It was early in the new millennium. I was 18, just out of high school, and addicted to opioids. I had moved far away from my hometown to a big city full of dope and coke. I had a decision to make: I could either jump right into the drug world in this big urban area/city and probably find more drugs than I ever would have dreamed possible in my small rural hometown, or I could really make an effort to get myself clean and concentrate on my studies, as I was enrolled in college.

The fears and apprehensions I had about moving away from home to start college were not typical. I was not worried, for instance, that I wouldn’t be able to keep up with my school work. I didn’t think about whether or not I would be able to make friends in this new city. Even the thought that I was about to be as far away from my friends and family as I had ever been didn’t occupy my mind all that much. What I worried about most — and indeed what I spent the majority of my last months at home preparing for during that summer before the move — was the idea that I would be stranded in a new city without access to the drug dealers/hookups that I had become dependent on. I was scared to death that I would run out of opioids and be helplessly stranded without.

I made every effort during those weeks and months before the move to amass a stash of opioids that would either give me enough time to find a hookup in my new city once I finally moved, or allow me to comfortably detox and give up the dope for good. As moving day approached I had enough to last me for no more than about a week, 10 days at the most. When all the boxes were unpacked and I was settling into my “new” recliner from Goodwill that first night in the new house, I had one and a half (40mg) methadone wafers, 1 oc 80, and a handful of 5/325 hydrocodone.

When the time for reckoning finally came and everything was gone I hadn’t yet found a hookup. I panicked. I was 18 years old and had been addicted to opioids since 15. I had obviously been without dope many times in my short 3 years as an addict, either from a lack of funds or lack of connection, but this was different. I knew that in my hometown it was only a matter of time until I found something. Now, in a huge city full of drugs, I found myself too inexperienced, much too white, and frankly just not brave enough to try to cop some dope in one of the quasi-open air markets I knew were just a couple of miles away.

I got sick, what I thought at the time was really sick, from the withdrawal. The worst of it was the inability to sleep. So fucking frustrating. After a few nights I made the call and got myself an appointment at the local methadone clinic. Two days later I was there getting my first dose of 30mg. It was great. The daily doses had me nodding out and itching all day. I loved it. And it really did help me, mainly by allowing me to concentrate on my studies and find a job instead of trying to find a fix. I was an advocate for MMT. I told all my using friends back at home they just had to find a way to get into a clinic.

As the years passed and any glow I got from my daily methadone dose had long since gone, I started to hate the side effects more and more. The constipation, the sweating, the cravings I always had for sugary cereal and ice cream, etc., really started to wear on me. But even after all that and 10 years on MMT I still thought I had made the right decision by getting on ‘done. After all, I thought, without it I never would have made it through college and would probably be living on the streets. It wasn’t until I finally *had* to get off the methadone that I realized just how much worse I had made it for myself.

Staying on the methadone just seemed like a given while I was in the clinic. The idea of one day getting off was barely in the back of my mind, and when I did give it a thought it was usually negative. I figured if I did ever quit it would only be after months, or even years, of slowly weaning myself down from the 147mgs I was taking daily. When I was finally forced to get off of MMT after 10 long years, the withdrawal I faced was something I never imagined in my worst nightmares. And this is where I suffer from a bit of hindsight bias.

When I think back to how sick I thought I was from withdrawal when I decided to get on MMT in the first place I am ashamed. Compared to what I faced after 10 years of daily methadone, the withdrawal and panic that drove me to the clinic all those years ago seems like nothing. I would have given everything I owned to feel like I did back then when I was coming off the ‘done. If I could have just “toughed it out” a couple more days back in 2002 I could have avoided this sick underworld of maintenance “treatment” in the U.S. altogether. But then hindsight is always 20/20 isn’t it?

I simply cannot know whether or not I would have ended up in the streets without the MMT. What I do know is that my mindset at the time was such that on the day of intake to the clinic, if I wouldn’t have been accepted, I already had plans to make the 800+ mile roundtrip all in one shot back to my hometown to score. I’m sure it would have been the first of many treacherous road trips.

I guess the point of this post, — from a harm reduction standpoint at least — is that people should really think hard before making the jump to such a long acting and potent maintenance drug. Obviously the fact that I was not able to do the recommended slow taper when I got off the done really has me biased in another way here. I am sure the experience would have been totally different had I not been forced to quit cold turkey.

On the other hand, that’s just the nature of the maintenance treatment game. I would wager a large percentage of people on MMT end up detoxing because something forced their hand, whether it be a couple of months in jail or a lack of money, etc. Entreatment.