Opiate Replacement Therapy saved Gary’s life and he believes it saves many others from heroin overdose.
But he believes it is being so badly administered to patients that Scotland needs to come up better ways to control it.
He tells Chief Reporter Mark McGivern he is friends with many people who are fighting addictions and he does not know a single person who doesn’t top up NHS methadone with street drugs.
A close friend of Gary's died recently after a typical drugs cocktail - one of more than 1,000 expected to lose their life in Scotland this year.
Gary isn’t your stereotypical drug addict.
Educated at a private school, he is currently at an advanced stage of setting up a business, relying on the prescribed opiate replacement therapy Subutex to stabilise him as he recovers from heroin addiction.
Many of his friends are also in treatment – most are, by his description, articulate and good natured. They don’t fit the common, damaging stereotypes either.
But he claims every one of them is bonded in a deadly way by a shared tendency to mix their prescribed treatment with street drugs, dicing with the poly drug peril – multiple substance abuse – that has claimed the lives of thousands of Scots in recent years.
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Of about 50 people Gary knows on opiate replacement therapies, mainly methadone, he admits he cannot think of one who does not top up their script with heroin or other drugs that are cheaply available on our streets.
He runs through the names in his head, one by one. Each person plays Russian roulette in topping up, despite warnings that this poly drug misadventure is what makes Scotland the drugs death capital of Europe.
Gary believes opiate replacement therapy – he was prescribed buprenorphine – saved his life and he is currently trying to set up his own business, while maintaining a daily 12ml prescription.
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He said: “You can’t just say that methadone is good or bad. It is great, life saving, when used correctly and it’s a disaster when it’s abused and that happens far too often.
“Methadone and buprenorphine are essential and a million times better than a life on heroin.
“But in Perth, I knew about 50 people on methadone programmes and I’d say that every single one of them tops up with heroin or blues bought on the street. Some people view methadone as free drugs. That’s what needs to be addressed.
“I’d say that you might get tested for heroin by the GP every couple of weeks at most – and sometimes every couple of months – and doctors can stop the prescription if they feel it’s being abused.
“But heroin is out of the system quickly, so it’s easy to cover it up when topping up.
“In the meantime, methadone keeps being prescribed, it all becomes a mush and you don’t know if it’s helping or making things worse. It definitely makes it more likely that people will die.”
Gary – not his real name, as few people wish to be named amid high levels of stigma – believes every GP in Scotland is aware that methadone is often consumed along with random add-on drugs.
He believes this chaotic reality is tolerated, making a mockery of prescribing guidelines, as no better alternative systems or safeguards have been put forward by public health chiefs. The argument is further complicated by the fears that many GPs are underdosing patients – effectively sending them back to the heroin dealers who are happy to oblige.
Gary believes GPs prescribe daily methadone to people they know are topping up because they are forced to choose the lesser of two evils. Despite acknowledging individuals choose to abuse prescriptions, Gary says circumstances that lead people to addiction – unemployment, poverty and life trauma – are inevitably pushing people into such a vicious cycle.
He said: “The thing that wrecks all the best intentions is that it’s so easy to get your hands on cheap drugs these days and people who are addicted to drugs will always be open to temptation because they want a dunt from the harder drugs.”
As for Gary, he’s looking onward. He said: “I still have to take a daily script but I’m functioning well, I’m free of illegal drugs and I feel that I’m moving towards a normal life.”
