doses every few hours. Instead, they were happy with the same dose once a day, which could carry them through the next twenty-four hours. Methadone addicts could actually discuss topics unrelated to dope. This was not true of heroin addicts, whom Dole found tediously single-minded in their focus on the drug. Dole believed addicts could be maintained on methadone indefinitely, and that with one dose a day they could function as normal human beings. In 1970 in New York City, he opened the first methadone clinic for heroin addicts.
Dole believed that rehabilitation was dependent on human relationships—group therapy, 12-step meetings, and the like. But as a last resort for those who defied all efforts to kick the habit, methadone, Dole believed, could be a crutch, helping them through life.
President Richard Nixon permitted methadone as a treatment for heroin addiction, which plagued many soldiers returning from the Vietnam War. By the late 1970s, federally regulated methadone clinics were popping up around the country. These clinics quietly showed how a narcotic might be dispensed legally in a safe, crime-free environment. Methadone stabilized an addict and allowed him to find a job and repair damaged relationships. There were also no dirty needles, no crime, and addicts knew they couldn’t be robbed at the clinics. What’s more, methadone undercut and replaced the street heroin dealers’ trade with a clean, well-lighted place for opiates; everyone was better off.
Methadone clinics opened before sunrise. One reason for this was that many addicts, looking for trades easy to enter, had become construction workers, carpenters, painters. They had to get to these jobs early. Methadone users were like ghosts, showing up early in the morning for years on end, drinking their dose, and silently going about their lives. In time, though, methadone became a battlefield between those who thought it should be used to wean addicts off opiates, and those, like Vincent Dole, who saw it as a lifelong drug, like insulin for diabetics.
One strategy or the other might well have worked. But the worst of both emerged at many clinics. Methadone was often dispensed as if the goal was kicking the habit, with small doses. But as methadone clinics became for-profit affairs, many cut the counseling and therapy that might help patients kick opiates altogether. Critics could be forgiven for seeing some clinic owners as drug dealers, stringing patients out for years, and charging twenty and thirty times what the drug actually cost, which was about fifty cents a dose. In 1990, the U.S. General Accounting Office reported that half the clinics were poorly managed, unaccountable, and provided little counseling or aftercare.
The result was that many methadone clinics maintained core populations of opiate addicts in cities all across the country, but on doses that were too small, and usually without much therapeutic support. Addicts who weren’t given high enough doses craved another opiate later in the afternoon, after the clinics closed. They had to find their dope elsewhere, usually on the street, and thus remained tied to the heroin underworld. At clinics that combined low doses and insufficient rehab therapy, addicts took to using methadone and heroin interchangeably.
Methadone was a better alternative to weak powder heroin, which was more expensive and available only in dangerous housing projects or skid rows. But maintaining large numbers of people on any kind of opiate, particularly on low doses, made them easy prey for someone with a more efficient and convenient opiate delivery system. For years, though, no one could conceive of such a thing: a system of retailing street heroin that was cheaper than, as safe as, and more convenient than a methadone clinic.
But in the mid-1990s, that’s exactly what the Xalisco Boys brought to towns across America. They discovered that methadone clinics were, in effect, game preserves.
Methadone clinics
Dole believed that rehabilitation was dependent on human relationships—group therapy, 12-step meetings, and the like. But as a last resort for those who defied all efforts to kick the habit, methadone, Dole believed, could be a crutch, helping them through life.
President Richard Nixon permitted methadone as a treatment for heroin addiction, which plagued many soldiers returning from the Vietnam War. By the late 1970s, federally regulated methadone clinics were popping up around the country. These clinics quietly showed how a narcotic might be dispensed legally in a safe, crime-free environment. Methadone stabilized an addict and allowed him to find a job and repair damaged relationships. There were also no dirty needles, no crime, and addicts knew they couldn’t be robbed at the clinics. What’s more, methadone undercut and replaced the street heroin dealers’ trade with a clean, well-lighted place for opiates; everyone was better off.
Methadone clinics opened before sunrise. One reason for this was that many addicts, looking for trades easy to enter, had become construction workers, carpenters, painters. They had to get to these jobs early. Methadone users were like ghosts, showing up early in the morning for years on end, drinking their dose, and silently going about their lives. In time, though, methadone became a battlefield between those who thought it should be used to wean addicts off opiates, and those, like Vincent Dole, who saw it as a lifelong drug, like insulin for diabetics.
One strategy or the other might well have worked. But the worst of both emerged at many clinics. Methadone was often dispensed as if the goal was kicking the habit, with small doses. But as methadone clinics became for-profit affairs, many cut the counseling and therapy that might help patients kick opiates altogether. Critics could be forgiven for seeing some clinic owners as drug dealers, stringing patients out for years, and charging twenty and thirty times what the drug actually cost, which was about fifty cents a dose. In 1990, the U.S. General Accounting Office reported that half the clinics were poorly managed, unaccountable, and provided little counseling or aftercare.
The result was that many methadone clinics maintained core populations of opiate addicts in cities all across the country, but on doses that were too small, and usually without much therapeutic support. Addicts who weren’t given high enough doses craved another opiate later in the afternoon, after the clinics closed. They had to find their dope elsewhere, usually on the street, and thus remained tied to the heroin underworld. At clinics that combined low doses and insufficient rehab therapy, addicts took to using methadone and heroin interchangeably.
Methadone was a better alternative to weak powder heroin, which was more expensive and available only in dangerous housing projects or skid rows. But maintaining large numbers of people on any kind of opiate, particularly on low doses, made them easy prey for someone with a more efficient and convenient opiate delivery system. For years, though, no one could conceive of such a thing: a system of retailing street heroin that was cheaper than, as safe as, and more convenient than a methadone clinic.
But in the mid-1990s, that’s exactly what the Xalisco Boys brought to towns across America. They discovered that methadone clinics were, in effect, game preserves.
Methadone clinics
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