I Chose Fentanyl Over the Humiliation of Methadone Treatment

    I already knew that my methadone clinic didn’t give a fuck about me or my fellow patients—that much was clear from Day One. But early on a wet winter morning in December 2021, I truly felt the consequences of their active resentment.

    It was a Sunday, so dosing hours were very short and ridiculously early—from 5:30 to 8 am, and God help you if you were a minute late. I wearily drove my Ford Focus down the Lexington, Kentucky, highway, willing it to heat up faster, shivering from the near-freezing temperatures.

    On the weekends I usually tried to beat the morning rush by arriving as early as possible, aiming to pop in and out in minutes; I hated spending any longer at that place than I had to.

    But today I wasn’t destined for the dosing express lane. As I pulled into the parking lot a little after 6 am, I recoiled at the sight of a long line of people—snaking out the clinic’s double doors, down the sidewalk, through the parking lot, and around the building.

    We were all getting soaked, with hailstones bouncing off our heads. I walked to the end of the line, which had now settled around the dumpsters.

    Most of the patients at this particular clinic were older, many of them veterans of the Oxycontin golden days, when there were real pills aplenty and a safe-ish supply wasn’t a thing of the past. Some folks had been on methadone for years, funneled from pain management clinics or general practitioners afraid of prosecution.

    I was in the younger minority. Many of my peers had never taken methadone at all. Some had the relative privilege of buprenorphine access and could take their meds at home to recover or suffer in private—either way, on their terms.

    This clinic, part of a sprawling, machine-like national chain, was one of only two in Fayette County, though we were near an epicenter of overdoses and infectious disease outbreaks related to injection drug use.

    I maneuvered my car around the patients spilled into the street and pulled into a space from one of the few cars leaving. The line of people was turning into something more like a crowd—the irritation palpable, if dampened by the weather and the early hour.

    This morning we were all getting soaked, with hailstones bouncing off our heads and sweaters. Few of us were prepared to be outside, so we were underdressed and shivering. I walked up to the end of the line, which had now settled around the dumpsters.

    “What the hell is going on?” I asked the other patients.

    “Computer’s down,” someone offered, and whether this was true or not, I passed it down to the next person like a game of telephone.

    “This is fucking ridiculous,” yelled a guy in a construction cap. “I’m going to get fired if I’m late to work because of y’all again!”

    The atmosphere in the Sunday morning dosing line was rarely one of celebration, and waits of 45 minutes or more were not uncommon. On weekends the clinic was minimally staffed, usually with a receptionist and one dosing nurse, though sometimes just the dosing nurse.

    But this was a new low. We all stood around like wet dogs, barely moving forward. As people got colder and wetter and the wind howled louder, we were getting fired up.

    “I don’t see how they can treat us like this, make us stand out here like animals in the freezing rain,” said a woman in a leg brace a few feet in front of me.

    “This is fucking ridiculous,” yelled a guy in a construction cap closer to the door. “I’m going to get fired if I’m late to work because of y’all again!”

    Unfortunately he was yelling into the void. There was nobody to hear our concerns. And that was normal. When you wear the “liquid handcuffs,” you might as well be locked up in county jail, because everyone will treat you as if you’re a prisoner anyway.

    Even with COVID-19 exemptions that loosened federal guidelines on methadone take-homes, it was still damn hard to find any independence on the shit. Any use of another substance meant that you had to dose at the clinic in the morning, every morning. It didn’t matter if you stopped shooting fentanyl, substituting with Kentucky bourbon at night; the only way you were ever getting your mornings back was if you stopped using everything completely and perfectly for about a year.

    And even then, you were subject to the whim of your counselor or clinic staff, who could revoke your dosing privileges at any time for pretty much any reason.

    It’s what they thought we deserved, I guess.

    Clinics, let’s not forget, rely on an endless stream of patients with Medicaid cards that pay for each visit. With bare-bones, underpaid staff and little overhead, they become money-printing machines.

    That’s why we were all standing in the freezing rain for hours just to finally reach the lobby doors and wait shoulder-to-shoulder for hours more—in the midst of a global pandemic.

    It’s what they thought we deserved, I guess. For trying to numb our pain. For trying to live and breathe and work in a disturbed world that cares little about the personal traumas we carry with us on mornings like this to clinics like this.

    Instead of spiraling out on sex, or food, or social media, or the pursuit of wealth, me and everyone else in this line had looked to chemical relief to cope emotionally or address physical pain. When that finally stopped working—or we were forced into treatment—we looked to this clinic for a legal fix with a safe supply. And this is where it landed us: soaked and hopeless as we waited for our next fix, punished (again) by society.

    I rarely got a chance to interact with my fellow patients with anything closer than a passing greeting, but we were certainly getting to know each other better today. We continued to inch along, the queue advancing maybe one patient every 10 minutes.

    As I neared the lobby, angry patients were banging on the glass doors and walls, or shoving and squeezing to get cover from the winter storm. When I finally got under the awning near the front entrance, my ETA for a 100 mg dose was likely another two hours and counting.

    Rather than hand over my last drop of dignity to the clinic, I went to go get some dope that day.

    The situation evaporated any justification I made to myself about the sunk cost in time and suffering. That’s when I finally succumbed to the agitation: “Fuck this shit, I’m leaving.”

    I squeezed through the folks behind me and walked back into the frigid winter air. What a lovely day, full of holiday cheer. Rather than hand over my last drop of dignity to the clinic, I went to go get some dope that day.

    After four months of daily dosing, it wasn’t working for me anyway. It’s possible the dose wasn’t high enough, or perhaps I just needed something else. So I continued using fentanyl.

    I’m one of the lucky few to have access to a dealer with a sort-of safe supply. Of course I don’t have my own mass spectrometer, so the exact composition is still a mystery, but their sizable operation helps keep their shit the same from one day to the next. Thankfully I’ve managed to minimize the ever-present risks of street supply, and now have several years free of overdose.

    For many people, methadone itself works. If it weren’t for the insulting and arbitrary rules, it might have helped me. Methadone cuts mortality related to opioid use by about 50 percent. But the methadone system in the United States—restricted to clinics and dispensed under draconian regulations—is an utter failure.

    My experiences on that day, and others, have been shared by countless thousands of people since the Food and Drug Administration approved methadone as the first pharmacological treatment for opioid addiction in 1972. People leave treatment because of the lack of support and indecipherable, senseless rules. It gives methadone a bad reputation in drug-user communities, and many people avoid clinics in the first place. With nearly one million dead from the US overdose crisis, we cannot afford to continue making the same mistakes.

    Today at least 1.3 million people worldwide receive methadone treatment. But stigma, NIMBYism, and outright vitriol toward methadone patients persist. So almost nobody cares if we are chained to the clinic every day of our lives, subject to more stringent supervision than most folks on felony probation. A patient who has been compliant with methadone treatment for decades is still often maligned and viewed with disdain by others in the health care field and society at large.

    And can you ever get to visit a methadone clinic to begin with? In rural areas or small cities, access is limited to one or two clinics, if any. Many patients at my clinic commuted an hour both ways for dosing—carpooling, or waiting for the irregular bus from our underfunded public transportation system.

    What happens to the patient who is kicked out of the only clinic in their area? This often occurs because of a patient “violation”—a false positive on a cheap and unreliable urine drug screen, for example—and can result in a patient being forced to quickly taper their dose, the medicine that is ostensibly saving their life abruptly discontinued with no warning.

    Naturally, the high expectations of us are not reciprocated. Methadone clinics have little accountability to patients and often do the bare minimum of service provision. They are commonly understaffed by underpaid workers with a high turnover rate. Even in cases of clear wrongdoing, clinics are rarely held accountable because few people care about the rights of people who use or used drugs.

    At least the fentanyl never forced me to stand in the freezing rain for two hours. I’ve been considering treatment options again; one place I won’t consider is the methadone clinic.

    Always a glutton for punishment, I didn’t immediately leave the clinic after that particularly bad day. The next morning I returned to a slightly faster line and a frazzled staff. And so on, for another month or so, until I finally couldn’t bear it any longer.

    At least the fentanyl I was shooting never forced me to stand in the freezing rain for two hours.  At least it was always there for me. At least it made my painful memories less violent, less colorful.

    Now that I’ve been thinking of cutting the drugs back a bit, I’ve been considering treatment options again. One place I won’t consider is the methadone clinic.

    By the way, the reason for the clinic’s computer systems being down that day? We did not learn until much later that Behavioral Health Group lost the personally identifying information of 197,507 patients to a cyberattack.

    Eighty clinics, one of which was mine, lost IT services for an entire week. The hackers gained highly personal information including our social security numbers, IDs, addresses, payment information and medical histories. The staff at my clinic “forgot” to inform us that the breach resulted in this theft. We would not learn the extent of it for nearly eight months, when BHG finally sent out—to some patients—a piece of carefully worded snail mail.

    To this day, I have never received notice of the data breach, and Behavioral Health Group is now the subject of a class action lawsuit



    Photograph via PickPik

    • Ethan is a militant harm reductionist and part of the non-binary, queer, HIV-positive, drug-user and recovery communities. A self-employed graphic designer, their experience includes nonprofit management, fundraising, grantwriting and recovery peer support. Ethan lives in Lexington, Kentucky, with their two adored cats.

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