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By Edwin A. Salsitz, MD
Specialist in Addiction Medicine - July 19, 2001
"Being required to attend a clinic multiple times per week is often difficult under the best of circumstances, but having to balance such attendance requirements with the responsibilities of a job or a family can be close to impossible, especially when there is a need to maintain their condition in secret. Patients are often forced to concoct humiliating explanations for their unusual schedules".
"The clinics are generally not permitted to adapt to special needs of individuals. How can you expect patients to hold jobs and the responsibility that is often associated, especially jobs that require traveling and unscheduled activities? This is a tremendous problem. While we tell patients that they have a disease, and that methadone is a medication like any other, they can't reveal their status because of the widespread stigma! I've had patients who've told their employers that they had cancer and had to go for chemotherapy, rather than reveal they were receiving methadone."
"A patient comes into the emergency room of a community hospital on a snowy winter day. He is the head of a company and he has broken his ankle on the street. He is in pain and is waiting in the admitting area. The resident says to him 'What medications do you take?' This is a routine question, right? But not for a methadone patient. He answers 'I'm on this for blood pressure and this for cholesterol,' and then he needs to make the decision – 'do I disclose that I'm on methadone or not?' He decides to tell the doctor.
"The first reaction, especially outside of an urban area reflects the fact that the staff has never even seen a person on methadone, and haven't the vaguest idea what it is. And the typical response is 'Methadone? What are you doing on methadone? You don't look like an addict.' He answers 'I've been on methadone 25 years, I'm on 60mg. I'm in this very special program for stable individuals with a long-term record of abstinence from all illicit substances.' But they don't have any idea what the 'special program' is, so it's meaningless. And the patient says 'Listen, I'm just in a lot of pain with this broken ankle; could I get something for the pain?' And now the doctor thinks, 'Well, methadone's an opiate, that's what we use for pain ” he shouldn't be in pain. Obviously, this is an "addict" who's drug seeking.
He's just trying to get opiates from me. "The doctor may even yell out 'We've got an "addict" in room five with a leg injury.' And then this man who is a big-time executive is reduced to "an addict in room five". Sure he wants Demerol and he needs it, but he'll be lucky if he even gets Tylenol.
"When these things happen over and over again, eventually the person says 'I'm not going to tell them — I'm much better off that way.' Because if he doesn't tell them, then he's Mr. X; he's a patient with insurance to be catered to. He's treated the way he deserves to be treated, and the way all patients deserve – and expect – to be treated, except those receiving methadone maintenance."
"Stigmatization of methadone maintenance can be a threat to more than one's ego or livelihood. It can be deadly. Overdoses take the lives of those who have shied away from maintenance, or dropped out of treatment because of the ignorance and contempt with which they've been treated. Infectious diseases are transmitted by users unable to stop injecting heroin and unwilling to subject themselves to the prejudice associated with methadone."
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