I first heard Edith Springer speak at the 2004 Harm Reduction Coalition conference in New Orleans. She was explaining how the harm reduction model can help people experiencing addiction.
She told us that drug use was not “abuse,” that social determinants of drug use were vital to understand; that people are capable of great change; and that we must stop blaming and shaming people who use drugs.
Springer also said she didn’t agree with the tenets of the 12 Steps because she wasn’t “powerless” over her drug use, and in a patriarchal society she could never accept powerlessness for women.
Her talk that day blew me away. Quite simply, it convinced me to work with people who use drugs and become a harm reductionist. Only later did I learn the extent to which Springer—as a fighter for drug-user rights, an ethical social worker and an extraordinary teacher—is a pioneer in the United States harm reduction movement.
She began conducting hands-on harm reduction in New York City back in the 1980s, and founded the NY Peer AIDS Education Coalition at the height of the HIV crisis. In 1993, she was part of the working group that led to the formation of the Harm Reduction Coalition (now the National Harm Reduction Coalition).
Her story is all too familiar; she went to a clinic expecting help, and was punished instead.
She’s been known as “the goddess of harm reduction,” and Maia Szalavitz’s must-read 2021 book, Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction, devotes an entire chapter to Springer.
Springer previously used heroin, and began taking methadone; she later spent time working at a methadone clinic during the HIV crisis. So I wanted to ask about her experiences and hear her thoughts on methadone access.
Her story is all too familiar; she went to a clinic expecting help, and was punished instead. She was kicked out of numerous programs for “dirty” urine and other rule infractions. She tried, to no avail, to change the culture of cruelty. Now she is in favor of closing clinics, and integrating methadone prescribing into mainstream health care.
Edith Springer has chronic health conditions, but still made time to speak with Filter about these issues. Our interview has been lightly edited for length and clarity.
Helen Redmond: Why did you decide to take methadone?
Edith Springer: I wanted to get off heroin and I tried to by myself many times and failed. And I heard about methadone from my doctor. This was in the 1970s. And there was a new program that opened up … all the others, you would be waiting for years. It was called Bellevue Psychiatric Methadone Program, and I was able to get in.
The program was horrible. The counselors were social workers and it was run by psychiatrists. And they treated me like a criminal. We had to come in six days a week and had to give urine specimens. They didn’t believe anything we said. They gave you days off when you’re “good,” and then they took away those days when you were “bad.” I hated the program.
“I was starting to get a little bit of self-esteem, but they took it away. Whenever I got it, they took it away.”
HR: Did the methadone take away the cravings?
ES: Yes. But one problem was, I didn’t need a high dose of methadone. I could have used 20 milligrams, but they insisted that everybody be on a minimum of 70 milligrams. So I was sleepy. But other than that, it worked to stop my cravings and made me feel normal. I was able to work. I was a secretary at the time. And you know, I was starting to get a little bit of self-esteem, but they took it away. Whenever I got it, they took it away. They treated us terribly.
HR: What kinds of things would the staff at the clinic say to you?
ES: They would say I had “dirty” urine. Urine isn’t dirty or clean. They didn’t understand that people don’t change all at once.
HR: They didn’t understand the Stages of Change.
ES: Exactly. And so they would say you had dirty urine and we’re taking your take-home methadone away, you have to come in six days a week instead of five or four, or whatever it was. Group counseling was forced; you had to go.
You can’t force counseling on people; they have to want it. It was a shitty, free program and the other people in the group and the staff hated me, so I didn’t fit in.
HR: Did you speak up and say, “Hey, this is wrong, and we shouldn’t be treated this way?”
ES: I didn’t have the courage. I didn’t have the self-esteem to speak up for myself. I left that program and went to a private one, because I was working and I had insurance that paid for it. It was called the Mary Scranton Foundation. It has long since closed.
And there we had once-a-week group therapy, no forced counseling. The clinical head was a psychiatrist who had been at the Bellevue Program, and he was very nice and treated us with respect. It was the first time that I was treated with respect in a methadone program. So I did pretty well and eventually detoxed.
“I tried to do the work the way I thought it should be done, with dignity and respect. The staff said I was an enabler.”
HR: How did you decide to stop methadone?
ES: I always wanted to stop, from the time I was in the Bellevue Program. But they discouraged it. But at the Mary Scranton program they encouraged it. So I was able to do it. Unfortunately, they didn’t do it slow enough. It was very hard and painful, but I did it.
I was able to finish college and then eventually I went to social work school to get a master’s degree. I had to do an internship and I said I wanted to work in drug treatment.
They put me in a methadone program as an intern. I tried to do the work the way I thought it should be done, with dignity and respect. The staff said I was an enabler. They didn’t appreciate my method. None of the patients got better—not mine, or anybody else’s—because of the tough rules that every program has to follow. Then the AIDS epidemic hit.
HR: As a social work intern, you thought you were going to change the culture of the methadone clinic you joined in the Bronx, the Van Etten Drug Treatment Program?
ES: I thought I was going to change at least my caseload. My supervisor was a social worker, but she didn’t appreciate my methods at all. She thought I should treat people like criminals, and try to control them. I thought I could treat them like equals and not like criminals. So we didn’t get along very well.
But I was so good at knowing and understanding the issues, they couldn’t really get rid of me. Eventually the AIDS epidemic hit and my patients started dying, and the program was doing nothing about it. They weren’t teaching people prevention or anything, so me and another social worker, a real social worker named Louis Palacios, started to run harm reduction seminars teaching patients how to protect themselves.
We were called down by the director and told that we had no right to do that; only nurses can give lectures on health issues.
So we both left the program and became trainers at the Narcotic and Drug Research Institutes [now the National Development and Research Institutes]. We were the two AIDS trainers and we trained drug treatment staff, mostly from methadone programs, in how to do prevention work with their patients. I became a trainer and I was a trainer for the rest of my career.
“The whole drug treatment system, including therapeutic communities, were racist when I was involved.”
HR: You were an amazing trainer. I attended several of your training sessions.
ES: Louie taught me how to be a trainer because I didn’t know anything about it. We were the only two doing it, but later we were joined by three or four more. Louis was the director, but he got AIDS. He was a gay man. Then I became the director of that little program.
HR: When injection drug use was one of the main factors in HIV transmissions, why didn’t methadone clinics change their rules to make it easier to stay in treatment, to save lives?
ES: I don’t know why. They were just horrible people as far as I was concerned. They really didn’t care about the patients.
HR: For a long time, counselors in clinics came from therapeutic communities, like Synanon. These are people who believe that drug treatment is like boot camp and consists of confrontation and humiliation.
ES: Yes, and they believed in total, complete, immediate abstinence. The counselors were against methadone, they hated it. The whole drug treatment system, including therapeutic communities, were racist when I was involved with them. They believed that Black people were all drug addicts and criminals and they needed to be punished. There were white patients there too, but mostly they were Black and Hispanic.
The staff didn’t understand what people needed. There is a book by Erving Goffman about human emotions, and he talks about how shame is the most detrimental emotion. They shamed people.
In one methadone program I was in, the counselors actually watched people urinate in a cup in the bathroom. How humiliating is that? There’s something sexual about it, too. It’s traumatizing. I didn’t agree with it and I had to fight with them because I wouldn’t do it.
HR: Did you get kicked out of the clinic?
ES: Yes, they kicked me out. I got encouraged to leave all of them. I was humiliated and I didn’t have pride in myself. I knew that I was better than what they were making me out to be. I tried to behave that way. And they hated me for it. And years later, when I was a social worker and employed as a trainer, I met my old counselor from the first methadone program and she told me that she always felt I got a raw deal. She was afraid to say anything about it.
“Social workers have no business working in methadone programs. We have a Code of Ethics and we need to follow it.”
HR: I’m a social worker, too. I think it’s unethical for our profession to work in methadone clinics because we have a Code of Ethics that cannot exist in those spaces. Staff have total power over patients, and the clinic system forces us to constantly surveil and punish very vulnerable people.
ES: I agree with you. As I said many times, social workers have no business working in methadone programs or therapeutic communities. We have a Code of Ethics and we need to follow it.
HR: There has not been a visible, powerful movement of people who take methadone to fight for their rights.
ES: People who take methadone have no self-esteem. The people that I knew didn’t believe they had any rights. They believed they were all the negative things that the counselors said. I learned in my years of being a counselor that drug users were drug users for a reason. One federal study showed that over 80 percent of female drug injectors had been sexually assaulted as children. My patients told me stories of how they were mistreated by their families. They were made to feel as if they were nothing, and so they didn’t have the courage to stand up for themselves.
HR: You went to Britain and saw another way of delivering methadone. What were your impressions of that?
ES: My friend Peter McDermott took me to his program in Liverpool and it was completely different. First of all, everybody only came, I think, once or twice a week. And the dosage was determined by the patient with the counselor. There was no forced counseling.
One day when I was with Peter, a counselor came over to him and said, “Would you mind having a little time for me one day?” Peter used to be in the habit of drinking all his methadone on the day he got it. That’s the way he did it. And his counselor didn’t disapprove. People were treated with dignity and respect. I was just amazed by it. Just amazed.
“If they can’t stop using drugs, so what? People do what they need to do.”
HR: How does the methadone clinic system in the United States need to change?
ES: Well, I think it should become like a medical model, where you have a treatment person, a doctor, a nurse, a counselor, and you see them by appointment. The rules are changed completely so that people can choose their own dosage and don’t have to urinate in front of counselors.
If a person can’t get off of all drugs right away, that is understood, and they’re helped with the therapeutic issues that are driving their drug use. If they can’t stop using drugs, so what? People do what they need to do. And not being treated like a criminal, but like a patient. That’s what I think.
HR: Are you in favor of getting rid of the clinic system and having a health care provider write a prescription for methadone that is picked up in the pharmacy?
ES: Exactly. It’s just like any other drug.
Right now, I’m paralyzed. I have a tumor in my spine, which is pressing on my nerves. I have a morphine pump that was surgically implanted in my body and I get morphine 24 hours a day, seven days a week. Nobody thinks anything of it, and so I don’t think anything of it. I’m treated with respect. I see a doctor once every few months when he refills the pump. That’s the way they should do methadone.
HR: Is there anything positive about the methadone clinic system that you can point to?
ES: No, I don’t think so, except the methadone itself.
Top image by Helen Redmond