Nova Scotia pushing more opioid addicts to methadone, away from detox

Nova Scotia is shifting away from publicly funded detox programs for opioid addicts looking to get clean in favour of a controversial treatment that involves using one drug to treat the addiction of another.

A CBC News investigation has found the Nova Scotia Health Authority wants to focus on long-term methadone therapy to treat opioid addiction instead of inpatient detox, which the head of addictions services said can turn deadly in worst-case scenarios.

CBC learned about this new direction after calling every treatment centre in the province.

Detox for opioid addicts "doesn't work," said Dr. Linda Courey, director of mental health and addictions for the health authority.

"We really want to avoid that use of inpatient withdrawal management ... for people with opioid use disorder."

Detox as a 1st step

The first step for those looking to kick the opioid habit under the province's current system is often inpatient detox, also known as withdrawal management, which involves spending a week or two in hospital being weaned off drugs.

Often, this is aided by medications such as methadone that are used to help stave off discomfort or pain associated with the grueling withdrawal process.

Methadone is a legal opioid intended to take the place of illicit narcotics in addicts, but treating addiction with drugs has been contentious.

Patients are drug-free when they leave the hospital after detox but may end up waiting weeks to get into a methadone maintenance program or a long-term rehab program, which can include residential treatment with therapy and other supports.

The new strategy would eliminate hospital-based detox for opioid addicts. Instead, people would go to their doctor or a clinic seeking a prescription for long-term methadone, along with counselling and other supports.

People addicted to alcohol and other drugs are still encouraged to seek withdrawal management.

'They can certainly overdose'

While 721 people took part in a publicly funded detox program for opioid addiction last year, Courey said the treatment is problematic.

Courey said a major problem with opioid detox is the fact many patients fail to follow up with outpatient treatment and end up relapsing.

In those cases, detox can turn deadly.

"Because they've gone through withdrawal, their systems aren't ready for that amount of drugs and they certainly can overdose," said Courey.

Detox alone not working: health minister

Provincial Health Minister Leo Glavine said he supports the shift away from detox to methadone treatment.

Opioid treatment is a "very challenging area" and having patients go through inpatient withdrawal and then be discharged without medication such as methadone or suboxone hasn't been working, he said.

"I know people who were detoxed seven times," said Glavine, adding that he was aware of a situation where that ended in a "tragic circumstances."

Methadone for life?

Courey said some patients may end up taking methadone for the rest of their lives. In some cases, that may be the easiest option.

"It's also possible that people, once their lives are stable, then they could choose ... to gradually withdraw over a very extended time," she said.

"It is not easy to withdraw from methadone."

Family physicians across the province are being encouraged by the health authority to follow up with methadone patients in their office and will be compensated for the extra service.

Struggling on methadone

Stephanie Benham, a former opioid addict, understands the struggles with methadone.

The Shelburne, N.S., woman unsuccessfully tried beating her Dilaudid addiction before with methadone, but it only worsened her drug abuse. She was on methadone for five years but continued to take other drugs and cheated drug tests by using other people's clean urine.

"You go on methadone so you don't have to use every day, but you still have that hanging over your head for the rest of your life," said Benham, 30.

Benham was finally able to get off opioids four years ago after going through a medical detox in Detroit at her mother's urging.

"Thank God," she said. "Without her pushing every day, and in my face and telling me, 'You should be doing this,' I probably would have let it slip."

'Liquid handcuffs'

Her mother, Melanie Benham, described methadone as "liquid handcuffs." She had to drive her daughter from Shelburne to Wolfville once a month for her methadone prescription.

Then there were the daily trips to the local pharmacy.

"She couldn't go out of town overnight because she had to get to the pharmacy every day. So you didn't have that freedom," she said. "It was like you were on house arrest but in your community instead of a home."

She believes Nova Scotia should increase access to medical detox rather than shift away from it completely.

"I feel for all of the moms that are out there doing the same fight, and they're just helpless," she said.

"Because when an addict says, 'OK, I'm ready,' there's not a facility in the world that says, 'OK, let's go.' Not one that I found anywhere."

Residential care not always the best answer

While Courey acknowledged that some people may prefer a rehab program over long-term methadone, she said that's not a quick fix either.

"The problem often with residential treatment is that skills and support that exist in an institution do not generalize well to the community," she said.

"Not to say it's not ever effective in some cases, but for most people that transition from living in a protected environment to their community is extremely difficult to navigate."