Methadone patients face many harsh restrictions. Among them, clinics frequently test for and punish cannabis use, including by withdrawing services—even when cannabis is legally prescribed, and despite this not being required by federal guidelines. This is not universal, however. One methadone clinic in deep-red Indiana, for example, is continuing to serve patients who use cannabis, albeit with some limitations.
Tammera Mercer of Greenwood, Indiana reached out to Filter to describe her experience as a patient at the New Vista Outpatient Recovery Center, about 20 minutes outside Indianapolis. New Vista offers services for people with opioid use disorder including methadone, case management and psychological therapy.
Cannabis remains illegal for medical or recreational use in Indiana. But this clinic, unlike most in the state, allows patients who test positive for cannabis to continue receiving services without fear of discharge.
That’s not to say there are no adverse consequences. The clinic requires patients who test positive to attend a monthly marijuana process group; more significantly, it also requires them to take their methadone dose in-house, with no take-home option.
The coronavirus emergency is currently impacting everything. Providers in Indiana have taken new measures to protect patients and staff, and programs are now offering lockboxes containing opioid medications and the overdose antidote naloxone for take-home use—even for patients who are generally denied this. This followed March 16 guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA) that all states with declared states of emergency could request “blanket exceptions” to provide “stable” methadone patients with up to 28 days’ take-home supply, and “less stable” patients with a supply for up to 14 days.
Many advocates would point out that there should never be sanctions for cannabis use, and that take-home methadone doses—in normal circumstances as well as national emergencies—are vital to patients’ ability to get on with their lives. Yet as Mercer described it, New Vista’s approach is far better than the alternatives that were available to her.
“They had weaponized the methadone and were now using it to force me to quit marijuana.”
Mercer told Filter that she became dependent on opioids that she was legally prescribed for pain when she previously lived in Oregon. She lived there during the state’s successful marijuana legalization campaign; once legalization was enacted in 2014, she was able to visit dispensaries and find out for herself about marijuana’s therapeutic value.
Mercer’s doctor was then criminally indicted and her opioid supply cut off—part of a wider crackdown on opioid prescribing that has harmed pain patients. She needed to find methadone, fast. But like many people in rural areas, she didn’t live anywhere near a provider. The nearest clinic in Oregon was three hours away. She felt that she had a clear choice: Use heroin instead, or move back to Indiana for treatment.
She moved. But her initial providers in Indiana harassed her for her cannabis use. “I went to the biggest clinic here in town, which serves over a thousand clients and is run by Indianapolis Treatment Center,” she said. “After six months of being threatened over my marijuana use, I was afraid I was going to lose my treatment. They had weaponized the methadone and were now using it to force me to quit using marijuana.”
Mercer had no desire to quit cannabis. She found that it helped manage her pain and other medical conditions, as well as improving her appetite and sleep. “When I used the pot, I still felt sick,” she said. “But it somehow became tolerable. I could think and I began to see hope, even in the midst of the worst health crisis of my life.”
In 2018 the New Vista clinic opened in Greenwood, and to Mercer’s amazement, it took a different stance on marijuana use. She said that staff explain to patients that marijuana is illegal under state law and discourage patients from using before they visit the clinic. But her providers don’t shame or judge her for marijuana use.
“The counselor facilitating the marijuana user group is clearly supportive,” Mercer said. “He explains they don’t want people to leave treatment, possibly relapse and overdose all because they chose to use marijuana. The clinic has not ‘lost’ anyone yet—meaning no one has overdosed and died while in treatment at this clinic.”
Mercer reports that the clinic’s patient population has tripled to over 800 since she joined, with many people transferring from other clinics and some coming from as far as Ohio. Its marijuana policy is partly to thank, she believes.
Yet patients like her still face a general prohibition on take-home methadone, which Mercer puts down to the clinic’s fear of potentially losing its license.
“In methadone treatment, earning the take-home meds is a milestone in recovery,” she said. “It’s held up as proof that the client is very successful in treatment. So to be denied that based on nothing more than pot use makes me feel that my recovery is somehow not as legitimate as that of others.”
She has been getting up at 5 am every morning to visit the clinic for her dose. Despite the inconvenience, she reports that she’s more stable than ever before in her recovery. She stays on a low methadone dose to help make future detoxification process easier. Cannabis helps her manage her anxiety and depression so she can participate in group therapy sessions and work on her own issues.
“I am not going to say that pot has taken away my depression,” she said. “It doesn’t work like that. But because I am allowed to continue marijuana and not worry about losing my treatment, I could get into the skills-building work that lets me see that the ability to get better is within me.”
“It truly is remarkable that this position taken by the clinic seems to be enduring and meaningful,” she concluded. “Recovery is … fluid, and it’s a process that requires engagement over our lifetime. Marijuana helps us in that process.”
Those methadone clinics with relatively compassionate policies should serve as examples to the others that punishments for marijuana use are unnecessary as well as damaging. One side effect of the COVID-19 emergency might be a similar demonstration that denying patients take-homes in normal circumstances does more harm than good.