My Methadone Journey: The Gold Standard In Frustration

Narrative MattersCommunity Voices Health AffairsVol. 44, No. 9 My Methadone Journey: The Gold Standard In FrustrationAndrew Goodman AffiliationsAndrew Goodman (email protected) is a board member of the National Coalition to Liberate Methadone, a coordinator of educational opportunities at Right Response Colorado, an advisory board member and policy advocate at the Colorado Drug Policy Coalition, and a community navigator for the Overdose Data 2 Action program at the Denver Department of Public Health and Environment, in Denver, Colorado. The author acknowledges Hannan Braun and Kate Roberts for help conceptualizing and developing this essay. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4. 0) license, which permits others to distribute this work provided the original work is properly cited, not altered, and not used for commercial purposes. See https: //creativecommons. org/licenses/by-nc-nd/4. 0/. To access the author's disclosures, click on the Details tab of the article online. PUBLISHED: September 2025Open Accesshttps: //doi. org/10. 1377/hlthaff. 2025. 00347AboutSectionsView articleSupplemental MaterialView PDFPermissions ShareShare onFacebookXLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits View articleAbstract A person with opioid use disorder navigates ineffective treatment before receiving methadone, which works but is hampered by restrictions. TOPICSMethadoneTreatmentPharmaceuticalsNonsubstance related addictionsClinicsAccess to careWithdrawalSubstance useRegulationOpioid use disorderIllustration by Brett Ryder Fortunately, I am infinitely stubborn, or else I might have actually believed that yelling commands at an ashtray would somehow help my addiction. I struggled with heroin use for years—an endless catalog of disaster and degradation. Through countless failed interventions in my late teens and twenties, I internalized the messages that my addiction was "treatment resistant" and that my inability to remain sober through abstinence-based, twelve-step programs was my moral failing. Looking back, I recognize that instead of possessing an inherent character flaw or supposed resistance, I had simply never been offered the gold-standard treatment for opioid use disorder (OUD): methadone. Searching For Treatment Early in my opioid use, I mistook withdrawal for the flu. When I was growing up, the absence of value-neutral, evidence-based education on drugs left me ignorant of the symptoms associated with prolonged use. Once physically dependent, I was unable to stop on my own. My addiction required intervention within a year. I first sought treatment at a residential facility, attempting Alcoholics Anonymous and throwing myself into the sober community for support upon discharge. When it failed, I reverted to a seemingly insurmountable pattern of unhealthy behaviors. Doctors prescribed me a myriad of medications that were primarily aimed at treating withdrawal—quetiapine, prazosin, ondansetron, clonidine, benzodiazepines—but never methadone. Treating my withdrawal was not the same as treating the addiction. I believed that something was intrinsically wrong with me, unaware that the medical establishment had similarly failed countless others. Reflecting the experience of many middle-class, White Americans seeking refuge from the chaos and criminalization of opioid use disorder, I was offered and tried buprenorphine repeatedly. Unfortunately, it was never the right fit. Despite attempting multiple formulations including Suboxone and Subutex, I was never able to stabilize and continued to cycle through use, withdrawal, and reinduction. Buprenorphine is highly effective for some people, but it made me feel physically unwell and mentally one tick off from reality, never offering relief from the withdrawal symptoms and haunting cravings. Until I started methadone, the only thing that had reliably alleviated the "dope sickness" was my drug of choice. I am proof that access to diverse options of medications for OUD (MOUD) is crucial to ensuring maximum reach. Harmful, Ineffective Treatments My family's desperate search for treatment led to disproven, harmful, and cult-like programs before methadone was even considered. The addiction treatment industry is riddled with quackery. Bad actors and misleading advertising are all too common in the rehab and sober-living spaces. When I was twenty-three years old, I unwittingly ended up at a program associated with the Church of Scientology. During my three months there, "treatment" consisted of excessive amounts of vitamins, forced exercise, and hours in the sauna to "sweat out" my addiction. The organization's "technology" and training routines, where individuals scream at ashtrays or engage in staring contests while being verbally taunted, always imbued with novel jargon, seem specially designed toward the goal of disassociation from reality. Social control tactics ensured compliance, including a blackout period restricting outside communication for new clients. With no medical supervision to manage withdrawal, people with severe cases of potentially lethal alcohol and benzodiazepine withdrawal are grouped with everyone else to "socially" detox. My withdrawal from heroin, alprazolam, and zolpidem was permitted to escalate even though this was foreseeable. After hours of nausea, vomiting, shaking, and high blood pressure, I had to be rushed to the care of a physician. It hurts to know that one of the last actions my grandpa—the man I most admired on this planet—took was to write a check for more than 20, 000 to this facility. I am grateful that he passed without knowing the truth about its unsubstantiated, fraudulent tactics. Many patients return home from such "treatment" centers with fresh trauma, fueling a relapse. My family's struggles to find legitimate treatment options highlight how difficult it can be to determine which programs employ effective, evidence-based practices. Desperate families simply want competent care. Although most of my detox and treatment experiences were less dramatic, they were equally ineffective. With financial and familial support, I was spared lengthy incarceration, yet I cycled through many thirty-day "spin dry" rehab centers. Connected To Methadone It was through a judge in drug court that I was finally connected to methadone maintenance treatment. In the fall of 2015, I was arrested while using in the bathroom of a downtown college campus I had once attended, located next to the city's (then) open-air drug market known as the River. Fatefully, this arrest landed me on the docket before this particular judge. I was familiar with tropes that methadone "gets into your bones, " turning patients into "lifers. " Threatened with jail time after multiple positive urine drug tests, I was desperate and no longer willing to let the treatment's reputation deter me. Crucially, someone in the court whispered that one of our judges had been on methadone himself, showing me a newspaper article highlighting his story. I read it repeatedly, inspired. He had risen from a life on the streets to one on the bench, and this representation of redemption gave me hope. Until that point in my life, I had only ever associated methadone with negative stereotypes. After seeing his example, I was ready to give methadone maintenance treatment a try. Methadone is a full μ-opioid receptor agonist with a long half-life and is associated with a reduced opioid overdose fatality risk, as well as decreased rates of overall mortality, hepatitis C, and HIV risk behaviors. I am eternally grateful to that magistrate for guiding me to the clinic door, behind which I had been previously convinced waited only defeat and darkness. In reality, it was the path to wellness I'd been seeking for so long. Still, methadone induction within the framework of opioid treatment programs is made unnecessarily arduous for new patients. I had to show up to the clinic between 4: 30 and 5: 00 a. m. to sit on the concrete stairs and hopefully claim one of the two methadone maintenance treatment spots offered daily. Once I was admitted, progress was slow and not without frustration. Daily attendance was required, and my initial dose was far too low; I later learned that it was limited by federal regulations. High rates of turnover among staff created long wait times and a lack of trust between patients and clinic employees. An assumption of good will or benefit of the doubt was not afforded; your daily dose was presented as a privilege to be dispensed only after payment, paperwork, diversion checks, call-in lines, camera-supervised urine analysis, and other steps were complete. Much of my time in the beginning was spent just trying to get the treatment. But after a few months, when I was finally at an adequate dose and granted additional take-homes, my circumstances began improving. With my energy and time freed from the constant chase of the next high, I enrolled at the same college on whose campus I had been arrested and went on to graduate with a degree in philosophy. My return to the classroom rekindled an enthusiasm for learning and discovery, wrestling with tensions between the notions of free will and sociobiological determinism, or age-old questions about the nature of "right" and "wrong. " Implicitly or overtly, I connected our classroom exploration of ethics with drug policy. It offered me a lexicon to critique what I inherently felt to be an unjust system, trying on new ethical lenses through which the issues could be viewed. I now work for the very city whose jails I once frequented. I often forget how far I have come and find myself ruminating in self-pity and complaining about the stifling effect of excessive opioid treatment program (OTP) regulations. With just 200 methadone clinics spread across fifty states, 80 percent of US counties lack access to OTPs, according to the Congressional Research Service. With these programs located primarily in urban, lower-income neighborhoods, methadone maintenance treatment was never considered by my hometown doctors in Edwards, Colorado. The nearest clinic was at least three hours away—an unrealistic commute, given daily dosing mandates. Buprenorphine was scarce, with only one physician prescribing it in my state's entire Mountain West region in 2011. Waitlists were standard. Even traditional twelve-step recovery programs, which are often explicitly prescribed by well-meaning health care professionals, were conspicuously missing. The area was not unique among other rural communities as a provider desert for mental health and addiction care. I sometimes wonder what my twenties could have looked like had I been offered methadone earlier, avoiding years of trauma and harm. A Light In The Darkness Despite its effectiveness, my methadone treatment and constant trips to the clinic became a lonely, shameful secret. MOUD was held in disdain by certain recovery communities, where a person's "clean time" is directly correlated with self-worth and social capital. Fortunately, finding my way into legislative advocacy offered not only direction but also the community I was desperately missing. In recent years, I have connected with the National Coalition to Liberate Methadone, a collection of like-minded patients, clinicians, and researchers pushing to increase access to methadone by reducing regulatory barriers. A main focus of the coalition has been to allow this lifesaving medication to be prescribed by a primary care physician or outpatient addiction specialist and to be picked up at a local pharmacy, just like practically all other medicines. In fact, at this time, pain management patients are prescribed the exact same medication (methadone) but are subjected to none of the obstacles. In 2024, a bill that would have implemented this simple yet critical reform, the Modernization of Opioid Treatment Access Act, was introduced in Congress by Sen. Ed Markey (D-MA) but could not garner the necessary support. The course correction is apparent, but we must first foster sufficient political will. OTPs will continue to be necessary for new patients in need of accountability and support. One size does not fit all in medicine: Differing levels of care must be offered, including an avenue to phase out or graduate from the clinic setting if sustained stability is demonstrated. Changes in dosing should not come with an assumed increased risk to the patient or the public. Opposition to the Modernization of Opioid Treatment Access Act centers on the assertion that the liberalization of take-home dosing (dispensed to a patient for unsupervised use, not at an opioid treatment program facility) will result in increased diversion to the illicit market and, consequently, an increase in overdose deaths. This claim was disproven during the COVID-19 pandemic, when take-homes were made more available and no such phenomena occurred. Improved access to this reliable medication will not aggravate the opioid overdose rate but, instead, will save countless lives. Although the Modernization of Opioid Treatment Access Act died on the floor of Congress, this legislation can and must be brought back to support the millions of individuals like me who are begging for policy makers to allow their doctors to provide critical medical care and make methadone accessible. With the revival of the act, we can begin to challenge the structural barriers to care that are characteristic of current methadone regulation. Methadone maintenance treatment should be offered as a first-line treatment, not a last resort. Drug Policy In The USWhen it comes to methadone, drug policy in this country is a paradoxical hamster wheel that perpetuates its own continued failure to provide medication to people with OUD. When it comes to methadone, drug policy in this country is a paradoxical hamster wheel that perpetuates its own continued failure to provide medication to people with OUD. Scientific evidence is ignored, hard-earned wisdom often neglected, and the scorching stove of prohibition perpetually stoked to ensure that it remains hot. Whether a substance is demonized and criminalized versus taxed, sold, and deemed socially acceptable has not been based on the risks involved in the substance's use but, rather, on larger social forces or political agendas. As the United States remains in the grip of a persistent opioid and overdose epidemic, the transition from the punitive War on Drugs toward a model structured around public health and harm reduction remains essential, but it is happening far too gradually. Such a transition would promote meaningful progress in addressing poor health and social outcomes; curb overdose deaths and disease; and finally provide effective, evidence-based treatment for people who use substances. Some of my closest friends have found decades of sobriety following traditional twelve-step programs, and that is a blessing. Unfortunately, in equal measure, I know numerous others for whom this was not the result and who were stigmatized out of using MOUD. Questioning the perceived wisdom of abstinence-based programs can be received as iconoclasm and borderline blasphemy. Must I have fallen to such degrading lows before methadone was deemed appropriate? Why are harm reduction and abstinence-based recovery framed as mutually exclusive and diametrically opposed? Had I not found the former, I would not be on target to attain the latter. Therefore, I simultaneously view methadone as a literal lifesaver and as "liquid handcuffs, " limiting my future. Century-Old Policy And Undue Hardship The OTP clinic system also fails to acknowledge my hard-fought progress. Why am I still treated like a criminal when my life has dramatically transformed? I currently feel tethered to the physical clinic location, unable to travel for extended periods of time, and limited in where I can move or attend graduate school. Although I grew up in a rural area and have thought about returning home, current methadone treatment access and regulations make this change unrealistic. The inability to ensure adequate take-home doses has caused me to miss weddings and funerals, sparking an unproductive sense of guilt. After ten years receiving methadone, I should continue my treatment, given the stability it provides, but I am perpetually tempted to stop because of the endless hoops I must navigate. Further, once I became gainfully employed and productive—a status the system should incentivize—my insurance changed from Medicaid to private coverage, at which point I started to unknowingly accrue a balance. I learned of it when I came in to dose and was faced with the ultimatum of making a payment or going through phase reduction and potential discharge because of an inability to pay. This strategy of "feetox" is unconscionable and can result in needless loss of life. The US opioid crisis traces back not only to Purdue Pharma and the overprescribing of "painkillers" but also to systemic failures of policy. The Harrison Narcotics Tax Act of 1914 and its subsequent misinterpretation planted rotten seeds that are responsible for today's forest of ineptitude. The act initiated a paradigm shift that would strip doctors of their ability to rely on their training, judgment, and discretion when treating a patient with addiction, where making "such a person comfortable" (which is supposedly a prime function of medicine) was not a "legitimate use" of narcotic drugs. The Treasury Department, which was then responsible for narcotics control, set forth 112 articles (clarifying rules and regulations), aptly described by Henry Smith Williams as "the supreme and incomparable example of…unconstitutional bureaucratic Code in defiance of federal law. " Williams wrote that "the Harrison Act is a pure revenue measure having no control over the practice of a profession, that being a matter reserved to individual states. " The Harrison Narcotics Tax Act was then codified with the United States Supreme Court decision Webb et al. v. United States (1919). To address the early-twentieth-century wave of opioid addiction, physicians were prescribing maintenance and comfort dosing to care for people trying to find stability. The Court ruling resulted in the restricting of physicians' ability to rely on their medical expertise. The Court outlawed maintenance opioid prescribing to those with known dependency, except for short periods of tapering. As Maia Szalavitz, in her seminal work, Undoing Drugs, states, this ruling marked the medical profession's abandonment of the drug addict. Although there are now Food and Drug Administration–approved opioid agonist treatments, the demand that they be delivered in confinement echoes the restrictions put in place by the Webb decision. As a consequence, in 1924, Charles Linder, who was renowned in Washington State as an honorable, well-respected physician, was entrapped by one of the Treasury Department's "stool pigeons" while prescribing morphine. He was indicted, convicted, and sentenced to jail. Drug users were routinely used by law enforcement to entrap doctors, fostering paranoia and distrust. A wedge developed between those with addiction and medical professionals. Eventually, the Supreme Court reversed Linder's conviction, and he was wholly vindicated. The unanimous opinion in Linder v. United States, written by Justice James Clark McReynolds on April 13, 1925, sets forth what should have become the controlling interpretation of the Harrison Narcotics Tax Act: "It says nothing of 'addicts' and does not undertake to prescribe methods for their medical treatment. They are diseased and proper subjects for such treatment, and we cannot possibly conclude that a physician acted improperly or unwisely or for other than medical purposes solely because he has dispensed to one of them, in the ordinary course and in good faith, …tablets of morphine…for relief of conditions incident to addiction. " More than a century later, these unfortunate policy decisions live on in spirit through the Controlled Substances Act of 1970, the current authoritative decree regarding narcotics regulation in the US. Despite the Supreme Court ruling that I am "diseased and one of the proper subjects for such treatment, " the medication that addresses my disease remains guarded within OTPs, plagued by red tape. These paternalistic regulations are the material manifestations of a moralizing medical model that reverberate in the lives of methadone patients with a profoundly negative effect. For a treatment that often serves unhoused people, the exorbitant costs are indefensible. Many clinics prioritize financial interests over patients' well-being, with excessive drug testing and counseling requirements seemingly designed to maximize billing rather than to support recovery. Private equity firms have acquired nearly one-third of all methadone clinics in the US, according to 2020 industry survey data from the Substance Abuse and Mental Health Services Administration, and they largely oppose regulatory reforms such as the Modernization of Opioid Treatment Access Act. Why do people say no to methadone maintenance treatment? As a demographic often struggling to get out from underneath judicial surveillance, many of those who would likely benefit from methadone refuse to submit themselves to undue hardship, superfluous supervision, and reduced freedom. With recent trends signaling a waning overdose epidemic from the highs of recent years as a result of the increased availability of naloxone and opioid pharmaceutical settlement funds flowing to local providers, there will be more survivors of fentanyl addiction in need of comprehensive treatment. It is time to lift the barriers to methadone maintenance treatment. Loading Comments. . . 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