Methadone or job? Halifax woman says she was given impossible choice

After six years hooked on snorting hydromorphine and Dilaudid, Krista Miller took stock of her life in February, giving up the pills and seeking treatment for her addiction.

But now the 21-year-old woman says she's being forced to choose between treatment and her job. Miller has been kicked out of the only methadone program run by the Nova Scotia Health Authority in Dartmouth.

The Halifax woman admits she missed 13 doses of methadone in November because she had to work during the two-hour window at the Opioid Treatment Program. The clinic is open between 8 a.m. and 10 a.m., although in some cases it allows clients in as early as 6:30 a.m. and as late as 10:30 a.m.

Miller says she pleaded with staff to let her come later in the afternoon, especially since she drives in from Clayton Park. Instead, Miller says she was told she wasn't taking the program seriously and would be cut off in one month, a deadline that's since been extended by three weeks.

"It doesn't make any sense to me. Why would they do that to me if they want to put people on it for a long-term program?" she said.

"I sit here and cry and I'm scared that when they take me off methadone that I'm not going to be able to do it. I still dream about doing drugs."

Involuntary withdrawal

Her problems come even though the province increasingly favours methadone over detox as the treatment of choice for opioid addiction.

Methadone is a legal opioid intended to take the place of illicit narcotics. Some patients remain on the medication for decades, and the head of addictions for the Nova Scotia Health Authority said last week that weaning off methadone can take an entire year.

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Even so, Miller says she has been given only weeks to get the drug out of her system. Her daily dose has dropped from 65 milligrams to 20 milligrams after she says she was placed on "involuntary withdrawal" on Nov. 22.

"I've been throwing up. My stomach hurts," said Miller. "I'm scared I am going to fall back into relapse and do drugs again. I don't want to be off the program."

Working early

Miller worked at pet store as an animal bather a job she loved and thought would lead to a career. On many days, however, she was expected to be at work by 7 am.

She says she ultimately quit to remain in the methadone program, but had trouble finding a new job. She found work at a restaurant, but it also involves morning shifts.

The clinic allowed her to come for her methadone in the afternoon on at least three occasions, but Miller says she was warned her treatment had to come first.

Failing to follow the rules

The health authority won't speak about Miller's case. But health service manager Charlene Casey-Gomes confirmed people are placed into involuntary withdrawal if they break rules at the Dartmouth clinic.

"Continual no-shows, not coming in to see their physician, not providing urine drug screens," she said. "And that would be a behaviour that would be continued because they are certainly given lots of opportunities to change."

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Casey-Gomes says staff try to work around clients' schedules in many cases and only a handful of people are involuntarily discharged from the program each year.

"We realize that they have lives outside the program. They have responsibilities, they have families, jobs," she said.

There are currently 181 clients enrolled in the Dartmouth methadone program and another 17 people on the wait-list.

Where to turn?

Those dismissed from the treatment program often end up at Direction 180, a non-profit clinic on Gottingen Street in Halifax that supplies about 470 people with methadone daily.

Executive director Cathy MacIsaac says her program is "fundamentally different" from the provincially run clinic in that it treats people even if they're using illicit drugs.

"A lot of the folk we work with who have ongoing challenges with substance use, and have complex health or social issues, it's not ideal," she said. "And so for those folk, this program is better at meeting your needs in terms of flexibility."

The only time someone is discharged is for violence, she says.

Direction 180 has a wait-list of 60 people, and Miller says she has been told her only option is to add her name.

In a month, she will be completely cut off methadone and fears slipping back into old habits. Methadone, she says, makes her feel normal, not like a "zombie."

"I don't feel the way I felt when I did pills all of the time," she said. "I feel good. I feel like a person."

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