Posted on: 3 December, 2021
Cranstoun responds to The Telegraph article: Methadone to be replaced by ‘abstinence-based’ rehab to treat drug-addicted prisoners
Cranstoun is a social justice charity empowering people and empowering change working across the areas of substance use, criminal justice, domestic abuse, housing, and young people. Prison is a notoriously difficult and challenging environment. Those entering prison estates very often bring with them a number of acute vulnerabilities including addiction, poor mental health and a history of trauma.
Those leaving prison continue to be at high risk of accidental overdose due to the reduced or removed tolerance levels they may have. In an age where drug related deaths are at an all-time high the government should be looking at the journey of those in and leaving prison to promote services that will keep them safe. Prison leavers are at a substantially increased risk of fatal overdose within the first month of leaving prison abstinent.
The Telegraph article ‘Methadone to be replaced by ‘abstinence-based’ rehab to treat drug-addicted prisoners’, if true, demonstrates a lack of understanding of the treatment of those using heroin and other opiates as well as the needs and risks of those in prison. The treatment of opiate (heroin) addiction is multi-faceted and should be tailored to meet the needs of the individual. The use of different interventions is key to ensure the safety of the individual, their wider support networks and the community whilst at the same time looking at the most suitable interventions to achieve their long term goals. Methadone is a well-established substitute medication that is commonly used throughout treatment services and acts as a slow acting opiate that reduces the need to use illicit opiates.
Mr Raab was quoted as saying: “Too many offenders are placed on methadone and other opiate substitutes because it puts prevention of harm… to individual offenders, other offenders and prison officers at the forefront. That might be fine temporarily but methadone is harder to get off than heroin. It is more addictive than heroin. You have to ask yourself if they are staying on it indefinitely, how much is that driving towards recovery.”
In fact there has never been a drug taken orally that comes close to the addictive potential of one that’s smokeable, let alone injectable. And as for harder to ‘get off’, it is indeed slower to clear from the system because it’s fat soluble unlike heroin which isn’t, and that is an advantage in maintaining stable tolerance over 24 hours. Heroin needs to be re-administered every 5-6 hours or withdrawal ensues. When it comes to reducing or stopping methadone that means it takes longer for it to leave the body but that is offset because you can taper off accurately in a way that is impossible to do with street heroin.
The position taken against methadone despite the evidence for its benefits is not new. We’ve heard about people being ‘parked on methadone’ for over a decade, implying that abstinence is preferable. That is largely an ideological position not backed up by evidence. There are many people who have successfully achieved abstinence, this should be celebrated and it was clearly the right route for them as individuals. However there are just as many who have more complex issues (as is the case for most prisoners) who cannot achieve stability without a medication like methadone. We also celebrate the stability they have achieved as a result. Without methadone, many prisoners are far more vulnerable to relapse and the subsequent harms associated with injecting and overdose. Making assumptions that all people need, want and can achieve the same is very dangerous territory, and is not something politicians should embark on. Especially on behalf of the most vulnerable in society.
A better approach would be to look at the overall Continuity Of Care for those entering and leaving prison to ensure community based treatment continues when in prison and then follows through upon release back into the community. With the most recent CoC averages at 45% for opiate users and 37.5% across all substances we know there is much more to be done to ensure those leaving prion engage with the community based teams where are range of harm reduction, substitute prescribing and psychosocial interventions can be delivered to meet their needs.
Addiction is often the result of trauma and looking at the way in which people move through the Criminal justice System where a range of interventions can be provided to build stability and safety is key. One size does not fit all and an abstinence or rehab based approach whilst downplaying the effectiveness of methadone to those in prison or leaving prison could result in a further heart-breaking increase in drug related deaths.
At Cranstoun, we have a wealth of experience and evidence and will support politicians and their officials to save lives and reduce harm and cost to wider society by advocating for a people-centric whole system approach to substance use.