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Not
just in substance abuse, mental health, and AIDS services do
methadone patients face routine discrimination.
San Francisco MUNI will not allow methadone patients to drive its
buses, even though an important legal ruling in New York overturned a
similar policy (Beazer vs New York City Transit Authority, 1975).
Not
just in those instances but in many other instances, there is
discrimination against methadone patients.
Providers of methadone-related treatment routinely ask whether
their patients might be allow access to various services.
The
prejudice stems from many sources.
First, the methadone patient is still considered an addict.
After all, they are still physically dependent upon a substance.
It does not matter to morally righteous people that the methadone
patient no longer feels like or behaves like an addict.
It certainly does not matter to them that methadone may have
saved the persons life and saved society thousands of dollars.
The moralists view methadone patients as morally weak, morally
inferior.
The
substance abuse treatment subculture itself, and especially the 12-step
approach, is probably the main source of prejudice against methadone
patients. the 12-step program began as a voluntary and anonymous
association of people trying to help themselves. It has become a massive
moral crusade, unhesitatingly imposing its will on all others, and has
almost completely cast anonymity aside.
With God and the Higher Power on its side, it has no doubt about
its righteous belief in the absolute necessity for abstinence and the
moral superiority of abstinent people over all others.
The
12-step abstinence uber alles ideology is not prevalent that most
people dont question its claims at all.
Throughout drug and alcohol treatment programs, it is taken for
granted that the 12-step program no only works, but works better than
anything else. Yet, there
is no proof of that in the literature.
If there were such a study, it would be the most widely cited
study in drug and alcohol literature.
Twelve-step programs might be useful, or might not, or they might
be useful for some people with some problems.
The
point is that almost everyone automatically assumes 12-step programs
must work because, they are seen as the morally superior way.
Hardly anyone even thinks proof is necessary for the 12 steps.
Few physicians would prescribe a medication based on testimonial
support, but most of them unhesitatingly do so in the psychosocial
treatment they prescribe.
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Many
of the myths about methadone, and must of the rampant misinformation
about it are really based on the belief that people
on substances are morally inferior. In fact, this position – the
moral weakness vs disease model viewpoint – is what AA battled
against decades ago. How
ironic that the 12-step and codependency treatment subculture is at the
core of the bigotry against methadone patients.
A
Little History
Two
New York physicians, Vincent Dole, a metabolic specialist, and his
colleague, Marie Nyswander, a psychiatrist,
invented methadone maintenance. They
considered heroin addiction largely a metabolic defect or deficit or
disorder. In other words,
they believed that people who tended to become heroin addicts were
different biologically from other people and that this biological
difference largely contributed to their seeking heroin.
Dole and Nyswander discovered, quite by chance, that methadone
was good at correcting for the deficit, particularly so since methadone
was so long-acting.
As
a metabolic specialist Dole had studied obesity for many years.
Todays theory that obesity can be attributed to a biological
origin and not a weakness of will partly stems from his work. Dole observed that his obese patients craving for food and
relapse to overeating was as if they were addicted. He decided to look at heroin addiction to see if there were
similarities between his obese patients and addicts.
So,
initially, Dole and Nyswander were not trying to solve the American
heroin problem. The study
they had undertaken was to follow the metabolic pathways of morphine
because they hypothesized that heroin addicts metabolized opiates
differently from normal people. Two
addicts were admitted to the morphine study.
First they were given morphine and allowed to increase it as they
pleased. Within three weeks
the subjects were receiving eight injections totaling 600 mgs a day.
They cooperated honestly with the barrage of tests to which they
were subjected. But, much
of their time was spent in front of the television set waiting for the
next injection.
By
law Dole had to detox his two subjects when the experiment was
completed. He switched them to methadone, the approved form of treatment
for detoxification. However, instead of reducing the methadone, Dole and
Nyswander decided to run the same tests as they had on morphine.
This way they could compare morphine to methadone.
Now
something unusual began to happen.
The older subject began to paint and the younger began requesting
to go back to finish high school. The
two subjects continued to take their methadone daily.
Their behavior transformed for the better.
They went from the street to stable living and better housing,
from the jailhouse to the school house, from sickness unto health.
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