Supports needed for methadone treatment to work: study
People with criminal histories who stopped taking methadone to treat an opioid addiction were three times more likely to die from an overdose, new research suggests.
But their chances of continuing treatment with the drug could have increased dramatically with support for issues like mental illness, housing and employment, says Julian Somers, one author of a new study of 14,530 people whose data were obtained through the ministries of health, justice and social development in B.C.
Somers said most of the substance users studied were serving community sentences while being prescribed methadone.
“We’re not doing much else for them,” said Somers, a professor at Simon Fraser University’s faculty of health sciences, adding the substance users had prescriptions for methadone for an average of 7.9 years but took it for only about half that time between 1998 and 2015.
The study, published Tuesday in the journal PLOS Medicine, says 1,275 participants died during that time.
Participants were 15 times more likely than the general population to also have schizophrenia and eight times more likely to be diagnosed with bipolar disorder, said Somers, a clinical psychologist.
The methadone patients were in regular contact with government agencies that failed to adequately address their social and mental heath needs, leaving them enduring homelessness, involvement with the justice system and repeated hospitalizations, he said.
“So they’re well known to many, many service providers but they ’re not improving,” Somers said. “Our resources are apparently not being applied to their best effect.
“It’s not simply a matter of figuring out a way to strap an automatic methadone-administration backpack onto people so they’re getting it all the time. We need to think more expansively about the supports and interventions that are necessary for people to recover from an addiction.”
Professionals, including doctors and lawyers battling addiction, often recover without any drugsubstitution treatment, he said.
“The programs that support doctors overcoming opiate dependence and have over 80-per-cent, five-year recovery rates are able to capitalize on the fact that their clients have a number of substantial and important things going for them,” Somers said, referring to so-called social capital.
Drug treatment courts work for many users because they offer housing and vocational and cultural support, and those supports would also help marginalized people taking methadone, including convicted offenders, many of whom are Indigenous, he said.
“This population, with the range of disadvantages that they face, requires a far more comprehensive approach to treatment, both in order to get the methadone adherence rate up but also to stand a more meaningful chance of helping people move forward with their lives in a state of recovery.”
A study Somers led in Vancouver between 2009 and 2013 showed providing housing in the private rental market for mentally ill people and then giving them medical support resulted in use of fewer emergency services.