Could an alternative to methadone give people in recovery more control over their present

Paula Kearney began treatment for opioid addiction in 1995, she says.

Terrible trauma growing up caused her to “self-medicate” as an adult, she said by phone on Thursday. This eventually led to heroin addiction, she says.

“The rave scene was around. It was the ’90s. Many of us ended up in the same kind of position,” Kearney says.

So, in 1995 she began taking methadone – a synthetic opioid used to treat Opioid Use Disorder (OUD).

Opiate Replacement Therapy means substituting the opiate that a patient is dependent on, be it heroin or over-the-counter codeine products like Nurofen Plus or Solpadine, says Dr Deirdre Dowdall, a Dublin GP.

Methadone was the original replacement therapy, Dowdall said by phone on Thursday.

People who use heroin need it every four to six hours, dominating every aspect of their lives, she says. Methadone was once-a-day, offering greater stability, she says.

Methadone was a game-changer, Kearney says, and started her on a road of recovery that she remains on today. But life on methadone is not plain sailing, she says.

Nicknamed “liquid handcuffs” by people who take it, methadone can require daily doses, administered by professionals in a clinic or pharmacy.

The regularity of the doses, and the need to go in person each time, means people can struggle to maintain a routine – and to fit in employment or education.

In 2018, Kearney switched to buprenorphine and began, she says, on a new path that empowered her to take back control of her life, to finish an undergraduate degree, and then a master’s.

There are reasons why methadone may continue to be the treatment of choice for some people. For example, Kearney is concerned that for some, not having to check-in with professionals for a week or month at a time may be isolating.

They may misuse substances again in the interim, she says. “I think somebody should be in a stable enough place in their life to do it.”

But having a suite of options for people, that includes buprenorphine, is the way to go from here, says Dowdall.

A recent paper by the Health Research Board cited a survey carried out in early 2023 in Dublin which found that: “Many respondents felt there was no end in sight for their treatment journey: as many as 87% reported they had never been offered an alternative to methadone treatment.”

The world reopened

At first, Kearney took buprenorphine in the form of Suboxone, which is absorbed under the tongue. The doses can be brought home and taken daily by the patient themselves, she says.

Suddenly, the need to be in the same place at the same time every day was gone, she says.

She could take up full-time education – and did. Not something, she says, that was possible for her while taking methadone.

After a few years on Suboxone, Kearney took part in a pilot programme during the COVID-19 pandemic for a new buprenorphine-based product called Buvidal.

This freed her up further, she says. It is a long-acting injectable treatment, which can be taken weekly or monthly – slowly releasing itself over that time.

This marked another huge positive change, she says.

Even with Suboxone, as it is a daily dose, you can wake up in the morning with the awful feeling of withdrawal, she says.

“There’s also a psychological piece of knowing you have to get up every day and take something so that you feel normal,” she says.

When she started on Buvidal, she was a year or two into her college degree – with much greater control over her days.

In 2021, Kearney graduated from Maynooth University with a first-class honours Bachelor of Social Science Degree in Community Development and Youth Work.

In 2023, she received her Master of Social Science Degree in Rights and Social Policy.

Kearney has now moved to a point in her recovery where she is no longer receiving opioid replacement therapy.

Today, she works with the SAOL Project where she is the coordinator of the BRIO programme that works with women who experience the intersectional issues of substance misuse and criminal justice involvement.

Buprenorphine in Ireland

The most recent figures published by the Health Research Board, from 2022, show that an estimated 19,460 people were experiencing problematic opioid use in Ireland.

In Dublin, it was estimated at 11,100 people.

Countrywide, more than three quarters were in the older age group of 35–64-year-olds, the research found. Over two thirds were male.

The Health Research Board report says that while the number of clients receiving buprenorphine-based products in Ireland has increased since its introduction, 94 percent of those receiving Opioid Replacement Therapy in 2023 were prescribed methadone.

Buprenorphine was first licensed for use in Ireland back in 2006, says Dr Garrett McGovern, medical director and founder of the Priority Medical Centre in Dundrum.

But it wasn’t until 2016 that it started to appear in specialist clinics here, and even then, it was hard to come by, he says.

Beyond heroin, buprenorphine is also effective in treating people who are addicted to opiate-based painkillers like Nurofen Plus or Solpadine, says McGovern.

While heroin remains the most common opioid problem, in the past decade or so, more people are also seeking treatment for those over-the-counter products, McGovern says.

Now with the pilot phase of its roll-out passed, Buvidal is starting to slowly gain ground here, he says. “Nothing happens quickly in this country.”

One barrier that remains is that many doctors remain unfamiliar with buprenorphine and are more confident prescribing the tried and tested methadone. “Doctors just might go, ‘I don't know enough about that drug, and I'm not prescribing it’”.

Says McGovern: “Hopefully in 2026 we'll see more people on this.”

Dowdall, the GP, says that buprenorphine generally offers people a much clearer head than methadone.

It’s also very difficult to overdose on, she says. Overdoses on buprenorphine products usually also involve other substances like benzodiazepines and alcohol, says Dowdall.

Buvidal, in particular, is far more convenient for people living in remote areas, who may struggle to attend a chemist or clinic, she says.

It can also be very beneficial for people leaving prison, she says.

The slow-release injection leaves the person in a very steady and comfortable state for up to a month.

When people in recovery leave prison, they can be vulnerable to relapse, she says. Because the Buvidal injection lasts for weeks, it gives people some elbow room to re-engage with services in the community.

The Health Research Board report cites a study of prescribing in prisons between 2012 and 2020, for those with a history of Opioid Replacement Therapy.

Methadone was most common with monthly prescribing rates ranging from 364–723 per 1,000 women, and 96–163 per 1,000 men, it says. Meanwhile, “For buprenorphine and naloxone in-combination preparations, the monthly prescribing rates ranged from 0–13 per 1,000 women, and 0–1.3 per 1,000 men.”

Buprenorphine also helps to alleviate some of the stigma that is still associated with methadone and drug use, says Dowdall.

Lingering stigma

“If every junkie in this country were to die tomorrow I would cheer,” wrote Ian O’Doherty in the Irish Independent in 2011.

It was part of an article titled “Sterilising junkies may seem harsh, but it does make sense”, a Magill article from that year recalls. The piece also described drug users as “vermin”, and “feral, worthless scumbags”.

The Press Ombudsman upheld a complaint against the Irish Independent for the column.

In 2014, Dún Laoghaire-Rathdown Ratepayers’ Association (DLRPA) distributed postcards depicting methadone users as zombies.

It was part of its efforts to close the Dún Laoghaire Methadone Clinic at the time. “The Walking Dead, courtesy of the HSE,” it read.

“It just completely dehumanised the vulnerable people we treat,” says McGovern.

The stigma remains today, says Kearney.

People taking methadone feel that they must explain themselves to people around them, she says – to employers, colleagues, lecturers.

If someone is a diabetic and needs treatment, they don't have to disclose that to an employer, she says.

Because of the stigma attached to addiction, Kearney says that often people automatically assume that they have to tell.

“Buvidal is great in terms of giving people the options to actually do something with their days, without having to explain to somebody,” she says.

As well as grogginess for some, methadone can also give people heavy sweats, she says. “That can be quite embarrassing for us. It can have an impact on our self-confidence.”

When she moved from methadone to buprenorphine initially, she says, those heavy sweats disappeared.

Still, that transition from methadone was tough, she says. “Coming off methadone in the past was absolutely horrific.”

When she eventually stopped taking Buvidal a few years ago, she says, it was “completely different in terms of the impact on your body”.

McGovern sees this in his own patients, he says.

If you have been taking methadone, and switch to buprenorphine, it kicks the methadone off the opioid receptors in your body and sends the patient into what’s known as “precipitated withdrawal”, he says. “It's horrendous.”

Moving the other way around, from buprenorphine to methadone, doesn’t cause the same effects, McGovern says.

Funded by the Local Democracy Reporting Scheme.