Home > The lived experience of those on methadone maintenance in Dublin North East.

Keane, Martin (2012) The lived experience of those on methadone maintenance in Dublin North East. Drugnet Ireland, Issue 41, Spring 2012, pp. 19-20.

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Van Hout and Bingham1 were commissioned by the client forum of Dublin North East Drugs Task Force to undertake an exploratory study of the experience of individuals in receipt of methadone maintenance who had engaged with the Special Community Employment scheme. Data were collected through in-depth interviews with 15 men and 11 women. The main issues to emerge from the interviews are described in the report and are summarised in this article.  

Experiences of methadone
Getting access to prescribed methadone was reported as being relatively straightforward, with the main criteria for access being the provision of three urine samples that tested positive for heroin use. Some interviewees reported moving to weekly take-home supplies of methadone after providing clean urines for 16 weeks. Although some interviewees agreed with the practice of regular urine testing, the majority, and especially women, perceived this practice as embarrassing and degrading. Most of the people interviewed, particularly the women, gave examples of improved daily functioning when they replaced the use of street drugs with daily doses of methadone.
Interviewees reported a lack of therapeutic dialogue between themselves and the doctors and clinic staff prescribing methadone. Issues mentioned in this context included not being informed of the physical side-effects of methadone, and an absence of clinical advice and support on dosage reduction or detoxification. Arising from the absence of therapeutic dialogue, interviewees expressed ambivalence around detoxification, with some preferring indefinite maintenance instead of potentially painful withdrawal, while others expressed frustration at the prospect of long-term maintenance and signalled intentions to eventually detoxify.
Several interviewees talked about their dependence on methadone and their fear of the withdrawal symptoms if they tried to detoxify; they perceived a detoxification from methadone as more difficult than coming off heroin and perceived methadone as being more addictive than heroin. Many saw their daily dependence on methadone as restricting their personal freedoms, with some referring to methadone as ‘a ball and chain’.
Many of the interviewees felt stigmatised because of their heroin addiction and, although they were receiving prescribed methadone, they also felt ashamed of being seen by neighbours when frequenting the methadone clinics and the pharmacies. 
Experiences of recovery, progression and Special Community Employment schemes
The meaning of recovery and rehabilitation differed among participants: for some it meant being on methadone and not using the main problem drug, i.e. heroin, while for others it meant the cessation of all substance use. The improvement in quality of life and the pursuit of mainstream norms such as employment and a settled family life were also cited as meaningful components of recovery.
The majority of participants reported that their engagement with the Special Community Employment schemes was a positive experience. Accounts varied as to the nature of these experiences and included improvements in personal development and addiction management strategies and the development of positive daily structures. For some participants, the value of the schemes lay in interaction they had with other participants who were ‘clean’ and with staff who a listening ear and support. The effectiveness of the schemes in developing vocational and employment skills was less pronounced; however, some participants reported that they had developed literacy and computer skills. Several participants expressed the aspiration of progressing to third-level education from the schemes.
The variety of experiences narrated in this report is testament to the diverse needs of this cohort of people – needs which, according to the people themselves, are not being met by the provision of other addiction recovery supports and services in the area. Participants referred to the lack of connectivity between services, having to wait long periods to access a counsellor and not having adequate information on what services were available to promote and support progression and social reintegration. Several participants noted a lack of tangible outcomes for those who attended the employment schemes. For example, there was a feeling that employers would be prejudiced against potential applicants due to their engagement with such schemes, gaps in their curriculum vitae and a lack of formal education and training qualifications. Several noted the lack of aftercare and support for those that exit the schemes.
This report, although exploratory in nature, and confined to the context-specific location of the Dublin North East Drugs Task Force area, provides a welcome insight into the lived experience of people in receipt of prescribed methadone and accessing the Special Community Employment schemes. The reported absence of therapeutic dialogue between prescribers of methadone and clients can lead to confusion and frustration among clients around dosage reduction, detoxification and dependence on long-term maintenance.
The Special Community Employment schemes serve the personal development needs of participants but do not help to develop educational skills and improve employability, the role they were established for. Several participants expressed the aspiration of progressing to third-level education from the schemes but could not envision how this aspiration could be tested and fulfilled.
While both interventions, either separately or combined, contributed to some improvements in the lived experiences of the people interviewed the authors found that they were delivered in a way that prevented meaningful progression for participants. They conclude: ‘It appeared that not only was methadone maintenance treatment a “holding pattern” for heroin users, but Special Community Employment schemes also operated in a similar fashion, with little real life employment preparation, assistance in seeking and securing employment or vocational skills development.’ (p. 44)
1.     Van Hout M C and Bingham T (2011) Holding pattern: an exploratory study of the lived experiences of those on methadone maintenance in Dublin North East. Dublin: Dublin North East Drugs Task Force. www.drugsandalcohol.ie/16231

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