Methadone programme transforms lives

In 2020 a drug withdrawal programme was launched at Moses Mabhida Stadium, where members of the homeless community were sheltered as the Covid-19 pandemic broke out. At the time, about 80 people elected to start methadone treatment. Now, two years later, 160-200 patients visit the Bellhaven Harm Reduction centre every day. In a weekly series, Berea Mail will find out more about the programme. This week we chat to Professor Monique Marks from the Urban Features Centre at Durban University of Technology.

FOR Marks, the centre has become a ‘critical place maker.’ The space offers the broader community a lens to understand the homeless community and those struggling with drug use disorder.

“The centre offers critical evidence based medical and psycho-social services aimed at assisting people with drug use disorder to normalise their lives,” she said.

All patients are recovering from drug abuse disorder involving heroin or whoonga, a form of black-tar heroin often mixed with other substances.

In June 2020, the centre moved into its existing premises in Greyville, where nurses administer methadone treatment to 160-200 patients each day. Marks explained that methadone is effective for 24 hours, making daily treatment vital.

“When a patient is stabilised, they are not chasing after a fix every four hours. This reduces the patient’s desire to take other opiates, so they’re able to stop using them,” she said.

According to Marks, the programme has been successful, and this has been achieved through a dedicated team which has been at the centre every day for the past 19 months – come rain or shine.

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“The nurses made sure they came to work through the riots and two storms. I think it’s because they see the transformation in our clients. It’s an amazing team,” said Marks.

By transforming the lives of individuals, the programme plays a role in transforming the city.

“It’s a known fact that methadone programmes decrease criminality. Our programme takes 200 people away from being on the street, constantly looking for ways to get money through begging or petty crime,” said Marks.

She noted, however, that heroin users are unlikely to engage in serious crimes.

“A lot of people blame whoonga users for violent crime. What they don’t understand is that heroin is a sedative; it’s not an upper. Once you take heroin, you can’t do much after that as it relaxes your entire body system. There’s no way a heroin user is going to be actively engaged in crime – especially organized crime – that is just not possible,” said Marks.

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Drugs – a problem or a solution

While most people begin using heroin with the idea they will be able to stop, Marks says the truth of the matter is it is almost impossible to do so without medical intervention.

“If you ask people how they got into active drug use, it’s usually a case where someone put heroin into what they thought was cannabis or it was actually cheaper to buy heroin than many other substances, including alcohol,” said Marks.

“Problematic drug use is always linked to trauma and disconnection from family, institutions or friends,” says Marks.

“The drug is used to dull the pain of the experience of disconnect and trauma. I spent a lot of time recovering the stories of people on our programme who use drugs, and embedded in every single story is a story of disconnect and trauma. What I always say, which is controversial but true, is that drugs are not the problem; rather, they are a solution to an existing problem,” said Marks.

This is paramount in treating drug abuse as, Marks notes, it takes time and a lot of empathy to find out what underlying problems have led to the drug abuse.

Abstinence versus harm-reduction

The harm-reduction model supports the patient’s goals.

“If a smoker wanted to reduce from smoking 10 times a day to twice a day, most doctors would say that is not an acceptable goal. In the harm-reduction model, if two cigarettes is the patient’s self-determined goal, we will support it. Once you start recognising a patient’s achievement, it motivates them,” said Marks.

Methadone treatment is often a long-term plan, and continuing treatment for a year is advised.

“Methadone is a safe, regulated opiate which has a similar effect on opiate receptors as an illicit opiate such as heroin, except that it doesn’t lead to a mood elevation. You won’t get a high – rather what it does is stabilise your mood and take away withdrawals,” she added.

“People should stay on methadone for at least a year, so they build their own confidence in being able to cope without taking illicit opiates,” said Marks. Methadone doses can be reduced gradually during the process.

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