citybeat (2006-10)

Looking inside one local methadone clinic

Wednesday, March 1

Trading Addictions

For such a dull and early winter morning, there’s a lot of activity bustling around a nondescript office building near Mechanicsville. No one stays too long: Cars drift through the parking lot as people stream in and out of the facility. It’s business as usual at the Bernard Avenue office of DRD Knoxville Medical Clinic. DRD, short for Drug Research & Development, is Knoxville’s methadone clinic. And business is booming. 

A quick glance at the cars in the lot offers a demographic clue as to who comes here, day after weary day. A haggard young woman weeps in a rusty, ’80s economy car as an Acura driven by a sharply-dressed young businessman-type pulls up into the adjacent space. Under the united colors of opiate addiction, diversity is in full effect.

The atmosphere inside DRD is cool, efficient and clinical. Patients line up quietly, do their business and vacate the premises. The daily transactions are handled tersely, with little conversation. A security guard stands watch at the front of the building. At the door, there is a sign that says something to the effect of, “No loitering. Sign in, get your dose, and leave.”

Described by many as “trading one addiction for another,” methadone maintenance programs have been an ongoing source of controversy for decades. Methadone maintenance boils down to a rather simplistic equation: Addicts use methadone, a synthetic narcotic, as a replacement for their original opiate of choice. There are, however, differences between methadone maintenance and using other opiates; addicts usually don’t get high on methadone itself, and they are able to keep their withdrawal symptoms at bay with the regularly administered doses. While on methadone, users find it much more difficult to get high on other opiates they might cop on the streets. And most importantly, methadone is legal.

But methadone maintenance is no cure-all for opiate addiction. First, there are logistical considerations to contend with. Beginners on the methadone maintenance program must be at the clinic to receive their dosage every morning, lest they get sick. With good behavior and clean drug screens, program participants may gain status where they can take home extra doses—up to a month’s supply for the most disciplined, long-term users. 

And then there’s the price issue. DRD patients pay around $85 to $90 per week. While this is nowhere near as expensive as a street drug habit, it’s pricey. At about $4,500 per year, the cost of methadone maintenance is roughly equivalent to a year’s payments on a mid-priced car.

There are some advantages to staying on methadone as opposed to a gradual tapering-off through a reduction/detox program. While the eventual benefits of a reduction program seem obvious, one must first examine the mindset of an addict. Contrary to popular belief, opiate addicts are a shrewd, driven and resourceful bunch. And under the dictates of addiction, the user’s life assumes a clockwork regimen. Daily existence is reduced to a repetitive cycle of procuring, by whatever means, and consumption—pain followed by relief (or vice versa) in a ceaseless, Sisyphusian continuum.

According to writer and subculture figurehead, William S. Burroughs, opiates are the ultimate commodity and addiction is a cellular condition: “The kick of junk is that you have to have it. Junkies run on junk time and junk metabolism.”  

Dr. Charles Stephens, state methadone authority/pharmacist for the Tennessee Department of Health Licensure, explains, “Most literature today calls opiate addiction a permanent illness…the addiction never goes away, and the physiological changes that occur within the body take a long time to reverse. The advantage of methadone is that users can hold a job, be productive, re-establish connections with their family, and stay out of trouble.”

“I knew a guy who was on methadone for 13 years,” says Tracy (an alias), a 26-year-old user who has been on the methadone program intermittently for around six years. “And Knoxville’s DRD is run like a boot camp. I mean, if you’re even a penny short, they put you on what they call financial detox.”

Until the methadone user pays, he or she is detoxed ten milligrams a day. Upon a third financial detox, the user is kicked off the program for 30 days.

“When I first got on the program, the doctor himself told me that they want you to pay your [drug] bill before you feed your children, before you pay the light bill, before you buy toilet paper,” Tracy continues. “That may sound a little harsh, though. ’Cause these junkies, they lie. It’s kind of like how a bartender can’t let people slide. But when they take that ten milligrams away, you’re hurting. And that’s when you end up back on the streets. Mary Little is a powerful person.”

A Grandmotherly presence, DRD Regional Supervisor Mary Little isn’t exactly the kind of person you’d expect to find running a methadone clinic. She began her career in drug treatment as a military medical specialist and, since retiring from that position, has worked at DRD for 16 years.

“Withdrawal symptoms are horrible,” says Little. “After they get through the withdrawal period—and that can last for up to two weeks—then they’ll be alright physiologically. The thing about it is, people are not strong enough to stay clean for the endurance of the withdrawal period. So when they get so sick, they just go find themselves [street drugs] because they simply cannot tolerate the withdrawal.”

Asked why a user might choose methadone maintenance as opposed to a tapering-off program, Little explains that complex changes in brain chemistry occur for anyone who becomes addicted to opiates.  “Some people simply can’t stay clean without something ,” she says. “You should think of methadone as a medication that makes this person better. It makes them stable, they can function, they’re like normal human beings with it. Without it, they’re either going to go back onto the streets, or they’re going to be miserable human beings.”

Little explains that the clinic prefers and encourages the tapering off method but that, in many cases, it’s unsuccessful. “I’ve had people that have been on up to 20 treatment centers before. It’s not for lack of trying. They try to stay clean, and they simply cannot do it. And I’d rather have them here for 10 years on methadone than to be out there 10 years on the streets.”

And DRD’s patients continue increasing. The clinic, which has two Knoxville locations, has around 1,600 enrolled clients with many more on the waiting list. Stephens, the state methadone expert, claims that around 90 to 95 percent of the incoming patients in the Knoxville area are addicted to oxycontin, a prescription pain reliever also known as “hillbilly heroin.”  

“They’re addicted because of oxycontin, and they’re starting out much younger,” says Little. “So I’m getting 19-year-olds coming in that have been using for four or five years.”

In its present chemical makeup, users can render the time-released drug to act in full force at the moment of its ingestion. After smashing the oxycontin tablets, abusers can swallow, snort, smoke or inject the drug for a quick, intense high.

“Around five years ago, I communicated back and forth with Purdue Pharma (makers of oxycontin) a lot,” says Little. “And I asked them, ‘Why can you not develop this product where they won’t be able to melt it down and shoot it in their veins, they won’t be able to crush it up and snort it, and be a little bit more guarded on who gets it and who doesn’t?’ Because there’s way too much of it on the streets.”

Recently, Purdue Pharma began encountering lawsuits, and Little says one of the company’s representatives told her that they were launching a survey to gauge the seriousness of the problem. “But they’re only doing that as a PR gimmick,” she says. “What they’re doing is making millions of dollars while they do this little three-year survey. And in three years, just think of how many people are going to get addicted to this drug.”

While methadone is not a panacea for opiate addicts, enlisting in a maintenance program allows users an opportunity to restructure their lives. DRD patients are required to go through a regimen of drug screenings, testing for blood-borne diseases such as HIV and hepatitis C, and psychological counseling with the eventual goal of complete detox. All of the methadone clinics in Tennessee are privately owned, for-profit businesses.

“The thing about us is we don’t get any grant money, and we don’t get any state or federal funding,” says Little. “What we exist on is what the patients pay. And we try to treat the patients so they can take responsibility for their problems…. They need to get out there and work, they need to be responsible for their problem, and they need to pay for their treatment.”  

But therein lies the rub. Critics of methadone programs contend that the owners of the for-profit clinics are, in a sense, exploiting addiction for financial gain.

The chemical qualities that make methadone an effective tool in addiction management also make it more difficult for users to eventually wean off its use. Methadone’s long half-life allows users to function normally without experiencing withdrawal between doses, but withdrawing from the drug itself is much slower than with other opiates such as heroin or morphine.

Tracy is one who’s well aware of the vicious cycle, and testifies firsthand that methadone can stay in one’s system longer—upwards of six months—than most drugs, whose withdrawal symptoms cease within several days. “If you get on methadone, you won’t get off,” he says. “I’ve been tapering off for six months, and I still ain’t right. I’ve still got a habit, and I’m still addicted. And right now I’m so low, I really wanna make that jump.”


Wednesday, March 1

Thursday, March 2

Friday, March 3

Saturday, March 4

Sunday, March 5

Monday, March 6

Tuesday, March 7