Dr Simon Adamson
“Heroin” an evocative name for a powerful drug. However, we have virtually no heroin in New Zealand. Why? Because our border controls are good and there are local alternatives. What are those alternatives? Heroin is an opioid, and a range of pharmaceutical opioids, in particular morphine and oxycodone, are widely used here, as they have essentially the same effect when injected. So-called “home bake” heroin is also produced by chemically treating codeine-based medication and opium from common-or-garden poppies.
The best estimate is that New Zealand has something like 10,000 people who are dependent on (addicted to) opioids. In addition there are an unknown, possibly larger, number of less regular recreational users, many of whom are likely to eventually develop an addiction of their own. Recent high profile murder trials have revealed how vulnerable some of these people are, often with multiple life problems in addition to addiction.
How do people get hooked? Most are introduced to opioids by friends, with opioid dependence having been described as a “contagious illness of youth”. Disproportionately they are troubled, with multi-disadvantaged backgrounds, but there are plenty of exceptions. Developing an addiction following legitimate medical use is an increasing concern, particularly with the recent arrival of oxycodone.
So how can we help? Opioid substitution treatment (OST) is the primary intervention. This is what methadone treatment is, while buprenorphine is another opioid used for this purpose. Attitudes are very mixed about this form of treatment, because it involves long term use of a replacement opioid. It’s been described as “like giving gin to an alcoholic”. But this really isn’t a good analogy. Literally giving gin to an alcohol would continue to expose them to risk of organ damage and intoxication-related aggression and injury. For opioids switching to a free, oral medication that only needs to be taken once a day avoids the main risks of intravenous opioid use – blood born viruses (i.e. hepatitis C and HIV), the presence of adulterants, and the need to generate something like $1000 a week to pay for your habit, more often than not via illicit means. The risk of overdose is also greatly reduced with a predictable dose of a lower risk opioid.
Nationally there are over 5000 people currently receiving OST, with over 800 in Christchurch alone. They could be your relative, neighbour or work colleague. The great majority are trying to live better lives and make positive changes. As well as reducing risk, opioid substitution treatment provides an opportunity to address other issues such as health, criminal, family, vocational, and psychological.
Once on a stable dose, a person will experience only mild withdrawal symptoms and minimal intoxication. People on OST can drive a car. They can work. Unfortunately far too few do work, with one reason being the impact of treatment restrictions. Treatment usually requires consuming medication at a pharmacy between three and seven days a week. These “pharmacy pick ups” can impact on employment, with pharmacies not usually open long enough for many workers to avoid interference with their hours of work. Most people in treatment seeking employment choose not to reveal that they are receiving treatment for a drug problem. While some enlightened employers are supportive many are not. This is the cost of stigma, getting or retaining employment becomes too hard, which is a real shame as work very often has a huge positive impact on the recovery process.
OST enables people affected by opioid addiction to get their life back on track. For some it has never been on track in the first place. OST, when done well, provides the opportunity for support and achieving important goals, such as attending to dental hygiene, a period of stable rental tenancy and improving credit rating, work preparation courses, re-established and improved relationships with family, and resolving outstanding criminal justice issues. Successful treatment for some people involves eventually weaning themselves off the programme, while for others it can mean long term OST. In both cases this new life represents a dramatic improvement on what had been happening for them when they were caught up in their drug addiction. The individual, their family, and the community all benefit when this occurs.
