Ontario Changes to Methadone Program a Mistake, BC Patients Warn.

Ontario’s 40,000 methadone patients are being switched to a new formulation of methadone, a medication prescribed to treat opiate addiction. Patients in BC were switched on to the new product – called Methadose – earlier this year. The results are proving problematic. Many patients are reporting that the new methadone doesn’t hold them until their next dose. They wind up in withdrawal, back in the cycle of sickness and craving from which they fought to escape. Some are relapsing back to heroin.

The BC Minister of Health recently conceded “for some people, perhaps methadone is better than Methadose.” He has ordered a review of the effectiveness of BC’s switch to Methadose.

The old methadone, compounded in the pharmacy in a Tang solution was to be delisted from Ontario Drug Benefits this summer. As in BC, the date was pushed back. But the new medication is now hitting pharmacy shelves in Ontario.

Patients on Methadose, like Dean Wilson, urge Ontario to reflect on BC’s experience before charging ahead with a move that could send thousands back into active addiction.

Most of Dr. Christy Sutherland’s patients are feeling withdrawal symptoms on Methadose. Sutherland is the co-medical director of the Portland Hotel Society on Vancouver’s Downtown Eastside and treats about 100 patients for addiction.

Another addictions doctor I spoke to on the condition of anonymity said that 30 percent of her long-term patients are reporting withdrawal symptoms after being switched – these are patients that had been stable and off street drugs for years. One admitted to buying illicit methadone on the street to compensate for the ineffectiveness of Methadose.

Opiate withdrawal 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.

Laura Shaver of the BC Association of People on Methadone (BCAPOM) has been on methadone for years. A couple days after being switched to Methadose, Shaver began feeling withdrawal symptoms. By 7 AM each morning, she was sick. “On the old methadone, I didn’t wake up in the morning sick,” she said. “I didn’t go to bed sick. I was fine.”

Soon, Shaver was missing meetings and couldn’t carry on with her advocacy work. After years of abstinence from opiates, she started using heroin again. Choked with emotion, she showed me two new injection sites.
Jeff Louden is in the same boat. He’s been in methadone treatment for a decade. Each day, he takes Methadose at around 10 AM, yet is feeling withdrawal symptoms by midnight – ten hours before his next prescribed dose.
At 3 AM on the day we spoke, Louden was awake, sweating with “the spider [of withdrawal] crawling up and down my spine.” He is also using heroin again. I asked Louden what the solution is. “Just give me the old stuff back,” he said.

The switch to Methadose was apparently made to prevent “diversion” – street use of the drug which is often injected instead of taking it orally, under a pharmacist’s supervision. If injected, Methadose will congeal under the skin or in the veins.

There are stories in Vancouver about people injecting Methadose and getting bad abscesses. Jimmy was one of them. He injected Methadose. The next day, he showed me his swollen and discoloured forearm, slapping it several times to demonstrate the lack of feeling in the area. I strongly urged him to see the street nurse right away.

Dr. Benedikt Fischer of the Canadian Institute of Health Research rejects the idea of tamper-proofing drugs to prevent diversion. “Drug users can circumvent tamper-proofing,” he said. “It’s not an effective deterrent and there can be complications… people can get sick, it can be a horrible experience.”

In August, BCAPOM and the Drug Users Resource Centre (DURC) wrote an open letter to the BC minister of Health: “Many of us are facing a return to an unstable life of addiction, sickness, crime and misery from which we have fought so hard to extricate ourselves. MMT [Methadone Maintenance Treatment] has been a key tool in many of our recoveries, but one that has now been sabotaged.” The letter closed by asking that the old methadone be made available again.

The government says it will look into the matter, but the activists and patients aren’t just waiting on the Minister. They’re also doing research on the effectiveness of Methadose.

The BC Centre for Disease Control (BCCDC), has partnered with the Vancouver Area Network of Drug Users and The First Nations Health Authority to survey people’s experience with Methadose.

Sarah Moreheart at BCCDC said in an email: “Concerns have been raised regarding the change of compounded methadone to Methadose. Therefore we added some questions to the annual survey to objectively assess the perspectives of persons who were in the methadone maintenance program at the time of the transition.” However, the results won’t be available for several months.

DURC and BCAPOM members are also planning to have their blood tested to determine how fast Methadose loses its effectiveness.

Until all the research is in, Dean Wilson of DURC advises Ontario not to rush into things. “Look into it,” he said. “There are obviously some problems. Hold off. Don’t commit until you understand what’s going on.”