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Why Do We Have Methadone Clinics?

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Alen J. Salerian, MD

         The question, "Why do we have methadone clinics?", has been tormenting me ever since mid July. That's when a patient of mine committed suicide after his discharge from a methadone clinic.

         Joe had many issues, among them depression and addiction. He had done well with a cocktail of medications and talk therapy until April 5, 2012, when unusual occurrences did interrupt his treatment. The last time we spoke by phone Joe's voice was cracking. My counsel was for him to enroll in a local methadone clinic. He was unnerved by my suggestion. A few months later I would hear that he killed himself after being discharged from the clinic. There are some other details, but they are not essential. What matters is that the end was tragic.

         Joe's suicide was predictable, well-defined by the largest epidemiological study ever conducted on substance abuse and psychiatric disorders. In this groundbreaking 2004 study, Dr. Bridget Grant and her colleagues had a blunt warning for all mental-health experts treating people with addiction and psychiatric problems: not treating addicts on the assumption that their troubles are because of substance abuse can be fatal, as observed by many suicides of former drug addicts.

         As shown by Dr. Grant's ground-breaking study, it is impossible to be a drug addict unless one suffers from a psychiatric condition. Oddly, we still have thousands of methadone clinics offering treatment to addicts as if being an addict is only about one thing and that is drugs and avoiding them. Another message is subtle and obvious: "You are less than the rest of us; you are a second-class citizen." It is not that the methadone clinics are some government-run, community-based efforts, less than perfect because of bureaucracy, but rather they are all private for-profit institutions that seem to benefit from the weaknesses of a large number of people with problems of addiction. The rules of treatment are straightforward: attend classes 365 times a year, be on time, and be patient; do not complain, wait for turn, take your pill, walk away and when asked do not protest and give urines for you're not a man or a woman to be trusted; you are an addict after all and you have no right. You are something less than good.

         If this is an exaggeration, why then do we make people attend clinics every day, 365 days a year, and deprive them of their freedom to travel? Why do they have to wait for their medications? What is unsafe about methadone? The truth is methadone is one of the safest and nonabusable medications. Yes, methadone is not abusable, but patients who take them are. If a diabetic can go to a pharmacy and obtain needles and insulin and is not forced to go to a clinic every day, why then do we make a patient with addiction endure humiliation and indignity to receive care?

         Science says there is nothing rational about methadone being delivered on a daily basis. It may also be true that our ancient laws continue to promote prejudice against our second-class citizens. We may claim that neuroscience has advanced a lot and we are much more compassionate toward the mentally ill, but for sure this is not true when it comes to people with addictive disorders. It is also true that the people we call addicts and the treatment package they receive has a lot to do with what possibly led to Joe's death. Joe died because he could neither afford the daily 30-dollar payment to attend the clinic nor had the time to spare to work and pursue higher education at the same time.

         It is time for us to change our laws and stop punishing people with addiction as a subclass. The time is now and the responsibility is on the shoulder of doctors who run those clinics to say, we don't think our patients need to come every day; there are better ways to practice medicine; there are better laws to protect society against dangers beside treating some of us as second-class citizens.

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Alen J. Salerian, MD is a Washington, DC based physician, author, and historian who has been practicing psychiatry and psychopharmacology for 35 years. He is the former chief psychiatrist of the FBI's mobile psychiatric unit. He has authored (more...)
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