Lack of methadone in Lisbon
by Ernst Buning
About 60% of the 10 million Portuguese live in the area of the beautiful capital Lisbon. The number of heroin addicts in Portugal is unknown, but is estimated to be between 30,000 and 50,000. Although the city of Porto in the Northern part of the country has a long history of provision of methadone, the capital Lisbon only provides methadone to a handful of heroin addicts. We spoke with Dr. Maria JosÚ Campos, doctor in the Hospital Egas Moniz and volunteer for the Aids organisation Abrašo, about the lack of methadone in Lisbon.
How many drug users receive methadone in Lisbon?
Maria JosÚ Campos: "Hardly anybody. I know about a psychiatrist in one of our hospitals who prescribes methadone to about 15 HIV positive patients. The big drug treatment institute TAIPAS, which has a monopoly in Lisbon, is against methadone. They do give LAAM to a limited number of patients, but most of their treatment is aimed at complete abstinence. When one of my patients really needs methadone, I have to refer him to a doctor in a city about 100 kilometers from Lisbon! They receive methadone there, but only if they are supervised by a family member. You can understand that this is complicated: they have to find travelling money every week and the family member has to take time off from work. So, it is only a handful of drug users who receive methadone in Lisbon."
How is it that a big city like Lisbon has hardly any methadone available?
"I think this is due to the attitude of the psychiatrists. They see methadone as a drug and they say why should I give a drug to someone? The drug helping system is dominated by TAIPAS, a government supported organisation. As long as they are against methadone, nothing will change. In my spare time, I work as a volunteer at the Aids Prevention Association, Abrašo. We see a lot of drug users who are HIV positive and very sick. In the hospitals, the drug users terminate treatment prematurely when they have withdrawal symptoms. Even the doctors often dont recognize these symptoms. If they do, they might give some tranquilizers, but never methadone. It is a shame the way these HIV patients are treated"
How are drug users perceived?
"I would say that most people hate drug users. They see them as criminals. You can see them everywhere in the city, but especially in certain areas such as in Barrio Alto where our volunteer organisation is located. Since there is no methadone available, drug users cannot live a more relaxed life. They run from one shot to the next and of course they are involved in criminal activities. However, lately we have seen a new phenomenon: drug users help you to find a parking spot. You give them a couple of coins. This is a good service in a city where it is so difficult to find parking space. I also think that the government is not very interested in drug users. They only seem to be interested in prevention and drug free treatment, but dont see the problems of chronic drug users who are not capable of giving up their use and are infected with HIV."
Are you advocating the provision of methadone?
"Yes, of course. But not only methadone. I think that we should have a range of options for treating drug users, depending on what their specific needs are. It might in some cases be heroin or group therapy or naltraxon or methadone. Advocating this turns me into a radical in the eyes of some people. But Im not a radical, Im just a realist. I see methadone as one of the options to help drug users, especially if they are sick and need medical treatment. We all know that the treatment compliance in methadone programmes is very high. So, if sick drug users are participating in a methadone programme, I can give them medical treatment and I would be sure that they take the medication I prescribe. This is especially important if you look at tuberculosis. Portugal scores high regarding tuberculosis, as high as some third world countries. We have to treat tuberculosis effectively in order to prevent a further spread among the general population. To do this, drug users with tuberculosis have to be identified and treated. How can one do this if so many drug users dont come to treatment centres and if hospitals scare drug users away? If we had methadone, at least we would be in contact with a large segment of the drug using population and be able to treat them for medical problems".
What is your next step?
"It is very difficult. I hope that TAIPAS will change their attitude. I have also spoken to the clinical director of my hospital. He sees the problem of drug users in our hospital who have withdrawal symptoms, get aggressive and terminate treatment prematurely. However, he argues that providing methadone in our hospital might attract many drug users.
I think that the attitude of the psychiatrists is difficult to change. They have moral objections. You cannot change moral objections with reasonable discussions. The situation is going to get worse, and maybe later more people will realize that the provision of methadone is one of the necessary options to implement. I am seen as a troublemaker. But I know that Im right. I did a placement in a methadone clinic in London. One of my observations was that the clients were much healthier than our clients. I will keep on fighting for a human existence for drug users, especially those who are in the terminal phase of Aids. In some of our ghettos, 3 or 4 drug users die every day. Nobody seems to care: they are drug users, they have Aids, it is their own fault, so let them die. It is terrible, but that is how many people look at it."
For more information: Abrašo Rua da Rosa 243 -1st floor 1200 Lisbon Portugal tel: +351 1 342 5929 fax: +351 1 347 9243
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