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By Olof Blix, MD
Specialist in Addiction Medicine - July 19, 2001
The general public tends to see in the media only those methadone patients who can't help being seen, i.e. those who get into trouble. The public remains oblivious to those patients with whom they work, with whom they socialize, perhaps even with whom they live. These are the patients that are doing well and are stable, productive citizens, but nevertheless feel ashamed to be on methadone. Accordingly, they keep it a secret that is shared with as few people as possible. I have six patients right now who have never even told their partners they're on methadone! Some of these relationships have existed for years, and the patient was known to have been addicted to heroin at some point in the past, with associated arrests and incarcerations. But now, having left all that behind them, these patients are afraid to tell their partners that their current success is due to their treatment with methadone, and as the years go by the fear of exposure keeps building.
Beyond the stigma attached to having been heroin addicted, patients suffer from the shame of being perceived as "too weak" to abstain without receiving methadone. Some feel the stigma attached to the medication is almost as great as their prior addiction to heroin. In many instances the environment of the clinics and the street culture increases the patients' own sense of inadequacy and failure, because even if they see themselves doing well, they continue to be viewed as the "street junky" who is just applying for admission and subject to essentially the same restrictions. For example, I have someone who's currently working, married and whose life is reasonably well put together and functional. That person is afraid to go to a methadone clinic for fear that somebody might see him go in or go out, and I fully understand that fear. I have never met a middle class, still socially integrated, actively opiate addicted individual who's come to see me for a consultation who has agreed to go on methadone the first time we get together. This option is rejected because of the worry over where the clinics are located, what they are like, and the myths about methadone and what it means to be on it.
In the NY metropolitan area (and probably elsewhere as well) there are disproportionate numbers of destitute people in methadone clinics as compared to the opiate addicted population as a whole. Those who are working and more educated try drug-free approaches, or naltrexone (an opiate antagonist). They try anything in an effort to avoid methadone. Inevitably, the majority relapse again and again. If they could access methadone through a private physician, in an office of a community-based generalist, or in a pharmacy -just as they are accustomed to for all their other medical needs — many of them would accept methadone without hesitation.
Many "clinics" are in poor, dilapidated locations and in badly deteriorating buildings. Since most care for all levels of patients — the newly admitted as well the stable, long-term individual — there will be people who are not doing well, who just 'hang out'. There will be trafficking in drugs. Its all well and good to tell a patient he or she has a chronic illness and will be treated with an effective and safe medication, but that image conflicts with the environment and the circumstances surrounding the delivery of the treatment services.
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