Each day, 32-year-old Adam Knochelmann visits NKY Clinic in Covington, Kentucky, to pick up his 100-milligram prescription of methadone that he takes to manage an opioid addiction he’s been fighting ever since a car crash left him addicted to pain pills eight years ago.

Methadone is one of the most widely-used drugs to treat opioid addiction, but because it is so highly regulated, most patients are required to visit a clinic for each dose. Those limits are aimed at stopping potential overdoses and preventing patients from selling their pills to others.

But now they’re forcing methadone recipients to make a potentially deadly decision: to practice the CDC’s social distancing guidelines and risk their recovery, or go to their clinics and expose themselves to another epidemic.

“My clinic is a tinderbox, ready to go up in flames with an outbreak,” Knochelmann said.

The federal government relaxed the rules March 16 in the face of the coronavirus epidemic in a bid to ease crowding at the 1,611 methadone-distributing clinics across the country. But patients say their clinics just aren’t following the new guidelines, which allow a 14-day “take-home” prescription.

Last week, when Knochelmann picked up his ticket number and walked to the clinic’s waiting room, patients were stuffed shoulder-to-shoulder while they waited for their numbers to be called. Some of them were coughing.

Knockelmann said when he approached the counter, the clinic clerk gave him his regular dose through a turnstile and sent him on his way. Through covered holes in the plexiglass wall between the patients and the clinic staff, the clerk called the next number.

“It’s a double-edged sword. Something bad’s going to happen either way,” Knochelmann said. “You do have a choice, but the choices aren’t fair.”

Jessica Allender, director of the clinic in Covington, says they’ve been taking precautions for the past three weeks such as staggering people waiting inside the building and giving three-week take-home prescriptions to some patients. She said if Knochelman isn’t getting take-home pills, it’s on a doctor’s orders.

Lower-level patients aren’t usually allowed take-homes at all. Under the guidelines, doctors can still refuse those patients take-home pills.

The lag in adopting the protocols reflects a greater issue about methadone regulation: Even in a national emergency, clinics can opt in or out of the new federal protocols — and it’s falling on patients to advocate for their rights to dose at home.

“We are not the DEA. We do not enforce regulation or make law.”

“We are not the DEA. We do not enforce regulation or make law, the guidelines are exactly that ... guidelines, recommendations,” said a spokesperson for the Substance Abuse and Mental Health Services Administration, the agency within the U.S. Department of Health and Human Services that leads efforts to reduce substance abuse in America. “We have no authority or power to enforce them.”

Across the country, methadone patients are complaining about long lines, crowded wait rooms.

Joshua LaRue, a 32 year-old in Daytona Beach, Florida, switched three weeks ago from suboxone, another drug used to treat opioid addiction, to methadone. Under the new guidelines, he should be eligible for at least 14 days of take-homes from the New Season Daytona Treatment Center, but his counselor has told him to wait until the next week for his take-homes.

“It's getting to the point where it's safer to go back to using street drugs.”

“It's getting to the point where it's safer to go back to using street drugs,” LaRue said. “I won't have to be packed into rooms full of people, and since everyone is on edge, I've seen three fights in the parking lot last week.”

A spokesperson for New Season Daytona Treatment Center said they base their prescription decisions on a case-by-case, individual assessments of patients.

In Las Vegas, 44-year-old Johnny Spade picks up his doses every two weeks at the Center for Behavioral Health. He’s been taking prescription methadone since 2003. Last week, before showing up to the treatment center, he called ahead to ask if the clinic planned to follow the new federal protocols. A clinic staff member told him they were still determining whether they’d adopt them.

“None of the protocols had been adopted, and they were treating it as any other day save for some very lame attempts at social distancing.”

“When I arrived to pick up my take-homes this week I was met with complete indifference,” Spade said. “None of the protocols had been adopted, and they were treating it as any other day save for some very lame attempts at social distancing.”

Spade argued with the staff members for his extra take-homes, and he got them.

A treatment professional at Nevada Centre for Behavioral Health Treatment said that they, too, are giving out take-homes on a case-by-case basis, and that a handful of factors play into whether a patient receives them.

“I’ve been trying to figure out for years why programs do crazy things like this,” said Joycelyn Woods, the director of the National Association for Medically Assisted Recovery. She added that she’d already received a few calls from patients whose clinics weren’t giving them take-homes, and expected more. “There’s no rhyme or reason for it. “

Activists and researchers have long worried that methadone is too heavily regulated: While doctors can easily prescribe opioids like OxyContin and Vicodin, patients can only receive prescription methadone if they show up in person.

Medication assisted treatment, or MAT, is a lifeline for recovering addicts. “I couldn't have the success that I've had in my life without MAT.” said Louise Vincent, executive director of the Urban Survivor’s Union.

After losing her daughter to an overdose and struggling with addiction herself, Vincent went through graduate school and became an advocate for the rights of drug users, whom she says are treated as society’s trash.

At her clinic in Greensboro, North Carolina, doctors are prescribing take-homes to some patients — but on Friday morning, when she arrived to pick up her doses, she said 40 people were crowded into the building.

“Being chained to a clinic with this sort of culture of cruelty ... has made my life more unmanageable and more difficult,” she said.