Trinity research examines experiences of those on methadone treatment

Posted on: 11 December 2018

Report shows long-term participants on methadone maintenance treatment face complex obstacles to social reintegration  

Methadone maintenance treatment can bring stability to the lives of drug users, but they need multifaceted and multidisciplinary supports to achieve social reintegration. That’s according to a new research report commissioned by Dún Laoghaire Rathdown Drug and Alcohol Task Force (DLRDATF) and launched  by Mary Mitchell O’Connor TD, Minister of State at the Department of Education and Skills this week.

The report, “Just Maintaining the Status Quo”?, was written by a team of researchers from Trinity College Dublin, led by Dr Paula Mayock, School of Social Work and Social Policy. It examines the experiences of 25 people who have been on methadone treatment for 10 years or more. The average age of research participants was 43.

The report shows that while methadone treatment is effective in providing stability, long-term users need a range of social interventions and supports, including education, training, housing and family welfare supports – in addition to medical treatment.  Furthermore, the report highlights the stigma associated with methadone treatment, particularly for those availing of the treatment in public clinic settings.

Commenting at the launch today, Dr Mayock, said: “This is the first study in Ireland that specifically focuses on people who are long-term participants in methadone maintenance treatment.  We found that levels of social reintegration amongst our participants was exceptionally low.  Most did not have access to the kind of economic, social or personal resources that are needed to bolster and sustain the recovery process.

“The dominant experience of being a methadone user was one of stigma, with many of those we engaged with for this research attempting to conceal their methadone use for fear of being judged. Stigma contributes to social isolation, with participants sharing with us how they felt excluded from community and family life.”

Key findings of the research include:

• The average age that research participants first used drugs was 14 years old. The average age that they first used heroin was 19 years old.
• Methadone treatment impacted participants’ lives positively by bringing stability and normality to their lives. At the same time, participants reported negative sentiments about methadone and the treatment system more broadly, feeling they had little say in their treatment, particularly in relation to long-term rehabilitation planning.
• The majority of participants in the research study had low levels of educational attainment, with nearly 80 per cent leaving school by Junior Certificate level.
• Mental health problems were widely reported, with depression being the most commonly-cited mental health condition. Some participants cited lifelong mental health conditions stemming from childhood. Chronic physical health problems – including hepatitis C, liver cirrhosis and a range of respiratory, renal and coronary diseases – were reported.
• Research participants had extremely low levels of social integration. The vast majority were unemployed and did not see any realistic prospect of employment. Many were homeless or precariously housed with over half the participants experiencing homelessness at some point in their lives.

Social Reintegration

Dún Laoghaire Rathdown Drug and Alcohol Task Force (DLRDATF) commissioned the research following concerns that the needs of a particularly vulnerable group – long-term methadone-users – were not being met in a clinical setting alone.

Speaking at the launch, Dr. Barry Cullen, Coordinator of DLRDATF, said, “Methadone treatment works as a public health measure and individually, but it inadvertently compounds users’ experience of social exclusion. The daily life of a long-term methadone user is characterised by seclusion and loneliness, with few dependable or trusted people in their lives.

“While the obstacles they face are multiple and complex, we must not accept that this vulnerable group will live their lives on the margins of our community.  Social reintegration is about access to housing; access to education, training and employment; and the opportunity and support to repair relationships.

“Agencies operating in these fields must establish relevant programmes and services.  For our part, the Task Force will convene a collaborative team, involving housing support, the Local Employment Service, the Community Addiction Team, and family support to deliver more effective and holistic supports to long-term methadone-users in our community.”

Launching the research report, Minister of State for Higher Education – and TD for the Dún Laoghaire constituency – Mary Mitchell O’Connor said: “Research into social issues has a major role to play in developing new knowledge and evidence to help policymakers and practitioners meet societal challenges.

“I commend Dr. Mayock, her team, and the Dún Laoghaire Rathdown Drug and Alcohol Task Force for highlighting the societal and health needs of older methadone-users.  Meeting their needs will take an evidence-based, collaborative effort involving a range of stakeholders in our community. The research report launched today provides a solid foundation from which to begin that work.”

Dr. Eamon Keenan, National Clinical Director, HSE Addiction Services welcomed the launch of the research report today. Dr. Keenan said, “I wish to acknowledge the launch of this report and commend the hard work of all the authors particularly Dr Mayock. The report raises a number of challenging issues for service providers but we are confident that services can be developed into the future that will address more actively the needs of this cohort of individuals on long term methadone maintenance treatment. The HSE is committed to implementing all aspects of our National Drugs and Alcohol strategy, Reducing Harm, Supporting Recovery and many of the recommendations from this report resonate with our objectives. Methadone maintenance treatment remains an Essential medicine as defined by the WHO and a key component of our Harm reduction approach to the problem of long term opioid dependence. We will also continue to work with the Drug and Alcohol Task Forces and other departments to promote the continuum of Recovery.”