Concerns over replacing one drug with another in order to wean heroin addicts off drugs have recently been voiced in drug rehabilitation circles in Limpopo.
This follows after the Sanca Limpopo Alcohol and Drug Centre in Polokwane held a methadone product and medical management workshop in the city recently, which was attended by various members of the medical fraternity. Methadone is a drug that is frequently used in replacement or maintenance therapy for heroin or other opioids such as nyaope and morphine. This is called harm reduction. It is a Schedule 6 medication and can be prescribed by any medical doctor.
Speaking at the workshop was medical practitioner Braam Nieuwoudt, who among other things specialises in drug addiction, specifically heroin and advocates methadone being used in replacement or maintenance therapy.
Also at the workshop was a representative of a pharmaceutical company licensed to distribute methadone. Polokwane Observer was informed by the representative that neither her name nor that of her company could be published as this would be against their policy as well as the relevant act that governs pharmaceutical companies in South Africa. According to the representative of the pharmaceutical company who also spoke at the workshop, research has shown universally that 60% of heroin addicts relapse within three months of leaving a rehabilitation centre.
Sanca Limpopo Alcohol and Drug Centre Director Amanda Swart explained that the workshop was held in order to better inform the medical fraternity about the use of methadone when rehabilitating opioid addicts. “Where drug addiction was previously considered a disorder, it has now officially been declared a disease. Therefore it stands to reason that as a disease, it can be treated and managed with medication,” she explained. She added that drug addiction is a chronic relapsing disease.
Swart advocated controlled medication specifically mentioning methadone be used together with psycho-social intervention in order that rehabilitated heroin addicts do not relapse. “Sanca has witnessed continuous relapses when total abstinence is required of heroin addicts. Success has nothing to do with abstinence as drug addiction is now considered a disease. It has to do with the successful reintegration into society with the help of medication to assist the addict to function normally. Drug addiction is preventable and manageable but not curable,” she said.
She further said that Sanca Limpopo Alcohol and Drug Centre already offers aftercare services and out-patient rehabilitation, and would like to make it possible for rehabilitated heroin and other opioid addicts to make use of a maintenance programme involving methadone replacement. “We already have a qualified professional nurse with a dispensing licence but we still need a medical doctor to prescribe the methadone.”
According to Swart, addicts on methadone replacement therapy through their centre will be very closely monitored and managed with the methadone dosage being slowly reduced until the addict is completely weaned off it. “However, our plans for this therapy are still at the beginning stages and a lot of work still needs to be done before we launch a pilot project,” she said.
Michele Dix-Peek, an addictions councillor in the private drug and alcohol rehabilitation sector for the past seven years, said she is not in favour of methadone replacement therapy. “Yes, getting off heroin is extremely painful and withdrawal usually lasts around two weeks. However, I have found that alternative methods are also highly effective,” she said, adding that heroin addicts in need of a fix usually become extremely violent and do anything, including stealing, to feed their addiction.
According to her, she has successfully used a combination of acudetox, a type of acupuncture that targets the ear and assists in alleviating withdrawal symptoms, together with over-the-counter medication for nausea, cramps and diarrhoea as well as pain medication not containing opioids such as codeine. Vitamin cocktails as well as natural sleep aids are also used. “With acudetox, the client will pull out of withdrawal within three days and while they will still be experiencing a certain measure of discomfort, they will be eating again and won’t be violent either,” Dix-Peek said.
She further said methadone replacement therapy should be used with extreme caution and close monitoring. “It doesn’t work for everyone and I have had quite a handful of clients who were originally heroin addicts, switched to methadone and then needed help to get off the methadone.”
Medication alone will not keep an addict off heroin or other opioids without the addict also being taught how to live a life clean of drugs, she said.
Also of concern to her is the fact that methadone is very expensive. “Somewhere along the line, the addict is not going to be able to afford it and will go back onto heroin. But because methadone takes away the ‘high’ usually experienced on heroin, the addict will try to chase that high by trying crack cocaine, crystal meth or alcohol.
“No one has ever died of heroin withdrawal, but there are numerous documented cases and studies done worldwide of methadone overdoses being fatal,” Dix-Peek concluded.
Polokwane Observer spoke to several other people in the private drug rehabilitation sector, none of whom wished to be identified. They were unanimous in their concern over methadone replacement therapy being made easily available. “A lot of aspects will have to be considered and strict monitoring will have to take place should Sanca’s plans go ahead,” one source said, adding that the medical and rehabilitation sectors should take care to prevent a nation of addicts being cultivated.
Story & photo: KAREN VENTER
>>karen@observer.co.za
