The speeches at the press conference in Harlem were a distillation of stigmatizing ideas about methadone, clinics and patients that have existed since clinics opened in the 1970s.
Communities engaged in NIMBY protests against opioid treatment programs (OTP) from New York to North Dakota have a tried-and-true template: They are a threat to children and families, increase crime, attract drug dealers and decrease quality of life. And always, This isn’t the right location for an OTP; somewhere else is. Except there is no somewhere else. No neighborhood welcomes a methadone clinic, and nothing unites a community faster than when one tries to open its doors.
I met Fab 5 Freddy, the host of Yo! MTV Raps, hip-hop pioneer, artist and filmmaker, at the press conference a few blocks from where I live in Harlem. He wore a black T-shirt that said “Harlem American” and a broad-brimmed pork pie hat. It was a sunny day in August 2018. A Who’s Who group of local politicians, wearing crisp light blue and brown suits and ties, stood behind a podium. About 20 members of the neighborhood were arranged behind them on the sidewalk. The local media set up video cameras on tripods and clipped microphones to the podium. Everyone was assembled to celebrate that they had stopped a methadone clinic from opening in a historic brownstone.
A woman representing the Sugar Hill Concerned Neighbors Group described how they mobilized a hundred people within two days to attend a meeting with Argus, the corporation that planned to open the clinic and had paid $4.3 million for the property. She asked, “Who would want to live next to a methadone clinic?”
“We’re not anti the people who need these services. Just not here.”
Another speaker explained that Sugar Hill was a family community of brownstones and therefore it was the wrong location for a clinic. Speakers were mindful to say they cared about people struggling with an addiction and that it wasn’t “pushing back at the lesser of us.”
Al Taylor (D), a reverend and state assembly member who represents Harlem said, “We’re not anti the people who need these services. Just not here.”
Adriano Espaillat (D), a United States representative whose congressional district includes Harlem, asserted, “This isn’t a not-in-my-backyard thing. We need to have empathy.” He added that the neighborhood wanted to keep its quality of life and that Argus should look for another location. Espaillat suggested the Upper East Side of Manhattan.
Then he smiled and called everyone involved in the fight the “Sugar Hill Gang.” The crowd broke into laughter.
Several speakers asserted Harlem was oversaturated with methadone clinics, and thousands of people were commuting in from other boroughs. It wasn’t fair, they said. The press conference ended with another elected official commending everyone and cautioning, “We must stay united. One finger you do nothing. With a fist, you can win. We won!”
After the press conference, I approached Fab 5 Freddy. I wanted to ask him why he opposed the methadone clinic, and he agreed to an interview. In front of the Kingdom Hall Of Jehovah’s Witnesses, Fab explained that for 20 years he has lived in a brownstone about a block from where Argus wanted to open the OTP. Over that time, he saw the neighborhood change for the better.
I assured him that no one wanted to travel to a clinic in Harlem six days a week … The solution was to let all patients pick up a prescription at a pharmacy in their neighborhood.
He said that Sugar Hill was damaged by open drug dealing and drug use for decades: “The neighborhood has gone through a lot of trauma, and we don’t want to see something that could take us back there.” He was not a fan of methadone and said, “I’m not a doctor, but I don’t think methadone is the best treatment. It keeps them caught up in an addictive state.”
During the conversation, Fab was easily convinced that methadone was a lifesaving maintenance medication and that the problem was the clinic system. I assured him that no one wanted to travel to a clinic in Harlem six days a week and stand in a line to get dosed. The solution was to shut down OTP and let all patients pick up a prescription once a month at a pharmacy in their neighborhood. It was a light-bulb moment for Fab.
NIMBY movements use a number of strategies and tactics to keep clinics out. One of Dr. Beny Primm’s greatest frustrations was the community opposition he encountered whenever he tried to open an OTP in Harlem or Brooklyn in the 1970s and ‘80s.
Primm, the late pioneer in addiction medicine, HIV research and public health advocacy, said, “It seemed that there were people who would use any means to block us … We found a building at 145th Street and Eighth Avenue and began renovations for a clinic. The building was set on fire. We brought guard dogs to the location and they killed the dogs.” Primm suspected that a drug-free organization in Harlem was responsible. The clinic never opened.
A Lynnwood council member said during a 2023 hearing, “We can’t sacrifice the safety of our children.”
Residents from the city of Lynnwood in Washington State launched a fight against Acadia Healthcare, the largest methadone provider in the state, to block a clinic from opening in 2023. They were angry that it was near the Boys & Girls Club building. They formed a group called Safe Lynnwood and organized a protest march to the site where the OTP would open.
At a city council meeting, an older woman told a representative from Acadia that he should be ashamed to open a clinic near the Boys & Girls Club. A city council member said during a hearing, “We can’t sacrifice the safety of our children.” Another official added, “If a single child is injured as a result, what is the price for that single child being injured due to the location of this facility?”
The obsessive focus on “the children” and the perceived harm that a clinic could cause has no basis in reality. There is no evidence that OTPs make a neighborhood unsafe for children. Are the people who promote these hateful ideas aware that thousands of methadone patients are parents?
As is common when an OTP wants to open a clinic, Arcadia submitted a written response to address community safety concerns and to explain how a clinic operates. They clarified it would only be open six hours a day, about 140 patients per day would be medicated, and all dosing would be completed by 11:30 am. Arcadia assured the community that patients receive counseling.
To assuage community fears, methadone clinics promise to police and punish patients.
For security, the OTP would employ guards during and after operating hours to deter loitering at the facility or surrounding areas. Patients would be told loitering would not be tolerated and any illegal activity would be immediately reported to the police.
To assuage community fears, methadone clinics promise to police and punish patients. They hype that security guards and video cameras will surveil them constantly inside and outside the clinic. They’ll only provide narrow windows of time when people can get medicated to assure the community that those people will only be in the area for a short time. If caught lingering, patients will be penalized.
These carceral concessions to NIMBY groups further criminalize patients, reinforce discrimination and create hardships. For decades, patients have complained about the limited hours OTPs are open, which contributes to missing doses, being late for work or school, and not being able to take care of life responsibilities.
Clinic owners focus on reducing and penalizing “loitering” because they believe that it triggers community complaints, so they want patients to get medicated and get out—dose and dash! It’s an iteration of the sundown town.
The Family Guidance Center OTP in Chicago has a sign on the entrance door that threatens: “If you are seen loitering or lingering around the building or the surrounding area, you will immediately be placed on involuntary withdrawal.” The clinic is in a Black neighborhood that has gentrified and it’s a few blocks from Magnificent Mile, a luxury shopping district on Michigan Avenue.
This article is excerpted with permission from Liquid Handcuffs: Policing and Punishment in Methadone Clinics and the Future of Opioid Addiction Treatment—the new book by Helen Redmond, published by North Atlantic Books. The book is available in paperback and ebook formats as of March 3.
A panel event to launch the book will be held in New York City on March 5. Tickets are free but can be reserved here.
Top photograph (cropped) by Jaime Fearer via Flickr/Creative Commons 2.0
Image of book cover courtesy of North Atlantic Books