Doctors, Not Dealers

To access methadone in America, you might have to set your daily alarm to 4:00 a.m. — maybe earlier, if you live in a rural part of the country, like South Dakota, which only has one methadone clinic. You will take your car or a bus — or two, or three — to get to the clinic. You might have to cross state lines. You will join a line of people that snakes around an unmarked façade with police presence outside. Security cameras are fastened to the walls. A sign saying “no firearms or weapons allowed” hangs on an off-white wall in need of spackling. If the methadone clinic happens to be in a building with other doctors’ offices, no other patients are there because the sun is not yet up. You’re bundled in a coat because it is below freezing outside.

“Dosing” may start as early as 5:00 a.m. A clinician hands you your methadone through the small opening of a plexiglass window and watches you swallow, confirming by asking you to stick out your tongue. Someone may watch while you give a urine sample. If you’re due for a counseling session, you will wait longer. Once you’ve gotten your dose, you head back home so you can get ready for work. But, because you’re on methadone, you might not have a job, since the treatment regime is so disruptive to one’s life.

The cycle repeats daily. There is little forgiveness or room for the unexpected realities, the needed pivots, that come with being alive. If your daily dosing is disrupted — by a family emergency, by your own trip to urgent care — your clinic might penalize you. Punishment, not care, characterizes this form of addiction treatment. I hesitate to even label it “treatment,” because nothing else I’ve seen as a doctor in my first year of residency remotely