Fortunately, I needn’t have worried so much. An Australian friend who is also on methadone helped me to make an appointment with her doctor in Sydney. Being able to make an appointment to see a doctor was a welcome change for me, before I’d even moved.  

I’d spent years in the one-size-fits all US methadone system, where anyone who needs the medication for opioid substitution must navigate highly regulated opioid treatment programs. These clinics exercise carceral control over their clients’ lives, requiring many to attend daily and dose under intrusive supervision. 

Isolating this treatment from the broader US health care system not only restricts access, but reinforces stigmatization, making it harder for people to seek the help they need. 

Throughout my transition to accessing methadone through the Australian system, the contrasts have been stark and profound.  

Getting methadone in the US was a daily exercise in punishment for me. Take-home doses, a symbol of stability and progress, are often withheld to keep clients tethered to daily visits. Clinic owners and operators often deflect to federal or state laws and regulations when challenged on the pervasive cruelty of this system. However, after many years as a client, it seems clear to me that financial motives drive their rules and policies.

Throughout my transition to accessing methadone through the Australian system, the contrasts have been stark and profound.  

Australia, for example, provides several different options for people to access methadone—including the one I took, of consulting with a primary care physician who would write me a prescription.   

After I arrived in Sydney, I attended my initial appointment with the GP. He requested a urine drug screen, explaining that this is a requirement for anyone when they are prescribed methadone for the first time. 

But then he apologized—saying that this would be the last drug screen I would ever have to do with him. Requiring further drug screens, he added, could damage the trust that’s essential to the doctor-patient relationship, and prevent me from feeling comfortable discussing any needs I have regarding my drug use.  

I felt a sense of shock. This approach was light years away from my experience at US clinics—where I was subjected to a urine drug screen every Thursday for the entire year of 2022, despite years of negatives. Like daily attendance, drug screens are a revenue stream for many US clinics, sidelining the genuine wellbeing of those seeking treatment and violating basic standards of informed consent.  

The clinics gathered so much information about my own body over the years, yet there was no transparency. Unless test results could be used to impose shame, or to coerce information from me, no information was ever shared or communicated to me—even when it could have helped me improve my health. My safety and needs were never centered.

Conversely, almost right after that first GP visit in Sydney, I was provided additional take-home doses of medication, even before I had increased to a stable dosage. It’s an accommodation that would be unimaginable in the US clinic system, because you cannot charge money for someone who is not there. 

Receiving my medication from a pharmacist who treats me like they would any other customer is an enjoyable experience.  

In the US, my daily clinic visits—with the judgmental stares of staff, the atmosphere of suspicion and distrust, the surrendering of personal dignity during medication pickups, observed dosing and urine screens—were utterly dehumanizing. 

On days when I had to meet with clinic staff more than usual, I would have to allow additional time in my schedule, to accommodate time I would spend crying in my car down the road from the clinic.  Having strangers wield so much power and control over my life was frustrating and distressing. I felt trapped. 

Now, I pick up my prescription for methadone at a community pharmacy. Receiving my medication from a pharmacist who treats me like they would any other customer is an enjoyable experience.  

In the US, clinics strip away more human dignity by numbering clients, instead of using our names. In Australia, my pharmacist not only knows my name but also recognizes my partner when he joins me for pickups. It might sound like a small gesture, but to me, it’s not small. It makes me feel like a human being, instead of an object on an assembly line.  

Making pharmacy pickups was a dramatic shift from being treated like a perpetual child and a criminal at US clinics. The weight of constant surveillance was lifted, allowing room for autonomy and dignity in the treatment process. Now, I am treated as a responsible adult, capable of making informed decisions about my own health.  

An assumption inherent to the US system is that individuals seeking methadone are incapable of responsible decision-making. This assumption fosters a damaging culture of stigma and control. And it just makes no sense: People who seek methadone treatment have made a deliberate choice to improve their lives, their stability and their safety—about the most responsible piece of decision-making imaginable.

There’s little else to say about my Australian methadone experience, because it’s so much simpler, as well as better, than the US system. 

I now have a personalized, trusting relationship with my GP that would be impossible with US clinic staff. And the convenience of dropping in at a local pharmacy has eliminated my past need for daily trekking, granting me a sense of autonomy and respect that I was never previously afforded.

It is important to recognize the diversity of experiences among people accessing methadone in Australia. While my overwhelmingly positive story here in Sydney is a testament to the strides being made, it’s essential to acknowledge that this may not be universal. 

Different states, doctors and pharmacies may contribute to varied experiences within the Australian system. It’s not my intention to generalize my own experience, and I want to be respectful of people on methadone in different Australian contexts.  

Yet by offering multiple options to access methadone for opioid substitution, Australia at least accepts the diversity in needs and preferences of people who utilize this life-saving resource. 

That’s a giant step forward compared to the US. And it fosters—at least some of the time, and certainly in my case—compassion, support and, ultimately, empowerment. 

Methadone without clinics is not just possible; it’s already the norm, successfully so, in other countries.

What I won’t do is forget the many people I left behind, still forced to contend with US clinics. My hope is that the urgent need to break the clinics’ cartel-like control of this vital medication becomes more widely evident, as we contrast a punitive system with something so much better.

The jarring disparities between US and Australian methadone landscapes emphasize the need to replace the US clinic system with one that prioritizes the wellbeing, dignity, agency and liberation of people on methadone. 

Methadone without clinics is not just possible; it’s already the norm, successfully so, in other countries. Australia may not be perfect, but it demonstrates that a system can exist where compassion and understanding guide our responses to individuals who need treatment and support.  

Methadone clinics must be replaced. But this isn’t just about policy change; it’s a plea for a shift in ethos—to replace a culture of cruelty with one of care and respect.

Photograph by Michelle Ress via Flickr/Creative Commons 2.0

The post After Years of US Clinics, I Get Methadone With Dignity in Australia appeared first on Filter.

When I first got into a clinic almost 10 years ago, I just felt lucky. I’d slept outside the first clinic I tried to get into, to be one of the first few in line on intake day, only to be turned away when I disclosed my chronic leg wounds. The clinic doctor told me that methadone would alleviate some of my physical pain, but that I needed to be in pain so I would “seek help.” I’d been under the naive impression that they were “help.”

At the next clinic, I made sure to not mention any of my health problems, and I got in. Thankfully, an older, experienced provider quickly raised my dose to a level I felt stable at. With the newfound stability of access to a safe supply of opioids, I managed to register for classes at my local community college, where I got my associate’s degree. I had to attend the clinic every single day, but I was so happy to have control of my life again that I made excuses for what I now recognize as abusive and controlling behavior.

Even though I was eventually permitted to receive take-home doses that I only had to pick up once a month from the clinic, they never let me forget the precarity of my situation and how much control they still wielded over my life.

I continued with school, eventually transferring to Arizona State University, where I completed my undergrad and master’s degrees. I’m now a PhD candidate, hoping to finish my doctorate next semester. With other people who use drugs, I’d become involved in mutual aid work. I even recently won an award, which offered me the opportunity to travel to Sydney, Australia and Glasgow, Scotland this fall.

I had the chance to go with someone to pick up her methadone. A big difference was that we would be doing this not at a clinic, but at a pharmacy.

I was beyond excited, but the clinic was quite the reality check.  Several months before my travel dates, I began asking staff to help ensure I could pick up my monthly doses at a time that wouldn’t impact my plans. It felt very inappropriate to be almost 40 years old and having to ask permission to travel—especially from a total stranger at a medical clinic. They left me with that too–familiar feeling of precarity up until the very last moment. Not until the week before my flight did they finally decide to adjust my pickup date.

In Australia, I had the privilege of meeting so many incredible people who use drugs and are doing amazing work and activism. I also had the chance, in Sydney, to go with someone to pick up her methadone. A big difference to my own past experiences was that we would be doing this not at a clinic, but at a pharmacy.

I was nervous as we walked together that day. I knew my clinic would never let me bring someone with me to pick up my doses. Some clinics don’t even allow parents to bring their children inside. My Australian friend also had her dog with us. My clinic seems to hate dogs and children. But she seemed quite confident about what we were doing, so I ignored my fears and followed along.

When we got to the pharmacy, she set her dog down and the pharmacist cheerfully greeted all of us while her dog comfortably explored and sniffed the aisles. He already had my friend’s methadone in a bag—a couple of weeks’ supply ready for her to pick up.

He even knew her name, which stood out to me. Because even after being at the same clinic for so many years, with the high turnover and lack of personal care, no one knows my name there.  

The clinic has assigned everyone prison-like ID numbers, an extra layer of impersonal disregard.

I heard her making unconcerned small talk, asking the pharmacist about his family. I suddenly felt like crying.

I listened in on the conversation. My friend had mentioned that she owed the pharmacy some money, and wouldn’t be able to pay that day either. I felt anxious, thinking of how the clinic back home immediately starts tapering and rapid-detoxing anyone who can’t pay their fee on time. I’ve watched enough people crying uncontrollably in the clinic waiting room after being unable to pay to know how they operate.

But the pharmacist seemed fine for my friend to wait until her next payday to settle her account. I heard her making unconcerned small talk, asking him about his family. I suddenly felt like crying, so I tried to focus on the dog sniffing the display of ointments.

As we started to leave, I quickly pulled myself together, embarrassed that seeing someone treated with basic dignity and kindness while getting their methadone could trigger such an emotional reaction from me. The pharmacist waved as we were leaving, but my arms just felt like heavy lumps at my side.

Afterwards, I asked my friend and a few other people about how they get drug tested. One person said that they had been on methadone for seven years, and another 10. Both had only been drug tested once, when they first started on methadone.

This experience was unrecognizable to me. I was “randomly” drug tested every single Thursday for the entire year of 2021. Even though I had years of drug tests showing methadone-only preceding that year.

While I am incredibly happy for my Australian friends that their experience is so much more humane than my own—and I understand that not everyone in Australia has such positive experiences getting methadone there—I also feel, even as I reflect on this now, utterly sad.

The stark contrast of the kindness and accessibility I saw in Australia to the intrusive and abusive treatment we endure here in the States was impossible to ignore.

At my clinic, they even paternalistically refer to getting any extra take-home bottles of medication as “privileges.” I may have many privileges in life, but access to a few bottles of medication is not one of them.

When I got home, going back to the clinic with its embedded culture of cruelty was harder than ever.  The stark contrast of the kindness and accessibility I saw in Australia to the intrusive and abusive treatment we endure here in the States was impossible to ignore.

Since that time, years ago, when I felt lucky just to have got into a clinic—and, like many others on methadone, made excuses for the abuse I experienced—my gut sense that I deserve to be treated with respect and kindness has only intensified.

Going to school has helped me in many ways—like giving me a sense of self-worth and confidence that I lacked all those years ago when I slept outside a clinic.  It has become ever harder to accept paternalistic and controlling demands—and especially the precarity of my take-home doses.

December 13 was my pickup day at the clinic. It also ended up being my last day there. Because even though methadone has been life-changing for me, I can no longer abide the cruelty with which this medication is dispensed. So I made a conscious decision to walk out, and take my chances with trying to finish tapering off opioids with drugs I buy on the illicit market. I’m done trading my dignity for safety.

After years at that clinic, no one even noticed as I walked out. Why would they? No one there even knows my name.

I saw that a better way is possible. I deserve better. We all do. 

Photograph of a pharmacy in Victoria, Australia by Matthew Paul Argall via Flickr/Creative Commons 2.0

The post To a US Methadone Recipient, Visiting Australia Was Shocking appeared first on Filter.