Long-term addict Martin Wijnen tells Amanda Elliot why he
thinks HIV positive drug users have been conned by methadone maintenance programmes
Before the advent of highly active anti-retroviral therapy (HAART), HIV positive
people were lucky if they got tea and sympathy and the occasional massage.
If you were an injecting drug user in the UK you may even have been offered
‘harm reduction’ options: clean works from needle exchanges or
methadone to help you kick the heroin. Over the years some people lived, some
died, and some managed to get clean. But for others, drug dependency remained
a fact of life.
Martin Wijnen is one of these. Diagnosed with HIV in 1987 after his sister
died of a heroin overdose, he was told he had “six months to a year
tops” to live. Seventeen years on he is still here and still heavily
addicted, not to heroin, but to the synthetic opiate methadone. In his view,
one shared by many current and ex-drug users, methadone is a dirty drug; harder
to kick than heroin, potentially more dangerous, and one that reinforces using
behaviour.
“I may sound like an angry addict but I feel people with HIV who are
drug users have been written off. Methadone maintenance may have made sense
pre-HAART. They had nothing else to offer, but after it became clear we had
a fighting chance they should have offered us alternatives.”
Methadone was first developed by German scientists during World War II as
a pain-killer. But the Nazis decided against mass producing the drug because
of its side effects when administered in large doses.
In this country, methadone is usually prescribed to drug users as green sticky
liquid and administered under supervision. If used for short periods it can
help addicts get through the physical and psychological trauma of opiate withdrawal
in detoxification programmes.
But more controversially it is used for ‘maintenance’; prescribed
for an indefinite period as part of a ‘harm reduction’ strategy
with no automatic step down. Methadone is longer acting than heroin, so can
be taken just once a day. The idea of maintenance is to enable addicts to
live more stable lives and thereby remove the destructive effects of heroin
withdrawal: needle-sharing, drug-related crime and risk of infection from
blood-borne viruses and onward transmission of HIV.
From a prevention point of view, harm reduction policies have worked. IV drug
use has played a smaller part in the UK HIV epidemic than in many other developed
countries. In 2003, 118 people acquired HIV infection through injecting drug
use. At the end of September 2004, a total of 4,170 people had acquired HIV
by this route from the time Health Protection Agency started collecting data.
Needle exchanges have clearly worked. But little has been done to support
HIV positive drug users now hooked on methadone.
And for Martin, who is co-infected with hep C, methadone maintenance has led
to anything but a stable lifestyle.
“I arrived back in the UK on the 1 January 1997, just out of prison
in Zimbabwe; determined to do something about my addiction once and for all.
My addiction and I had circled the globe a number of times looking to lose
each other. HAART had put in its appearance and I had a reason to live. Actually,
it was more a case of no longer having an excuse to use.
“I approached the NHS in Scotland for help with my drug problem. And
guess what the solution was: more drugs.”
“It is an amazing piece of medical chicanery. So amazing I can’t
believe I even bought into it. Yet I am still here, still addicted. Only this
time it is to a cocktail of cheap and nasty drugs: methadone, benzodiazapines,
anti-depressants, and so on.
“All the emotional issues that led me to ‘pick up’ in the
first place are unresolved and my self esteem is in tatters.
“Sure, when people were dying like flies, pre combination therapy, methadone
maintenance was, I suppose, acceptable. It gave the NHS access to a vulnerable
group of people who might otherwise have initiated the ‘Iceberg’
scenario’ that we all saw on TV and it allowed addicts to die with some
semblance of dignity.
“But the times have changed and it is no longer acceptable, in my view,
to shackle addicts to a substance they don’t even like. If the policy
is maintenance, then at least maintain people on their drug of choice. Coming
off heroin is hard but you are usually up and about after a week. With methadone
it can go on for a couple of months. It’s a nightmare.”
After starting on methadone, Martin ostensibly began to address his HIV status
by volunteering for HIV charities. He even landed a job for Body Positive
Strathclyde.
“On the outside everything looked good. I had a job, a girlfriend and
I was helping to support others with HIV. Problem was, on the inside I was
in turmoil. I was still running from my diagnosis, still dependent on methadone
and still sure I was going to die.”
“If you are not HIV positive, they make more effort to get you to step
down. But in Glasgow it was quite easy for patients to get their scripts increased.
It was a bit of a candy shop mentality. We were given benzodiazapines, Mogadon
and Valium, to top up the methadone, but they forgot to mention that you can’t
come off those without fits and convulsions.”
Matters finally came to a head last year when he started combination therapy.
He quickly realised that he was one of the 14 per cent of people unable to
tolerate Combivir or efarvirenz. He became severely anaemic on the former,
and psychotic on the latter.
“It confirmed all my worst fears about HIV drugs. I felt so low I began
self-medicating and ended ‘picking up’ [the needle] again. At
that moment my future as an addict loomed before me. I was not prepared to
go through that again, so I decided to end it.”
Martin took a deliberate overdose. When he came too in his flat five days
later he was covered in vomit and much more. He immediately rang his doctor.
“I told him I had taken everything he had prescribed: all my methadone,
200 Mogadon, (nitrazepam), Valium and antidepressants. He said that wouldn’t
kill me and then told me to come in as I would need another script. Can you
believe it? I was desperately in need of some psychiatric support and he offered
more methadone.”
After switching to a more tolerable HIV drug regimen, Martin moved to London
in search of a solution. For three months he bounced between IV drug units,
HIV clinics, social services and HIV organisations. He also found time to
co-facilitate St8talk, a support group for non-African HIV positive heterosexuals.
Finally, under the care of a consultant psychiatrist at Chelsea and Westminster
IVD unit, he was offered help. Last month he was accepted for detox and residential
rehab, which, says Martin, will hopefully finally free him from the “ball
and chain” of methadone.
“I would love to be able to say hey, shove your methadone and all that
other crap too. But the truth is I am so addicted, I am going to have to spend
the next six months, at least, fighting tooth and nail, just to become drug
free. Free to start some real therapy.”
Useful numbers:
• Mainliners: national HIV and hepatitis C charity working with ex and
current drugs users helpline: 020 7582 5226 www.mainliners.org.uk
• Str8talk: group for non-African heterosexuals meets 6.30 to 9pm at
the Lighthouse London West. Next meeting 2 Feb str8@btinternet.com
