A Former Methadone Clinic Counselor

Q: Tell me about your job.
A: I was a counselor/case manager at a methadone clinic.

Q: What is methadone? I’ve heard the word but don’t really know what it is.
A: It’s a synthetic opioid. It can be used as a painkiller or prescribed to people trying to get off opiates. It blocks the opioid receptors so you don’t have to use heroin or painkillers because you don’t go into withdrawal.

People will be on it for decades, although it’s intended for MUCH shorter-term use; a lot of people are able to kick their addiction by taking methadone.

Q: So basically people switch from taking heroin to taking methadone?
A: Temporarily (ideally). For me, being on methadone is a medication, not “you’re still using drugs.” With methadone you’re able to live a normal life; you’re not worried about scoring or going into withdrawal, so you can address the psychological aspects of your addiction once you’re medically stable.

Q: And your job was to counsel people?
A: In order to receive methadone treatment, you had to come in from once a month to once a week for counseling, depending on if you had Medicare or paid cash.

Some people were on methadone and hadn’t used in 25 years and would just say, “Well, I’ll never get off, I’m used to it.” And with those people we’d just talk about their jobs or their kids.

Q: Did you ever feel like you were in danger?
A: Most people were really nice. A lot had old gang tattoos.

Of the people who’d been on heroin (most of my clients), almost all had a criminal record.

One time there was a guy who came in and had a psychotic break. I’m short, and this guy was a foot and a half taller than me. He came in wearing a bathrobe with definitely nothing underneath it, and UGG boots. He swore his brother put meth in his methadone. He was completely pleasant, though. They told me to keep him in my office, by myself; I wasn’t particularly afraid.

Q: Did you get a sense for why most people did heroin in the first place?
A: Out of probably 100 people, only one started for fun.

They rest started because they had shitty lives. Others were in so much pain that they started on painkillers, but they were in so much pain that they eventually used heroin to help with it.

Q: What is methadone like? Is it a pill or?
A: We used the cherry-flavored liquid form that you mix with water. I did actually taste it. EVERY milligram had to be accounted for, even the teeny bit at the end of the bottle. One time though, one of the nurses was disposing of the dregs and I stuck my pinky in to taste it. It is so disgusting, so gross.

Q: What was your daily routine like?
A: The hours were 5 am-1:30 pm. We’d have lunch at 9:30. It was like, sweet! Time for a burrito!

I had 70 clients on my caseload. It took forever to remember who everyone was. I really liked my clients. I left two and a half years ago and some of them I still think of often. I wonder which client is getting dosed right now.

Q: How long were you there?
A: I was there for a year and a half. I have a master’s degree and the pay was like it would be for an upscale store at the mall. The caseload was high, the pay was terrible, the hours were terrible, the managers were terrible…

I learned a lot about addiction and about humans in general though.

There was this one couple that would come in—it was a young woman and her boyfriend and they were both using heroin. The woman told me her boyfriend decided to inject it into his penis and it started swelling up and turning purple. He was freaking out and they were driving to the hospital and he thought they’d have to amputate his penis. I mean it was blown up like an eggplant!

But he still kept using after that. Basically you feel guilty about using, and then in order to not feel bad, you use more.

Q: Did you ever see someone get “cured”?
A: I saw people who were a mess get clean. One woman used heroin while she was pregnant, up until two weeks before the baby was born. The baby was OK and she got clean after that and would bring the baby with her. She was a really good parent.

Q: Were there other crazy people you had to deal with?
A: Another guy had a skin condition all over his body and he was like, “I have it everywhere, it’s bad on my legs. Let me show you.” And started undoing his pants. I was like, “Nononono!” He collected all kinds of money—he was fascinating…

There was another guy—a 71-year-old guy who lived in his truck. He was homeless and never showered, and he’d be in my little room for an hour, and I had to sit there with a hand to my face. He was off heroin but he was using crack a few times a day because his back hurt. I would tell him, “Normal people don’t use crack for a back problem.” He refused to see a doctor.

He was really religious, so I’d try, “How would God feel?” I was thinking, there is no way God would be like, Good job dude, keep it up.

Q: It must be tempting to want to help people.
A: I used to live in a place that had a carport. There was a guy who would hang out there and say to himself, “I am the best jazz musician IN THE WORLD!” I would be wondering why, if he was the best jazz musician, why was he rooting through my trashcan.

I decided to make him a peanut butter sandwich, and I took it to him. He said, “Is this going to give me diarrhea?” He told me he thought his parents were going to kill him, and then he told me he loved me.

Q: I wonder why he was so afraid of diarrhea.
A: Well, he’d leave diarrhea in the carport… and leave toilet paper on it.

Q: Oh no. Was that before or after you gave him the sandwich?
A: Before.

Q: And you’re sure he was the one pooping in the carport?
A: I’m pretty sure he was the one, because I could hear him having it.

Q: Noooooo!
A: It was a little secluded, so I think it was a good place for him to go.

Q: Oh god. Back to the job. Do you remember your last day at work?
A: I was very close with the last patient I saw, he was my favorite. We were both crying.

When I finally got out to the car I broke down in a combination of laughing and crying. I kept repeating, “I’m finally fucking leaving.”