Upon my recent return to United Health Services Hospital in Binghamton, NY, I caught the eyes of Carol, a nurse in the methadone maintenance treatment (MMT) program. She stared back, glazed over, dreamily. In July, I became the coordinator of this clinic, where Carol medicated me as a patient 20 years ago. Today, I stand before her and the world as both a clinical supervisor and a fellow in the Robert Wood Johnson Developing Leadership in Reducing Substance Abuse program for my methadone treatment work in the decades between.

Methadone worked for me at that time. I was able to get through a day without using heroin. But what was my day like? Very empty. Or to paraphrase some words from Lou Reed and The Velvet Underground, who seemed able to identify the feelings of alienation and desperation that I was experiencing: I have made a big decision, I’m going to try to nullify my life, When I put the spike in to my vein, Let me tell you things aren’t quite the same. When someone gets to that point in life, just giving methadone is not the solution. I became a sitting duck for addiction to take over.

I was free from heroin for a little over a year, but smoked marijuana freely and drank alcohol, and tried heroin again. Within 10 days, I was addicted, again. This cycle continued for many years. I separated from methadone for the last(?) time in 1983. Again, I became a sitting duck for addiction. Although I had gone to some of the best MMT clinics in New York, I had not treated my addiction. So when I separated from methadone, I thought I could use other drugs. I still did not understand addiction.

The next five years of my life were hell, probably worse than my days as an active heroin addict. Although I was the president and CEO of a successful Mobil Oil Distributorship, Top 20 Nationwide, I was hopelessly addicted to cocaine, alcohol, barbiturates, and marijuana. It was not until I checked into a rehab and was treated with holistic bio-psycho-social-spiritual treatment — which when combined with chemically assisted treatment (if needed), affords one the best way, in my opinion, to get sober — that my life in sobriety began.

Recently, I have seen some clinicians deny MMT patients the possibility of treatment and further stigmatize them. I had one case of a patient in an outpatient aftercare group in which the counselor asked the group if anyone had been sober a year. No one raised a hand. The counselor then asked if anyone was sober for nine months. My patient raised his hand, at which point the counselor said, “You’re on methadone, you’re not sober.” This exemplifies the treatment many MMT patients experience at 12-step meetings. It is a type of condemnation solely based on the negative connotation and lack of understanding that society has regarding methadone.

Methadone works
Methadone is good medicine, especially when combined with a continuum of care. I could not stop heroin, but I could stop methadone. Why? Heroin is a quick onset, short-duration opiate. Methadone, on the other hand is a slow onset, long-acting medication that allows opiate addicts to be ready for treatment. The United Health Services Hospital clinic closely monitors the progress of its methadone patients. This progressive hospital, which operates a complete chemical dependency treatment program, had the vision to realize that part of MMT had to include group and individual counseling.

Fortunately, I had the chance to start recovery groups in this agency, after another clinician and I did some research and visited other programs to see what worked best. We began to encourage social connectedness for our patients. We empowered them. The patients were encouraged to begin a support group. I gave them the idea of “Methadone Anonymous,” which I learned about through a colleague. Shortly afterward, when the group was operating itself, one of the group members came to me and said, “We’d like to change the name. Methadone Anonymous relates to stopping using methadone, like Alcoholics Anony-mous relates to the discontinuation of alcohol. We don’t see methadone as something we want to stop.”
I realized at this point, we (they) had something. I worked with this group, doing my master’s research project with them. The results indicated that the group had improved their employment, reduced criminal activity, reduced risky health behaviors, and reduced use of illicit drugs.

The times, they are a changin’
On May 17, 2001, new regulations were proposed by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Admin-istration (SAMHSA) when CSAT took over the federal governing of methadone. CSAT has approved medical methadone maintenance to be available through a physician; however, states do have the last word in adopting more strict rules.
I recently spoke with a dear friend who has been a methadone patient for 25 years. Today, he goes to his doctor monthly for his medication. When he received his supply, he noticed there was an extra week’s worth. He thought there was a mistake, so he called his doctor. My friend was told, “No, no mistake — that is how it is done.” He began to cry. For the first time in 25 years, he didn’t have to worry about getting to the clinic.
To begin to understand, try to imagine what it felt like to be a methadone patient in need of your medication in New York City on September 11, 2001. Or try to see yourself as a diabetic only getting a day’s supply of insulin. Imagine that after proving for a year or two that you were a responsible insulin-dependent person, you still could not obtain more than a week’s supply. Add being told that your goal is to try to be free of insulin, to beat diabetes on your own. And only if you were able to do that would your treatment be deemed successful. Sounds ludicrous, doesn’t it? Imagine having to live with this daily. Knowing that if you don’t get your methadone, you will be ill. I remember living with the gnawing, lurking fear, always surrounded with a cloud of doom, what if I can’t get to the clinic? My whole routine had to be planned around my getting to the clinic.

Personal questions
Why do methadone patients enter treatment in a one-down position, I often wonder as I go about my daily work. Maintaining them in treatment makes good sense from a public health perspective (e.g., IV drug use presents the greatest risk for spread of disease such as HIV or HCV, Schoofs, 1998). I personally became infected with HCV in 1976 and have struggled with liver disease that could have been prevented if I had the education regarding IV drug use — we know that educating IV users and providing clean syringes has markedly lowered the rate of infection. Society seems to want to spend more time, money, and energy in punishing sick people than educating and treating them. Why do we stigmatize those who need our help most?

Barry S. Schecter, MSW, CASAC ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is a Program Coordina-tor of Specialty Outpatient Programs at United Health Services Hospital in Binghamton, NY. He is a fellow in the Robert Wood Johnson Developing Leadership in Reducing Substance Abuse program.

Reference
Schoofs, M. (1998). “HIV Down Among IV-Drug Users.” The Body: An AIDS and HIV Information Resource. Available: http://www.thebody.com/schoofs/ivdrug.html

This article is published in Counselor, The Magazine for Addiction Professionals, October 2003, v.4, n.5, pp. 64-65.

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