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A Day in the Life of a Methadone Clinic

Updated: Aug 30, 2021

With the approach of Labor Day, I’ve been thinking of one my first jobs. The place where I cut my teeth as a mental health worker was in a methadone clinic. I’ve held many positions since, but never one quite as fascinating or disheartening, or one that was as exciting and depressing in equal measure; where the clients could be lovable and endearing, horrible and frustrating, all within a few minutes.

A methadone clinic is in a world of its own, and not for the faint of heart. It comes to life at 5:30 in the morning. Waking up at the crack of dawn was not my thing, and I would vow daily that that day would be the day I’d hand in my resignation. But then I would arrive at the clinic and get sucked into this strange world we called Methadonia.

The clinic, in an unmarked building, on the edge of the commercial part of town, was on a street where women plied their trade by night. Whether snow or rain, cold, or hot, each dawn a few dozens of people had already formed a line outside before we even opened. Sometimes a fight would break up because someone tried to cut the line, and we had to remind them that we would NOT run out of “juice,” what we euphemistically called the medication.

Now and then I’d see Carmen, one of my clients, tired from her night work, dragging her feet toward the clinic, her two young kids in tow. When I found out that her kids were with her while she was prostituting, I called child protective services. After paying Carmen a visit they informed me that her fridge contained food and the kids well nourished and not physically harmed. The kids stayed with Carmen, and I could only hope they wouldn’t follow her into her trade.

When I started my job, the director told me that one could spot a methadone clinic a mile away because it’s the only place where you’d see people of every race and age and socio-economic background congregating together. Addiction: an equal opportunity activity. Indeed, they came from all walks of life, and although the likes of a Keith Richards never graced our clinic, we did have one or two Wall Street types, pass through our doors. But even though we could claim an ambassador’s son, and a rock band manager, in our roster, the overwhelming majority of our clients were the poor and destitute.

They gathered there every morning to get relief from their cravings and constant search for heroin on the street. We provided it in the form of a synthetic opiate, methadone. But our rules were strict. Only working folks were allowed to get medicated before 9:00 a.m. They had to come six days a week and were eligible for take home medications only if they tested clean for a few months and had a job. It was the carrot and the stick approach. It rarely worked.

By 7:00 a.m we started running groups for those who were still struggling with drug use. Cocaine, benzodiazepines, alcohol, pot, anything that would give them a high or just an escape from the emotional pain of facing a wrecked life.

We’d run groups, individual sessions, and in-between, supervise clients taking a urine test, the least appealing part of the job. Who wants to watch someone pee into a cup? But watch we did. We were on the look-out for the ingenious ways some clients had for pulling a switcheroo. A common trick was while pretending to pee, pour someone else’s urine into the cup. Try doing that as someone’s watching you! Ingenuity at work. Women were obviously better suited for this type of trickery, but men found ways too. Once we tested Steve’s suspiciously cold bottle of urine, only to discover that Steve was pregnant. What?

Steve and most of the clients would claim innocence even in the face of clear evidence. The bolder the lie, the louder the denial. Sometimes even I was taken in by it. But usually, we would dismiss tiresome excuses such as “It’s secondhand smoke from a party I went to,” or “it must’a been the poppyseed bagel I ate.”

By 11 a.m, after various tussles with clients we closed for business. That’s when we did our chart work. That meant explaining in Carmen’s chart that even though neither her drug use nor her lifestyle hadn’t changed much, she still benefited from our program. And most of our clients did. But this was where I learned creative writing.

When I decided to write my novel Hope, That Thing with Feathers, I knew I would have a methadone clinic serve as the background for my story. Because it was these clients who taught me about resiliency, love, and hope.

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