I lost my leg in a car accident when I was 15. A little while after, I started having pain from nerve damage. I was prescribed oxycodone. Very quickly, and unlike the large majority of people prescribed opioids, I became addicted, using oxy to treat my mental as well as physical pain.
I was going through my prescriptions too fast. Then I was introduced to heroin, and fell in love.
Fast forward some years, to 2012. I had pushed my family and friends away to the brink of no return, and I went to detox. I was scared of the pain, of both kinds, that I would experience without the comfort of a needle and drugs.
But they gave me methadone for withdrawal, and right away, I wasn’t in nearly as much pain. Actually, I was more pain-free then I had been since losing my leg.
After eight days, I left detox and returned home. I was scared again. This time, it was for the embarrassment and shame I would feel for what I’d put my family through; I was also afraid of what kind of life lay ahead.
I went to my doctor, and we had a conversation because I was back in a great deal of pain and wanting to use.
I told the doctor about methadone and how well it worked for me, and he said he was comfortable prescribing it as pain management and a deterrence to using heroin.
I began what at last felt like a normal life. Eight years passed. Then, one day in 2020, I found out my doctor was retiring.
It was the pain management aspect that allowed him to prescribe it to me directly; methadone rules in the United States forbid this if it’s being prescribed for opioid use disorder.
I began what at last felt like a normal life, taking my methadone and not using illicit drugs. Eight years passed.
Then, one day in 2020, I found out my doctor was retiring.
He told me that nothing would change with my medication. But restrictions and crackdowns during the overdose crisis have left doctors scared to prescribe opioids. I would soon learn just how scared.
The first time I saw my new doctor, he told me straight out that he wasn’t comfortable prescribing me methadone. He suggested that I go to a methadone clinic instead.
I had heard of these of course, but had never been to one. So I did some research, and found one 15 miles away. I called and did an intake interview.
I was told I could dose. And that I was going to start at 30 mg. Yeah, 30mg! One quarter of the dose I’d been on long-term.
I gave them a brief version of my medical history and told them that I was on 120 mg of methadone, and had been for over eight years. I was assured I would be well taken care of.
I attended my first appointment. Having run out of methadone by that point, I was sicker than I had been in a long time—and wanting to go back to old habits. I pushed those thoughts aside, sucked it up and waited my turn.
After an exam, I was told I could dose. And that I was going to start at 30 mg. Yeah, 30mg! One quarter of the dose I’d been on long-term.
At the dosing window, I was told that after two to three days, they would do a dose review and see where I was at.
The clinic was closed on Sundays, they said, so all patients got one take-home per week. We had to attend in person on the other six days.
I dose, go home and I am still sick. I’m in severe pain, literally wanting to die.
I went back to the clinic the next day, which was a Saturday, and asked about my dose review. I told them I was very sick and wanted to use. But they said it had to be a minimum of 48 hours before the dose review. So I suffered through it.
By Monday, I was up at 3 am, counting the milliseconds until 5:30 when the clinic opened. I took hot showers every 30 minutes, to try to get some relief. Finally, I drove to the clinic.
My review took place, and they told me they would up my dose—by 10 mg. I got just a little relief.
This sequence repeated itself for some time, through multiple further dose reviews, until finally I got to a dose I was ok with.
The clinic hours put my ability to keep my job on a knife-edge. I have to start work 30 minutes after the clinic opens. It’s a 20-mile drive.
Meanwhile, I had to drive to the clinic six days a week, for three months, during the height of COVID, until they had urine-tested me enough to have three “clean” results. Then I was permitted to get two take-homes. This cycle goes on and on.
I got a job offer more recently. But the clinic hours put my ability to keep that job on a knife-edge. I have to start work 30 minutes after the clinic opens. It’s a 20-mile drive from the clinic to work. So as long as I’m waiting at the clinic beforehand and there’s no delay, I can make it, with no room for error.
The clinic’s missed dose policy, which removes your take-home “privileges,” can really set you back. If I lived further away or didn’t have a car, I’d be in a much worse situation.
It’s bad enough as it is. At the clinic, counseling is mandatory. One of the first things I was told in rehab years ago is that you can’t force counseling on anyone: You have to want it, otherwise it doesn’t work.
At the clinic, every patient is a number. You type a number in a computer to check in, and when you’re at the window they ask your clinic number, date of birth and dosage. I’m not sure if they even know my name; they never use it. But facing the threat of being dope sick, you stand up and salute them: “Yes sir,” or “Yes ma’am.”
I keep returning to this thought: Not so long ago, I was going to my doctor once a month for a prescription and picking it up at a pharmacy. It worked just fine.
Have I seen evidence of SAMHSA’s “relaxed” methadone rules in my clinic? Not so much.
It took me four years to get to 13 take-homes per month, and I am told how lucky I am. I guess luck is a perception thing; these days, I don’t feel lucky. I’m just hoping maybe one day I won’t have to panic about the time when I go to work.
When I evaluate my life, and how it’s now dominated by driving back and forth to the clinic and the way they treat me there, I keep returning to this thought: Not so long ago, I was going to my doctor once a month for a prescription and picking it up at a pharmacy. It worked just fine.
One day, I’m hoping that we can get some change and be treated with more dignity.
Photograph by Helen Redmond
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