When I first neared the nondescript two-story building, I wasn’t sure I was in the right place. There was no sign labeling what lay behind the stucco walls, and the windows were too few and too small to catch a glimpse. The clinic itself seemed ashamed of its own existence, or perhaps just worried about what the neighbors would think. The parking lot was surrounded by barbed wire and patrolled by a police officer.
In the corner just behind a tall, iron gate, a group of patients gathered. In the center, an old woman lay on the pebbled ground, talking loudly in a scratchy voice between drags from her cigarette. A man wearing stained jeans and holding an extra-large Circle K cup stood beside a younger woman in flannel pajamas, and chunky black slides. The officer had also noticed this congregation and was walking toward them; according to a posted sign, no loitering was allowed on the premises. I guided my bicycle to the rack behind them, a little worried whether it would still be there when I returned.
It was January 2020, and I was applying to work part-time as a physician at a methadone clinic. Primarily an emergency room doctor, I had become increasingly interested in addiction medicine over the past few years.
To gain credibility—something I was always chasing as a young woman in medicine—I decided to pursue board certification in the field. This meant that I needed to work at least 500 clinical hours in addiction, and in Tucson, the only place looking for help was a methadone clinic. I had never imagined myself working somewhere like this; methadone clinics weren’t exactly seen as desirable. Nobody in my medical school aspired to work at one, nor was it presented as a career goal that we might strive for. But here I was, in a nice dress and leather boots, with freshly washed hair, ready for my interview.
If my doctor asked me to follow such condescending, punitive rules, I would be outraged. But if you wanted methadone, there was no choice but to comply.
Swinging open the tinted glass door, I entered the buzz of the crowded waiting room. A line of patience formed to my right, waiting to get their daily doses. The air smelled of stale cigarettes and cherry cough syrup, the flavor added to the liquid methadone. Many of the patients had sunburned shoulders, and a few had cheap, thin roller bags that they dragged alongside them—signs of housing insecurity.
To my left was a sea of vinyl chairs filled with patients, waiting to see therapists, clinicians, or lab techs. Several times a year, patients were randomly selected to give a urine sample to determine whether they were still using drugs. They peed into cups held over toilets with silver handles taped in place to remind them of the rules, which were printed on a piece of paper, highlighted in yellow, and tacked to the rear wall—no flushing the toilet or running the faucet, even though there was no sink inside the small bathroom itself. There was no lock on the door. The freshness of the sample was verified by a flimsy thermometer attached to the cup.
The printed rules also detailed what happened if someone couldn’t pee within three minutes: If they decided to leave the clinic instead of waiting in the lobby and trying again, a staff member would watch them urinate when they next returned.
If my doctor asked me to follow such condescending, punitive rules, I would be outraged. I would demand to see their policies, argue with the staff, or storm out. But if you wanted methadone, there was no choice but to comply.
…
[The previous year, the author had received a shocking letter about her Suboxone (buprenorphine) prescribing.]
Much like text messages from my mom, the letterhead was in all caps, and the sender was none other than Michigan’s Medical Board. It was definitely not an award.
“Dear Licensee,” it began. “Enclosed is an Administrative Complaint, charging you with violation of the Public Health Code. You must respond to this Complaint IN WRITING WITHIN 30 DAYS from the day you received it. If you fail to do so, the complaint will be sent to your Board’s Disciplinary Subcommittee to impose a sanction…”
I flipped to the next page, and there, to the bottom of the page, I found my first clue: “Suboxone is known as ‘prison heroin,’ and is commonly abused and diverted.”
Prison heroin? Really? Suboxone was increasingly seen as a gold-standard treatment for opioid use disorder; it was not some fringe illicit drug. The letter read less like one from an official medical board, which was supposed to be based in science, and more like propaganda from some abstinence- based troll on social media. Yet here it was.
“From May 2018 through September 2018, Respondent wrote seventeen (17) prescriptions for controlled substances in Michigan … Respondent’s conduct constitutes a violation of general duty, consisting of negligence, or failure to exercise due care, and fails to conform to minimal standards of acceptable, prevailing practice for the health profession…”
The legal jargon was confusing. What had I done wrong? What was at stake? Would I lose my medical license? The last four years of medical school, three years of residency, and one year of fellowship all made obsolete? How would I repay my $262,000 of student debt?
The board was continuing the century-long tradition of criminalizing maintenance medications and the doctors who prescribed them. Via telemedicine, I was making buprenorphine too accessible.
In 1981, [drug historian] David Courtwright asked [methadone pioneer Dr. Marie Nyswander], “Which groups would you identify as the most influential opponent of methadone maintenance?”
She answered, “My feeling was always that the [Federal Bureau of Narcotics] that turned the doctors against addicts, that scared them out of treatment… As far as I like to think of it, the Narcotics men had really so scared the doctors that they abandoned the treatment of drug addiction, and therefore, there is no place for them to go. So they would be against addicts in the sense that professionally, they are denying a group of people treatment. “
Once I knew this history, I began to see the Michigan Medical Board investigation in a new context. The board was simply continuing the century-long tradition of criminalizing maintenance medications and the doctors who prescribed them. Even though addiction docs such as myself were reducing the demand for illegal opioids, enforcement saw our contribution to the opioid supply as the greater offense. Via telemedicine, I was making buprenorphine too accessible.
Although changes in federal regulation meant that agents could no longer straight-out arrest doctors like me who prescribed medications for opioid use disorder, they could still get us when we broke small technicalities, an error easy to make in today’s confusing, regulatory patchwork.
Such an approach framed a systemic problem—stigma against addiction treatment—as an individual failing: a doctor who is too loose with her prescription pad, that is, a modern-day script doctor. The goal? To scare doctors away from offering addiction treatment. They had also tried this with Marie. And, by and large, it worked.
I emailed the president of the Michigan chapter of the American Society of Addiction Medicine (ASAM). Myself a member, I assumed they would be outraged that the medical board referred to buprenorphine as “prison heroin.” Who knew how many other doctors have been accused of the same thing? Once ASAM heard of this, surely they would start advocating to change the medical board’s opinion.
Instead, the president emailed me back to recuse herself from discussing my situation, as she herself was on the Michigan Medical Board. Were addiction doctors themselves leading the charge against me?
Later, I’d learned that Marie and [methadone pioneer Dr. Vincent Dole] felt the same betrayal, and were outraged by the medical community’s silence when regulators circumscribed their ability to offer effective treatment. A cruel loneliness settled into my bones; there was nobody to help shoulder the repercussions or to help guide me through this experience. If only I had a mentor, someone to help me forge this path through the wilderness. But, like Marie, I was doing this alone.
Excerpted from Chapters 1 and 3 of Mother of Methadone: A Doctor’s Quest, a Forgotten History, and a Modern-Day Crisis by Melody Glenn (Beacon Press, 2025). Reprinted with permission from Beacon Press.
You can read Filter‘s interview with Dr. Melody Glenn here.
Top image by Helen Redmond
