“Turning Junkies Into Junkies: America’s Methadone Treatment Program”
Published May, 1995, Hustler magazine
It took a year, but Bruce Moreland finally ran out of cash. Shooting $100 of heroin every day has a way of shooting a money load. Twelve hours after his last fix, Bruce’s bones ached, and his body twitched. The content of his last meal – a 48-ounce malt liquor – teased their way up his throat, before descending quickly to his cramping gut. He would’ve given his last buck for a bag, if he hadn’t just done that the night before.
Faced with the daunting proposition of getting high without cash, Bruce recalled a fucked-up conversation with another shooter regarding methadone clinics. The two had laughed then at the kindly image of Uncle Sam getting junkies clean by turning them onto methadone. Bruce wasn’t laughing anymore. If the government was selling, he was definitely buying.
The methadone clinic was in the crotch of Hollywood, a few streets away from the scrawny hookers pacing Sunset and Vine. It was after 7:30am when he entered the clinic. He gave a urine sample, showed his track to the doctor during a brief interview and filled out some forms. Half an hour later, he was handed a paper cup like those children use to swill Kool Aid at birthday barbeques. Only this punch was spiked with 80 milligrams of methadone, pale-orange inertia. The gulp was sweet.
He handed the empty cup back to the nurse through a sliding, metal tray. He smiled his thanks and wandered aimlessly into the morning’s smoggy glare. “Welcome to the first day of methadone detox,” the part-time doctor had said. “It’s the first day of the rest of your life.” For Bruce, it would be the first of 300 days of the rest of his life.
At least half a million Americans are addicted to heroin today. Until the mid-‘80s, the bastard offspring of opium was exported primarily from Southeast Asia’s Golden Triangle, a remote, mountainous area where the borders of Thailand, Laos and Myanmar (formerly Burma) converge. But by 1989, Iran and Afghanistan were two of the many countries that had increased their opium exports in hopes of earning a bigger chunk of the annual $500 billion global drug trade. Today, even Mexico is growing more opium, and its neighborly proximity to the U.S. makes it a threat to become America’s new heroin supplier. In this competitive market, heroin purity has improved, while prices have dropped thanks to the increased supply. As a result, drug experts now fear America is on the verge of a heroin epidemic.
As the government searches for ways to control the crime and spread of AIDS associated with heroin abuse, solutions prove scarce and sometimes controversial as the heroin itself. Some addicts are offered expensive hospital detox clinics, others are thrown in jail. But approximately 110,000 junkies are currently enrolled in the methadone-treatment program, a tax-funded venture designed to get addicts off heroin by getting them addicted to methadone.
The drug was first developed in World War II when German casualties were cut off from their supply of pain-killing morphine. German chemists, under orders from Hitler, developed an inexpensive morphine substitute that didn’t require opium as a raw material. The synthetic opiate was first called Adolfine, in honor of the brutal dictator, but later became known as methadone.
In 1965, as heroin addiction rose in America, the first methadone clinics were established in the U.S., after methadone was shown to block a junkie’s craving for heroin. The program was successful enough to spawn others, and today there are about 750 methadone clinics nationwide. The procedure is simple: Anyone over 16 years old who claims to be an addict and her traces of opiates in his or her system can enter the program. Consent forms are completed, and a daily dosage is determined by the clinic’s doctor based on the severity of the patient’s addiction. The longer a junkie’s history of addiction, the stronger jolt of methadone, with 120 milligrams being the maximum. The patient goes to the clinic every day and drinks his methadone on the premises.
Where a good shot of smack will keep the average doper high for only three or four hours, the methadone stupor lasts longer than 24 hours, keeping the user blotted until the next day when he returns for another dose. In addition, the methadone high is purportedly calmer and less euphoric than the heroin sledgehammer. It is the methadone program’s belief that long-term treatment can break an addict’s rollercoaster cycle of forever chasing a fix to stave off withdrawals, providing stability to get his or her life on track.
There are two kinds of methadone treatment. Detoxification lasts 21 days. If the junkie uses nothing other than his daily dose of methadone, he is quickly weaned on lower and lower milligram amounts until his dosage is so low that he can leave the program after three weeks drug free and without the craving for heroin. But a person who has fixed every day for years will almost certainly yield to the heroin juggernaut within days after his detox release. Dr. John Ball, senior scientist at the Addiction Research Center and co-author of The Effectiveness of Methadone Maintenance Treatment, found that 82% of the patients who left methadone treatment relapsed into intravenous drug use within the first year. “Everybody has given up on (detox),” admits Dr. Ball. “That alone, we know now, does not go very far.”
The only way for the program to be successful is through a patient’s long-term commitment called methadone maintenance. A successful methadone-maintenance program has no time limit and, in fact, is considered life long. In other words, a patient who requests maintenance (usually after several failed detox attempts) receives daily doses of the drug over whatever extended period of time is deemed clinically appropriate, as outlined by the Methadone Treatment Manual (MTM), written for the U.S. Department of Justice in 1973. Dr. Ball is adamant that the longer the treatment persists, the greater its success. “For those who enter the clinic for a year or longer and change from shooting heroin to taking oral methadone and are under medical supervision and go along with the program routine, there’s a 71% decrease in their intravenous use and an 80% reduction in their criminal behavior.”
In the case of methadone maintenance, the government supports a life sentence of controlled addiction. Some patients have been in the program, receiving tax-funded doses of methadone for more than 20 years, and will most likely continue in this way until the day they die. But the longer maintenance drags on, the more money must be allocated for its upkeep. Since patients tend to drift in and out of the program, exact expense figures vary. In 1990 the average cost per patient was approximately $1,750 for ever six months, according to a spokesperson for the National Institute on Drug Abuse. Double that figure, and the yearly average for patient upkeep totals $3,500 per person. Multiply that figure by the 110,000 people currently enrolled in methadone clinics, and the annual average could reach a staggering $385 million spent on getting junkies high. Nevertheless, Dr. Ball insists the budget should be even greater. “It should be three times more,” he says. “We’ve got women coming in with young children, you’ve got pregnant addicts; you can say, ‘Turn them out, it’s their problem.’ But that’s hardly realistic. You need medical coverage and support and efforts to rehabilitate.”
John A. drifted in and out of methadone programs during his years of heroin abuse. He finally realized that methadone was futile in his fight against other drugs. “I’ve never met anybody who’s detoxed with methadone,” he says. “If your whole world is built around using heroin, then just getting something like methadone that’s maybe going to take the edge off is not going to do anything. Assuming that the drug (heroin) is the problem is really simplistic and fairly stupid. It’s not. There area lot of problems that cause somebody to take drugs. Methadone addresses the symptoms, but not the cause.”
The methadone program has assigned itself greater import since the dawn of AIDS. In 1981 there were only 21 cases of AIDS among heterosexuals who acquired the disease through intravenous drug use. Over the next ten years, that number skyrocketed to 41,988. IV drug use is now the primary way the killer disease is spread within the heterosexual community. The methadone program’s logic insists that since methadone is taken orally, addicts in treatment no longer use needles, thus reducing the risk of spreading diseases like hepititus and, most importantly, AIDS. But methadone treatment has only shown success rates after a year or more of treatment. A report by the General Accounting Office in 1990 discovered that “a substantial number of heroin addicts in the methadone program…continue to use heroin six months after entering treatment.” In addition, there are fewer pure heroin users than ever before.
According to the Los Angeles Times, shooting speedballs, a mixture of heroin and cocaine, has become the latest craze am on the junkie set. Where methadone at the proper dose may block the addict’s craving for heroin, it does nothing for cocaine. Even if the junkie stops shooting smack, he’ll still crave the coke rush that, for him, can only be obtained by blasting it through his veins. “I knew people who were on high doses of methadone that would shoot coke because they needed to have something to shoot,” says John A. In these cases, the argument for oral methadone as a way to ween addicts off the needle proves moot.
Although clinics are supposed to take weekly urine sample to determine if a patient is still using narcotics, the methadone program does not punish or ever terminate a patient’s enrollment, even if the patient’s urine proves dirty. If urine shows that narcotics are present, the patient is elevated to a higher dosage of methadone in an attempt to curb other cravings. “Addicts don’t become Boy Scouts overnight,” admits the matronly Dr. Isobel Dalali, clinic coordinator of the methadone program at the Veterans Administration Hospital in Los Angeles. “If (a patient) continues to use (heroin or other drugs), then we will detox him. When he starts getting down to 30 milligrams of methadone, he feels it.” She smiles as if speaking of laboratory mice. “Then he wants to know how he can get back in good standing and earn higher dosages. If the patient cleans up, we will reconsider putting him back on maintenance.” For the addict who likes to be high, it’s a win-win situation.
The question remains: Does an addict who enters the methadone program with a heroin addiction benefit by being given a new one? “Methadone is addicting,” states the MTM. But “for the person already addicted to heroin, the addicting nature of methadone is one of methadone’s chief therapeutic advantages.” The program’s logic reasons that since addicts are assured of a daily fix that’ll last 24 hours, the patient can seek employment and get his life on track. Especially since “methadone-maintenance treatment enables patients to function without abnormal fluctuations in performance,” according to Dr. Norman B. Gordon in the MTM.
What’s normal about a synthetic opiate that not only impairs the body’s motor functions, but also keeps the user in a mental haze that may impede his social interactions? “It’s a central-nervous-system depressant,” explains Dr. Dalali. “But people on methadone have no trouble driving or working around machinery. People just kind of adapt to it.” Former methadone patient Michelle R. remembers a different reaction. “There were days if I went to work, I would nod out,” she recalls. “I was always dinging the car when I was on methadone.” Yet methadone patients have no restriction on their driver’s licenses. Other side effects, such as constipation, headaches, nausea and lack of sex drive, pale in comparison to the most dangerous and common occurrence of “nodding,” or suddenly falling asleep no matter when or where the patient may be.
“Methadone incapacitates you,” says Rod D., who sought methadone detox when his $100-a-day heroin habit broke his bank account. “I’d take it in the morning, get insanely euphoric and around five (p.m.) I was nodding out no matter where I was,” he relates. The clinics he attended in New York still tried to push him into long-term maintenance in lieu of the short and unsuccessful detox. Rod always declined. “I had seen people who had been on methadone maintenance for 12 years, and the way they looked frightened me so much. They all had really swollen hands and sores, and they were like zombies.”
It has been suggested that turning heroin addicts into zombies may be the true purpose of the methadone program. An article in the Journal of the American Medical Associated cited a Village Voice critic of methadone who wrote, “Methadone is not rehabilitation. It is the state’s way of keeping tabs on junkies by providing them with a legalized way to get high that’s more debilitating than heroin. The state would just as soon give all junkies a life sentence in this chemical jail.” Actually, the government that allocates money to fund this program still isn’t sure where it stands on the methadone issue. The White House Conference for a Drug Free America’s Final Report in June 1988 acknowledged that, “Methadone substitutes one drug for another, and if it were not available, addicts would have no option but to go through withdrawals and become drug free.”
Bruce Moreland went through withdrawals when he was arrested a second time for possession of heroin. Moreland, the bass player for the now-defunct band Wall of Voodoo, says he nearly went out of his mind in prison. He didn’t sleep for a month and battled the flu and pneumonia for the first six months of his two-year sentence. When he was paroled, he was sober, and has remained clean for the past three years. Still, he adamantly maintains his prison hell was preferable to his 300 attempts at methadone detox and five tries at long-term maintenance. Bruce says that if he hadn’t spent 15 years in methadone programs, he would be a lot further along in his life than he is today.
The only chance methadone treatment has for success – long-term commitment – is with patient support and close counselor rapport. Handing an addict a gulp of methadone and sending him blindly on his way does nothing to change his social patterns. The program must have an available staff that maintains constant positive support of their patients. The V.A. Hospital’s methadone program in Los Angeles seems exemplary in following the guidelines for staff availability and offering its patients “counseling, counseling, counseling until you’re blue in the face with counseling,” laughs Dr. Dalali, the clinic’s psychologist.
Unfortunately, most clinics either can’t afford or don’t care enough to maintain a large, supportive staff. Except for the public programs that operate out of hospitals, many of the private clinics function out of closed banks or converted warehouses, and provide little in the way of counseling. Despite government funding, patients at private clinics contribute $300 or more a month to obtain their methadone. The atmosphere at these centers can be as sleazy as the one the addict hopes to escape.
Michelle R. began her methadone treatment as a way to escape the financial burden of buying dope on the streets. At one point during her three years of maintenance, she received her daily doses from a private office inside one of the cheerless high-rises in Century City, California. She paid $200 a month and never saw a doctor after her initial consultation. Instead of dealing with a supportive staff, she was often harassed by the man who ran the operation at that time. “He was a creep who would be letchy with me,” she says bitterly. “At first he was nice and even let me pay cheaper rates for the doses. Eventually I couldn’t pay anymore, and finally he kicked me out because I wouldn’t sleep with him.” She left the clinic and has now been clean for nearly five years thanks to Narcotics Anonymous, which boasts over 700,000 former addicts who’ve gotten clean through their patient-supported programs.
If there is a lack of staff support at some of the methadone clinics, it’s a direct result of the decreased funding, according to Dr. Ball. “There area bad programs out there, just like there’s good and bad surgery,” he admits, “and if the funding keeps decreasing, there are not going to be as many good programs.”
But former addict Rod saw similar understaffing problems even ten years ago when he was in the program. “I’ve been to methadone clinics all across the country, and there was no staff support whatsoever,” he insists. “The ones I’ve been to in Florida and Los Angeles are like this private racket. People sold pills in the parking lot. I had to pay $10 a day, and that was clearly all they were interested in.”
John A. agrees. “Nobody ever talked to me once, and nobody ever suggested that I go to any kind of groups.”
Some former addicts feel that the millions spent on methadone treatment would be better spent on hospital detox programs or recovery houses that get people off drugs with counseling and hands-on support. The idea of paying for an addict to get clean in a multi-month, in-house program seems preferable to supporting his methadone intake for many years. “I went through a recovery house,” explains John. “The house was a combination of heavy discipline and Twelve Step meetings. There’s no drugs at all. I was there for 16 months and it worked beautifully.” John’s been clean for seven years. Rod concurs. After methadone failed so often, he went into a rigorous six-month treatment program paid for by the state. “It’s like boot camp,” he says. “They teach you how to live without drugs.” After those six months, he never used again. That was five years ago.
Meanwhile, until a conclusive solution to heroin addiction can be found, a needle exchange program that provides clean needles to junkies might prove a more efficient barrier to the spread of AIDS. Ironically, the government seems opposed to needle-exchange programs on the basis that it encourages junkies to use drugs. Former President Bush was “opposed to exchange of needles under any condition”; and John Gibbons, a spokesman for Health and Human Services Secretary Louis Sullivan said, “Such programs can be viewed as sanctioning drug use. The administration has consistently conveyed that illicit drug use is unacceptable and will not be tolerated.” Unless, of course, it’s government controlled.
“Nothing is going to be miraculous,” admits Dr. Ball, who remains an adamant supporter of methadone treatment. “We’re dealing with a very difficult problem. You’re not going to turn these people around and make them middle-class, upstanding individuals overnight. It’s going to take time, usually some years. Instead of looking for magical quick fixes and always being critical (of methadone), we have to look at the end result.”
Dr. Dalali and the V.A. Hospital’s press watchdog, Marc DeFalco, walk past the methadone distribution area of the V.A.’s clinic. A patient flashes his ID badge to the nurse behind the glass who slides the man his dose of methadone. The man’s eyes are distant and sunken deep into his skull. His prematurely graying hair is also receding. He places the paper cup to his lips and slowly tilts his head further and further back, until his bald spot practically parallels his spine. He drinks.
Long after the tiny portion has slid down his throat, the patient holds the position and taps his finger on the bottom of the paper cup. Tap-tap-tap. He strives for any remaining drop that may be stubbornly clinging to the cup’s waxy lining. There is no more. He straightens up and smiles at the elderly nurse.
Before he passes the cup back to her, the optimist tries once more, quickly tilting the empty cup to his mouth. The drug is definitely gone. He thanks the nurse, lights a cigarette and wanders aimlessly into the morning glare. Today is another day of the rest of his life.