Anti-Methadone Rhetoric Exacerbates Public Health Crisis In The UK

Drug related deaths are once again at an all-time high, with Scotland and England reporting increases in fatalities. In the case of England and Wales this is the ninth year in a row there has been an increase in deaths, and Scotland tragically leads the European table for drug related deaths. The 4335 lives lost in all three countries, are heart breaking. Those who have died are someone’s someone, and every one of these deaths are avoidable. 

Drug consumption rooms, decriminalisation, safe supply and drug checking are all tools that could be deployed to address this public health crisis but which are blocked by the UK government and their commitment to a ‘tough on drugs’ rhetoric. And whilst drug reformers will continue to challenge this position and will push for evidence-based responses, there is one thing that could stop immediately: the consistent and stigmatising attacks on methadone as a medication for the treatment of heroin dependency. 

Take for example the Daily Record’s recent headline ‘Opiate substitution treatment can save methadone users lives’. Now, shoddy media reporting on drugs is nothing new.  Sensationalism. Stigma. Misrepresentation of evidence. These are sadly the norm rather than the exception when it comes to reporting on drug use and people who use drugs. But a headline shouting ‘Opioid substitution treatment saves the lives of people on opioid substitution treatment’ was a bizarre one. This story is the latest in a series of mainstream press reports over the past year on a new opioid substitution treatment (OST) product called Buvidal. 

 

Buvidal In The Media 

 

Buvidal is a slow-release injectable form of buprenorphine, a medication that is typically taken orally on a daily basis. Buvidal is available in both 7 day and 28-day injectables, eliminating the need for daily dosing for people on OST.  Breathlessly described as a ‘game-changer’ by both the BBC and ITV, and as ‘better than sliced bread’ by a GP interviewed for WalesOnline, Buvidal is receiving a level of press enthusiasm not typically enjoyed by harm reduction interventions. It is also a product being rapidly rolled out to people on OST in Scotland and Wales.

On the one hand, this is great. Positive media commentary on harm reduction interventions and people accessing them is a welcome change to the usual negativity. The availability of another treatment option for people on OST is also a welcome development, expanding the choices currently available. 

However, the reporting of this new treatment also raises concerns. Most notably, the positive coverage of Buvidal relies on rehashing and reinforcing the same old stigmatising stereotypes about methadone, ‘addiction’ and drug related deaths that do nothing to improve access to OST for people who use drugs.

The reports typically equate methadone access with illicit heroin use, lumping them both under that dreaded ‘evil’ of ‘addiction’.  Buvidal is commonly portrayed as getting patients ‘clean’ from methadone, rather than more accurately describing it as a switch from one OST product to another. News reports consistently credit Buvidal alone as producing positive outcomes for patients – stabilising people’s lives and relationships, enabling them to work or exercise – that are well documented benefits of OST generally, including methadone.  This is not only inaccurate reporting, but further stigmatises methadone and people prescribed it, setting up a dynamic of one treatment option as ‘good’ and another as ‘bad’.

People prescribed methadone are described as being locked into the medication (read ‘addicted’) forever, while injectable buprenorphine is said to allow people to taper off should they wish.  Of course, this is not only incorrect (many people can and do taper off methadone altogether) but adds to the stigma of methadone by equating it with ‘addiction’ rather than describing it accurately as a lifesaving medication.  

This is not new territory for media reporting on OST, as methadone bashing has been a press pastime for ages. Who can forget BBC’s Home Affairs Editor, Mark Easton’s, infamous ‘Addicted to Methadone’ column back in 2009, which stated ‘A philosophy of harm-reduction had seen tens of thousands of heroin addicts effectively parked on methadone for years’?

 

A Stigmatising Treatment?

 

One of the most glaring problems with the reporting is the conflation of methadone dispensing protocols and the efficacy of the medicine itself. Reports state that people wanted to switch from methadone because it ‘was a stigmatising treatment’. People speak of the ‘stigmatising’ and ‘dehumanising’ experience of having the queue daily for their dose.  We totally agree with this. However, forcing people to queue daily says nothing about the medication, but rather about the uniquely stigmatising controls enforced on people prescribed methadone.  

Many people take medications daily for a variety of chronic medical conditions – from hypertension to diabetes to pain.  Surely anyone accessing any type of prescription would find it awful and undignified to have to attend the pharmacy every day and queue up to be observed while taking your dose.  However, the dehumanising and stigmatising experiences of many methadone patients come not from the need to take a daily dose, but from the policies and protocols surrounding the dispensing of the medication, often driven by stereotypes and suspicions about the people prescribed it.  

Rather than questioning the necessity of this level of suspicion and control, and arguing to relax strict dosing practices as a way to improve patient satisfaction, news reports instead blame the medicine itself. What we should be doing instead is challenging those aspects of treatment that are stigmatising and that in fact turn people off treatment, as well as the paternalism and power imbalances entrenched by such practices. This is particularly important considering over 50 per cent of people who die from opioids have not been in contact with services for over 5 years. 

 

Putting People’s Lives At Risk

 

Services should ensure same day prescribing, that people are not under dosed, that they do not have to queue up daily at chemists where someone watches them consume their medication, that there are not conditions attached to their meds. The pandemic has shown that we can provide people with weekly or fortnightly scripts, that touching base with people by phone works for the many, that people who are drug dependent can be trusted.  Choice and dignity must be core principles for all treatment models. While the development of new OST products and technologies are welcome, methadone will remain the treatment option available for most people, and this type of media discourse does nothing to protect the lives. 

In 2010, the ‘parked on methadone’ narrative helped to feed into the new UK Government’s attack on harm reduction with a policy shift towards treatment outcomes focused on ‘recovery’, which they defined as abstinence. Policy papers like ‘Putting Full Recovery First’, pioneered by Ian Duncan Smith MP and featuring the logos of eight Government departments, denounced methadone, using the language of ‘parked’, and instead promoted ‘full independence from any chemical’. At that time, harm reduction and HIV organisations warned that this approach would ‘put people’s lives at risk’. It is no accident that two years after that document was published, drug related deaths started to increase and that nine years later they continue to increase. The anti-methadone rhetoric, along with austerity which was only beginning to take effect, were arguably the two drivers for the public health crisis we now face. Stigmatising people who are drug dependent is also a reason for this crisis, so let’s stop the stigma, which includes not stigmatising the medication that most people in treatment are on.