12 of 15 people found the following review helpful
on September 17, 2007
Methadone Clinic provides a glimpse into the darker, seamier side of heroin addiction and methadone clinics. Although the author, David Steier, said he has worked as a methadone clinic counselor, he does not claim this book is non-fiction. The New York methadone clinic discussed in the book primarily serves heroin addicts, with very few chronic pain patients. The heroin addicts, in this book, have almost no interest in becoming addiction free and are mostly dishonest, manipulative, inconsiderate, abusive and profane. The addicts realize that they will not be denied treatment, despite disobeying clinic rules, since clinic methadone prevents them from committing even more crimes, to obtain more expensive, illegal black market heroin.
The book overflows with profanity, which will offend some readers. The author, David Steier, describes how he frequently offered cigarettes to patients and how he smoked cigarettes, with patients, in his counselors office, with methadone clinic patients. Offering patients cigarettes would be prohibited, by most counseling programs, which would also prohibit cigarette smoking, on the premises.
Problems with methadone and other drug dealing, on and adjacent to the methadone clinic, are given a face, by descriptions of counselors being required to patrol the immediate neighborhood and facility grounds, and patients being prohibited from "loitering," in the vicinity of the methadone clinic. You would not want this methadone clinic in your neighborhood.
The underqualification, lack of education and experience,low pay and high turnover of methadone counselors are described, along with the ineffective supervision, lack of support and extreme pressures they face from management and patients. This book puts a human face on the abusive client and how they abuse and manipulate counselors.
The low pay and high counselor turnover, at Methadone clinics helps explain the following alarming information:
149 staff in U.S. methadone clinics were surveyed about their knowledge of methadone toxicity. Only 14% knew that a methadone maintenance patient's risk of dying was highest in the first two weeks of treatment, and only 15% knew that starting new maintenance patients on daily doses of 30 mg. to 40 mg. of methadone could be unsafe. (Maxwell, J.C., Pullum, T.W. & Tannert, K (2005).Deaths of clients in methadone treatment in Texas: 1994-2002. Drug and Alcohol Dependence, 78(1), 73-81).
There appears to be no justification for the low pay and shortage of counseling and medical staff, at Methadone clinics, since the clinics appear to be highly profitable, with profits reported, from 16 to 50 percent of revenue, after taxes. CRC, treating over 20,000 methadone patients daily, reports daily profits per Methadone patient of $10.91 to $11.07.
This book mostly overlooks chronic pain patients, who are not abusing clinic methadone and may need methadone pain treatment, until they receive more effective pain treatment, with transdermal prescription pain creams, electroauriculotherapy, prolotherapy, or effective treatment of Lyme Disease, Lupus, fibromyalgia, Bartonella, Babesia, migraines, etc. These pain patients tend to be honest, self supporting, contributing members of society, to the extent their disabilities allow them to be. Without talking to the author, it is unknown whether his methadone clinic had patients like this or whether almost the entire caseload consisted of heroin addicts.
Since this is a novel, it is difficult to determine if some methadone clinics are as horrible, as the one described, in this novel. A very grim, depressing picture of methadone clinics is portrayed, in this novel.
I am rating this book a 2, since I feel it may portray a more negative picture of methadone clinics than they deserve. If the author is a whistleblower and some methadone clinics are this terrible, the book deserves a 4.