Methadone: 'Liquid handcuffs'
A heavy-handed culture at the Christchurch Methadone Programme (CMP) is condemning addicts to a world of suicide, accidental overdose, crime and prostitution, according to a damning review.
Methadone, or opioid substitution treatment, helps wean addicts off hardcore drugs, but inflexible barriers and a "risk averse culture" has left consumers terrified, angry and, in some cases, dead.
An external review of the Canterbury District Health Board (CDHB)-run programme, which was leaked to The Press, highlights at least four breaches of the Health and Disability Code of Consumer Rights.
"The review team heard not just of suicide and accidental death, but stories of loss of employment, deterioration of mental health, compromised physical health, financial insecurity with increased criminal behaviour and work in the sex industry," it said.
Stringent regulations at the Christchurch programme force consumers to provide at least three clean urine samples before being accepted - a practice not used anywhere else in New Zealand and "quite out of keeping" with national guidelines.
To remain on the programme, consumers must attend monthly medical appointments at Hillmorton Hospital which the review said was "time consuming and unnecessary", citing other programmes that only required two appointments a year.
Consumers told the review team they felt "utterly controlled" by CMP and some couldn't sleep the night before an appointment through fear they would be kicked off to face a withdrawal accepted to be worse then heroin.
The "restrictive" culture was not only putting consumers at risk, it was also endangering other parts of the health sector, the review said.
"Their rules make their practice safe, but our practice more dangerous," one senior mental health practitioner said.
Doctors, desperate to keep their patients on the programme, had been lying to CMP about prescriptions and "dirty" urine tests.
Some GPs, and even clinicians at the programme, had been warning consumers about upcoming urine screens to make sure they were clean.
The external review was commissioned by the CDHB after it received 23 formal complaints from organisations such as the National Addiction Centre and the National Association of Opioid Treatment Providers.
The CDHB has accepted the findings and since implemented changes to the service, which are being overseen by a steering group.
Five thousand Kiwis are on opioid substitution treatment, with more than 700 in Christchurch.
Yet, CMP is responsible for almost 60 per cent of the involuntary discharges from methadone programmes in New Zealand.
Of the 234 consumers unwillingly withdrawn from programmes in the past five years, 137 were from Christchurch.
At least four people have died within a year of being forcefully withdrawn from the CMP, the CDHB confirmed.
And just last week a 52-year-old father, who was forced off the CMP in September, died from septicemia after using an infected needle, The Press understands.
Involuntary withdrawal was the "very last resort a clinician would make in a desperate attempt to prevent death - not cause it," CDHB chief of psychiatry Dr Sue Nightingale said.
If methadone was combined with commonly abused drugs, including alcohol, it could be fatal and continuing to prescribe the treatment "when someone is knowingly using this dangerous combination is very high risk", she said.
Eight people died while on the programme between 2011 and 2013.
CMP's excessive rate of involuntary withdrawals was also pinned on violent behaviour and abuse towards staff, pharmacists or other clients - a phenomenon that had increased in the post-earthquake environment, the CDHB said.
A long list of recommendations for CMP were put forward by the reviewers, including developing a philosophical approach to harm minimisation in line with the national policy.
"The importance of this cultural change cannot be over-emphasised," the reviewers said.
The programme's current culture was so ingrained its staff would need to be watched to ensure the changes were implemented, they said.
Dave Longstaffe, 52, died in a run-down Phillipstown flat surrounded by used syringes and stained home-bake spoons.
He was unwillingly weaned off the Christchurch Methadone Programme (CMP) in September after returning a dirty urine test.
"They've taken me off, I have to find my own drugs now", Dave told his children.
He had grown dependent on methadone after swallowing it daily for more than 20 years and in the last few weeks of his life, as his health failed and he suffered nightmarish withdrawal symptoms, Dave became "a dead man walking", his daughter told The Press.
An autopsy report confirmed Dave died from blood poisoning on March 12, after injecting himself with an infected needle.
Long-time friend, Phil Hall, 46, had taken a few hits with Dave over the years.
He attended his funeral on Tuesday.
Hall, who is on the methadone programme, has done three "lags" behind bars for falsifying prescriptions to obtain drugs.
He has been dependent on opioids for two thirds of his life, consuming methadone on programmes in both Australia and New Zealand.
Methadone is an "addictive and dangerous drug" and Hall said he could appreciate authorities must manage the programme strictly.
However, he said, the CMP was "like the Fourth Reich".
Without a chance to explain, consumers were kicked off for positive urine tests or bad behaviour, some had been reported to the New Zealand Transport Authority after having a single drink at a party and others had their doses halved without warning, he claimed.
"I have heard so many hideous stories out there, someone's got to do something," he said.
"My friends are dying."
The withdrawal from methadone is accepted to be worse then heroin.
Marea Marino, 50, can testify to that.
She went "cold turkey" after she claimed she was punished by the programme when her script wasn't processed on a Sunday and she swallowed two valium to make it through the day.
Marino was once a respected player in Christchurch's underworld - she started drinking alcohol and dabbling in crime at the age of 10 and by 18 she was a drug dealer.
In late 2003, she recalls crying in a pool of bloody tissues as she struggled to find a vein.
Her shot began to congeal and Marino begged her 16-year-old son to "help get the hit away".
This moment became the catalyst for her recovery and soon after she joined the CMP.
Marino has lived a hard life, but her withdrawal from methadone was "by far the most excruciating thing I have ever been through".
"It was like I was in The Exorcist. I could not stop moving and screaming and smashing things," she said. "My sons didn't recognise me. I lost the plot. I honestly would rather go to jail for a year then go through that again."
She ended up in hospital with a hiatus hernia from the stress on her body and refused all pain relief through fear it would spiral her withdrawal backwards.
Marino is now three months clean, her eyes are clear, her fingernails have started to grow again and she has gained weight.
She feels liberated to have escaped what she described as a "draconian" programme.
"The whole nine years I was on it was just a nightmare. I was 50 and they were treating me like a 5-year-old," she claimed. "They had power over my whole life. They had me in liquid handcuffs."
Marino had also known Dave Longstaffe, whose children believe his involuntary withdrawal from methadone played a role in his death.
"They tried to play God with what he needed. It was like a game to them," Dave's daughter, Melissa Fisk, 32, told The Press. While on methadone, Dave had managed to run his own plastering business, hold down a marriage and raise his children. At his funeral, he was remembered as a friendly, generous family man. "He was an exception to the junkies," Fisk said.
Methadone belongs to a class of narcotic painkillers and is used as a substitute for opioid addiction.
Consumers swallow the liquid drug in front of a pharmacist daily.
The free, oral medication helps addicts avoid the main risks of intravenous opioid use, such as blood-born viruses and criminal behaviour.
Prescribed methadone greatly reduces the risk of overdose.