Parked on methadone

This phrase is used in the UK media and in political debate on drug issues and also sometimes by people who have a drug problem, people in treatment and people working in treatment and support services.

It is generally used in a way that is dismissive of or denigrates opiate substitution therapy (OST), and methadone in particular (see opiate substitution treatment). Interestingly it does not seem to be used with regard to OST that involves buprenorphine. This suggests that the term reflects the stigmatisation of methadone – which while not unique to Scotland is highly developed in Scotland (see stigma).

There seem to be two aspects to the use of this term which are distinct and crucially different.

Firstly, a person is described as ‘parked on methadone’ if they are on methadone for a long time. It is worth noting that in Scotland there are no statistics available about how long people are in continuous treatment. Although people commonly report being on methadone continuously, when this is questioned, many people recount that they have actually been in and out of treatment several times for various reason including being forced out perhaps through a ‘disciplinary discharge’ or because of relapse or because they were hospitalised or imprisoned and did not resume treatment on release or discharge or through a choice they made at the time.

Secondly, there is an issue of understanding the nature of OST as a treatment. The evidence is that one of the benefits of being in OST is that it significantly reduces the risk of overdose and fatal overdose. However, this is only the case if a person has been on continuous OST for over a year.

Also, it is important to note that OST is intended as a long-term treatment. The hope is that the person can reduce or eliminate their use of drugs which frees them from having to get money to buy drugs; seeking drugs; consuming drugs. This may help remove their engagement with the police or criminal justice system. It may also help them to move away from a group of drug- using peers and form and re-form relationships with people who do not have a drug problem. This may include family, their children and other relationships. These relationships can support people in making progress. In this more stable and supportive situation, the person may be able to move on to address issues they face and resolve practical issues including housing and debt issues. They may also engage with services supporting them around their physical and mental health better than they were able to when they were using street drugs. Being on OST may also help people build a daily routine involving meaningful activity including, for example, any care responsibilities, volunteering, learning and training and paid employment. All of this is possible for some people while on a methadone prescription, at an appropriate dose and while adequately supported, if and where necessary.

The term ‘parked on methadone’ can be used to raise legitimate concern that treatment and other services have not supported a person to make the kind of progress described above when that support is required and may have been requested by the person themselves; when attempts to engage with other supports have been refused, perhaps, because they are on OST. There is a legitimate concern here. There are issues with mainstream services being reluctant or not having the capacity to support people with complex needs and there are stigmatising attitudes and behaviours toward people who have a drug problem and people in treatment, particularly methadone. There are issues also with the quality of treatment services themselves and their capacity to work with people on OST to design and then deliver or ensure delivery of a package of treatment, care and support that meet the needs and desires people have in making progress on a range of issues as illustrated above. All of these criticisms can be applied to various services and there is much improvement that could be made however the issues is with the quality of services and services systems and not the medication which people are prescribed.

The phrase ‘parked on methadone’ often reflects the stigmatising and prejudiced attitude towards methadone and people who are prescribed methadone. This stigma is deeply unhelpful in that it discourages people from engaging in treatment; it lowers their expectation of treatment services; demotivates them in engaging with wider supports; it may mean families are concerned their family member is even in treatment; it results in more barriers to volunteering, training and other meaningful activity. It contributes to the isolation of treatment services from mainstream services. In other words it contributes to the very issue that the term ‘parked on methadone’ attempts to describe.