Methadose: A Parable of Putting Profit Before Human Lives

    Imagine being on a medication, any medication, and all a sudden it doesn’t work anymore. It only works for about one-third of the time, and you get sick before you can have your next dose. That’s what MethadoseTM frequently is to people who have been on methadone. It’s more diluted and less effective (and yes, peer-reviewed research has shown that).

    People who use drugs have been saying for years that making “the switch” between compounded methadone and Methadose was killing them. Being on an adequate dose of traditional methadone typically meant you were safe, that you didn’t have to buy illicit drugs that day if you didn’t want to. It felt like stability and freedom. Then all a sudden you were “switched” and the medication didn’t work, dope-sickness was imminent, you had restless legs and couldn’t sleep, you had pain throughout your body. It was like you weren’t on any kind of opioid.

    Now, imagine that a behind-closed-doors deal created a monopoly for the manufacturers of Methadose, so that everyone on a government-funded program to help people in need of income assistance received this inferior medication instead of methadone.

    People who use opioids in British Columbia, Canada don’t have to imagine, because in 2014, that’s exactly what a pending lawsuit says happened.

    You wake up sick and so then you use. Sometimes to use is to die.

    Neither was it limited to that province. I have been on and off one form of methadone or another for the last 10 years, and remember when “the switch” took place in Nova Scotia, where I live, in around 2017—the British Columbia approach had spread far and wide.

    I have been on both compounded methadone, which is “regular” methadone (or Metadol-D), and Methadose, and I can say first-hand that Methadose is far less effective. The half-life is 12-14 hours instead of 24-36; you still have aches and pains in your legs, you wake up sick and so then you use. Sometimes to use is to die.

    Listening to Garth Mullins in the new Crackdown episode reading a notice of claim for a proposed class action lawsuit led by Laura Shaver from the British Columbia Association of People on Opioid Methadone (BCAPOM) gave me the chills. You could feel the loss.

    The notice states that sometime between 2011-2012, an agreement referred to as the “Exclusive Exchange” was struck between Methadose manufacturer Mallinckrodt Pharmaceutical and the government of British Columbia. “The Exclusive Exchange Agreement,” reads the notice, “effectively granted Mallinckrodt the right to sell Methadose as the exclusive OAT therapy within British Columbia.” It gave Mallinckrodt the whole market to provide Methadose for people on provincially funded PharmaCare (income assistance for prescription drugs).

    The Exclusive Exchange agreement was, according to the notice, a “contributing cause of the overdose epidemic.”

    This was, according to the notice, a “contributing cause of the overdose epidemic”—in other words, the prioritization of profit over human lives. Almost 17,000 people were switched from methadone to Methadose as a result. This population was amongst the worst hit by the overdose crisis. In 2016 the British Columbia government declared the overdose crisis a public health emergency; the timing is at a minimum suggestive that “the switch” was a factor.

    The danger was so apparent that the British Columbia Centre for Substance Use created a guiding document in May 2019 to help clinicians and pharmacists support the transition of their patients from Methadose back to compounded methadone.

    “It’s the switch that causes problems,” Jason Gratl, the lawyer representing Shaver et al, told Crackdown, “to force everybody who is on compounded methadone to switch to Methadose. Even if they didn’t want to. Even if they didn’t know about it.”

    “I remember going to memorials, it felt like every week back then. But nobody believed us.” Mullins said.

    I know the feeling, I’ve been to a lot of the memorials myself. Failed drug policies, in combination with our capitalistic culture, have ensured death for drug users. We are the survivors.

    Chereece Keewatin was one of the patients that never made it to the lawsuit but fought for it. She was on Crackdown’s editorial board, and advocated widely for drug-user rights. The dope-sickness from Methadose ended up contributing to her death, as Crackdown reported.

    I was at her memorial in the Downtown Eastside of Vancouver in March 2019, and learned for myself about the impact that she had there. The neighborhood’s Japanese Hall was filled with not just members of that hard-hit drug-using community, but all communities.

    We, the survivors of the drug war, must fight against these abuses and the systems that create them.

    I didn’t know Chereece Keewatin in person, but I felt like I did. She was one of us, tragically and needlessly, like so many of my fellow drug users, lost to this crisis.

    We, the survivors of the drug war, must fight against these abuses and the systems that create them. One way is through legal channels: Patients in British Columbia will finally have their day in court.

    The proposed class action lawsuit has as its defendants Mallinckrodt Pharmaceutical, the British Columbia College of Pharmacists and the British Columbia Provincial Ministry of Health. According to its statement of facts, the defendants met on multiple occasions in 2011 and 2012 and struck the Exclusive Exchange deal, under which the province agreed to add Methadose to the Pharmacare Plan C and then to remove the means to dispense compounded methadone under that plan.

    “The Exclusive Exchange Agreement effectively granted Mallinckrodt the right to sell Methadose as the exclusive OAT therapy within British Columbia,” states the notice.

    Without Crackdown’s investigative work, the ‘Exclusive Exchange’ agreement might never have been made public. But it was uncovered in 2019 through a Freedom of Information Act request made by Crackdown’s senior producer, Sam Fenn.

    “Essentially what we wanted to do was use the Freedom of Information Act to look back at government emails leading up to ‘the switch’ to try and get an understanding of what they were talking about,” Fenn told Filter.

    Fenn described the back-and-forth emails between the government and a Mallinckrodt representative, Christophe Goffoz, as more or less trying to “pave the way for the switch, he’s discussing with them what the steps will be to roll out Methadose.”

    At one point, though, “the emails kind of stopped,” Fenn said. Then Christophe Goffoz “sends a few stern emails, one to the Ministry of Health and one to the College of Pharmacists, where he reminds everyone [of] the work that Mallinckrodt has done to bring Methadose to Canada, which is an expensive process for a company.”

    An “Exclusive Exchange” for an ineffective medication for people who are on opioid agonist therapy in British Columbia and on provincial pharmacare? If that doesn’t sound fucking shady, I don’t know what does.

    People who use drugs should have a safe supply of unadulterated medicationincluding when it’s Pharma companies that are doing the adulterating. 

    The province was not only complicit in this wrongdoing, it seems, but failed to respond when people who use drugs expressed their concern and outrage. Many advocatesShaver, Mullins, Crackdown and the BCAPOMhad to fight for this for a long time.

    Both capitalism and authoritarianism were to blame, through their greed and arrogance, for needlessly jeopardising the health of thousands of vulnerable people, the notice details. It’s now the job of the BCAPOM to make sure their voices are heard loud and clear.

    There is no doubt that my own switch to Methadose, among so many others, contributed to my unsafe using practices and fentanyl dependency. In 2019 I was prescribed Metadol-D tablets as they are easier for travel but I had to pay for them and the cost became too muchthey are not covered for people with opioid use disorder, just chronic pain patients. So I went with the government-funded program and got the Methadose that repeatedly failed to hold me.

    All this, if demonstrated in court, is on Mallinckrodt and the government. Especially in British Columbia, which just suffered its highest-ever number of fatalities in one month, with 170 confirmed overdose deaths.

    Enough is enough. It’s about time someone stood up to Big Pharma in Canada and put people firmly before profit. People who use drugs should have a safe supply of unadulterated medicationincluding when it’s Pharma companies that are doing the adulterating. 



    * For more on information, Crackdown has aired three podcast episodes on this topic: “Change in Tolerance”, “Change in Tolerance Part 2” and “Class Action.” 


    Photograph of methadone take-home doses by Matthew Bonn

    • Matthew is an International Board member with International Network of Health and Hepatitis in Substance Users, and a knowledge translator for the Dr. Peters Centre. He was previously the program manager with the Canadian Association of People Who Use Drugs. His freelance writing has appeared in publications including The Conversation, CATIE, Doctors Nova Scotia, Policy Options and The Coast. Matthew was also on the 64th Canadian delegation to the Commission on Narcotic Drugs. He is a current drug user and a formerly incarcerated person.

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