To a US Methadone Recipient, Visiting Australia Was Shocking

The author, Danielle Russell, during her visit to Australia

At Users News we often hear stories about people facing stigma when accessing OTP services. However, there’s always somewhere worse, and if the issue is stigmatisation of people who use drugs, that somewhere is often the USA. Danielle Russell, a harm reduction activist from Phoenix, Arizona, was in Australia last September as keynote speaker at NUAA’s Peers and Consumers Forum. While she was here, she was with a Users News staff member when they were picking up their methadone. She was totally blown away by the fact that our staff member was treated like a human. She wrote this article for Filter magazine when she returned to the US.

Asking for help requires humility, but you shouldn’t have to humble yourself into the dirt and kiss someone’s feet to get it. When it comes to methadone clinics, that’s exactly what’s required every day.

When I first got into a clinic almost 10 years ago, I just felt lucky. I’d slept outside the first clinic I tried to get into, to be one of the first few in line on intake day, only to be turned away when I disclosed my chronic leg wounds. The clinic doctor told me that methadone would alleviate some of my physical pain, but that I needed to be in pain so I would “seek help.” I’d been under the naive impression that they were “help.”

At the next clinic, I made sure to not mention any of my health problems, and I got in. Thankfully, an older, experienced provider quickly raised my dose to a level I felt stable at. With the newfound stability of access to a safe supply of opioids, I managed to register for classes at my local community college, where I got my associate’s degree. I had to attend the clinic every single day, but I was so happy to have control of my life again that I made excuses for what I now recognize as abusive and controlling behaviour.

Even though I was eventually permitted to receive take-home doses that I only had to pick up once a month from the clinic, they never let me forget the precarity of my situation and how much control they still wielded over my life.

I continued with school, eventually transferring to Arizona State University, where I completed my undergrad and master’s degrees. I’m now a PhD candidate, hoping to finish my doctorate next semester. With other people who use drugs, I’d become involved in mutual aid work. I even recently won an award, which offered me the opportunity to travel to Sydney, Australia and Glasgow, Scotland this fall.

I was beyond excited, but the clinic was quite the reality check.  Several months before my travel dates, I began asking staff to help ensure I could pick up my monthly doses at a time that wouldn’t impact my plans. It felt very inappropriate to be almost 40 years old and having to ask permission to travel—especially from a total stranger at a medical clinic. They left me with that too–familiar feeling of precarity up until the very last moment. Not until the week before my flight did they finally decide to adjust my pickup date.

In Australia, I had the privilege of meeting so many incredible people who use drugs and are doing amazing work and activism. I also had the chance, in Sydney, to go with someone to pick up her methadone. A big difference to my own past experiences was that we would be doing this not at a clinic, but at a pharmacy.

I was nervous as we walked together that day. I knew my clinic would never let me bring someone with me to pick up my doses. Some clinics don’t even allow parents to bring their children inside. My Australian friend also had her dog with us. My clinic seems to hate dogs and children. But she seemed quite confident about what we were doing, so I ignored my fears and followed along.

When we got to the pharmacy, she set her dog down and the pharmacist cheerfully greeted all of us while her dog comfortably explored and sniffed the aisles. He already had my friend’s methadone in a bag—a couple of weeks’ supply ready for her to pick up.

He even knew her name, which stood out to me. Because even after being at the same clinic for so many years, with the high turnover and lack of personal care, no one knows my name there.  

The clinic has assigned everyone prison-like ID numbers, an extra layer of impersonal disregard.

I listened in on the conversation. My friend had mentioned that she owed the pharmacy some money, and wouldn’t be able to pay that day either. I felt anxious, thinking of how the clinic back home immediately starts tapering and rapid-detoxing anyone who can’t pay their fee on time. I’ve watched enough people crying uncontrollably in the clinic waiting room after being unable to pay to know how they operate.

But the pharmacist seemed fine for my friend to wait until her next payday to settle her account. I heard her making unconcerned small talk, asking him about his family. I suddenly felt like crying, so I tried to focus on the dog sniffing the display of ointments.

As we started to leave, I quickly pulled myself together, embarrassed that seeing someone treated with basic dignity and kindness while getting their methadone could trigger such an emotional reaction from me. The pharmacist waved as we were leaving, but my arms just felt like heavy lumps at my side.

Afterwards, I asked my friend and a few other people about how they get drug tested. One person said that they had been on methadone for seven years, and another 10. Both had only been drug tested once, when they first started on methadone.

This experience was unrecognizable to me. I was “randomly” drug tested every single Thursday for the entire year of 2021. Even though I had years of drug tests showing methadone-only preceding that year.

While I am incredibly happy for my Australian friends that their experience is so much more humane than my own—and I understand that not everyone in Australia has such positive experiences getting methadone there—I also feel, even as I reflect on this now, utterly sad.

At my clinic, they even paternalistically refer to getting any extra take-home bottles of medication as “privileges.” I may have many privileges in life, but access to a few bottles of medication is not one of them.

When I got home, going back to the clinic with its embedded culture of cruelty was harder than ever.  The stark contrast of the kindness and accessibility I saw in Australia to the intrusive and abusive treatment we endure here in the States was impossible to ignore.

Since that time, years ago, when I felt lucky just to have got into a clinic—and, like many others on methadone, made excuses for the abuse I experienced—my gut sense that I deserve to be treated with respect and kindness has only intensified.

Going to school has helped me in many ways—like giving me a sense of self-worth and confidence that I lacked all those years ago when I slept outside a clinic.  It has become ever harder to accept paternalistic and controlling demands—and especially the precarity of my take-home doses.

December 13 was my pickup day at the clinic. It also ended up being my last day there. Because even though methadone has been life-changing for me, I can no longer abide the cruelty with which this medication is dispensed. So I made a conscious decision to walk out, and take my chances with trying to finish tapering off opioids with drugs I buy on the illicit market. I’m done trading my dignity for safety.

After years at that clinic, no one even noticed as I walked out. Why would they? No one there even knows my name.

I saw that a better way is possible. I deserve better. We all do.