The disadvantages of the methadone program

The Methadone Replacement Program (MRP) will celebrate its 10th anniversary in Georgia next year. The Georgian Health Ministry introduced this program in 2007. That’s the exact time when the scope of drug use and hepatitis throughout the country reached a catastrophic point. According to U.S. State Department statics from that year, there were 275,000 drug users and 200,000 people with Hepatitis C in Georgia.

A total of 4,000 people have taken advantage of the Replacement Therapy this year in Georgia. At this stage, there are two ways you can participate in the program – free of charge and by payment. The free of charge variant is funded by the Global Foundation and with their support, 750,000 beneficiaries undergo the therapy. The program is free for HIV-positive, socially vulnerable and disabled individuals. As for the beneficiaries of the payment-based program, to get their daily dose of methadone, they have to pay 110 GEL per month.

The state-run, payment-based methadone replacement program is available in Tbilisi, Poti, Kutaisi, Zugdidi, Batumi, Ozurgeti, Telavi, as well as during the summer, in Kobuleti. Whereas, the Global Foundation’s free program covers the districts of Saburtalo and Gldani in Tbilisi, Gori, Batumi, as well as Tbilisi and Kutaisi-based penitentiary facilities.

Only opioid substance users can join the methadone program. According to the data on the latest survey by the NGO Bemone  (2014), there are over 50,000 injection drug users in Georgia. Such statistics give grounds to experts’ concerns – some 5 years ago, there were just 45,000 drug addicts, though their number has considerably increased in recent years, mainly due to the consumption of home-made drugs (‘crocodile’, ‘vint’, ‘jeff’).

From year to year, the World Health Organization (WHO) has been actively recommending Methadone Replacement Therapy in its guidelines, because from the 1960s onward, the medical practice of the methadone treatment has proved that this medication is the most effective not only in relieving drug users’ abstinence struggles (‘withdrawals’), but also combatting against contagions from infections.

When consumed in an unregulated dose, methadone has an effect similar to that of morphine. However, unlike the latter, methadone does not allow the onset of euphoria and considerably reduces one’s chronic dependence. The most important thing in this case is to get the dose right, which is determined by a doctor with his patient. Methadone is a synthetic drug and in order to avoid dependence on it, the doctor time by time reduces the dose. This process often lasts for years and drug addicts can get back into an ordinary rhythm of life. They no longer wake up in the morning with the feeling that they need to get money for drugs, since there is a dose of methadone waiting for them at a medical center. They no longer have to share somebody’s syringe. As a result, they no longer contract blood-borne infectious diseases.

Participants in the methadone program maintain control over themselves, they can perform jobs that requires responsibility and they can have normal relationships with members of society. The effect of methadone lasts for 25-36 hours. That is why those in the program need to be stringent about taking their daily doses.

However, along with its numerous advantages, representatives of the drug addict community, as well as substance abuse professionals also point to the disadvantages of the Methadone Replacement Therapy in Georgia.

We have talked to the beneficiaries involved in the program and received information about the disadvantages of the replacement therapy from them:

Disadvantage 1 

It is impossible for a beneficiary in a state-run program to regularly pay 110 GEL, especially if he/she is participating in the program for years. That’s the reason, why many quit the therapy in the midst of it and get back to the drug use again. No one in the country keeps any statistics on the beneficiaries, who quit the program; neither does anyone study the reasons for that.

Disadvantage 2

There are no stable mechanisms to encourage the participants in the program. “I’ve been a beneficiary in this program for 5 years. My methadone dose has been cut down from 120 milligrams to 25. I have never violated any regulations. Despite this fact, I am not allowed to take my weekend dose of methadone home. So, I have to turn up everyday at the center no matter what the weather is like and get the dose that belongs to me,” says Giorgi M. In Europe this has been a long standing practice, and no one has been the worse for it.

Disadvantage 3

Overly strict dependence on the program is uncomfortable not only a beneficiary, but also to his/her family. The beneficiaries of the Methadone Replacement Program can obtain methadone only during a small window of time, from 9a.m. to 2p.m. (and until 1 p.m. on weekends). Since hundreds of people turn to the service center for methadone daily, there are huge queues there, especially during morning hours. They complain that they are often late for work because of this, and it prevents them from becoming full-fledged members of society. Furthermore, they cannot spend vacation with their families, since they cannot go far from the place where their center is.

“There is no methadone program, free or one which requires payment, in Samtskhe-Javakheti, Racha, Svaneti, as well as in areas where people spend their summer holidays. Moreover, people come from Terjola, Zestafoni, Samtredia, Chiatura to join the payment-based program in Georgia’s second largest city, Kutaisi, where there is no free program. Just imagine how much time and money they spend to travel there daily! So, when are they supposed to work? How long will their desire to continue treatment last to pay unguaranteed treatment costs are a strain for the family budget?” wonders Mamuka G.

Disadvantage 4

When using methadone, it is important that the proper dose is administered, as determined by a doctor together with his/her patient. In order to avoid methadone addiction, the dose should be reduced by microscopic amounts over time. However, once you express the intention to manage the dosage yourself in order to finish the therapy and move into another stage of treatment, the doctor tells you, “Regulate the dose yourself.” In doing so, it’s as if the doctor shrugging off his responsibility. The reason for this is that doctors simply don’t have the know-how for regulating dosages, and they are unwilling to admit that. Doctors’ lack of competence causes their patients to start using stimulants and sleeping pills, in addition to methadone, that affect their health and could possibly lead to expulsion from the program.

Disadvantage 5

Methadone Replacement Therapy does not imply that the patient just pours methadone into a cup. Every beneficiary needs a doctor’s psychological assistance. However, drug addicts often suffer from negligence on part of the medical personnel. The beneficiaries are often treated in a rude manner if they have any complaints. “If you turn up for a program a few minutes late, they may shut the door right in your face. They don’t care much about how you are supposed to make it until the next day. Or maybe they will open the door for your, but that will be followed by thousands of reprimands, says Giorgi M.

Disadvantage 6

There are not many women that take part in the methadone program. According to drug abuse experts, women make up 2% of all beneficiaries involved in the program. Female drug users rarely turn to drug clinics, and the reason is the social stigma, shame, and fear that the truth of their drug abuse will be spread throughout the community. A woman’s anonymity is not observed at the methadone pick-up centers.

Disadvantage 7

Recipients of Methadone Replacement Therapy are prohibited from using a driving license not only while participating in the program, but also for a period of one year after its completion. A car is a source of income for the majority of the beneficiaries (distribution sphere, driving a taxi, etc.). The government does not offer any alternative jobs. It turns out that even after completing the program, one has limited employment prospects. “What socialization are we talking about? We are doomed to unemployment and social alienation,” says Gela S.

Disadvantage 8

One of the major disadvantages of this program is its vague future. The Global Foundation is expected to leave Georgia in 2018, and after that time the issue of funding the program will remain open. None of the agencies have an answer to the question whether the government will be able to manage to continue funding the Global Foundation’s program.

published 1.06.2016