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Chemical Dependency Research Working Group |
Street addicts developed their own conceptions of stigma against methadone maintenance. However, the history of street stigma is related to the stigma from the media, government and medicine itself. Each source feeds the other. Interestingly, prior to the establishment of methadone maintenance programs in the 1960s, methadone in the form of dolophine tablets had an excellent reputation among street addicts. Dolophine tablets were widely used by active heroin addicts to self medicate withdrawal symptoms and for extended use or short term maintenance when heroin was not available (e.g., street panics). Dolophines were obtained from physicians who would write prescriptions that were filled by local drug stores in the 1950s and 1960s. A frequent crime committed in the years prior to the establishment of methadone maintenance was the forging of dolophine prescriptions by addicts. Forged prescriptions of dolophine were the first examples of "methadone diversion" which persisted when the programs opened " the sale of methadone diverted from their take home medication by unemployed and dysfunctional patients.
Methadone is the generic name for methadone while dolophine is the trade name that was developed by Eli Lilly to market methadone as an analgesic. The word dolophine is derived from two sources: the Latin word dolor for pain and the second syllable of morphine, a term derived from Morpheus, the Greek god of sleep. Addicts did not attribute destructive side effects to dolophine such as is currently believed about methadone (e.g., rot the bones or teeth). It was a benign drug with the street name "dollies." However, in street mythology, methadone and dolophine are not the same drug. The following quote is from the National Methadone Conference held in Washington in 1994. A methadone patient was voicing fears about long term methadone treatment (Town Hall Meeting, 1994):
"Long term methadone is a dangerous drug. It tears the body down. I am a methadone patient but I don't believe in long term treatment. There was another method to treat drug addiction " dolophine, but the government took this pill off the market. It is the best pill they ever had for addiction. Why did the government take this pill off the market?"
Unfortunately the patient was not answered precisely by the physician who responded. The patient was told that dolophine tablets were used in methadone clinics to fine tune stabilization doses of methadone. The patient was not told that methadone and dolophine are the same medication.
However, there is a street ambivalence about dolophine. Since methadone was synthesized in Germany in World War II, street addicts assumed that the drug was named for Adolph Hitler " "adolphine." In street mythology the "a" is simply removed. Dolophine, therefore, is looked upon as a "Nazi Drug" but a benign and helpful "Nazi drug." In a study conducted by the Street Studies Unit of the New York State Office of Alcoholism and Substance Abuse Services (OASAS) in 1993, the perception that methadone is a "Nazi drug" was given as a reason by one of the untreated heroin addicts for not applying for methadone treatment.
The fact that methadone was dveloped in Nazi Germany is used in street publications directed to the poor and minorities. As indicated in the previous chapter, the origin of methadone is presented in books and on television as a narcotic developed by the Germans in World War II.
The Origins of Street Myths
To determine the origins of street mythology, the officers of NAMA were interviewed. The purpose of NAMA is to educate patients, the public, physicians, social service providers and especially professionals working in the field about methadone maintenance; to assure that patients are treated with dignity and respect by physicians in private practice, clinics, hospitals, and jails; to dispel mythologies about methadone and methadone maintenance; to fight the stigma, biases, prejudices and discrimination that methadone maintenance patients face worldwide in employment, education, health insurance, housing, health care and so forth. The organization also keeps records of problems related to mistreatment, stigma and mythologies worldwide that methadone patients and others report.
NAMA was founded in 1988 and currently has about 8,700 members in 18 chapters in 15 states and five international affiliates have been organized in Canada, Australia and Sweden. While most of the members are current and former methadone patients, membership also includes interested health care professionals, researchers and others who are sympathetic to the problems faced by methadone patients. For this study the president, Stanley Novick and the vice president, Joycelyn Woods who is also the editor of the organization's newsletter, The Ombudsman, were interviewed in July of 1994. Novick is a former methadone patient having withdrawn from methadone in good standing after more than ten years of treatment. He advises that he is one of the few former patients who are biologically able to live without medication and that he is an exception not the rule. Woods is an active patient in methadone maintenance for over twenty years, has a master's degree in neurological psychology and has worked at The Rockefeller University in the laboratory of Neil Miller and has been the principle author of one of the first papers on the endogenous opiate receptor system.
Both advised that to understand the street myths, the use of methadone as a medication must be understood. Methadone was introduced as a medication to withdraw heroin addicts in 1961 at the now closed Manhattan General Hospital where Mr. Novick had been a patient. He advised that high doses of methadone were prescribed but could not recall if the administration was oral or intramuscular. However, the amount of pure methadone prescribed for withdrawal caused the patients to experience a certain type of "high." He relayed the following:
"the "methadone high" is different from the euphoria produced by heroin. Heroin produce a real euphoria (for non-tolerant individuals) while the methadone high is sedated or dull (for non-tolerant individuals). Of course, the heroin high is preferable. As is wont in detoxification wards patients signed out before the withdrawal process was completed if they learned that somebody either had money or a good stash of heroin. After a hospital discharge against medical advice, the patients would begin to experience symptoms of methadone withdrawal which could not be relieved with impure unknown quantities of heroin. Since methadone is a long acting drug, the withdrawal is longer than heroin but less severe. During methadone withdrawal you experience muscular aches and pain which some of the addicts attributed to "methadone in their bones." However, you must remember we signed out of the hospital early. I also was treated with methadone in Lexington1 but there were no problems because I stayed to complete the treatment."
The myths, according to Novick and Woods, were exacerbated during the early 1970s with the expansion of the methadone program. Prior to the 1970s dolophine, known as "dollies" were used by heroin addicts without any mythology. As Mr. Novick related:
"You never heard the myth that dolophine rots the bones, that dolophine is white man's genocide. Dollies did not have a repressive connotation. Drug dealers spread rumors that methadone rots the bones to try to prevent addicts from registering for treatment. When the program opened up in Harlem, there were protests by the community and politicians that methadone is 'white man's genocide.' This charge was in the papers - I believe it was in the Times. Also street addicts began to see "dollies" as something they themselves controlled and methadone treatment as adversarial: clinic regulations, nurses, supervisors, standing in line waiting to be medicated, counselors, urine tests. You had, in other words bureaucracy and power that controlled patients. With street dolophine they had control over the drug and in methadone treatment this control was removed and placed in the hands of the staff that was not trusted."
Therefore, with methadone treatment formalized into a highly regulated clinic system the medication was seen in a different or repressive context as opposed to unfettered street use. Mr. Novick related that patients began to believe all types of rumors:
"In the 1970s there was a great deal of competition for funds and methadone myths and anti-methadone propaganda were used by drug free programs to gain a political advantage for funding and residents. For example, Project Return, issued a leaflet in the 1970s claiming that methadone caused malformed babies. This leaflet was believed by many women, both active users that could be helped with methadone and women patients. I know of one pregnant woman who was a patient. Her husband had never used drugs so it was probably difficult for her because she was worried the baby would be born dependent, and it would be her fault. She some how got hold of one of these leaflets and was so upset and depressed that she was crying herself to sleep at night for several months. Finally she got the courage to ask her counselor and she broke out into tears that her baby was going to be born deformed and it was her fault. The only thing that I can call such an irresponsible idea (to make the pamphlet) is just plan vicious, mean and selfish. And this was done by one of the large international therapeutic communities."
Both NAMA officials indicated that street myths continue to proliferate and that there are no major educational programs targeted to the patients or the community to counteract the destructive street mythology or sensationalized reporting from the media. NAMA also insists that methadone patients be called patients instead of clients. Social workers and psychologists usually refer to people they treat in therapy as clients and that label has been transferred to methadone patients. The term client trivializes or negates the biological determinants and medical basis of addiction. Methadone is prescribed by a physician and administered by a nurse, therefore persons who take the medication should be considered patients. The term client removes the medical procedure as the primary therapy and therefore diminishes the importance of methadone in the treatment of opiate addiction. In a subtle sense it adds to the stigmatization of patients, since it brings to the fore psychological characteristics that do not apply to all patients. Although psychological characteristics in general may not be stigmatizing, those associated with addiction are: character disorder, psychopathic personality, liars, cheaters, etc. Therefore, to avoid further stigmatization and to stress the biological factors of an addictive disorder, NAMA insists that patients in programs be called patients and not clients. However, major sociologists while acknowledging methadone usually consign the medication to a secondary consideration contrary to the NAMA position.
An example of the misunderstandings that are perpetuated in the social sciences about methadone treatment has been presented in a previous chapter in the work of Abadinsky. However, Stephens (1991) while acknowledging biological factors in the addiction of street addicts, fails to appreciate the central role of methadone as a medication in the treatment of opiate addiction. In the following excerpt about clinics set up primarily for its dispensing, methadone is referred to as a narcotic not a medication.
"In many ways, methadone maintenance initially demands less of the clients than do some of the other modalities. This is because the modality does not mandate that addicts give up a central aspect of their lives, namely the use of narcotics. In fact, the narcotic becomes a central aspect of their lives, namely the use of narcotics" (Stephens, 1991: 146, 147).
This above statement reveals a fundamental misunderstanding of the role of methadone in the treatment of opiate addiction. Methadone in maintenance therapy functions as a normalizer of a deranged physiology and allows patients to live normally. Furthermore, methadone patients do not have an easy time transforming their lives, considering the prejudice directed against them. Many methadone patients come into treatment with serious social and medical conditions that cannot be resolved because of the bias and stigmatization that permete social and medical institutions. Methadone patients are consistently refused services unless they withdraw from methadone. The derangement of metabolic processes caused by a heroin addiction may be permanent for many patients and methadone is necessary as a medication not a drug. Also the term client " as NAMA officials state " to describe methadone patients subtly negates the biological factors of opiate addiction. Stephens also criticizes the centrality of the dispensing of methadone in methadone clinics as follows:
"The very fact of the centrality of the drug itself in methadone maintenance can also be seen as a criticism from the sociocultural viewpoint. It seems to me that the typography of many methadone clinics themselves reinforce what I am talking about. When one enters a clinic, almost invariably within the just a few steps of the front door is the methadone dispensing window. ... Thus, the client is constantly reminded of the central importance of the drug to his or her life. Other aspects of the therapeutic process of leaving the addict role are minimized. Taking of the drug is the only "therapeutic event" that ordinarily occurs every day in the patient's life. Drug is King!"
Stephens obviously has never been in many methadone clinics. Clinics offer a variety of services, but since addiction is a disease the medication is the primary aspect, just as insulin is to a diabetic or cardiac medication to a heart patient.
Counseling in methadone programs may not be funded adequately to address the complicated social and medical issues that confront and overwhelm the staff. Methadone is not just another drug as Stevens insinuates. The medication methadone is necessary to stabilize patients so they can begin to address their problems. The methadone clinic is organized primarily to dispense methadone, in the same manner as a cardiac clinic is organized to dispense cardiac medication. In both clinics, the prescription of medication is central to the control of the medical condition.
Street Propaganda
An example of the type of propaganda that is promulgated is an article entitled "Methadone" in the squatter newspaper Your House is Mine (Morales, 1992). The newspaper was distributed in the East Village of Manhattan in 1992. The article presents a conspiratorial viewpoint of methadone treatment and the system of clinics established to dispense methadone maintenance (See Appendix). Although this article was written recently it has historical precedents back to the 1970s when the programs were first expanding. Charges of genocide against methadone have abounded from minority communities since the inception of the program. However, as statistics have shown in this study when methadone programs were expanded in the early 1970s there were corresponding decreases in drug related crime, the transmission of infection and overall drug related deaths. Miller (1974) sums up the black militant critique of methadone as follows:
Morales' (1992) article is an example of the application of the above critique and conspiratorial beliefs about methadone. Nevertheless, this type of literature impacts on poor untreated addicts who have experienced discrimination. The opening sentences of the article stresses the Nazi connection:
"Methadone was invented by Nazi scientists at Adolph Hitler's request. It was named "adolphine" after Hitler."
The article then enumerates an exaggerated list of side effects including degenerative brain damage, rotting of the bones, sexual impotency, insomnia, abnormal menstrual periods, slurred speech, drowsiness, heart and lung failure. Methadone is perceived as a major cause of death and genocide spreading HIV infection and is ten times more "addicting" than heroin. He lies about the excessive funding. Morales infers that there is a methadone conspiracy to control addicts and the poor.
The article discusses rightfully the existence of exploitative medicaid programs that administer methadone. Unfortunately, he does not disentangle the issues (e.g., medical issues and the delivery of health care services). There are unscrupulous physicians and entrepreneurs in all areas of health care. This practice is common in the delivery of medical services in poor neighborhoods. However, the medicaid medical offices are woven into a broad political conspiratorial context. The shortcomings of medical practice in poor neighborhoods are not only connected to the administration of methadone to control an opiate addicted population but also to the methadone itself. It is potentially a killer drug prescribed by medically exploiting programs that "rots the bones."
The pivotal roles of Dole and Nyswander affiliated with The Rockefeller University and that of Dr. Robert Newman of Beth Israel Medical Center are also cited as proof of an interconnected conspiracy. Since the Rockefeller family is associated with capitalist exploitation, research that emanates from the university is suspect. Beth Israel Medical Center is perceived as part of an establishment to control the lives of the poor through methadone because of individuals associated with the hospital. For example, the head of the trustees at Beth Israel Medical Center is identified as belonging to a family with interests in the oil and pharmaceutical industries. Also, as a member of the New York State Public Health Council this person "actually approves clinics as methadone sites." There is no mention that only two new clinics opened up in the past 20 years in New York City. Eli Lilly is identified as the manufacturer of methadone2 and former president George Bush is reported as a stock holder in the company. This is considered the proof of a conspiracy to control, exploit and commit genocide against the poor with methadone.
Another source of anti-methadone propaganda filtered into poor drug addicted populations at risk for AIDS is unfortunately within organizations that are fighting the spread of HIV infection. In newsletters distributed by the People with AIDS Coalition of New York, methadone is presented as a potentially harmful drug. In their January, 1994 newsletter, the People with AIDS Coalition reprinted an article from a British anti-AIDS publication called Mainliners with the following statement:
"Methadone is a sugary substance and along with other sugars, helps to accelerate the rapid decline and decay of cavities that may already exist."
In another article the People with AIDS Coalition a column again reprinted from Mainliners:
"Methadone detox is about the worst. It takes more than twice as long as heroin and can be harder."
This statement summarizes a street mythology about methadone. Addicts perceive methadone as harder to "kick than heroin." However, given comparable amounts of methadone and heroin, methadone, since it is a long acting drug, has a longer onset for appearance of withdrawal symptoms than heroin, the duration of symptoms are more protracted but the symptoms themselves are less severe. In comparison, addicts use adulterated street heroin in uncertain amounts while methadone is obtained in pure and carefully calibrated amounts from clinics. The perception of addicts that methadone is harder to kick comes from unequal comparisons of heroin and methadone: one adulterated and of uncertain purity (heroin) and the other pure and carefully calibrated (methadone).
To understand the prejudices in the AIDS community against methadone, Bruce Stepherson, Director of the AIDS Outreach Unit of the National Development and Research Institute, Inc. (NDRI), a former methadone patient and an advocate for methadone treatment discussed the problem. He indicated that many AIDS activists come from a drug-free orientation, know very little about methadone and therefore adhere to their prejudices. In his unit he has trained workers about methadone and has employed both methadone patients with drug-free advocates as outreach workers. However, he is aware of the deeply held prejudices against methadone that exist across the spectrum of professionals including Ph.D.s and directors of projects.
Studies of Street Mythology about Methadone
Street mythologies about the perceived destructive effects of methadone became apparent in the 1970s. Three papers from three eras of methadone treatment document the rise of street mythology (Goldsmith, Hunt, Lipton and Strug, 1984; Langrod, Lowinson and Joseph, 1977; Rosenblum, Magura and Joseph, 1991). Street mythologies about perceived effects of methadone were first identified in the early 1970s by Langrod, Lowinson and Joseph (1977). At that time, the rumor that methadone rots the bones and the teeth were becoming a common mythology on the streets. However, medical studies reported that methadone had no effects except for transitory problems at the beginning of stabilization. Sedation, decrease in libido, constipation and sweating were the most common effects with sedation and decreases in libido corrected over time with either changes in dose or the development of tolerance. Sweating appeared to persist but constipation slowly subsided with the development of tolerance and changes in diet (Kreek, 1973). However, as patients entered the program from the streets, symptoms of various illnesses emerged that were masked by heroin (Langrod, Lowinson and Joseph, 1977). The patients attributed erroneously a variety of aches, pains and poor dentition from neglect and poor nutrition to methadone. These misconceptions intertwined with the perceived conspiratorial political agenda of control and genocide and combined into a powerful folk mythology. Perhaps the most persistent myth is that methadone rots the bones and teeth. Interestingly, the number of symptoms in the street folklore attributed to methadone increased with time. By the 1990s a solidified system of beliefs about methadone as a destructive drug (e.g., rots the bones and teeth) was firmly in place (Rosenblum, Magura and Joseph, 1991). Untreated addicts had developed a clear ambivalence about methadone treatment. This ambivalence, shaped by street mythologies, influenced adversely decisions to enter treatment, accept an adequate dose of methadone (preferring low dose which is ineffective) and the time they would remain in treatment to avoid what they perceived as long term detrimental effects.
Ethnographic studies by the Street Studies Unit of OASAS show that mythologies still persist. Untreated addicts primarily value diverted methadone for self medication (i.e., withdrawal and short term maintenance when they are unable to obtain heroin) (Galea, 1994).
The reasons heroin addicts are not in methadone treatment include the usual "rots the bones and teeth" myth, methadone is a Nazi drug (genocide), too addicting, harder to kick than heroin and more addicting, long waiting list to get into treatment, no identification for medicaid and too many rules and regulations in the programs (orange hand cuffs). Another term that was used to describe the program on the streets was "deathadone" referring to the large number of HIV-related deaths that were occurring in the program. Methadone therefore has become a program associated with death.
Since these mythologies were strongest in minority communities, African American patients in medical maintenance were questioned about the possible origins of these myths. One patient with a 24 year addiction history who had been enrolled in methadone treatment since 1971 and in medical maintenance for about eight years stated that he believes:
"The rumor about methadone rotting the bones was started by dealers to prevent addicts from entering treatment. I've been on methadone for 23 years and my bones are just fine."
About the theory that methadone is genocide and social control for the black community, the patient related the following:
"Methadone saved my life. I would not be here talking to you if it were not for the methadone program. Those addicts that I knew in the streets who did not enter methadone programs are not here. About methadone being used to control black people -- what about welfare, that is a form of control they don't talk about that -- yet they wait for their checks. When people start talking about methadone in this way I just walk away. They don't know what they are talking about, and they will not change.
I used dolophines, they were small pills and were called 'Dollies.' I knew that dolophine is methadone. I used them when there was a heroin panic. The Germans perfected the drug, that's a fact. There were no rumors that 'dollies' rotted bones."
Another African American patient, married and with two children, a good job in management and attending graduate school indicated that the methadone clinics are viewed with suspicion. Methadone is regarded as genocide in the black community and he advised that this was:
"...understandable, but unfortunate considering the history of blacks in this country. I think that the Tuskegee experiment with black men who had syphilis has a lot to do with the suspicions about medical programs that are set up in the community."
A former methadone patient who is African American and with a graduate degree, married and with children attending college offered a different view:
"A lot of poor addicted blacks may not know about the Tuskegee experiment, and this is unfortunate since they should. However, I believe that the negative attitudes towards methadone are just the result of general suspicion about white programs and institutions in the black community. Also, the community sees unemployed patients loitering selling and using drugs -- so it (methadone) gets a bad reputation."
However, at the 1994 National Methadone Conference in Washington, D.C. a large contingent of African American patients, community leaders, program administrators and politicians including the mayor were very supportive of methadone programs (Town Hall Meeting, 1994). Although sharp differences of opinion were expressed about spirituality, methadone dose and duration of treatment, the tone of the meeting was devoid of extreme hostility (e.g., methadone is genocide). People, including patients were trying to reach a consensus about the program. One female patient who appreciated the program and the progress she made indicated that "although it is a form of bondage" she had changed her life on the program. African American patients were proud to be on the program and related their progress and accomplishments. Street myths were not enunciated except for one patient who did not know that dolophine and methadone were the same drug. One black female patient stated that "methadone patients should stop overdosing on anonymity and come out of the closet."
Nevertheless there were confrontations with Marion Barry (Barry was between terms). Barry is an advocate of 12 step programs and came out against long term methadone treatment. However, one of his election workers at the meeting admitted to being a current methadone patient and was on methadone when he directed the campaign in the district in which Barry received his greatest victory. Barry was aware that this man had used drugs at one time but was unaware of his status as a methadone patient when he was hired to direct the campaign in this particular district. Barry made no comment after the public disclosure. It is noteworthy that the patient found it easier to acknowledge his former use of heroin than his current enrollment in methadone treatment.
It should be noted that the initial efforts to lobby for the expansion of methadone treatment in New York State were led by two leaders in the African American community: Dr. Arthur Logan and James Haughton, a labor leader and the founder of Harlem Fightback. The late Dr. Logan was Duke Ellington's personal physician and a social and political force within the African American community. Ellington knew jazz musicians who were addicted to heroin and functioning normally on methadone. He introduced the patients to Logan who knew about their heroin histories and was impressed with their transformations as methadone patients. Haughton became aware of methadone treatment through members of Harlem Fightback who were methadone patients. The two leaders were personal friends and organized a citizen's committee (See Appendix, Cover Page of Proposal for Expanded Methadone Treatment). Led by Hogan, Haughton and Dr. Ray Trussell, the founder of the Columbia University School of Public Health, the group lobbied for funding and the expansion of methadone treatment. As a result of the efforts of this group known as CODA, Governor Rockefeller allotted $15,000,000 for the initial expansion of methadone treatment through the New York City Department of Health in the early 1970s.
However, at the same time there were groups within the African American community that perceived of methadone as a means of genocide and control of the poor. These sentiments were also held by Chicanos and radical whites. Many of the criticisms of methadone treatment were based on the social inequities of the country in the 1970s including the Vietnam War. Demands at the Fourth National Methadone Conference by these groups called for greater representation from the community in the control of programs and representation from the community in the planning of conferences.
At present leaders within the African American community are divided in their support of methadone. For example, in New York City, Representative Charles Rangel has not openly supported methadone treatment, while in Baltimore, Mayor Kurt Schmolke is an advocate of methadone treatment. There exists now a group of African American physicians including Dr. Janet Mitchell of Harlem Hospital, Dr. Edward Drew and Dr. Melissa Freeman of Beth Israel Medical Center, Dr. Lawrence Brown and Dr. Beny Primm of Addiction Research and Treatment Center (ARTC) in New York City who are strong advocates of methadone treatment. However, the community planning board of Harlem and other groups within Harlem are against the expansion of methadone programs as are groups in other communities.
Conclusion
The prejudice against methadone found among addicts mirrors the stigma that the media continues to present. The mythologies that abound among the untreated addict population are an example of the prejudice directed towards them being projected onto a medication which has been shown to be medically safe and effective.
The stigma against methadone is so pervasive that it has entered into the "molecules" of the medication itself. No other medication in the history of modern medicine has been so unjustly maligned. It is impossible to expand the program to control the spread of HIV among the addicted and to bring into treatment sufficient new addicts to control the current heroin epidemic.
The origins of stigma are varied but among them are: the control that programs enforce upon patients; the lack of education among methadone professionals, patients and the community; the media portrayals of poorly managed programs and sick dysfunctional methadone patients; the confused interweaving of social inequities with common addictive metabolic processes that span the spectrum of social and ethnic groups. Foremost is the reluctance of the community, professionals, untreated addicts and many methadone patients to recognize that compulsive narcotic addiction is a metabolic disease, not a character disorder, and that it can be effectively treated with a medication (methadone).
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Last Update: March 15, 2001 |
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