Rick Harwood, the deputy director at the National Association of State Alcohol and Drug Abuse Directors, said the demographics of methadone clinics could be partly explained by patients who are middle class or white being less likely to see methadone as a treatment option.
“Ask people, middle class or otherwise, would they go to an opioid treatment program, a methadone clinic?” Mr. Harwood said. “Not too many of them probably would. A lot of times they’re inconvenient to where they live, or are in depressed neighborhoods, places people might consider unsafe.”
Mr. Harwood said that low-income patients could conceivably access buprenorphine treatment at methadone clinics, if they are interested. But methadone clinics are often already overwhelmed with methadone logistics and the social service programs they are required to provide; buprenorphine consultations are an additional service. That can produce an information gap in addition to a financial one. Dr. Kolodny also said that, realistically, buprenorphine treatment cuts against the business interests of for-profit methadone clinics, which are becoming more common nationally.
Mr. Perez could be served well by the flexibility that Suboxone would give him as he manages employment as a tattoo artist. He said he would like to consider transitioning to buprenorphine treatment, but does not know where he can get it or how he might pay for it. Meanwhile, some long-term users, including Ms. Neilson, who travels to the clinic from Long Island, say that methadone has a more satisfying effect than buprenorphine.
“I tried to go back on Suboxone,” she said. “I didn’t feel sick, but I still wanted to get high. I had no energy not even to get up and take a shower, let alone leave the house or stand up.” She added that she’s afraid to transition away from methadone. “The sickness is not something I can describe to anybody. This is a better way to do it….