People on methadone maintenance treatment (MMT) are in a difficult position. I should know since I’ve been on it for close to 20 years. They are caught in the space between a program that helps them in a way that is primarily pragmatic – by providing access to a safe and consistent supply of opioids outside of the difficult and dangerous conditions created by prohibition/criminalization – and our culture’s need to frame everything drug related through the ideological narrative of “addiction” and “recovery.” In short, MMT enables criminalized drug users to decriminalize their opioid use, and yet, like the emperor who wears no clothes, it must publicly masquerade as a “treatment for addiction” so as to not disrupt the War on Drugs ideologies that require firm distinctions between “drug” and “medicine”; “addict” and “non-addict”. It’s no wonder that people end up a little confused.
In Methadone: An American Way of Dealing, work is everywhere. Dayton, Ohio, the film’s primary location, is introduced to us as a “manufacturing community” beset by crime. These two types of work—factory and crime—come up again and again while we are in town. Straight work, at GM, or at a foundry, leads to getting high just to bear it, to “paint over the factory,” as one young worker puts it, and get through another soul-killing shift. Staying in the plant and getting by on methadone instead is tough. We meet only one worker doing this; he is trying to taper off and not making it, missing shifts for the first time because he feels so low. We meet many workers who have chosen to stay outside the factory, period, and stay high all the time. They claim they are living a better, more real life than their fathers did, trooping into factories every day with their coveralls and lunchboxes, “sheep” meekly accepting their slaughter. As the film notes, with its passing shots of street preachers and sex shows, the straight life is studded with its own addictive consolations. Dayton, we are told, has “1000 bars and just one [methadone] clinic.”
In 1976, the East German government stole and repurposed for its own broadcasts a copy of Julia Reichert’s and James Klein’s documentary film, Methadone: An American Way of Dealing. The theft was clumsy, almost unabashedly so, in the way that GDR intrusions often could be. Reichert and Klein had submitted the film for consideration in the 19th annual Leipzig Documentary Film Festival, but it was rejected for having been delivered to the committee after the deadline. When the film print was returned to the directors, it obviously had been cut and only partially reassembled. The original reels on which it had left the U.S. were gone, replaced by film cores. The leaders (the length of cellulose attached to the beginning or end of a film to assist the projectionist) were in German, not English. To add insult to injury, the package arrived with an exorbitant bill for cash-on-delivery shipping.
I’ve watched Methadone: An American Way of Dealing five times now. Each time, I’m taken aback by how skillfully directors Julia Reichert and James Klein present this moment—a period of peak tension in the addiction treatment community. By 1974, when the film was released, the early promises of methadone were butting up, often painfully, against the era’s difficult realities. Through interviews with patients at the Dayton, Ohio, Bureau of Drug Abuse clinic (BUDA) at the center of the film, Reichert and Klein make it clear that methadone, once hailed as the solution to the decade’s twin problems of addiction and crime, couldn’t overcome the era’s other issues: deindustrialization, Vietnam, and America’s trends toward atomization and its concomitant political right turn.
Time has a way of turning lived experience into memory and from then into stories that seem, by turns, improbable and fantastical (yes, kids, I used a typewriter to prepare my college research papers!). In the improbable category, one might include my attendance at the Yale School of Medicine’s conference marking the centennial of heroin, held in New Haven from September 18-20, 1998. Organized by the late David Musto, billed as a sweeping review of the heroin’s past and present, it lives in my memory as reunion of Nixon administration drug policy alumni. Egil “Bud” Krogh was there, handing out copies of his short volume The Day Elvis Met Nixon, which described in detail the culturally resonant meeting that Krogh helped arrange (a meeting in which the King asked the President for a federal drug enforcement badge). Daniel Patrick Moynihan was there, delivering an opening-night address that embarrassed some of us younger historians in the audience with its confident declaration that no one had heard of a drug problem back in his childhood days. And, of course, the Special Action Office for Drug Abuse Prevention (SAODAP) was well-represented, with both of its Directors—Jerry Jaffe and Bob DuPont—in attendance and giving presentations. In between the addresses and presentations—for which junior folks like myself had been invited to offer commentaries—they told stories, especially methadone stories.
“To what extent can social problems be circumvented by reducing them to technological problems? Canwe identify quick technological fixes for profound and almost infinitely complicated social problems, fixes that are within the grasp of modern technology and which would either eliminate the original social problem without requiring a change in the individual’s social attitudes or would alter the problem as to make its resolution more feasible?”
Dorothy Nelkin asked the questions above in her slim volume, Methadone Maintenance: A Technological Fix (New York: George Braziller, 1973), where she argued the practice would have a tenuous future as a “chemotherapeutic ‘fix’” for heroin addiction. The latter, she wrote, was an “adaptive response to real and overwhelming social or psychological difficulties that cannot be resolved by a simple technological fix” (3, 152). But methadone was no simple technological fix. Programs developed in a “climate of conflict extending from the level of policy down to the actual operation of individual clinics” (8). The Dayton, Ohio, methadone clinic where James Klein and Julia Reichert shot their film Methadone: An American Way of Dealing is a Black space full of energy and music—even as no-nonsense white nurses refuse to disclose to Black patients the dosage they are serving up in their “free cup of methadone.”
Welcome to the home page for the Points Methadone Marathon!
January marks ten years since the launch of the Points blog, and to celebrate this historic milestone, we’re invoking another, larger anniversary: passage of The Drug Abuse Office and Treatment Act of 1972 (Public Law 92-255). The ramifications of this law were far-reaching, not only in the “war on drugs” but also in the less-scrutinized evolution of substance abuse treatment. Methadone was the place where theorists of criminal justice and treatment met and—briefly—danced. In the shadow of the radical critiques both had suffered during the 1960s, they looked to find a cost-effective and empowering way to combat heroin addiction. But like so many grand ideas from this particular moment in time, things didn’t quite work out according to plan.
The reasons for that are many, of course, and the ramifications are legion; the Points Methadone Marathon aims to unpack them all. We kick off with an exclusive screening of James Klein and Julia Reichert’s outstanding 1974 film Methadone: An American Way of Dealing. This cinema verité classic was deemed too controversial for wide release back in the day, and has long been out of circulation. Thanks to the generosity of James Klein, you can see it here now at the link embedded below.
Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.
We have told ourselves the “opioid crisis” is an exception to past drug scares. In the past century, the narrative goes, we relied on law enforcement and punishment to curb widescale drug use, but our country now has turned over a new leaf—one centered on public health and compassion. Had it not been for Purdue Pharma, a uniquely bad actor, the spread of addiction and overdose deaths would have never occurred.
None of this is true. Rhetorically, yes, smart politicians now deemphasize the punishment aspect in public speeches. But law enforcement plays a greater role than ever before in regulating the use of drugs—from the zealous policing of some people who use illegal drugs to expansive prescription monitoring programs and from the detailed cataloging of the dosage of Americans’ medications to DEA to threats to doctors who fail to obey their dictates. Such strict and exacting regulations often leave elderly patients and patients with chronic pain out in the cold unable to secure necessary drugs. Yet, at the same time, prohibitionist drug control measures have also done little to stop the proliferation of black-market drugs.
Far from being a deviation, this has long been the norm and with often devastating results. Regardless of your thoughts about current events, this post will let us look back and travel to the past to try to clarify why overdose deaths continue to increase now despite a dramatic recent decrease in opioid prescriptions. And why this situation unlikely to change under current conditions. For about the last century, the United States government has abided by a philosophy that seems to prioritize drug abstinence and the strict policing of drug use at the expense of saving lives. To investigate this continuity, I will briefly examine two episodes: a 1930s critique of an early version of the war on drugs and the government’s opposition to needle exchanges during the AIDS epidemic of the 1980s.