Methadone Maintenance & Continental Socks.

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During my ten years of heroin addiction I have been in rehab just once. That was for a very specific reason and was not my choice. It lasted 5 months. This post details my reasons for entering rehab along with my experiences and observations of it. I do not go into the failings of that system, as it is outside the scope of this post.

I will start by saying: I don’t believe in rehabilitation... not for me anyway. To go for that means you think that you have something to be rehabilitated from, and I don’t feel I have. There is nothing wrong with me...I am dependent on a drug, that’s all. Rehabilitation suggests something so much more... that beyond heroin the person is the problem, that the person needs rehabilitating. But from what? From life?

My reasons for even considering rehab came about because of my wife. We’d been living together in London for a few months and each month had became more miserable and more depressing than the last (especially for her). What she thought she could handle, she quickly realised she couldn’t and that what may have seemed romantic on paper was not so when it was the crux of a daily existence.

By the end of October (I think she waited until after my birthday) she said she was leaving... returning to France. She asked if I was following, but I could only shake my head and look down. As our relationship crumbled all I could do was stare despondently at her red, flat soled shoes and continental socks. We parted on the corner of the street... me heading off to work and her heading to the airport. She was crying, but I was dry... of tears, apologies or goodbyes. Poetry would have been useless... it was that which had brought her here. And so she left.

After a month apart I realised that unless I done something the relationship was doomed and I didn’t want that. The last year (including the fights) had been the happiest of my life. In absence of any other acceptable solution I agreed to enter a rehabilitation clinic (though not to stop using) and promised that once I had been stabilised on methadone that I’d transfer my script to a hospital in Lyon and then we’d leave together. Whether transferring a script to France was even possible I had no idea, although I told her I’d looked into it and that it wasn't a problem. The reality of what I discovered was it was extremely difficult transferring a script from one London borough to another, let alone abroad. Still, I had to tell her something... and as I had nothing to tell her, I lied. On the back of that lie, and actual proof that I had really booked myself onto a maintenance program, she returned.

It was during the middle of December 2003 that I experienced my first taste of white-walled, fruit-filled and sickly Drug Substitution units. After passing my 2 months on a waiting list I was finally there, feigning junk illness so as I could get as much methadone as possible. It was 8.30am, and I was surrounded by snivelling, groaning, moaning junkies... sick to the bones and begging for their dose. From the start I had problems.

After waiting 30 minutes in the dying room I was called by a doctor. I followed him into his little surgery and was joined by my drug counsellor (my key worker). I tried pretending illness as best I could, but it’s a difficult thing to do, especially around those who know it so well.
“When was the last time you used Mr. Levene?”
“Last night... just before going to bed.” I admitted.... omitting to mention the injection I had taken just before leaving
“You’ve not gone the 24hrs? You are not withdrawing?” The doctor enquired.
I explained that I was withdrawing, but that I wasn’t sick and couldn’t understand why I had to show up ill.... did I have to earn my treatment?
“No, but you’ve got to show you want it... that you’re serious on quitting”
“ Well, I’m here...I’ve money in my pocket and I’m here, how more serious can I be?”
The doctor scribbled something on a notepad and gave it to my counsellor. “We’ll give you 10mls... if you want more, you’ll have to come here withdrawing.”
“10ml! That won’t do anything. I need at least 90ml!.. 10ml!!!”
“Mr. Levene, 40ml is enough to bring about fatal overdose... whilst using on top we cannot give you anymore. Tomorrow morning we’ll review your situation further. Good morning.”
“Good morning?? It will be... I’ve gotta go and score now!”
With that I left the doctor, swallowed down the measly 10ml I’d been prescribed and then caught the bus to Shepherds Bush where I scored before heading in to work.

This pattern continued for nearly two weeks. Each day the doctor telling me the same and upping my dose another 5 or 10 ml. By the end of the 14 days I was on 110ml a day, which was enough to stop me from becoming ill if I had no gear.

After being stabilised I still had to travel to the treatment centre each day, see the doctor, have my urine tested and then drink my little cup of juice in front of the nurse. It was a one system suits all... yet from what I could see it was a one system fails all. On account of my job, I asked for special permission to have a weeks script at a time... I explained that I could no longer justify to my directors why I had need of an hour and a half absence each morning (and for the foreseeable future too), but it was refused. It wasn’t until I forged a letter on company headed paper, threatening myself with disciplinary action, that I was finally given a weeks script. Thank God for common sense!

To cut the story short, I was at CAPS, the treatment centre in West London for 3 months before being in a position to transfer my script to France. During those three months my heroin intake remained the same as it had ever been. This disappointed my wife a little, as regardless of my lack of resolve to quit, I’m sure she secretly hoped that I would... or that I’d at least slow down a little. Instead the truth was this: when she left England I was a crack and heroin addict, and when she returned I was a crack, heroin and methadone addict... things hadn’t gotten better, they’d become worse. Anyway, soon she’d have her wish... soon she would experience a life free of any illegal drugs.

Surprisingly the transfer of my prescription to France couldn’t have been more simple. Two faxes and a note from my key worker and it was complete. So at the very beginning of March 2004, my wife and I left London to start a new life in Lyon... a life where heroin was no longer a barrier down the middle of the bed.

For me France would be the unknown.... not just in terms of the language or people, but as an adult living a drug free life. I knew that once I left England that heroin & crack were off the agenda... not possible, at least for the time being. My only heroin contact in France was Alexandre, my wife’s brother, but unfortunately he was serving 3 years for heroin trafficking charges in the local St. Paul Prison. So France was the real beginning of a heroin free life... my first in almost 5 years.

The methadone clinics in France are pretty much the same as in the UK. Early morning visits, drinking your juice in front of an observer... weekly urine test... psychiatrist reports and meetings. The main difference between France and England is the punishment on giving dirty urine's. In England you are punished severely for this, whilst in France they use the information more for monitoring your progress and the success of the treatments. In France all addicts have their own script, in England all addicts are thrown off their scripts. The ideal position to be in, and which I’m in now, is to give enough clean urine's to build up a little bit of trust. Once this has happened you can ask to be transferred to a GP (who rarely if ever takes urine tests).

In France I stayed clean for almost 5 months... just enough time to speak a little, and get some money in my pocket. Those 5 months were not miserable or unhappy I got down and got on with life. I used them to concentrate on my painting and writing and other creative outlets that I had neglected in my drug addiction. That little break really served its purpose as I reviewed the past 5 years and made certain promises to myself. My writing or thinking or painting heroin free was no different... it was no better or no worse. Heroin doesn’t affect one in that way.

My gradual descent back into addiction upset my wife, but she always knew I’d bring heroin back to our bed. Like everyone else I suppose she just hoped. At least here she had some control and a hand in my addiction. She knew the dealers and how much I was buying... if my usage was constant or increasing. The paranoia of London was not here and it was a huge release for us. Also, I had given up my addiction to crack cocaine so she was thankful for that She was also thankful that I was painting and at last doing something creative, though she was always urging me to write... well, maybe now’s the time to do that. In fact, I think it is.

I’ve explained a little of the program and my experience of it and now I will go through the problems of treatment.

1) Methadone or Subutex is NOT heroin. It stops the physical withdrawal but gives the addict nothing else. Unless the addict is also taken away from heroin these substitutions cannot work. 50 or so years of treatment have proved this.

2) The punishment of the addict and the subtle ways he is made to earn his treatment or to deserve it.

3) The strict discipline for dirty urine's. The clinic is fond of reassuring you that a slip up is nothing serious, that heroin is a long term addiction. Yet if you are caught using, or you stupidly admit to it, you have your methadone dose cut down and if use is continued will be thrown off the program.

5) 95% of addicts enter rehab because of financial problems. They’ve hit bottom and can no longer sustain a habit. They are there not because they want to give up junk, but because they can’t afford it.

6) The early morning meetings and all the hidden agenda’s that are attached to drug treatment. Instead of attacking the main problem they sneakily serve to discipline and train the addict.

Of the 52 addicts that I met during treatment in England only one managed to kick first time. Of the rest 46 admitted to being there because of financial reasons. Most were still using heroin at any opportunity.

I don’t offer up any solutions here for drug substitution treatments, I’m not informed enough to do that. But I do know that neither methadone nor subutex works. What is needed is Heroin maintenance programs. These do exist, but are extremely controversial (especially when state funded) and one has to be almost dying (if not dead) to get on one of these programs. The controversy (outside of giving addicts free heroin) is that they do not encourage the addict to stop... that they encourage prolonged drug use. They do, but they stop all the crime, dirt and destroyed lives that come with illicit addiction. And what will be surprising is just how quickly a completely stabilized addict will feel completely stupid using just to feel normal. Once the highs and lows are removed from heroin addiction, the addict is as good as permanently straight... there is very little difference. And if one is straight using, one may as well be straight and not using... I myself sometimes feel this... but then there is a drought.


Take care readers... was it really 7 days??? (No, it was 8! ;))