Episode 2: Change Intolerance
Chereece Keewatin, pictured in 2015, died on February 20th, 2019. (Photo: Garth Mullins)
“I never used heroin for years and years on the other stuff . . . Why would they change something that is already working?”
— Cheerece Keewatin, quoted in a 2015 Megaphone article about Methadose® written by Garth Mullins.
This episode is dedicated to Chereece Keewatin. Chereece was a member of Crackdown‘s editorial board, a former president of the British Columbia Association of People on Methadone (BCAPOM), and our friend.
In 2014, British Columbia switched nearly 15,000 methadone patients, including Chereece, to a new formulation called Methadose®. In Crackdown‘s second episode, Garth Mullins, Laura Shaver, and their colleagues at BCAPOM investigate what happened after the switch.
Transcript
Chereece Keewatin pictured at a Crackdown editorial board meeting in 2019. (Photo: Alexander Kim)
Laura Shaver in 2013. Right before the switch to Methadose® . (Photo: Garth Mullins)
Laura Shaver at a listening party for “Change Intolerance” in 2019. (Photo: Ryan McNeil)
Garth presenting “Change Intolerance” to BCAPOM. (Photo: Ryan McNeil)
Crackdown and BCAPOM Demands
We demand access to the old methadone formulation immediately. Give us medication that works for us, whether that is methadone, Metadol-D, Suboxone, slow release oral morphine, injectable Dilaudid, or prescription heroin.
We demand to have a say in policy decisions about our lives. Nothing about us without us.
We demand an apology from Mallinckrodt, the BC Ministry of Health, and the BC College of Pharmacists.
We demand a formal investigation to determine why Methadose® failed.
The Emails
In 2014, Garth emailed Mallinckrodt Pharmaceuticals and told them methadone patients in BC were getting dopesick after the Methadose® switch. A few hours later, Mallinckrodt responded.
Next, Garth sent Ryan McNeil’s 2015 paper to the BC Ministry of Health. Ryan started interviewing people the same week as the Methadose® switch and he also consistently heard Methadose® wasn’t holding.
This is how the Ministry responded:
Finally, Garth sent the Ministry Alison Greer’s 2015 paper. They responded by criticizing this study’s sample size as well.
Comments from Mallinckrodt, the BC Ministry of Health, and the BC College of pharmacists
Mallinckrodt, The BC Ministry of Health, and the BC College of Pharmacists denied our requests for interview for this story.
We emailed Mallinckrodt a list of questions. A representative for the company responded:
They will kindly decline to comment.
— Statement from Mallinckrodt Pharmaceuticals in February, 2019
The BC Ministry of Health and The BC College of Pharmacists also refused to answer emailed questions. Instead the College provided us with a one sentence statement:
“Using a commercially available drug over a pharmacy-compounded drug is a required practice for public safety.”
— Statement from the BC College of Pharmacists in February, 2019.
Works Cited
Gourevitch, Marc, Diana Hartel, Peter Tenore, Katherine Freeman, Ira Marion, Joe Hecht, Joyce Lowinson. “Three Oral Formulations of Methadone: A Clinical and Pharmacodynamic Comparison.” Journal of Substance Abuse Treatment 17:3 (1999): 237-241.
Greer, Alison. Sherry Hu, Ashraf Amlani, Sarah Moreheart, Olivia Sampson, and Jane Buxton, “Patient Perspectives of Methadone Formulation Change in British Columbia Canada: Outcomes of a Provincial Survey.” Substance Abuse Treatment, Prevention, and Policy 11:3 (2016): 1-8.
McNeil, Ryan, Thomas Kerr, Solanna Anderson, Lisa Maher, Chereece Keewatin, M.J. Milloy, Evan Wood, Will Small. “Negotiating Structural Vulnerability Following Regulatory Changes to a Provincial Methadone Program in Vancouver, Canada: A Qualitative Study.” Social Science and Medicine 133 (2015): 168-176.
Mullins, Garth. “New Methadose is Failing the People it’s Designed to Assist, Says Local Researcher.” Megahopne, June 15, 2015.
Silver, Junell, Howard Shaffer. “Change Intolerance to Shifts in Methadone Formulation: A Preliminary Investigation.” Journal of Substance Abuse Treatment 13:4 (1992): 331-39.
Socias, Eugenia, Evan Wood, Ryan McNeil , Thomas Kerr, Huiru Dong, Jean Shoveller, Julio Montaner, M.J. Milloy. “Unintended Impacts of Regulatory Changes to British Columbia Methadone Maintenance Program on Addiction and HIV-related Outcomes: An Interrupted Time Series Analysis.” International Journal of Drug Policy 45 (2017): 1-8.
Steels, M.D., M. Hamilton, and P.C. McLean. “The Consequence of a Change in Formulation of Methadone Prescribed in a Drug Clinic.” British Journal of Addiction 87 (1992): 1549-54.
Additional Suggested Reading
Moreheart, Sarah. “BC’s Change in Methadone Formulation: A Metanarrative Review of the Literature.” 2016.
Soyka, Michael and Christina Zingg. “Feasibility and safety of transfer from racemic methadone to (R)-methadone in primary care: Clinical Results from an Open Study.” The World Journal of Biological Psychiatry 10:3 (2009): 217-224.
Credits
Garth Mullins is Crackdown‘s host and executive producer.
Laura Shaver was this month’s lead editorial consultant.
Sam Fenn was this month’s lead producer.
Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, Al Fowler, and Chereece Keewatin.
Crackdown is produced by Garth Mullins, Sam Fenn, Alexander Kim, Lisa Hale and Gordon Katic. Our scientific adviser is Ryan McNeil from the BC Centre on Substance Use.
The music for this episode was written by Garth Mullins, Sam Fenn, Jacob Dryden and “Ray.”
Thanks to the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research for ongoing funding to Crackdown.
