Methadone therapy gives heroin addicts hope

I Wayan Juniartha, Denpasar

Ketut Agus J knew all too well what the vicious cycle of drug addiction meant.

At 26 he had first hand experience of virtually all the drugs available on the island's streets, befriended scores of big-time dealers, vainly tried various rehabilitation programs and paid the terrible price exacted by his addiction.

Born into a wealthy family -- his father was a successful player in Bali's tourism industry -- Agus savored his first barbiturate at the early age of 12.

In the following year he rolled and smoked his first joint. By his last year in one of Denpasar's best junior high schools, Agus had experienced his first dose of morphine.

His illicit relationship with various kinds of illegal drugs, as well as alcohol, continued to be the central theme of his life through his high school years.

"Then my parents found out and they sent me to London to get a better education and, mainly, to get clean," he said.

Estranged from his drug-using friends, Agus managed to get clean, get educated and even get a job in a fast-food outlet.

"I then returned to Bali, got a junior executive post with a big tour operator. I was earning Rp 3.5 million per month. It was quite a lot of money back then and I thought my life had changed for the better," he recalled.

It had not changed for the better, not by a long shot. An older relative -- a hardcore heroin addict -- made a series of seemingly innocent visits, borrowing some cash while bragging and showing Agus how satisfying the "high" provided by the new stuff was.

The temptation was too powerful for Agus and soon he was hooked on the white powder, the tiny syringe and the soothing yet enticing sensation of the drug.

"Before I fully realized it, I was spending over Rp 2 million per day to purchase the drug. I injected three times a day and took at least 1.5 grams of heroin per injection," he said.

"My life and time were dominated and dictated by the unbearable need to get high. All I could think of was the drug and how to get it," he recalled.

The addiction totally wrecked both his professional and social life. Once again, his parents tried to rescue him by sending him to various rehabilitation facilities at home and, eventually, abroad. This time, however, their efforts were in vain.

"I thought that I would be hooked to heroin for good, that there was no light at the end of the tunnel," he said.

Once again, time proved him wrong. There was light at the end of the tunnel. In Agus' case, that light came in the form of Methadone Maintenance Therapy (MMT), a comprehensive drug- addiction treatment in which the synthetic opiate Methadone is prescribed as a substitute for heroin.

"I joined the program six months ago and my life has been improving ever since," he said.

The island's Sanglah Central Hospital is one of the two sites in the country selected by the World Health Organization (WHO) to carry out MMT pilot projects. In Sanglah, the MMT program commenced in February 2003 with for 129 participants.

The participants are required to visit the MMT clinic every day to receive their daily doses of methadone.

They are also subjected to regular psychological assessments, blood and urine checks, and counseling and evaluation sessions.

Based on harm reduction principles, the primary objective of MMT is to curb the spread of HIV/AIDS among injecting drug users (IDUs). It is estimated that 70 percent of Indonesian IDUs have been infected with Hepatitis C and 50 percent with HIV/AIDS.

Conservative estimates put the number of IDUs in Indonesia at around 500,000 people while in Bali there are thought to be around 2,500 IDUs.

The high prevalence of Hepatitis C and HIV/AIDs is primarily caused by the widespread habit of sharing needles, syringes and other injecting paraphernalia among the country's IDUs. This habit provides the most efficient way for the transmission of blood-borne diseases, such as HIV/AIDS, Hepatitis B and C.

"The methadone is provided in liquid form and must be taken orally, thus eliminating the need for injecting or injecting paraphernalia. The participants are also required to stop injecting drugs," the head of the Sanglah MMT program, Dr Hanati, said.

Moreover, Methadone's effect on the human body lasts significantly longer, ranging from between 24 and 36 hours, compared to heroin's, which lasts for between 3 and 4 hours, thus provided the participants with more time to organize their lives.

It also gives the medical experts and counselors the time they need to conduct sufficient psychological intervention.

"I take one dose of methadone in the morning and then do my job or whatever for two full days without suffering any withdrawal symptoms. It would be impossible to do that with heroin, a very demanding drug, in which the withdrawal symptoms immediately kick in three hours after injecting. This forces us to immediately look for another fix," MMT participant Koko said.

A recent evaluation of the Sanglah MMT program showed that out of 129 participants, five had succeed in quitting drugs altogether and 72 participants were currently in the process of reducing their dosages of methadone.

"The majority of the participants also showed a significant increase in their productivity. They become more active in their professional, social and family lives. A significant increase in criminal activity has also been recorded," Hanati said.

The evaluation also showed that out of 88 interviewed participants, only eight were still injecting. Meanwhile, urine tests conducted on 21 participants showed that only five were still using heroin.

"We are currently looking for a way to expand the MMT program so as to make it available to as many IDUs as possible. We believe that this would have a significant impact in controlling the spread of HIV/AIDS among IDUs. The public's support and sufficient funds are two critical things for the success of this process," Hanati stressed.

For Agus, Koko and a number of other former IDUs, MMT has succeeded in providing them with hope and a second chance to rebuild their lives.

"Now, I can save money, buy toys for my daughter and in November I will go to Switzerland to promote my hotel," said Agus, currently a sales manager for a boutique hotel in western Bali.