Myths About Methadone by Emmett Velten

Methadose Dispensing

Emmett Velten, Ph.D. is the
Clinical Supervisor at the BAART Methadone Program, San Francisco, CA.

Methadone has
inspired an immense mythology.  Perhaps
it is the most extensive mythology surrounding any form of medical or
psychological treatment, living or dead.
Why has such a mythology developed?
This question is important given the deadly stakes of the AIDS
epidemic and methadone’s proven efficacy in attracting opiate addicts
into treatment and reducing their use of needles (Batki, 1988; Des
Jarlais, Friedman, Novick et al, 1989; Joseph & Springer, 1990).

Research
into psychology of rumor suggests that there are two conditions under
which rumor thrives.  One of
them is high emotion.  The
other condition is lack of information.
Methadone treatment amply meets these two criteria.
The rumors and mythology surrounding methadone treatment may
differ from normal rumors, because the emotionality surrounding
methadone largely causes the lack of information about it.
What causes the emotionality?
Prejudice!

Prejudice
toward a group of people involves judging them unfairly, as a group and
negatively.  Such judgments
are moralistic and start with an impossible standard for the victims but
one they are expected to meet to be worthy.
For instance, the standard may be maleness, or whiteness, which
the moralists consider the right way to be.
Those who don’t meet the stand, for instance females or
nonwhites, are inferior.  These
judgments:

 
  (1) apply different standards to the
victims

(2) function to keep them in their inferior status;

(3) deny them opportunities;

(4) call upon “everybody knows”
types of  common knowledge to legitimize the prejudiced opinions;

(5)
are often incorporated into the beliefs and self concepts
of the victims, who come to believe the bigoted opinions of the
majority culture.

The
victims of the prejudice may become prejudiced to some extent against
themselves.  All of these
conditions exist in the case of methadone patients.

Emotion
often runs high in opinions about methadone. the recipients of no other
form of medical treatment are so routinely discriminated against. For
instance, by custom and law, San Francisco has the reputation as one of
the real citadels of freedom in America.
It is one of the few places that take freedom seriously.
Minorities abound, and, for the most part, opportunity and harmony
reign. Except for methadone patients.

Some
Examples of Routine Discrimination

Numerous
drug and alcohol treatment programs in San Francisco refuse to provide
services to methadone patients.  The
most prominent County-funded program for gays and lesbians, for
instance, does not accept methadone patients into group therapy.
The County-funded program to provide mental health services for
medically indigent adults does not accept methadone patients.
When San Francisco County has to pass along to drug and alcohol
clinics a 20% cut in waiting list reduction funds, it passed alone a
100% cut to the methadone clinics, so that other treatment modalities
would not have to share the burden of the cuts.
At least one methadone patient, who was going to lose his
treatment slot, committed suicide.

In
the first competition for Ryan White emergency AIDS funds in San
Francisco, largely orchestrated by the AIDS Program, no methadone clinic
received funding.  Yet, one
of the drug-free outpatient counseling programs received funds to hire a
janitor!  At the second
round of competition, methadone maintenance was specifically excluded as
“not a priority service.”

At
a meeting in San Francisco about establishment of a residential
treatment facility for substance abusers who have AIDS, the question was
asked, “Will patients on methadone be allow to live there?” 
No one knew the answer.  the
question could be continued, “Or will they be forced to die on the
streets because of the prejudice against methadone and against people
who are on methadone?”