Abolish the methadone clinic system

There are many pathways to recovery from opioid addiction and misuse. One is the abstinence-only 12-step methodology;  another would be evidence-based SMART Recovery. The most medical of these pathways are the medication- assisted treatments using methadone, buprenorphine and the controversial naltrexone. But it has been established scientifically, by Case Western Reserve University, that the best of these three medical treatments is methadone. (tinyurl.com/3frtdxnz)

Much has been written about the necessity of methadone in addiction treatment, as can be seen in previous articles published in Workers World newspaper.  What has not been covered in the past, however, is the movement by methadone patients, loved ones, and some addiction researchers to liberate methadone from the grip of the methadone clinic system.

The clinic system serves as a system of social control for the capitalists seeking to maintain the status quo in order to both preserve profits and punish drug users and drug addicts for their perceived sins. The clinic system needs to be utterly destroyed if the drug epidemic is to be defeated.

The system punishes people who use methadone. It forces them into waking at early hours in the morning to receive methadone; forces them to line up indoors and outdoors leading to stigmatization of methadone users; and some patients are forced into observed consumption.

These issues lead to early dropout from methadone maintenance programs which can cause problems including overdose or HIV (human immunodeficiency virus) seroconversion.  People who drop out tend to return to using heroin, painkillers, fentanyl and other opioids.

Abolish the clinic system

There are many solutions to the question of what can be done to prevent methadone maintenance dropouts. All point back to the most basic: abolition of the methadone maintenance clinic system. Even the material cost of methadone – how much it costs to maintain a patient on methadone – would decrease if the system were abolished.

For a medication under capitalism, the cost of methadone is less than for many other medications. Most of the costs stem from the clinic system: transportation to the clinic, weekly doctors’ appointments, weekly, group therapy, and other in-person therapies.

This can be seen in cities like Philadelphia, where anti-drug user forces draw battle lines as to where they want or do not want facilities established for drug users to get help. It can especially be seen in rural areas, where the drug epidemic ravages in silence, and where it can take hours to get to a clinic on time, adding to the already inconvenient hours of when the methadone clinics are open.

Studies have shown that for patients in rural areas, pharmacy-based methadone distribution would serve those populations well. However, the government has responded by claiming methadone shouldn’t be made available through pharmacies just because some patients are not responding well to buprenorphine, which is available at pharmacies.

Challenging the status quo

Organizations dedicated to the liberation of methadone and the abolition of the clinic system have come together, as the opioid abuse epidemic rages and continues to worsen, to persuade the U.S. government into ending the system. These groups include the National Coalition to Liberate Methadone and the National Survivors’ Union (formerly called the Urban Survivors’ Union, a drug user union in the U.S.).

The National Coalition to Liberate Methadone has published several documents, challenging both the government and the American Association for the Treatment of Opioid Dependence – a lobby organization for the methadone clinic cartels that defends their poor public policy on methadone.

The Coalition challenged the lies that AATOD promotes in order to protect the clinic system. One lie they demolished is that if methadone clinics were abolished, it would lead to methadone being sold on the street with no control over it. The NCLM noted that the same policies that are maintained for other opioids would be maintained for methadone. That is just one, but perhaps the most important, of the lies debunked.

The National Survivors’ Union, with help from many methadone patients, created the Methadone Manifesto. This manifesto is a comprehensive document covering a multitude of methadone and methadone-related topics. It covers the traumas of being a drug user, and the trauma of losing friends and loved ones who die of overdose and HIV.

But most important is that it centers the humanity of methadone patients. It points out the unnecessary rules clinics place on clients, the rules that if broken either result in a reset of the patient’s methadone take-homes or in an entire removal from the methadone treatment program itself.

This is cruelty. A person who needs methadone cannot, or rather should not, go back to using street opioids because of the risk of overdose.

The most baffling of the rules in methadone treatment clinics are ones based on toxicology. If a person comes in on another opiate, or any other drug, they can get their take-home doses taken away. This is baffling because a relapse should be seen as a failure of treatment rather than a failure of the patient. They clearly need more than what the clinic is providing them and that clinic should double down in its efforts to help patients who relapse rather than punish them.

The Manifesto says that drug use is not “an inherently negative action” and the result of unstable methadone doses. This means the doctors need to do better, not the patient.

Methadone diversion failure

Methadone diversion, the boogeyman the AATOD uses to push against liberation of methadone, is actually an example of why the methadone clinic system is a failure for humanity while being a success for the capitalists.

People who use drugs know the horrors of withdrawal and dope sickness. People who can somehow get their hands on enough methadone to share it typically do so with people who truly need it. These are people in withdrawal or going into withdrawal and people who want to attempt to aim for a better, drug-free or drug-lesser lifestyle.

Those who share are doing what the methadone prescribers should be doing – providing users with the means to change their lives, even if that means staying on methadone for life. Diversion that aids people who need methadone is, in fact, a good thing in the face of a failed, anti-humane system.

Fortunately, some states – after the Drug Enforcement Administration removed its moratorium on mobile methadone maintenance vans due to the COVID-19 epidemic – are starting to put funding into methadone clinics fielding their own mobile units.

The New York state Office of Addiction Services and Supports funded a Mobile Medication Unit in New York City. Patients unable to go to clinics for whatever reason can get their medication from these mobile units. It’s less than the liberation organizations demanded, but it is a start.

The liberation groups, and even individual activists, are pushing for a freeing of methadone from the clinic system and we need to support their actions. Marxist-Leninists see the medical-industrial complex for what it is and must see the methadone cartels for what they are: a means of abusing the people. We must also remember the reactionary nature of the Richard Nixon administration which established these rules to begin with.

Even liberals see the Nixon era as ultimately a failure. We have to push everyone to the next logical step, to understand that his policies regarding drugs, including the methadone clinic systems, were also failures.