One of the most intriguing emails I have ever received hit my inbox in 2021. This, in part, is how it went:
Hi Helen. My name is Janet Urdahl and I am also an LCSW, CADC. I am a native New Yorker but relocated. My current position is as an executive director of a methadone clinic. This is my first experience working inside a methadone clinic although I have been in the field for 40 years.
I recently came across your article in Filter regarding the loosening of methadone take-home dose regulations and I support what you are saying 100%. I am about to do some advocating for these patients and would appreciate some pointers on what has already been learned or what I perceive as the exploitation of methadone clients related to the ridiculous rules and regulations around them receiving life-or-death medication. To me, the only ones who benefit from these rules are the folks who own the clinics.
I would enjoy speaking to you directly to at least get connected to some resources to help on this journey I am beginning.
What? The executive director of a methadone clinic agrees with me?
She and I began to talk regularly about what she observed in the opioid treatment program (OTP). For me, it was a window into a hidden world.
I finally met Urdahl when my co-filmmaker Marilena Marchetti and I interviewed her at a hotel in New York City. Turns out, Urdahl’s journey of running an OTP was so horrifyingly stressful, so antithetical to her social work values, that she resigned within six months.
She was hired by the clinic owner, she told us, to clean up the mess left by three previous directors; the last one was taken out in handcuffs. The OTP was out of compliance with numerous state and federal regulations and risked losing its license.
Right away, Urdahl had to confront the culture of cruelty that pervades methadone clinics. She insisted that all staff treat clients with dignity and respect. She ended Saturday dosing so patients could get take-homes instead of attending on weekends. The clinic lost $16,000 a month.
That’s when the trouble started.
“I hate coming here. I hate talking to my counselor, but if I don’t come she’ll call my probation officer,” one person told her.
Against staff opposition, Urdahl opened the clinic at 4 am to learn from patients about their experiences, bringing coffee and donuts. “That first hour before the pumps got open, I sat and chatted with everyone.”
She soon found out that patients were afraid of the nurses and counselors because of the power and control they wielded. “I hate coming here. I hate talking to my counselor, but if I don’t come she’ll call my probation officer,” one person told her.
Appalled by the massive power imbalance, Urdahl rapidly came to understand, as she put it, that “you can cite a client for almost anything and cut back on their methadone or take it away.”
She then learned that counselors had told patients they were not allowed to speak with her.
Urdahl is a trained therapist, so she saw the professionalism of counseling staff as a priority. She told us how she discovered that over half of them had no relevant counseling experience, training or education.
“I don’t know why they hired me,” one counselor with a resume showing zero experience of providing therapy told Urdahl.
She also found out that counselors regularly contacted probation officers and child welfare authorities if a client was late for an appointment—even just 10 minutes.
As Urdahl explained, nurses have the most power in an OTP, because without them “running the pumps,” there is no clinic.
Urdahl witnessed nurses yelling at patients and threatening to take away their methadone. One nurse refused to give a patient medication and ordered, “Go sit in the hallway.”
“I was afraid about what was happening in the clinic and I didn’t want to make any decisions where the clients would have to pay the price.”
She couldn’t believe the level of hostility the nurses openly displayed toward patients. Punishment and humiliation had become normalized. Urdahl wouldn’t allow this toxic environment to continue under her leadership, so a power struggle ensued. Then the nurses started to quit.
Urdahl resigned. “I couldn’t do it anymore,” she said. “I had to leave and a lot of it had to do with the nurses … I was afraid about what was happening in the clinic and I didn’t want to make any decisions where the clients would have to pay the price.”
You can watch parts of our interview in the video above.
I learned three important lessons from Urdahl’s dystopian experience. It’s all about the profits, not people’s health and wellbeing. Her empathy and social work ethics, grounded in self-determination and the inherent dignity and worth of every person, were no match for a deeply embedded culture of cruelty. And it’s not possible to reform this sick system.
The only solution is clinic abolition.