Recovering opioid addict pushes province to reconsider detox in Nova Scotia

After being in and out of detox programs multiple times, Danielle Noade says she didn't stop injecting drugs until she went to jail six months ago.

Noade, 24, says the confines of a locked cell at the Central Nova Correctional Facility in Dartmouth, N.S., forced her to decide it was finally time to focus on recovery.

"It was either 'I will be in jail for 20 years or be dead.' And I realized, I really wanted to get clean," she told CBC News.

Now, the only drug she's taking is methadone. Noade is currently on a dose of 50 milligrams per day.

While Noade says methadone is keeping her stable, she wants to be able to detox from methadone as well so she can be drug-free. She doesn't understand why the Nova Scotia Health Authority is shifting away from publicly funded detox toward a system where people with opioid addictions go directly to methadone therapy.

People addicted to alcohol and other drugs are still encouraged to seek detox, also know as withdrawal management.

Long-term methadone

The health authority says people could be on the liquid medication for life. Methadone is used to curb opioid cravings and ease the symptoms of withdrawal.

Noade says she fully intends to come off methadone, but she's worried what will happen if her daily dose is lowered.

"If they wean me down five milligrams and I was to come home and it was too much for me, then it would take so long to get back in to see somebody. And that's just not a risk I'm willing to take," she said.

Detox 'a safe place'

Noade feels that after six months on methadone, she's in a better place in her life and wants to try detox to wean off of it and move to an opioid-free life. Unlike previous detox attempts, she says she is more motivated than ever before.

"Detox would be a safe place, and I feel that for me that would be the most secure and safest way for me to do it," said Noade, from New Glasgow, N.S.

She believes inpatient treatment is important for people like her who "really want it."

'Relapse happens'

The executive director of Talbot House, a long-term rehab centre for men in Cape Breton, was shocked by the health authority's shift away from detox, also called withdrawal management.

"We see numerous opioid addicts a year who've chosen to go the abstinence-based model approach, which means they do not want methadone or suboxone," said Tom Blanchard.

He added that he knows some with opioid addictions who have tried methadone and didn't feel that process worked for them.

At Talbot House, people are only accepted after they go through detox. The program has a strict no-drug, abstinence-only policy, which means clients are not allowed to take methadone once they're in the program.

He adds that "relapse happens," whether it follows detox treatment or residential rehab.

"I don't believe that's a determination of what success is and what success is not. I mean one day clean is a success to me," Blanchard said.

Harm reduction

Meanwhile, doctors working in the addictions field warn that detox can have serious consequences for some.

Dr. Hakique Virani, addiction medicine specialist at the University of Alberta, says detox for opioid users are "extremely unsafe." He says it's risky for people who relapse because they can't handle the same amount of opioids they were previously taking following detox.

"I think an allocation of resources in the context of an opioid epidemic towards things that work, that are safe, and that are less expensive, is really critical," said Virani.

Relapsing can be deadly for some

The Nova Scotia Health Authority's director of mental health and addictions acknowledged that some people may prefer a rehab program over long-term methadone, she said that's not a quick fix either.

"The problem often with residential treatment is that skills and support that exist in an institution do not generalize well to the community," Dr. Linda Courey told CBC News.

"Not to say it's not ever effective in some cases, but for most people that transition from living in a protected environment to their community is extremely difficult to navigate."

A better solution?

As someone who continues to live through the daily struggles of staying clean, Noade wonders why the province can't work with long-term facilities to find a better solution.

"If they would come together and meet in the middle, it would benefit the addicts in need," she said.