Daily Methadone Clinic Dosing Creates Rural Transportation Nightmare

    Heather Strong lives in a rural area of Maine, and can’t afford a car. She also uses methadone. So to attend her methadone clinic—the only place she can obtain her essential medication—she has to rely entirely on transportation provided through Medicaid. No transportation, no methadone.

    I met Strong in Portland, at a screening of my film, Swallow THIS: A Documentary About Methadone & COVID-19. During the panel afterwards, she shared her history with methadone: beginning in 2011, tapering off it completely in 2017, then starting back on the medication in 2022.

    She also spoke powerfully of her nightmarish challenge of securing daily transportation, when her clinic requires her to attend six days a week to dose. This continually complicates her family life, and leaves her feeling frustrated and punished. Other people at her clinic face similar circumstances.

    In a perverse Catch-22, the unreliability of Strong’s transportation prevents her from “earning” the take-home doses that would reduce her reliance on that transportation. SAMHSA criteria demand that patients demonstrate “regularity of attendance for supervised medication administration” to receive take-homes.

    In our devastating opioid-involved overdose crisis, making it this hard for people to get a medication that cuts overdose risk by 50 percent or more is indefensible. Strong agreed to continue our conversation for Filter.


    Helen Redmond: What impact has going to the clinic had on your life? 

    Heather Strong: It helps to a certain degree, but it hinders other parts of my life. I can’t work. My grandparents have to take my kids to school for me because transportation to the clinic is at a time when the kids are supposed to be getting up. I cannot go anywhere without making sure I can get to the clinic the next day. I go six days a week, and get one take-home bottle for Sunday.


    How does your transportation to the clinic work? 

    I’ve been dealing with transportation problems ever since my vehicle was going to cost me an arm and a leg to pass inspection. So I have no car and my fate was left up to the only transportation service in our area that facilitates finding drivers to bring you to and from the clinic.

    Keep in mind though, we are not considered an emergency appointment. So if there is inclement weather, or if there are no drivers available, we are without a ride. It could be one day or several days. We are not a priority.

    “I cannot get take-home bottles, because I consistently miss days due to my rides being canceled for weather, or no drivers are available.” 

    You have to call 48 hours prior to your appointment to set rides up. They will not book rides 24 hours in advance, so if you forget—which everyone usually does at some point—you have to wait two days for them to set rides up again.

    There is always a shortage of drivers. They squish us all into small vans, and they don’t care if we don’t all have seat belts. Our driver falls asleep all the time. It takes two hours’ round trip—an hour there and an hour back.

    I cannot get take-home bottles, because I consistently miss days due to my rides being canceled for weather, or no drivers are available. 


    How does it impact you when you’re forced to miss appointments at the clinic?

    Going through methadone withdrawals is the worst. I’m constantly stressed out because I’m back at square one again in my recovery. 


    How do clinic staff react to your transportation difficulties?

    Most of the staff are pretty indifferent to your problems. Some feel bad for you. But nothing changes. I have a hard time scheduling time to meet with my counselor because the whole van has to wait. Or other riders have to meet with their counselors and so we have to wait another hour to go home.

    Some of the counselors are really nice, they offer resources, but the secretaries are awful. I’m sure they deal with a lot of crap, but they don’t go out of their way to help you either. They leave a voicemail or send an email for your counselor to meet with you, which most of the time the counselor doesn’t get. The secretaries forget about you, so you end up waiting an hour just to meet with your counselor.



    Photograph by Helen Redmond

    • Helen is Filter‘s senior editor and a multimedia journalist. She is on the methadone, vaping and nicotine train. Helen is also a filmmaker. Her two documentaries about methadone are Liquid Handcuffs and Swallow THIS. As an LCSW, she has worked with people who use drugs for over two decades. Helen is an adjunct assistant professor and teaches a course about the War on Drugs at NYU. She lives in Harlem.

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