Even as the lockdown is easing slightly, we’re all being urged to only avoid going out unless it’s for something essential. If you are a recovering heroine addict on a replacement therapy programme, getting that replacement certainly feels essential but methadone – by far the most commonly used opioid replacement in the UK – is generally administered daily.
This adds to the strain on already overworked pharmacies and increases the chance of spreading coronavirus by requiring more trips and contact with others. Now Wales is routinely offering an alternative drug called buprenorphine, which can be given monthly. This should have a knock-on effect of reducing the need for people recovering from heroin addiction to make so many trips for medication.
Announcing the roll-out, the Welsh Health Minister Vaughan Gething said that former heroin users could be at greater risk from Covid-19, because, as they frequently have lowered immune systems other underlying health conditions as a result of their drug addiction.
What is drug addiction?
In order to consider the best ways of treating heroin addiction and other problems related to drug abuse, it’s important to understand at least a little about what addiction is.
The National Institute on Drug Abuse (NIDA) defines addiction as a disorder of the brain and mental illness that is both chronic and relapsing. Some main characteristics associated with addiction are a compulsion to seek and take drugs, continued use despite the possibility of negative consequences, and long-lasting changes in the brain.
These chemical changes in the brain are one of the reasons that breaking free of an addiction is so difficult. You might have heard of the ‘heroin addict personality’ but, while some people do seem to be more prone to addiction than others (having an ‘addictive personality’), anyone can potentially become addicted to opiates such as heroin, often very quickly. These drugs are particularly addictive substances and the cravings and symptoms of heroin withdrawal tend to be extreme.
The compulsive part of the disease makes it very difficult for the addict to kick the habit without heroin addiction treatment. This might involve replacement therapy as an outpatient or a full detox and recovery process at a drug rehab centre.
Is replacement therapy effective at treating heroin addiction?
Using an alternative medication is a commonly used method to aid recovery for heroin addiction. The reason that heroin addicts struggle so badly to kick the habit is due to those previously mentioned changes to the brain. These can cause the addict to feel extreme psychological and physical reactions when they do not have access to the drug. Replacing the heroin with a suitable replacement is a way of lessening the withdrawal symptoms, allowing recovering heroin addicts to get the actual opiate out of their systems.
Some critics claim that replacement medications are not a suitable treatment because they simply replace one addiction with another.
The National Institute on Drug Abuse points out several key differences however. It says that the methods of taking heroin tend to result in an immediate ‘rush’ of intense euphoria that also wears off relatively quickly, resulting in a crash. This cycle of ‘euphoria, crash and crave’ is a hallmark of heroin and other forms of addiction, whereas replacement drugs such as methadone and buprenorphine have a slower release and lead to a more stable level of the drug in the patient’s brain.
The individual does not experience the rush but their compulsion to use opioids can be significantly reduced. The replacement drug is also measured and administered in strictly controlled doses and the recovering addict can be monitored by medical professionals.
NIDA says that maintenance treatments save lives as they help addicts to stabilise themselves. This provides the time and opportunity to treat medical and psychological problems as well as any other issues they might have, ultimately allowing them to “contribute effectively as members of families and of society”.
Buprenorphine is being trialled in Wales
Buprenorphine is not an entirely new drug but it is relatively new and it has not been prescribed on such a wide scale in the UK before, having only been approved at the end of last year.
Martin Blakebrough, the chief executive of the Cardiff-based drugs charity Kaleidoscope Project explained how it was being used.
He told the BBC that the project had carefully selected participants for the trials who they felt would benefit from the drug. These included two groups in particular. The first comprises individuals on comparatively low doses of methadone but who still had to make regular trips to the pharmacy in order to take their medication under supervised conditions. The second group was people who had more chaotic lifestyles, meaning they were unlikely to be able to keep regular appointments. The new drug could help by providing a monthly does, which required less organisation and fewer appointments.
He added that the project still tried to make sure that participants were also accessing other therapies and treatments. This is because buprenorphine – like methadone- only provides a medical fix without addressing underlying issues and root causes for drug use.
Does the new drug work?
Numerous studies have shown that replacement therapies can be an effective way of treating opioid addictions but the trials taking place in Wales will be an important step in establishing the effectiveness of buprenorphine compared to methadone.
There is some anecdotal evidence that the drug works. A 36-year old former heroin user, who wished to remain anonymous, spoke to the BBC about her experience with the drug. She said that she had previously been using over-the-counter medication in an attempt to “feel better”.
She said: “With opiate-based medication you lose sensation, you don’t yawn, feel goose bumps as there is a deadening effect on your body, you feel numb. But you don’t get that with this. It makes you feel well, but also awake in a way you don’t with methadone, which makes you feel dopey. It is only the last two months it has occurred to me that I just feel okay. I can’t remember the last time that happened.
“It is like having an angel on your shoulder,” she added.