Thousands of New Zealanders receive regular treatment for an opioid addiction that often starts with a prescription from a doctor. Sunday reporter Mava Moayyed investigates the treatment many consider a life saver – and the ‘junkie’ stigma that lingers.
Like so many women, Vanessa Thomas suffered from painful periods. She likens the cramps to “being stabbed in the stomach”, leaving her unable to sleep or eat.
When she was in her early twenties, her doctor prescribed Codeine for relief, about 30mgs to take the edge off those debilitating days of the month. The 49-year-old says she was on the medication for “a matter of weeks” but later went to the dentist, under the guise of a toothache, looking for a daily dose. By this point she was seeking relief from more than period pains.
“When I tried to stop taking it, the withdrawals would kick in very quickly. It’s almost like your bones are on fire. You’re nauseated all the time. It’s awful,” she says.
People who use opioids can develop a tolerance and physical dependence, meaning they need more of the drug to get an effect and over time require it just to feel normal.
Thomas would “do the rounds” of about a dozen pharmacies, keeping detailed notes on which ones would sell her painkillers and which ones had cut her off. At her worst, she was taking about 50 painkillers a day.
It was something she kept mainly to herself. “I was embarrassed because I was addicted to pain pills. I mean you’re a dirty junkie, right?”
She says the stigma around addiction meant it took her a long time to get help.
Made from poppies or created synthetically in a lab, opioids work by blocking pain messages to the brain and boosting feelings of pleasure. While drugs like Codeine, morphine and Oxycodone are effective in treating pain, they can also be highly addictive.
“I’m furious now,” says Thomas. “There should have been more of a discussion about what this medication can do to somebody, how quickly it can happen.”
She kept her addiction hidden for years but holding down a job became impossible, and she began stealing from family and friends. Eventually, her marriage ended and her relationship with her children was in tatters. She was desperate.
Initially Thomas sought treatment for alcoholism but eventually, she admitted her opioid use too. “That was the one thing that I was trying to hide the most. Quite happy to be drunk, but I don’t want people to find out I’m addicted to pain pills.”
Just before her 40th birthday, Thomas started Opioid Substitution Treatment. Ten years later her life has changed immeasurably.
“Now I’ve got a really good job. I have all my kids in my life. Anything they need, they know I’m there,” she says.
She works full-time at a gardening department in Northland and helps raise her three grandkids.
“It’s just nice to know that I’m a reliable person in society again. I’ve worked really hard on this.”
Opioid Substitution Treatment (OST) was pioneered by American doctors in the 1960s and introduced in New Zealand in the 1970s.
OST patients are prescribed a stable dose of an opioid called methadone in liquid form to manage cravings and withdrawals, without causing a high.
The treatment is not without its detractors and controversies. Tomorrow night’s SUNDAY program reveals the dangers and potentially tragic outcomes when the treatment is misused. However studies have shown the effectiveness of OST in reducing injecting opioid use, mortality and criminal offending as well as improving health and general functioning.
In 2012, Pharmac also began subsidising buprenorphine combined with naloxone for OST. It’s a tablet known by many as Suboxone which dissolves under the tongue.
The latest Te Whatu Ora dispensing data shows that in 2022, 5525 people were prescribed liquid methadone and 2238 were prescribed Suboxone. Both medications need to be taken daily, under supervision, at a pharmacy. Because of the restrictions around its use, some have described the treatments as “liquid handcuffs”.
Some long-term patients are allowed to take a small number of doses home, known as “takeaways“, but they must meet strict criteria for doing so, including random drug testing.
It began with braces on her teeth
Twiggy Swadel goes to the pharmacy three times a week, 156 times a year.
She drinks 60mgs of methadone diluted with water on the spot and takes one dose home for the next day. Despite the strict conditions of use, she believes OST has saved her life.
“I know I wouldn’t be sitting in a flat that I can pay for, having healthy relationships with my family and my friends. I can’t even imagine where I would be without it. Probably dead.”
When she was 14, Swadel got braces. It was the start of her addiction. “When they would tighten them, it was incredibly painful. I couldn’t even eat a grape.”
She was prescribed Codeine for the pain but began needing more and more to have an effect. Soon she was stealing her mum’s Tramadol and raiding friends’ medicine cabinets for anything she could find.
“There’s a reason why opiates are named after the god of Morpheus,” she says. “He’s the god of dream and you just float away, you don’t feel nothing. It’s all nice and soft.”
No such thing as ‘just one hit’
Many people who become reliant on opioids are also dealing with significant trauma. Like any drug, painkillers can help dull the mental anguish. “I didn’t understand at the time that I was having night terrors and panic attacks,” says Swadel, who was already dealing with a chaotic homelife when the medication entered her life.
“My whole goal in life was never to think because when I had to think, I had to feel, and I didn’t want to have to feel anything .”
By 15 Swadel was in foster care and by 19, she was homeless. That’s when she started injecting. “[I started taking] morphine, that turned to heroin. That was bad. You think you can just have one hit. You can’t just have one hit. It doesn’t work like that.”
She was stealing from family and friends to maintain her habit. Eventually, they cut her off.
“I know that the woman I was then was just as a shell of the person that I am now. I was just really hurt and angry at the world and not ready to take accountability for my own actions.”
The 42-year-old has now been taking methadone for 18 years.
“I’ve been called scum. I’ve been called a junkie. You name it, I’ve been called it at the pharmacy. People will give you dirty looks [but] they’re there to get a prescription just like me. What’s the difference?”
She wants to advocate for others struggling with addiction and says people need to talk about it openly.
“I just tell people straight up I’m on methadone. I’d rather let someone else know what I’m on and then they can’t use it against me. Unfortunately, it’s always the bad stuff that you hear about methadone, [but] I just see that it’s changed my life in a very positive way”.
Jason George leads a team in drug harm reduction at DISC trust, part of the New Zealand Needle Exchange.
“The reality is the ’just saying no’ approach doesn’t work. People do choose to use drugs. We accept that and we want them to be safer.”
The organisation provides safe injecting equipment and free drug checking for illicit drug users.
Recently, the New Zealand Needle Exchange detected a highly potent synthetic opioid in a fake Diazepam tablet. A nationwide alert was issued last week.
“We’re not here to push abstinence on people. That’s not our job. People often feel bad enough about drug use. There’s stigma, guilt and shame. We don’t want to add to that,” he says.
For the 44-year-old, it’s personal. He’s evidence of just how commonplace addiction can be. “I had a pretty normal upbringing. I think it didn’t have anything negative going on at home. I went to private school, I finished secondary school, and both parents were around.”
The problems started with alcohol abuse. He says the illicit drugs came later as his way of dealing with the problems caused by drinking too much. He used methamphetamine, sedatives, and benzos but it was the opiates that got him hooked. “You end up using them just to feel normal or to feel ‘well’ and to escape the withdrawals from not having them.”
He started buying pills illegally online and after several packages were intercepted by Customs, he found himself in court. He pleaded guilty to drug importation and was sentenced to 12 months home detention and 400 hours of community service.
It was at this low point that George signed up for Opioid Substitution Treatment.
“I was getting into a lot of trouble, I wasn’t employed, and I didn’t have stable housing. Whereas now, I work full-time in a leadership role, I pay my bills, I pay my rent, and I have a much better relationship with my family,” he says.
He’s been taking methadone for nearly two decades.
Through his work, George knows that not everyone sticks to the rules of the programme. For example, some boil down their diluted methadone and inject it, making them susceptible to infection and disease.
He believes, instead of punishment, we should accommodate people who want to inject by supplying a safe injectable form of opioid. He points to places like Canada and Switzerland where that’s already in place.
“It’s an evidence-based harm reduction measure and it can have all the same benefits that something like oral methadone does”.
Similarly, he thinks we can tackle the problem of people illegally selling their OST medication on the black market by making it easier to get. “People wouldn’t sell it if there wasn’t a demand for it. So, you’ve got to wonder, why is there that demand? I think some people might look to buy methadone on the black market because some of the programmes can be too restrictive. And they would prefer to avoid those restrictions.”
Ultimately, he thinks more options for safely supplied opioids could help the thousands of New Zealanders struggling with addiction.
“They reduce people’s involvement in crime, they reduce drug use, and in some cases, they have impact on the supply. These programmes are effective, they improve people’s lives, and they save lives.”
For more on New Zealand’s battle with opioids, watch SUNDAY tomorrow night at 7.30pm on TVNZ 1, or TVNZ+