Methadone Clinics

Who do they benefit?

By: Natalie James & Amber Smith

Good Press in Canadian News

Breakaway Addiction Services runs a methadone clinic at 41 Niagara. The clinic is in a nondescript, cream-painted brick building; the only reason you know it’s there is because I just told you.

But you may have heard that the clinic is about to be torn down to make way for condos, and it will move into my neighbourhood in a day or two.

Parkdale already has its fair share of social services, rooming houses, soup kitchens and so on; some of my neighbours are concerned about the clinic.

Bob said, “People are concerned in Parkdale that property values will decrease.” If so, it would be the first time in my dozen years in the neighbourhood that property values did anything but rise. “They’re also worried about who we serve.”

Lori said, “Up to 80 per cent of our clients have been sexually abused; addiction is one of the outcomes of untreated child abuse.” Is it true that those to whom evil is done will do evil in return?

Bob said, “It’s not the case that those who have been abused will abuse others; they abuse themselves.

“We have the people who were subject to repetitive neglect as children, who were not fed or clothed, who were ignored, who went from foster homes to jail.”

The clinic does not treat crazed predators, dazed moral degenerates, or the unwilling; it treats people who want to get well.

-The Toronto Star 2011; Toronto, ON

Bad Press in Canadian News

Reeve lives on Sheldon Avenue, just around the corner from where the city’s second methadone clinic opened last week at 1253 King St. E.

Hundreds of people addicted to OxyContin and other opioids attend the clinic to get methadone, which reduces the cravings for their drug of choice.

Reeve says he suddenly saw cars parked illegally on his street, bicycles scattered around the area in front of the clinic, dogs tied to nearby posts, litter on the sidewalks and a steady stream of people going in and out.

Reeve fears the heavy foot traffic of recovering addicts using the clinic will make it hard to sell his house.

“On Sundays between 9 a.m. and noon it is crazy because they all have to get in during that short time,” Reeve says.

Reeve and his partner Daniella Hutuleac went to city councillors with their complaints. They were joined by Rob and Suzy Kohlmeier, who also live on Sheldon Avenue.

“It’s outrageous, actually, what happens on that street,” Suzy Kohlmeier says, speaking of litter, loud conversations and public urination.

- TheRecord 2011; Kitchener, ON

History of Methadone

• First synthetically made in 1947

• Synthetic opioid

• Primary care use: analgesic (pain), antitussive (cough)

• Used as treatment in opioid addiction (morphine, heroin, percocet, oxycontin, demerol, fentanyl) for the first time in 1963 in British Columbia, Canada

• Guideline in prescribing methadone first introduced in 1972

• Acts on opioid receptors to produce similar effects of opioid drugs the patient is addicted to

What is a Methadone Clinic?

•Controlled methadone dose •Medical care •Treatment for other substance abuse •Counselling and support •Mental health services •Health promotion, disease prevention and education •Linkages with other community-based supports and services •Outreach and advocacy

Social • Rehabilitation

• Social networks • Support systems

Economic

• Covered by OHIP • Stops drug use which contributes to society

• Gets drug users off of the streets • Decreases unsafe needle use and littering • Can help to decrease mental health issues

associated with drug use

Benefits Associated with Methadone Clinics •Available to a variety of different people (teenagers, pregnant teens, different ethnicities, etc.)

•Can be taken during pregnancy (better than opioid addiction)

•Professional help provided

•Reduces the spread of infection and disease

•Builds a support network for those who seek help

•Controlled substance (well researched, adverse effects and contraindications are known)

Risks Associated with Methadone Clinics •Possibility of overdose

•Not 24 hour monitoring of patients; drop in basis only

•Patient can become addicted to methadone

•Clinics are generally only open during specific times during the day and some patients may miss their opportunity to receive treatment

•Some members within the communities may not support clinics due to the population the clinics work with

•Methadone clinics have been known to devalue housing, making it harder for people to sell their homes

•Methadone use has been linked to serious cardiac arrhythmias

Moral Dilemmas

The Community The moral dilemma within the community is whether or not the community should support the establishment of Methadone Clinics in their region.

Would the benefits and positive consequences that addicts achieve from the clinics outweigh the harmful and negative consequences the community may experience from the stigma associated with Methadone Clinics? Health Care Professionals The moral dilemma that health care professionals face is whether or not it is best practice to substitute one addictive drug for another drug that can become addictive. Is it moral, as an educated health care professional whom is aware of possible adverse effects, to supply patients with an addictive substance with the hopes that the patient will eventually come clean of all drug use?

Utilitarianism & The Principle of Utility

“we ought to maximize benefit/good consequences and minimize harm/negative consequences for the greatest number of individuals affected by a situation or our

actions.”

Methadone clinics were established to maximize benefits and good consequences and minimize harm and negative consequences by helping those who were addicted to opioid drugs and seeking help to overcome

their addiction.

Greatest Number of Individuals Affected By

Situation

Maximize Benefit ‘Patient’

Minimize Harm ‘Society'

• help addicts become sober

•encourages safe needle use

•Allows for proper health care treatment and monitoring of patients •there are no legal implications for seeking help with illegal drug addiction

• clinics are also designated needle disposal centres: they get dirty needles off the Street •Rehabilitates drug addicts so they can contribute to society

•Less transmission of infectious diseases among the community

Utilitarianism

Issues That Cannot Be Resolved With The Utilitarianism Theory

Decision Making Theory does not address that an individual will always make the right moral decision; rather it predicts through worth of the moral agent defined as any rational, mentally mature individual who is capable of understanding the various obligations and action options of a situation and who is held responsible for the choices made. Promise Keeping Methadone treatment success is based on trust between the patient and health care professional. The theory however, allows individuals to lie if they feel it is for the greater good for the most amount of people. Health care professionals also hold obligation to be with their patients until the treatment goal has been met, however this theory suggests that all consequences must occur before judgement can be made. This will cause health care professionals to wait until the goal is reached before they can assess the success of the treatment.

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