I recently moved from the United States to Sydney, Australia. Uprooting your entire life can always be stressful. But a big extra stressor for me was uncertainty around how I would access methadone, a medication I have used for over a decade.
Fortunately, I needn’t have worried so much. An Australian friend who is also on methadone helped me to make an appointment with her doctor in Sydney. Being able to make an appointment to see a doctor was a welcome change for me, before I’d even moved.
I’d spent years in the one-size-fits all US methadone system, where anyone who needs the medication for opioid substitution must navigate highly regulated opioid treatment programs. These clinics exercise carceral control over their clients’ lives, requiring many to attend daily and dose under intrusive supervision.
Isolating this treatment from the broader US health care system not only restricts access, but reinforces stigmatization, making it harder for people to seek the help they need.
Throughout my transition to accessing methadone through the Australian system, the contrasts have been stark and profound.
Getting methadone in the US was a daily exercise in punishment for me. Take-home doses, a symbol of stability and progress, are often withheld to keep clients tethered to daily visits. Clinic owners and operators often deflect to federal or state laws and regulations when challenged on the pervasive cruelty of this system. However, after many years as a client, it seems clear to me that financial motives drive their rules and policies.
Throughout my transition to accessing methadone through the Australian system, the contrasts have been stark and profound.
Australia, for example, provides several different options for people to access methadone—including the one I took, of consulting with a primary care physician who would write me a prescription.
After I arrived in Sydney, I attended my initial appointment with the GP. He requested a urine drug screen, explaining that this is a requirement for anyone when they are prescribed methadone for the first time.
But then he apologized—saying that this would be the last drug screen I would ever have to do with him. Requiring further drug screens, he added, could damage the trust that’s essential to the doctor-patient relationship, and prevent me from feeling comfortable discussing any needs I have regarding my drug use.
I felt a sense of shock. This approach was light years away from my experience at US clinics—where I was subjected to a urine drug screen every Thursday for the entire year of 2022, despite years of negatives. Like daily attendance, drug screens are a revenue stream for many US clinics, sidelining the genuine wellbeing of those seeking treatment and violating basic standards of informed consent.
The clinics gathered so much information about my own body over the years, yet there was no transparency. Unless test results could be used to impose shame, or to coerce information from me, no information was ever shared or communicated to me—even when it could have helped me improve my health. My safety and needs were never centered.
Conversely, almost right after that first GP visit in Sydney, I was provided additional take-home doses of medication, even before I had increased to a stable dosage. It’s an accommodation that would be unimaginable in the US clinic system, because you cannot charge money for someone who is not there.
Receiving my medication from a pharmacist who treats me like they would any other customer is an enjoyable experience.
In the US, my daily clinic visits—with the judgmental stares of staff, the atmosphere of suspicion and distrust, the surrendering of personal dignity during medication pickups, observed dosing and urine screens—were utterly dehumanizing.
On days when I had to meet with clinic staff more than usual, I would have to allow additional time in my schedule, to accommodate time I would spend crying in my car down the road from the clinic. Having strangers wield so much power and control over my life was frustrating and distressing. I felt trapped.
Now, I pick up my prescription for methadone at a community pharmacy. Receiving my medication from a pharmacist who treats me like they would any other customer is an enjoyable experience.
In the US, clinics strip away more human dignity by numbering clients, instead of using our names. In Australia, my pharmacist not only knows my name but also recognizes my partner when he joins me for pickups. It might sound like a small gesture, but to me, it’s not small. It makes me feel like a human being, instead of an object on an assembly line.
Making pharmacy pickups was a dramatic shift from being treated like a perpetual child and a criminal at US clinics. The weight of constant surveillance was lifted, allowing room for autonomy and dignity in the treatment process. Now, I am treated as a responsible adult, capable of making informed decisions about my own health.
An assumption inherent to the US system is that individuals seeking methadone are incapable of responsible decision-making. This assumption fosters a damaging culture of stigma and control. And it just makes no sense: People who seek methadone treatment have made a deliberate choice to improve their lives, their stability and their safety—about the most responsible piece of decision-making imaginable.
There’s little else to say about my Australian methadone experience, because it’s so much simpler, as well as better, than the US system.
I now have a personalized, trusting relationship with my GP that would be impossible with US clinic staff. And the convenience of dropping in at a local pharmacy has eliminated my past need for daily trekking, granting me a sense of autonomy and respect that I was never previously afforded.
It is important to recognize the diversity of experiences among people accessing methadone in Australia. While my overwhelmingly positive story here in Sydney is a testament to the strides being made, it’s essential to acknowledge that this may not be universal.
Different states, doctors and pharmacies may contribute to varied experiences within the Australian system. It’s not my intention to generalize my own experience, and I want to be respectful of people on methadone in different Australian contexts.
Yet by offering multiple options to access methadone for opioid substitution, Australia at least accepts the diversity in needs and preferences of people who utilize this life-saving resource.
That’s a giant step forward compared to the US. And it fosters—at least some of the time, and certainly in my case—compassion, support and, ultimately, empowerment.
Methadone without clinics is not just possible; it’s already the norm, successfully so, in other countries.
What I won’t do is forget the many people I left behind, still forced to contend with US clinics. My hope is that the urgent need to break the clinics’ cartel-like control of this vital medication becomes more widely evident, as we contrast a punitive system with something so much better.
The jarring disparities between US and Australian methadone landscapes emphasize the need to replace the US clinic system with one that prioritizes the wellbeing, dignity, agency and liberation of people on methadone.
Methadone without clinics is not just possible; it’s already the norm, successfully so, in other countries. Australia may not be perfect, but it demonstrates that a system can exist where compassion and understanding guide our responses to individuals who need treatment and support.
Methadone clinics must be replaced. But this isn’t just about policy change; it’s a plea for a shift in ethos—to replace a culture of cruelty with one of care and respect.
Photograph by Michelle Ress via Flickr/Creative Commons 2.0
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