In contrast , I was diagnosed with ADHD some years back and after being prescribed Ritalin , I found that my daily dose of the long-acting time-release drug did not suit me , I didn ’ t want to be permanently medicated . My consultant told me that my prescription was appropriate for my condition and that I should continue with it . I told him that his job was to help me reach my desired outcomes , not have me comply with his regime . He relented , I received a mixture of short and long- acting pills of different strengths , and for many years I ’ ve used Ritalin at the dose I want and when I need it – I often have days off .

NO SUBSTITUTIONS

When I was a heroin user , there were times I received a methadone prescription . Like many of my peers , I did not want to substitute heroin for methadone – I wanted methadone for when I could not get heroin , so that I didn ’ t go into withdrawals . Heroin withdrawal generates a degree of physical and psychological distress that is all-consuming . I wanted methadone so that I did not do crazy things to get money , so that I did not inject other people ’ s old dried blood clots or crushed up pills , hoping for relief .

There was a time when I was prescribed methadone in a way that worked for me . I went to the chemist weekly to collect my take-home supply . Eighty ml a day was the prescription , and two or three times a week I took some . The unused methadone went into lemonade bottles and was kept under the sink . The dose was ‘ a swig

out of the bottle when needed ’. Some methadone I gave to friends when they were stuck , some I sold to buy heroin or food , but that awful dread of withdrawal was gone – methadone was insurance .

My partner fell pregnant and , worried that her drug use may be reported to social services and risk having our baby taken into care , she disengaged from treatment . Her smaller methadone prescription was stopped . She cut down her heroin use and my methadone was sufficient to both keep her steady and give me an occasional emergency dose .

The service , however , grew increasingly concerned that my drug use was not reducing . My urine tests , when I gave them , were sometimes clean when I was able to manipulate the process – once or twice I would have shown up as pregnant myself – but too often heroin was detected . The service response was to increase my methadone dose to 90 then 100 up to 120ml a day . The service did not understand – and I was unable to say – that my prescription largely served a different purpose to my street drug use .

One day , collecting my script , I was called into a room and given the news that I was to be put on supervised consumption – my daily dose was to be consumed at the chemist watched by the pharmacist as I could not be trusted . Each day I was to consume 120ml of methadone that I did not want or need . My partner was now in trouble . I tried containers in the neck of my shirt to pour the methadone in while pretending to drink my dose , but it didn ’ t work and I left with methadone dripping down my clothes . The daily ritual humiliation did not last long – I disengaged with the service .

USING ON TOP

Many years later , I was working as the service user coordinator for Camden Council in central London . The commissioners wanted to know why 30 per cent of those on methadone were using on top of their script . I took the question to the user forum , where 50 people with lived experience laughed . Taking a straw poll of raised hands , the majority thought the figure was more like 90 per cent . Reporting

‘ I did not want to substitute heroin for methadone ... I wanted methadone so that I did not do crazy things to get money , so that I did not inject other people ’ s old dried blood clots or crushed up pills , hoping for relief .’

back to the commissioners , the issue was dropped – they could not be the first to reveal the emperor had no clothes .

The client wants to be well thought of and definitely doesn ’ t want to be punished with supervised consumption , so they under-report drug use . The worker wants to think they are doing well and to report success to their manager , so the under-reporting suits them . The service wants to report low drug use to the commissioners who in turn want to perform favourably compared to other areas . So , on one level , the worker says to the client ‘ what ’ s the problem ?’ and the client replies ‘ I ’ m not going to tell you , and the worker says ‘ great , I don ’ t want to know ’. The therapeutic relationship is too often based on this agreement . I remember service users telling me that when asked for a urine sample , suggesting ‘ next month might be better ’ often worked .

DEATH IS NO DETERRENT

Methadone is a powerful drug . It is mentioned in significant numbers of drug-related deaths , but those numbers are lower than those mentioning heroin . Those not in treatment are more likely to die than those who are supported by a service , and methadone prescribing is the number one

evidenced intervention in reducing drug-related deaths . Supervised consumption may be considered to increase safety , but it drives people out of treatment and prevents people from engaging . I remember a client who was cut off his script for missing three days methadone consumption at the pharmacy and was back on street drugs . He told me , ‘ I can die , as long as I don ’ t die on their methadone .’

Supervised consumption may have a place in the treatment system , but it is over-used – a recent small study questioned how much safety it provides , and many more would consider engaging it if wasn ’ t a requirement . Methadone is diverted – it is not always the name on the prescription that gets the dose . It is not helpful to consider users as failing to comply with the regime , or showing they cannot be trusted , as too many workers and services do . It is traumatised people helping friends or coping as best they can with the daily emergency of battling withdrawals , anxiety , self-hatred , and the judgement of others .

A BREATHING SPACE

Standing in the dock at court nearly 20 years ago , I feared the worst . The judge sentenced me to two years in prison , but before they could take me down , I swallowed the methadone from a bottle in my pocket that a friend had given me . I was not going into withdrawals alongside the shock of the sentence . It gave me breathing space before I was seen by prison healthcare the next day – methadone met my need perfectly .

There are some good services and drug workers . I like to think somewhere a user is saying to a drug service , ‘ Your job is to help me meet my desired outcomes , not to get me to comply with your regime ’, and the drug service saying , ‘ Sure , how can we help ?’

My son is happy and healthy and has just finished his first year at Bristol University . We rarely see his mother – she is still a chaotic drug user . Every now and then she engages with a drug service , but she cannot do the supervised consumption . Some days she is stuck in bed , some days she has enough drugs – she never lasts more than a week or two .

Jankovoy / iStock

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OCTOBER 2020 • DRINK AND DRUGS NEWS • 9