, which doesn’t chime too well with my rapidly decreasing access to funds.
In fact, over the years the amount of drugs I use has substantially increased; to function normally I now need to spent £50 a day on heroin. But unlike most users, I’ve chosen not to take methadone, a synthetic opioid prescribed to substitute the use of heroin. Because, aside from the taboos associated with queuing to pick up that mug of green liquid every day, long-term methadone use has been linked to a variety of health problems, some of which aren’t related to heroin abuse, such as bone damage and tooth decay.
There are many other alternative treatments, of course, but methadone remains the one most commonly prescribed by drug services. Personally, I prefer buprenorphine derivatives like Subutex or Suboxone, one reason being that they contain the substance Naltrexone – which you probably recognise from the time Pete Doherty had a widely publicised “anti-heroin” implant sometime in the mid-2000s. The substance blocks the effects of opiates and, for me, acts as a sort of safety net while working towards becoming abstinent. However, Subutex and Suboxone cost the government or treatment service considerably more than methadone – perhaps why they're not offered as regularly – and, with an average price of £3,000, implants and Naltrexone-aided detox will never be an option for most people.
Like many other addicts, methadone was the only option that my local service felt would reflect my immediate circumstances. However, I chose to just maintain the one addiction – heroin – than pick up another; there are few people who use heroin daily who don’t have a subsequent addiction to methadone. And just the same as heroin, the longer a person uses methadone, the more tolerant they become, making it harder to stop.
This second addiction allows services to keep track of and control those in treatment. Although presumably unintentional, this involves degrading many of those people on a daily basis, forcing them to publicly consume a less desirable but free supply of drugs. The way treatment is prescribed also impedes a person’s chance to kick their habit; as methadone is titrated slowly, its users form a strong physical and mental attachment to the drug, which only gets worse the longer they take it.
I’m all out of realistic ways to stay off heroin at the moment, as I don’t want to become dependent on another highly addictive and harmful substance. I have tried to reduce the amount of drugs I use, though, with the intention of ultimately becoming drug free. To help, I sourced a variety of non-opiate tablets – including Diazepam, zopiclone and pregabalin – to replace the heroin. I then compiled the tablets into a rota that was created around the availability and strength of each drug; in a typical day I might take four blues (10ml Diazepam) and two pregabalin. The typical combination I go for is a strong painkiller, alongside something that, for me, is slightly recreational.
The last time I attempted to get clean I passed out and popped my nose on a door, which I put down to the amount of tablets I’d consumed during that week and their impact on my body. Following this incident and a subsequent visit to A&E I looked into getting an appointment with my local drugs service.
I researched the treatment options the service offers before I made an appointment, and it seemed to cater for most people, claiming that drugs councillors could even visit a patient at home. This part caught my eye, as one of my regular complaints of drug services is their lack of coordination among clients. So many of those undergoing treatment are at different stages in their recovery, meaning services are prone to integrating people who are still using heroin with clients who’ve achieved abstinence – clearly not the most constructive way of doing things.
The last time I accessed drug treatment services, for example, I was forced to endure a conversation about the sale of drugs while waiting in reception. Say you’ve managed to switch over to exclusively taking methadone, rather than using it to supplement your heroin addiction; the last thing you want is drugs waved under your nose in the one place you go to get away from them. I was initially shocked that this hadn’t sparked any sort of reaction from the staff in the room, so raised a complaint to the manager. She suggested that the solution was for me to stand outside.
I often think how many factors there are to contend with when you start taking methadone. If you manage to overcome the physical withdrawal, let’s see how you fare against the social and psychological aftermath when you’re reunited with your previous drug dealer or the acquaintances who have no interest in seeing you get clean. Services specifically advise drug users to avoid compromising situations; however, due to a lack of organisation, those exact services presented the most compromising situation I’ve found myself in.
There are a number of failings that can be found in both the approach of services and government policy when it comes to drug use. In my opinion, the current policies appear to focus on tackling the effects of addiction, such as reducing the statistics of drug-fuelled crimes. The only beneficiary of this system are the services themselves.
I plan to keep a minimal involvement in services and keep relying on my local pharmacy, which provides a needle exchange. Achieving abstinence seems increasingly unlikely without a change in attitude towards addiction, as well as a more effective client-centred drugs policy. People know what works for them, so does it not make sense for users to have a more decisive say in their respective course of treatment, rather than a doctor choosing the "most suitable treatment option" (usually methadone) and offering patients the choice of whether to accept or decline it?
There also need to be more treatments available on the NHS, rather than this continued reliance on methadone – a fall-back remedy and, arguably, something doing more damage than it’s preventing. British studies have shown that prescribed heroin – diamorphine – injected under supervision produces better outcomes than a course of oral methadone, allowing users to be gradually weaned off the drug in a safe, sterile environment. Unfortunately, this service is rarely prescribed.
Of course, more drugs isn’t always the answer – there should also be more abstinence-based treatments for those who want to get clean, such as detox, alongside quality aftercare.
Depressingly, policymakers have never been particularly keen on taking frivolous stuff like scientific studies into account, preferring instead to change almost nothing. Funding is an issue, yes, but take the roughly £235 million the NHS spend on methadone every year and plough it into treatments proven to be more effective, and maybe we’ll start to see less harm caused and less taxpayer funds spent.
As my hope in this option fades to nil, I’ve begun to consider a plan B, which would involve me accessing private healthcare. However, as my primary income is a standard student loan, funding this would be impossible. So, as it stands, when my loan is paid I’ll be travelling to the nearest big city to buy enough gear to keep me going until January.
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