CCENDU 2003 Report

Methadone in BC
Methadone is a synthetic opiate-like medication used to treat heroin addiction. It can be taken orally, has a slow onset of action and does not result in continuing tolerance, allowing a relatively constant dose over time. Methadone does not cause euphoric or sedating effects and is long acting. Outpatient methadone treatment programs administer methadone to reduce patients’ cravings for heroin and block its effects. Typically, many patients enter and leave treatment a few times before they finally get the benefits of methadone maintenance treatment.

Some patients stay on methadone indefinitely, while others move from methadone to abstinence. Patients are physically dependent on methadone. Studies have shown that methadone maintenance reduces morbidity and mortality, diminishes the users’ involvement in crime, reduces the risk of contracting HIV and helps drug users to gain control of their lives.

Since 1995 the BC Methadone program has been administered by the College of Physicians and Surgeons of BC. The program monitors the standards of prescribing of methadone and other psychoactive medications to ensure compliance with the standards and guidelines of the methadone treatment program.

The program currently authorizes 558 physicians to prescribe methadone in BC. These physicians undergo an interview with the program director and attend a Methadone Training workshop held at the college and complete a preceptorship program also arranged by the college. Forty four percent of these physicians are located in the Lower Mainland, 7% in the Fraser Valley; 8% in Okanagan and east to Alberta; 22% are on Vancouver Island and the Gulf Islands and 4% in Northern BC.

The number of patients receiving methadone has steadily increased. Currently 7,868 patients are being treated with methadone for heroin dependency. This is a 20% increase since the previous annual report and more than double the number treated in 1997. Over the age of 25 years, males exceed females receiving methadone treatment in each age group.

Further expansion of methadone programs should take into account the need for such programs in prisons as well as the advantages of offering methadone treatment as an alternative to imprisonment and other forms of criminalization — i.e. drug courts.

Methamphetamine
Methamphetamine (MA) is a highly addictive synthetic central nervous system stimulant also known as meth, jib and speed. It can be swallowed, smoked, injected or snorted. A more potent form of MA, d-methamphetamine hydrochloride (crystal meth or ice), is a crystallized smokeable form has been available since 1980’s. The World Health Organization estimates there are more than 35 million users of amphetamine and methamphetamine worldwide; making them the most widely used illicit drugs after cannabis.

MA can be produced using relatively inexpensive over-the-counter ingredients; precursors such as ephedrine or pseudoephedrine are commonly found in cold remedies and other necessary ingredients can be obtained from hardware and retail stores. The manufacture of MA requires little knowledge or equipment; recipes can be downloaded from the Internet. Many of the chemicals used to produce MA are corrosive, toxic and may cause fires or explosions.

MA can keep the user ‘up’ for 16 - 24 hours at a time, which is much longer than cocaine. Once the initial euphoric effects of the drug has worn off, users may experience anxiety, depression, mental confusion, fatigue and headaches. Tolerance grows with long-term use, leading the user to take larger doses more frequently. The user binging on MA may stay awake for 8 days at a time. Such doses may result in psychosis, including extreme paranoia, and violence. They may also lead to seizures, heart problems, stroke, and even death. Prolonged use can cause permanent psychotic symptoms and movement disorders.

Health care providers from a community health centre in downtown Vancouver noticed an increasing amount of MA-related problems and brought their concerns to CCENDU – Vancouver Site meeting in September 2002. At the same meeting, Vancouver RCMP Drug Awareness Service reported an increase in the presence of MA in the analysis of drugs confiscated at raves, in clubs and on the street, figure E3. In response to these concerns a daylong “Methamphetamine Environmental Scan Summit” was held on November 28th, 2002 in Richmond BC.

In Canada, the Ontario Student Drug Use Survey (1999) found that 5.3% of grade 7-13 students admitted using MA in the last year. The highest MA use was by students in grades 11-13 where >8% had used MA in the last year. The 1998 McCreary Adolescent Health Survey in British Columbia reports similar numbers, with reported lifetime amphetamine (including MA and Ecstasy) usage of 5% high school students. More recently Pacific Community Resources (PCR) Lower Mainland Youth Drug Use Survey found a 19% lifetime usage rate for MA and a 30-day usage rate between 7% and 8%. Although the PCR study is more recent, results cannot be directly compared with the 2 earlier student studies as it used a convenience sample and respondents included youth who were not ‘in’ school.

A survey of street youth performed in 2000, using a convenience sample, found 71% of the street youth in Vancouver interviewed had ever used ‘amphetamines’ and 57% had used them >10 times. Covenant House provides food, shelter, clothing and counselling to street youth (aged 16-24) in Vancouver. A survey of clients in October 2001 found 69% had ‘ever’ used crystal methamphetamine.