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14. Methadone Maintenance
- The University of Tennessee Press
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14. Methadone Maintenance Although Daytop Village and other early therapeutic communities represented a significant departurefrom the Lexington model, they were by no means the most radical treatment alternative to develop duringthe 1960s. That distinaion would have to go to methadone maintenance. It was not that methadone was a new drug; it had infaa been usedforyears to gradually detoxify addias in Lexington. It was the way in which Drs. Vincent Dole and Marie Nyswander proposed using it, as part ofa regimen ofindefinite treatment, that was so revolutionary. This, ofcourse, violated theBureau ofNarcotics ' basicpolicy against maintenance and represented a standing challenge to all treatment programs, large or small, predicated on abstinence. The original premise behind methadone maintenance was that addias had undergone apermanent metabolic change, that they needed narcotics in a visceral way, the way a diabetic needs insulin. This explained relapse, and why abstinence was not a realisticgoal. But methadone maintenance could satisfy the underlying craving and enable the addict to lead a normal and produaive life. Methadone could be taken orally once a day, so addias would not have to constantly injea themselves with possibly contaminated needles. At a sufficiently high dose methadone blocked the euphoric effects ofa shot ofheroin, so that addias would not be tempted to continue using illegal narcotics. Nor would they need to, since methadone, itselfa narcotic, prevented withdrawal sickness. Finally, methadone was cheap and legal, so that addias couldescape thegrind ofhustlingandscoring, thereby improving their lives and reducing the amount ofcrime. There was, inevitably, a reaction, as both the premises and results ofmethadone maintenance were called into question. Critics said that the hypothesized metabolicchange was mere speculation; that methadone wasjust a quick chemical fix, substituting one drug for another; and that it failed to significantly reduce criminal or antisocial behavior because it ignored the underlying problems of addias-inforior or abnormal personalities, broken families, anomie, inebriety, ghetto squalor, deviant peers, or struaural unemployment, and so on down the 320 ADDICTS WHO SURVIVED list. Others charged that methadone did too much, that it was an insidiousform of social control aimed at turning restive inner-city minorities into harmless zombies ; or that it was dangerous, because large amounts ofmethadone were diverted into the black market and consumed by those who might not otherwise have used drugs. Probably thefairest and most accurate thing to say about these criticisms (and this is just a partial list) is that they arosefrom mixed motives: there were real and unresolved problems with methadone maintenance, but there were also vested interests to be defended, especially by those whose funding and prestige were tied to competing addiction theories and treatments. Medical controversies are seldom fought on purely scientificgrounds, and methadone is a classic case. The addicts we interviewed were not much interested in thefiner points ofthe controversy, but they were glad that methadone maintenance became available when it did. Thirty or forty years was a long time to survive as an addict in the Anslinger era-it amounted to perhaps three or four lifetimes of normal stress and danger-and by the 1960s the older survivors were starting to play out. Although they had some reservations about methadone, several interviewees remarked that it had been a lifesaverfor them. '~y worst enemy I wouldn't wish my heroin habit on, "Amparo cried out. "The time I spent on heroin was hell. That's why I get emotional whenever anyone asks me about it. That's why I'm comfortable on methadone now." Others expressed no regrets whatsoever about heroin or opium use and, were they given a choice, would have continued using them. "I'd smoke opium for the rest ofmy life," was AI's comment. But even those who preferred the drugs oftheiryouth allowed that methadone was a great convenience. Given the adulteration ofstreet drugs, the dangers ofscoring, and the difficulty of hustling, there was really no other choice open to them save detoxification, and they hadfailed so often to achieve and maintain abstinence that they were not very sanguine about the prospect. Dusty summed it up: Methadone's a crutch, in a way. You feel safe. I've said so many times, "I wonder what I'd be doing if there wasn't any methadone program?" I wondered if I'd still be alive. Because, without methadone, it would have been heroin, or cocaine, or something else, and the way the quality ofdrugs has deteriorated, I guess I would have shot five times as much as I shot before to find any satisfaction in...