by Peter Biskind
Cut, no. 5, 1975, pp. 9-11
The New York Times of August 16, 1974, reports:
These statistics suggest that history, with a particularly macabre grin, may be repeating itself. Heroin was initially developed in 1898 as an antidote for morphine addiction. The startling revelation of widespread methadone poising sums up the paradoxical consequences of methadone use in the treatment of heroin users. The cure is worse than the disease. METHADONE: AN AMERICAN WAY OF DEALING, a new film by Julia Reichert and Jim Klein, provides a devastating indictment of methadone programs. It marshals an impressive amount of evidence which suggests that methadone is at best ineffective and at worst dangerous. Before discussing the film, I will put methadone treatment in historical perspective.
Methadone maintenance is the latest fashion of the drug rehabilitation industry. Methadone advocates propose to solve the problem of narcotics addiction by substituting a legal drug (methadone) for an illegal one (heroin). If this seems like a purely formal solution, it is one characteristic of the topsy-turvy world of drugs.(1) Social attitudes towards drugs are a good example of arbitrary distinctions of an essentially cultural nature masquerading as medical fact or legal fiat. Good drugs are those employed in the treatment of disease. Bad drugs are those used for other purposes. Good drugs are safe; bad drugs are dangerous. Good drugs are medicine; bad drugs are narcotics, No one disputes that narcotics are dangerous. But so are many other drugs in common use that have gotten a clean bill of health. If the welfare of drug users were the primary criterion for discriminating between different types of drugs, why is the use of addictive substances like alcohol and tobacco, which both constitute greater health hazards than heroin, not only permitted but encouraged? One is tempted to suggest that drugs defined as good and safe are those manufactured and controlled by the drug companies. Drugs beyond their control, imported from foreign competitors, are bad and dangerous.
There is a substantial flow of so-called legitimate drugs like amphetamines, hallucinogens, and tranquilizers out of the United States to foreign markets. In fact, foreign sales account for about 25% of drug company profits. Compared to this, the trickle of “illicit” drugs into the United States from places like Turkey and Southeast Asia is negligible. The inflow of “hard” drugs is reprehensible. But the outflow of “soft” drugs is just good business—like the 10,000,000 capsules of Park-Davis’s chloromycetin, a dangerous drug known to produce fatal anemia, purchased by the Defense Department for the use of South Vietnamese soldiers and civilians.
Since 1914, when the Harrison Act was passed, heroin has been regarded as an illegal substance, and heroin users as criminals or, in the popular usage of pulp films like REEFER MADNESS, “dope fiends.” The effect of defining narcotic addiction as a problem of law enforcement has been to make it one. When heroin ceased to be easily available, its price skyrocketed on a new and vigorous black market. Users unable to support the cost of their habits (in the neighborhood of $10,000 to $15,000 a year) on income derived from legitimate work were forced to crime. The immense profits derived from dealing hard drugs guaranteed mob control of narcotics. What the Mafia lost through the repeal of Prohibition, it recovered through the criminalization of drug use.
The law enforcement approach to drug addiction has been a failure. In 1970, New York City narcs made 7266 “buys” that netted 4000 arrests but only 4.97 pounds of heroin were confiscated (as against an annual consumption estimated as 10,000 pounds). And most of that, as we know from the French Connection scandal, shortly reappeared on the streets courtesy of enterprising members of the NYPD. According to a government report, the United States has managed to seize only 6% of incoming heroin shipments. The heroin business has continued to thrive—despite, and perhaps because of the creation of a bloated narcotics bureaucracy and the dramatic talk of task forces, crash programs, and emergency measures. Although figures in this area tend to be unreliable, there are estimated to be anywhere from 300,000 to 600,000 heroin addicts in the United States. In the last 20 years, the number of addicts has risen by 300%.
According to Forbes Magazine,
With profits like these, no wonder the drug companies want a cut. Last year the United States paid Turkey $35,000,000 to suppress its opium crop. In effect, our government was erecting a protective tariff against foreign heroin, thereby subsidizing the domestic methadone market, dominated by such corporate giants as Eli Lilly and Malinckrodt Chemical.
As long as the drug problem was confined to inner city black and brown ghettoes, the law enforcement model was satisfactory, inadequate as it was in actually staunching the flow of drugs. In fact, as spokespeople for Third World groups have repeatedly charged, the situation it created was actually desirable. Doped-up and nodded-out slum dwellers were not likely to stir up much trouble. Also, narcotics traffic provided a plausible excuse for keeping large numbers of police on occupation duty in black and brown communities from Harlem to Watts. And it provided the police with substantial supplementary incomes. There was something in it for everyone.
In the mid-50s, however, this situation began to change. Forays by addicts against white middle-class property became increasingly frequent. White middle-class kids were mugged in the halls of their schools. Their parents could no longer walk in safety down the poorly lit streets of their own neighborhoods. Worse than crime, addiction began to penetrate middle- and upper-income suburbs, heretofore the exclusive preserve of alcohol addiction. By the 60s, significant numbers of middle-class kids were becoming junkies. The subsequent hue and cry for law and order does not need to be documented. Politicians responded with a flurry of repressive legislation—30 years for possession of one joint and so on. But, as in earlier periods, the police reply was more effective in harassing small time users and pushers than in making a dent in the mob controlled hard drug market,
As the public outcry grew louder, the liberal medical establishment, grown fat on New Frontier and Great Society programs, stepped in to take the play away from the law enforcement boys. Since the effort to control drugs had failed, reasoned the liberals, why not control drug users instead.
Suddenly we hear that drugs are not a law enforcement problem after all. They are a medical problem. Addicts are not bad, they're sick. They're not criminals but patients. They belong not in jails but hospitals. Social control of users is both more humane and more effective than the draconian measures recommended by rock-ribbed reactionaries and opportunistic politicians trying to stay one jump ahead of their outraged constituents. Give us the grants, urged researcher-entrepreneurs, and we'll show what we can do. We'll turn out a cheap, simple, technological solution to a stubborn social problem that no one has been able to solve.
In 1963, they did just that. Drs. Vincent Dole and Marie Nyswander of Rockefeller University pulled in a modest $100,000 grant from the Health Research Council (Dole was chairman of its addiction subcommittee) which they parlayed into a grant of $1.4 million two years later. The result was methadone.
Methadone is a synthetic addictive narcotic, three to four times stronger then heroin. It was, bizarrely enough, developed by I.G. Farben in Germany during the Second World War as a substitute for morphine which became scarce after the Werhmacht was driven out of North Africa. Its original name, dolophine, is reputedly derived from the name Adolph. Dole and Nyswander discovered that large doses of methadone “blocked” the heroin high and eliminated heroin withdrawal symptoms. Since methadone is so much more powerful than heroin, a small amount will block a much larger amount of heroin. For example, a daily dosage of 100 replace a 400 mg. daily dose of heroin, a $75 to $100 a day habit. Moreover, unlike heroin which requires increased dosages to ward off withdrawal symptoms, methadone intake can be stabilized at a uniform level. It can be maintained at this level for an indefinite period of time, allegedly with few ill effects. When taken orally mixed with Tang (synthetic fruit) soft drink, methadone eliminates the craving for heroin, and allows users to function normally. One expert claims that a person maintained on methadone would be perfectly able to serve as an airline pilot.
Dole and Nyswander believe that heroin addiction causes a “metabolic lesion,” that is, a permanent biochemical change in the addict which results in turn in a permanent biological need for narcotics. This means that the addict will require methadone for the rest of his life. Hence the term “maintenance.” Although methadone has been used as a method of detoxification, with gradually diminished dosage leading to total withdrawal, Dole and Nyswander claim that the high rate of return to heroin addiction proves that detoxification is impossible and that therefore their metabolic theory is correct.
Advocates of methadone maintenance claim impressive results. Former heroin addicts maintained on methadone are able to hold down jobs and lead normal lives. The rate of return to heroin addiction is low, and crime rates in areas serviced by methadone programs have fallen significantly. Critics of methadone fall into two camps. Radicals attack the program as addict pacification. Conservatives bridle at the notion of free access to narcotics and demand tighter regulation or, better, a return to the law enforcement model. Both ends of the spectrum tend to agree that methadone maintenance merely substitutes one kind of addiction for another. They both think there is very little hard evidence to support the Dole-Nyswander theory of a biochemical need for narcotics. They agree that methadone programs are responsible for a large number of “primary” methadone addicts (non-drug users who turn on for the first time with methadone). And they argue that methadone is a potentially dangerous drug which has not been sufficiently tested.
Much of the debate over methadone is carried on in medical and social policy journals or in interagency memos by people who, for the most part, neither know nor care very much about the lives of those who are drug rehabilitation programs’ guinea pigs. Resource allocation is dictated mostly by institutional clout and bureaucratic infighting within the rehabilitation industry, which now employs more than 1,000,000 professionals and paraprofessionals. Money spent has little to do with competing programs’ relative merits.
Julia Reichert and James Klein’s excellent new film METHADONE: AN AMERICAN WAY OF DEALING, provides us with a glimpse of the realities which lie behind the statistics.
The first two-thirds of the film present a profile of the methadone program of Dayton, Ohio, The Dayton clinic services 400 people a day from a wide area. These people are mostly black, young, and poor. From a montage of verité scenes and interviews with program participants emerges a bleak picture of people trapped by their own need for drugs into a dependency on the rehabilitation bureaucracy which satisfies that need. The film attacks the program on a number of fronts:
•The regulations which govern the clinic degrade and demean the people whose needs it serves. Patients are often kept in ignorance about the nature of the treatment. They are consequently confused and resentful.
•Supplementary counseling services are inadequate. The counselors themselves are frequently pushers.
•Methadone does not block the craving for heroin, Many addicts remain in the program only long enough to cut down their heroin habit to manageable proportions. Then they go back into the streets and heroin addiction. Others regularly take barbiturates and amphetamines as supplements to methadone.
•Methadone maintenance addresses itself to the symptoms, not the causes of addiction. It fosters the illusion of cure without the substance. For those who don't go back to heroin, methadone addiction is just as bad. As one person says: “You get hooked on it worse than you do heroin ... You're in as bad shape really as what you was then except you don't spend no money on it.” When Reichert asks another addict: “How long were you shooting drugs before you decided to quit?” he replies: “I never decided to quit—I'm still taking the drug ...I'm still dependent on drugs ... I have to come here every day for it ... If I was drug free—that'd be something different.”
•Methadone is relatively untested. Long term use of the drug may well-be dangerous. Short term side effects include nausea, constipation, loss of sexual desire, aching joints, nodding, and excessive weight gain. One woman interviewed gained 140 pounds during the course of one year’s treatment. The film shows patients nodding out and falling asleep during a therapy session.
•Dependency on government dispensed narcotics is a particularly diabolical form of social control, disguised as it is as therapy. (As one man puts it: “You have to have something that they got.” ) Methadone maintained addicts are the drugged drones of the brave new world. Many patients are remanded to the program by a judge. Thus they are subject to the triple supervision of program counselor, parole officer, and welfare worker. They must report as much as once a day, five to seven days a week, for the privilege of drinking their daily cup of Tang laced with methadone. The course of “treatment” follows the assumption that guides the program: it may well last the remainder of the user’s lifetime. During the course of this “lifetime” treatment, the addict knows that his supply may be cut off any time his behavior displeases any functionary of the innumerable bureaucracies under whose jurisdiction he falls. This is by no means an idle threat. Several program administrators have made treatment conditional on patients relinquishing membership in “extremist” community or political organizations. In Washington DC the police and courts regularly request from methadone clinics—patients’ photographs, clinic records, and personal data. Cops routinely ask for patients’s names and addresses in the hope of serving outstanding arrest warrants. (It is true that several clinic directors have preferred jail to relinquishing confidential files to the police. Dr. Robert Nean, director of New York City’s methadone program, was sentenced to 30 days for refusing to turn over one clinic’s photos of all black patients between the ages of 21 and 35.)
Reichert and Klein’s film is most valuable, perhaps in giving a glimpse of the social dimension of the drug problem, one that is notably absent from the methadone debate. Dayton is an industrial town, and many methadone users, like their fathers, work on the assembly line at dull, routine jobs. Methadone offers them their only relief. Drug rehabilitation bureaucrats speak glibly in the film of methadone maintenance patients resuming “productive” lives. Of course this fantasy presumes a plethora of challenging jobs readily available to demoralized and unskilled young people. In reality, as the film graphically shows, methadone does free addicts from the necessity of stealing and hustling to support their habits. But this new freedom plunges them into the barren world of the economically marginal. They shuffle from their bare, one-room walk-ups, to the clinic and back again. The listless long-haired white users whom Reichert interviews monotonously repeat in flat, affectless voices identical tales of boredom and anomie. While they talk the camera pans around their rooms, revealing the inevitable black and white TV, the board games, the blond wigs and stuffed animals, the ironing board leaning against the blank wall. One woman describes her day:
The blacks whom Reichert interviews reveal a vein of humor and vitality that massive doses of methadone have not yet been able to efface. One man caps a dismal account of how he spends his day with a brief spark of enthusiasm: “Oh, I smoke a reefer every night.” Hardly the budding airline pilots pictured by the methadone entrepreneurs. Another black man’s experience sums up the social reality which methadone advocates prefer to ignore:
When all is said and done, perhaps the most telling charge that can be made against methadone maintenance (regardless of the pros and cons of its effectiveness in blocking heroin or its potential danger to the people who use it), is that it is an addictive narcotic. It fosters dependency, low self-esteem, and general demoralization. This may be fine from the standpoint of a society that has never put a high premium on independence or initiative, especially among its dispossessed. In this respect, methadone is just what the doctor ordered. But if the goal of drug “rehabilitation” is not merely heroin withdrawal but the development of autonomous individuals, secure in their self-respect, confident in their judgment, aware of the social conditions that encourage drug addiction, and determined to change those conditions, then methadone maintenance is not only a failure, but dangerous as well.
AN AMERICAN WAY OF DEALING is designed to be used in two parts.I found this attempt to break down the passive relation between film and viewer effective. The portion of the film on the Dayton clinic is to be followed by a discussion. The deadend reached here leads inevitably to the second part of the film—an examination of a drug free program in Washington DC, called RAP, Inc.
RAP is a “therapeutic community” containing about 80 people who share living space and work tasks. The therapy consists mostly of encounter group sessions which encourage people to find the origins of their addiction in their own hang-ups, which are in turn placed in a political and social context. The therapy sessions are supplemented by classes on a variety of subjects, which qualify addicts for High School Equivalency diplomas and prepare them for life outside the program. RAP is largely community supported (it is disqualified for government subsidy by its refusal to use methadone). In turn, it services the neighborhood in which it is located with lunch programs and so on.
The film exchanges the sharply critical analytical attitude which it adopts towards the Dayton methadone program for a kind of sentimental lyricism which it adopts towards RAP. In this way the film loses some of its persuasiveness and begs some important questions. The RAP program with its political slant and warm atmosphere of self-help and mutual support must have seemed ideal after the dispiriting Dayton experience. But it is precisely the virtues of the drug-free therapeutic program that raise questions the film doesn't ask. Critics of therapeutic communities point out that their members become hooked on the community, much as methadone users get hooked on methadone. When the emotional props provided by the group fall away, the shock frequently drives the members back to heroin. Moreover, the film seems to feel that the political consciousness fostered by the program is sufficient to overcome the experience of powerlessness and despair attendant on the struggle for survival at the bottom of the capitalist heap. The dismal picture painted by the first part of the film makes this questionable.
The film’s failure to look as closely at RAP as it looks at the Dayton clinic is betrayed by its reliance on voice-over narration, which gives the program members’ more political utterances a slightly rhetorical flavor. The film tells where it should show. Had the filmmakers been willing or able to follow a detoxified RAP graduate back into the world, this section would have been strengthened immeasurably. On the other hand, the RAP sequence does contain some good footage of a therapy session, which conveys quite well the mixed sense of criticism in a context of emotional support that characterizes RAP’s approach.
It should be stressed that the strengths outweigh my reservations. Whatever weaknesses the film has are minor compared to its virtues. METHADONE: AN AMERICAN WAY OF DEALING takes a long hard look at the methadone problem. It conveys an impressive amount of information about a complex subject in a direct and economical way. It is consistently absorbing. Alicia Weber’s camerawork, self-effacing and straightforward, avoids the twin pitfalls of easy lyricism and palsied verité. The pacing is good, the editing precise. The music, “structured” by Bill Conway, as the credits say, is used to good effect. The film will be invaluable not only for drug users, health workers and community groups, but for anyone concerned with the methadone pacification program.
Distribution: METHADONE: AN AMERICAN WAY OF DEALING is available from P.O. Box 315, Franklin Lakes NJ 07417.
1. For a discussion of this aspect of the drug problem, see Howard Moody, Village Voice, September 14, 1972:
2. Health-PAC Bulletin, June, 1970.