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Addicted to methadone?

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Mark Easton | 13:02 UK time, Thursday, 8 October 2009

Old habits die hard. The latest figures on drug treatment in England [876KB PDF] show that despite calls for services to be "more ambitious", despite a new drugs strategy stressing the importance of helping users get clean, the proportion of addicts getting into rehab is stuck at just 2%.

Out of 207,000 problem drug users who were in treatment last year, the official data show that just 4,600 managed to access a residential rehab bed. Meanwhile, the number of heroin users in England prescribed methadone and other substitute drugs has gone up to a record 147,500.

Let me remind you what the National Treatment' Agency's Paul Hayes wrote last November:

"The problem with methadone (the standard treatment for opiate addiction) is not that it doesn't work, but that it works too well. Stability, improved health and reduced crime are necessary steps on the road to recovery and a drug-free life, but not the destination. We need to balance the risk of relapse if people attempt abstinence, against the risk of inappropriately thwarting their ambition to become drug-free."

In arguing that "too often the system is not ambitious enough", Mr Hayes was signalling a change of direction in drugs policy. A philosophy of harm-reduction had seen tens of thousands of heroin addicts effectively parked on methadone for years.

Government ministers, embarrassed by my revelations that only a handful of addicts leave treatment drug-free each year, demanded a shift from "maintenance" to "recovery".

So today's statistics will be a real disappointment. The agency wrote to me earlier this week to say that the latest figures "have given us cause for concern as they still show residential rehab not growing at the rate we would expect it to". Now I know why.

The NTA estimates that the treatment system currently has the capacity to provide residential treatment for around 17,300 people a year and, even accepting that the 4,600 users identified today is an under-estimate, it is clear that there are far too many empty beds.

Rehab centreEarlier this week I went to one reputable rehab centre in South London where managers told me they were operating at around 50% capacity. Half the rooms were unoccupied even though there were hundreds of people locally trying to get into the unit.

Manager Dave Heywood was particularly incensed that drug teams were not referring addicts because the National Treatment Agency had just spent thousands refurbishing the centre and equipping a new fitness room. He asks:

"Would you spend £10,000 redecorating your house and then walk away and leave it empty for six months?"

Nearby I met Mark Dennison, a 44-year-old homeless man who has used heroin for 25 years. He was caught shop-lifting at the beginning of this year and the court gave him a Drug Rehabilitation Requirement Order - basically he had to get treatment or he could be sent to jail.

Mark DennisonSo, Mark spent 12 weeks straightening himself out on methadone, he then went through six weeks of detox. The next step should have been rehab but he didn't get the funding. The consequence was entirely predictable.

"I ended up going back onto heroin. I didn't have anywhere to live and they expected me to go back onto the street, homeless and not take drugs. I'd done all that work and it just seemed ridiculous. It's obvious what's going to happen. And you don't even see the people it goes up in front of, a board which you have no contact with. We appealed it three times. They refused me three times."

Faced with a heroin user like Mark, drug workers have to make a calculation. Residential rehab typically costs between £500 and £1500 a week. Methadone, in contrast, costs virtually pennies. Many addicts won't manage intensive rehabilitation and end up using again.

But methadone is an addictive drug itself and there are real risks. Last year 378 people died from an overdose of methadone. One person every single day. The death toll was 16% higher than the year before and 73% more than in 2004 (Deaths related to drug poisoning in England and Wales [310KB PDF]).

When it comes to making the choice, drug workers tend to go for the cheaper option, as today's figures show.

Treatment table

Treatment exit reasons

The consequence is that only a small proportion of people using treatment services end up clean.

The phrase "no drug use" in the top line means that clients are free from substitute drugs as well as their "drug of dependency" so, while numbers are increasing, this chart is hardly a cue for celebration. Just under 9,000 people out of a total of 207,500 in treatment emerged drug free last year. That is 4.3%.

Quite rightly, the National Treatment Agency will argue that drug addiction is a chronic condition and users are likely to need a few goes at giving up. Just as smokers may quit many times, so might a heroin addict.

And there is some cause for optimism in today's statistics - fewer young people are coming into treatment for heroin and Paul Hayes feels confident enough to claim that "we may have passed the high-water mark for heroin addiction in this country".

But, but, but. More mature heroin and crack addicts are entering the system than ever - 24,000 last year - and if we want to help them get off drugs completely can we be satisfied with a half-a-billion pounds a year system that only managed to get 9,000 people clean?

PS The NTA has suggested I clarify the meaning of "no drug use" in the table I reproduced. To be clear - these are people who have been through treatment and are discharged free of their drug of dependency and, in the judgment of their clinician, of all other illegal drugs. Obviously, no-one who is discharged from treatment can still be on methadone.

Worth adding too that few believe the only value in treatment is getting people off all drugs. Clearly, there are social benefits in dealing with the destructive chaos that can often go with drug misuse. Yes, there is some good news in today's statistics but there is still some way to go to ensure that people like Mark (see above) are given every chance to get off drugs, to stop committing crime to fund his habit and to start contributing to wider society.

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