Mother grieves son and daughter: 'Methadone prescribing has to change'

Tracy East has lost two adult children to abuse of methadone, the legal drug prescribed for opioid addiction. She talks to Sunday reporter Mava Moayyed about the controversial treatment, and particularly its use of "takeaways".

Tattooed at the top of Tracy East’s right arm is a fedora with wings spread out from its sides.

"The fedora is for Daniel. He used to always wear one,” she says. “He’s my free bird now."

It’s a permanent reminder of her son Daniel Bennet who died unexpectedly in 2018.

The night before his death, Bennet and his two siblings, Jackie and Dion, gathered at their mum’s house in Marton for dinner.

“It was the first time in years, I had all three of the kids together at once. It was just one of those spontaneous nights where everybody was laughing and talking. It was full of joy,” says East.

They enjoyed dinner and lots of wine before getting into the spa.

“When Daniel got out, he was sitting on the couch sweating. He was rubbing his chest and I said, ‘you’re not having heart attack, are you?’”

Bennet assured his mum he was fine. The pair said goodnight and the 34-year-old went to sleep on the couch.

In the morning, she found him dead.

“I can't describe the pain. It was horrific. I would envision him walking through the door, hitching his pants up the way he used to. And his smile, I miss that.”

When his postmortem report arrived, East was shocked to see ‘methadone’ listed as a contributing cause of her son’s death.

“Daniel wasn’t on methadone,” she says.

Methadone is a synthetic opioid used for the treatment of opioid use disorder. It’s only available under prescription.

Tracy immediately knew who’d given it to Daniel. “It was an accident. She didn't know that was going to happen. She would not want that for a brother. She loved him.”

The night of the family dinner, Jackie Bennet had given her brother some of her prescription methadone. For someone without an opioid tolerance, even a small amount can be deadly.

“Jackie was a morphine addict. She started using very early, when she was about 12. At that time, there was no real support. I tried everything, and I mean everything,” says East.

“I asked her one day ‘Jackie, why do you use?” and she said, “because it takes me out of this world Mum’. It hid her pain.”

In her early 20s, while living in Palmerston North, Jackie Bennet started Opioid Substitution Treatment, also known as OST.

OST patients are prescribed a stable dose of an opioid – often methadone diluted in water – to manage cravings and withdrawals.

Some choose to take buprenorphine with naloxone, another synthetic opioid in tablet form known as Suboxone.

Replacing illicit drugs with legally prescribed ones has shown effectiveness in reducing mortality, criminal offending and improving health and general functioning. As outlined in yesterday's 1News story about New Zealand opioid addicts who receive OST, the latest Te Whatu Ora dispensing data shows that in 2022, 5525 people were prescribed liquid methadone. Another 2238 were prescribed suboxone.

The medication needs to be taken daily, under supervision, at a pharmacy. Some long-term patients are allowed to take a small number of doses home, known as “takeaways,” but they must meet strict criteria for doing so, including random drug testing.

The treatment appears to have a very postive effect on the lives of some addicts, but East believes her daughter Jackie should not have qualified for takeaway doses of methadone.

“When a person has mental health issues the way that Jackie had mental health issues, why would you give a person a drug that could kill them? Why would you?”

She also suspects her daughter was abusing her takeaways by boiling down the diluted methadone and injecting it.

“She would gets the nods. Nodding is when you fall asleep. I even videoed Jackie on the nod, having a cigarette and dropping it on my couch.”

Too high a dose can cause sedation but with appropriate oversight, the dose of methadone is adjusted to meet each person's need.

East says being on OST didn’t improve her daughter’s life. “I think in a way it made it easier for her to 'use'. Because that's what I see the methadone as”.

After her brother’s death, Bennet’s mental deteriorated.

“It broke her heart. It broke her heart.”

On June 23 last year, five years after her brother’s death, Jackie Bennet was found dead in her home.

“When the police went in there, there were methadone bottles everywhere prescribed to Jackie. Not a street drug, a prescribed medication. How does that happen?”

Bennet’s postmortem showed a mixture of drugs in her system, including a very high level of methadone.

“I'm not anti-methadone. If it's used correctly, and people consume it at the chemist, that's fine. Stop the takeaways. I think that if Jackie didn't have takeaways, both of my children would still be alive.”

“Jackie used to say, ‘I’m as mad as a hatter and as lost as Alice’.”

East's one remaining child, Dion, doesn’t touch drugs.

“I felt like a bad mother, but [Dion] said ‘No, Mum, you weren't. You're a good mother’. So that gives me hope.”

Dr Graeme Judson is an addiction medicine specialist, one of only a handful in the country.

“I've seen people go from a daily injecting drug habit, through to leading professional careers. Or mums and dads getting their kids back to school and get on with life and they're just becoming just part of society,” he says.

Judson runs an addiction clinic in Northland where around 200 people are on Opioid Substitution Treatment. Giving patients takeaway doses is a balance between safety and autonomy, he says.

“The issue of takeaways is always a balance between our responsibilities to society versus fostering self-autonomy and people getting well. People can’t get well and gain self-autonomy by having to attend to a pharmacy every day.”

But there’s a new option and it’s been called a “game changer” by patients, doctors and advocates. It's a formulation of buprenorphine that comes in a long-acting, injectable form. It slowly releases the drug over the of a month meaning patients don’t have to visit a pharmacy daily.

In New Zealand, a limited number of the injections is supplied for free by the drug company who makes it, but that generosity only goes so far.

In fact, there’s only one person in Northland on the monthly injections.

“We’ve just run out of allocated places. Some have come off, some have moved and we can’t really reallocate at this stage,” says Judson.

He wants Pharmac to fund it. “My message would be let’s get this funded. Particularly for patients that live outside of the main centres, its a real benefit because they can get on with their lives."

Pharmac’s director of pharmaceuticals, Geraldine MacGibbon, says the Mental Health subcommittee reviewed the applications for funding the injection and “recommended [it] for funding with high priority".

But she says that while Pharmac has added the medication to “options for investment”, it is unable to give a definitive timeframe for if, or when, a decision to fund the injections will be made.

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