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Is Canada’s New Methadone Leading Some Patients Back to Heroin?

Many patients are saying that Methadose doesn’t hold them until their next dose, and it’s causing them to experience withdrawal symptoms.

by Garth Mullins
Jun 22 2014, 12:22pm

Photo by Garth Mullins

This article originally appeared on VICE Canada.

Laura Shaver shows me two fresh track marks on her arm. She’s using heroin again, after years on the methadone program. When I ask her what happened, she looks down. The words catch in her throat.

In February, Shaver and the rest of BC’s 15,000 methadone patients were switched to a new formulation of the medication, called Methadose, used to treat opiate addiction.

Dr. Christy Sutherland, co-medical director of the Portland Hotel Society in Vancouver’s Downtown Eastside, tells me that since the switch, most of her methadone patients are feeling withdrawal symptoms — the same effects that Shaver is self-medicating with heroin.

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Regulators made the move to Methadose to standardize and cut down on diversion of the medication.

“The thing is with down (heroin), I was done,” Shaver said. “I didn’t have relapses.” But four to six days after being switched to Methadose, she began using again.

Many patients are saying that Methadose doesn’t hold them until their next dose, and it’s causing them to experience withdrawal symptoms — something methadone maintenance treatment is supposed to put a stop to. Some, like Shaver, are even turning back to heroin to make up the shortfall.

Opiate Agonists
Shaver, the vice-president of the BC Association of People on Methadone (BCAPOM), tells me about Methadose. “It doesn’t have legs,” she says. “On the old methadone, I didn’t wake up in the morning sick. I didn’t go to bed sick. I was fine. I drank my juice [methadone] — there you go.”

By 7 AM each morning, Shaver is in 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.

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But for many, Methadose is not lasting the full 24 hours. Withdrawal symptoms return before the next dose and patients become vulnerable to relapse.

And regular life becomes impossible.

“I’m not being able to fulfill my position or my mandate [at BCAPOM] the way I know I should.” Shaver said. “My medication shouldn’t be a fucking hustle. I don’t want to hustle anymore.”

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

Methadone, Wine & Cheese
In February, the executive of BCAPOM went to raise concerns with officials in charge of the methadone program. I rode along.

We sat around a boardroom table in the offices of the College of Pharmacists of BC. Coffee and sandwiches were offered. So was a large bottle of Methadose. The various professionals poured samples, sipping, like a wine tasting.

I was incredulous.

But they explained it was “inert” — no active medication. It was just to let the professionals find out what it tasted like: gasoline.

The representatives from BCAPOM explained that many were finding that Methadose was not lasting as long. Initially there was skepticism. But doctors in the trenches, like Sutherland, are seeing a real problem.

Another addictions doctor I spoke to on the condition of anonymity said that 25 percent of her long-term, formerly stable patients are now reporting the same thing: withdrawal symptoms after being switched. These are patients that had been stable and off street drugs for years, she said.

The doctor has started raising patients’ dosages to try to compensate, but BCAPOM’s members report that all doctors are not so quick to believe their patients.

Methadone Machinations
College of Pharmacists of BC knows something’s going on. Their spokesperson Mykle Ludvigsen told me in an email: “I do believe that when patients perceive a change on a fairly wide basis we have an obligation to look into it, and we have (and continue to do so).”

Additionally, BC's Ministry of Health said that it is aware of only "a very small number of reports of some patients having a ‘wearing off’ effect of Methadose."

The problem is, however, that methadone patients are a highly stigmatized group that are unlikely to report concerns to the government. The number of reports may not be a good metric.

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Mallinckrotd Pharmaceuticals (the manufacturer of Methadose) wrote in an emailed statement that the problem isn’t with its product: “opiate withdrawal in the context of patients switching between oral formulations of methadone has been studied. The observed patient intolerance to switching formulations appears not to have a pharmacodynamic basis."

There doesn’t appear to be a consensus among authorities. Regardless, some patients are feeling the pain.

Dose Disconnect
Nathan Crompton is all too aware of the disconnect between patients and officialdom. Crompton is a community organizer and volunteer coordinator at Vancouver Area Network of Drug Users (VANDU).

“It all could have been avoided if patients were part of the decision [to switch to Methadose]. BCAPOM explicitly asked to be part of a [Methadose] trial to make sure it would be ok, and their request was turned down.”

If Methadose isn’t holding people, Ludvigsen suggests that patients should “consider raising that issue with their physician.”

But not all doctors are accommodating of patients’ concerns and some dismiss their claims about withdrawal symptoms.

Patients Losing Patience
Jeff Louden is getting sick after being switched to Methadose. He’s been on methadone for nine years, 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, a nine-year veteran of the methadone program, goes to the pharmacy to take his Methadose at around 10 AM every day. But he’s starting to feel the effects of opiate withdrawal in the middle of the night. At 3 AM, the morning of the day 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.

Louden has a message for authorities: “I don’t take this stuff for fun, I don’t take it to get high,” he says.

“Just give me the old stuff back.”

VICE's Lisa Hale contributed to this report.