(BE)COMING CLEAN
I was riding the light rail to my second day of work, hours after visiting my new methadone clinic in Portland, Oregon, when I noticed the visual details of the Skidmore Fountain station. Solitary men in army surplus jackets leaned against the Burnside Bridge’s support beams. Women with gaunt faces huddled together smoking. Like an angler trained to spot the promising fishing holes, I could tell a dope zone from a non-dope zone. It wasn’t hard.
This was October, 2000. When I’d left my native Phoenix the previous week, I was twenty-five-years old, fresh off probation for felony heroin possession, and my fiancé Kari who I’d been living with had just abruptly dumped me with no more explanation than “I love you but I’m not in love with you.” I interpreted that as “You’re a loser,” and at that point I was. She hadn’t discovered my habit. She had only accepted what we’d both intuited for most of our three years: that we were a poor match. Yet as I watched my would-be mother-in-law help move Kari’s belongings from our apartment, the loss of her stabilizing presence left me all the more aware of how adrift I’d become. Rather than sulk, I ran to Portland to work at a bookstore. How else could I fail? I’d so clearly hit rock bottom that any future catastrophes would surely seem like improvements in comparison. Aside from the staff at my clinic, nobody knew I was on methadone.
The Skidmore Fountain station sat under the Burnside Bridge, two blocks up from the Willamette River. There was a large antique store and restaurant beside the station, an outdoor sporting goods store down the block. Unlike the grid of one-way streets surrounding it, only the light rail tracks ran under this part of the Bridge, so every weekend artists and vendors used the space for the bustling, family-friendly Portland Saturday Market. Yet busy missions and homeless shelters stood overhead on Burnside Street, their front lined with people waiting for rooms and food. Some people slept on the sidewalk, their bodies wrapped in soiled blankets and sleeping bags that smelled of wet flannel and ashtrays; others stood outside in the rain smoking for most of the day. And because its location sheltered dealers from the leering eyes of passing car traffic, Skidmore Fountain station was then one of the easiest places to buy heroin in town. I tried to ignore the fact that it was a five minute walk from work. I’d been clean for barely one year.
From the stop near my apartment, the train cruised silently station to station: NE 7th Avenue, Convention Center, Rose Quarter. Locals called the light rail system MAX, short for Metropolitan Area Express. I stared out the window and watched grey light flash through gaps in the Steel Bridge’s frame as we shuttled over the River and into downtown. When the train doors opened, an automated voice announced “Skidmore Fountain,” and cool damp air rushed inside, carrying with it the dirty smell of damp cement. The doors seemed to stay open forever. Each second felt like a taunt. When the train finally pulled away, I turned up the music in my headphones.
Originally the idea had been to get off methadone and begin my new life in Portland completely substance-free. I’d started my first program the previous year in Phoenix after my arrest, the details of which I’d also concealed from Kari and friends. The clinic stabilized me on a moderately high dose. Because I wanted to free myself from methadone before anyone discovered I was on it, I had the nurse start gradually reducing it to one milligram shortly after my enrollment. Before I left Arizona, the clinic gave me enough take-out doses to last my first week in Oregon, advising I drink half the contents of each tiny bottle—so half a milligram—in order to complete the tapering process. With my new job looming, and the pressure to perform while making favorable first impressions on coworkers, I decided I wasn’t ready for that. Was there a worse time to detox from opiates than during the start of a career? Due to its high fat solubility, methadone metabolizes slowly. Its longer half-life means it has greater therapeutic effects than morphine-based drugs; it also means that methadone withdrawal can span anywhere from two weeks to six months, much longer than heroin. Even though the nurse insisted discomfort would be negligible, I ignored her, drank the full milligram each morning and signed up with a new clinic.
I rented a small apartment in a wooded residential neighborhood. I started my new job at Powell’s. And with minimal research I found CODA. CODA was Portland’s oldest nonprofit methadone clinic and one of its most reputable. It was also the closest to my apartment. Set off Burnside Street in an ugly white building disfigured by mismatched materials and unflattering lines, CODA’s front door sat on 10th and NE Couch streets. Enrollment was anonymous. The clinic never disclosed its patients’ names if someone called asking. It even sheltered its entrance on a side street so patients wouldn’t be spotted by Burnside’s passing car and bus traffic. Methadone is one of the world’s most controversial forms of addiction treatment. CODA understood the need to keep our identities hidden from the family, friends, and coworkers who might disapprove of our method of recovery.
CODA’s methadone dispensary, as it’s known in clinical parlance, opened at 6:30 a.m. Monday through Saturday, and closed at 1:30 in the afternoon. When I arrived just after 7:00 the first time, the line of patients waiting to dose stretched from the dispensing window halfway to the front door, maybe twenty feet. Most of them looked to have just rolled out of bed: pajamas, fuzzy slippers, baggy Portland Beavers sweatshirts. The place smelled of morning breath and floor disinfectant. Between people besot with bed-head stood a solitary businessman in black slacks and a white collared shirt. I stepped in line behind the other patients and played music on my headphones, hoping to ease the tedium of waiting ten to twenty minutes for a sip of liquid.
My Phoenix clinic resembled a deli—a tiny counter, no glass partition, brief wait in a short line. CODA’s dispensary seemed as guarded as a bank teller’s drawer. Two side-by-side windows stood in a small alcove walled on three sides, and the windows were only accessible through a narrow doorway which staff could close and lock if necessary. A nurse sat at each computer terminal behind a thick pane of glass and a big, white, plastic bottle of methadone. A thin tube ran from the bottle into a contraption that administered the quantity designated by the patient’s computer profile. Protocol was strict and explicit. Patients had to wait behind a line of black magnetic tape until the patient in front of them left the dispensary. We had to drink the dose then throw the paper cup in the trash before leaving, while the nurse watched, so no one could share or sell their meds. On Saturdays, everyone received one take-home dose for Sunday. Those patients who had earned weekly take-out privileges carried a lockbox—meaning, any container fitted with a lockable lid—to store their week’s six bottles. The rest of us took our medicine at the window every morning, one dose at a time.
The list of brand and generic names for methadone reads like a list of aliens in a sci-fi movie: Adanon, Adolan, Althose, AN-148, Biodone, Dolamid, Eptadone, Heptadon, Heptalgin, Heptanal, Heptanon, Mephenon, Metasedin, Miadone, Pallidone, Pentalgin, Phenadone, Physeptone, Sedo-Rapide, Symoron, Tussol.
Methadone is available in various forms: a traditional pill, a sublingual tablet, a ready-to-dispense liquid oral concentrate, and a dissolvable “disket” which disperses in water just like an Alka-Seltzer tablet. The pre-mix liquid is the most common form, as it allows clinics to adjust a patient’s dose milligram by milligram. CODA used a pre-mix, colored red to distinguish it from water. Not that I ever asked the name of it. I just drank what they poured in the cup.
I never injected heroin regularly. I snorted it for a year, but everyone from high-level executive pill-poppers to people living in halfway houses enrolled here. My Phoenix clinic called their service “methadone maintenance.” Back then, CODA called theirs “opioid medication assisted outpatient treatment.” Now they call it “medication-assisted treatment.” Their purposes were the same: to relieve narcotic cravings and alleviate withdrawal symptoms so that addicts could stop using illicit substances long enough to rebuild their lives. Unfortunately, my original motivation for enrolling was not so noble. I simply wanted to avoid the physical t
orment of withdrawal. Methadone would get me off the heroin without inflicting dope sickness, and then, I thought, like magic, I’d live a sober life again.
In addition to its slow metabolism, methadone is a physically addictive chemical, so depending on your dosage it takes months to taper off of it, and often years before you’re psychologically ready to begin tapering. While there exist what are called “juice bars”—profit-driven businesses where patients can take their dose and keep using drugs if they want to, as long as they pay their money—reputable clinics are designed to help addicts transition from a dysfunctional dependent life to a productive sober one, and that requires a long-term commitment.
When I first enrolled in Phoenix I thought nothing about long-term investment or the daily irritations of such a routine. I was scared and hasty. By the time I arrived in Portland over a year later, I understood the complex nature of my chosen treatment and the fragility of my sobriety. At one milligram, I could either schedule my last day with CODA in advance, or I could simply quit visiting the clinic when I felt like it and detox on my own. Instead, I figured it was best to stay with CODA for a little while—a few weeks maybe, a few months at most, just feel it out.
I stared at CODA’s scuffed white linoleum while inching toward the front of the line. When the patient before me departed, I stepped through the door. “Hi,” I said, “my name’s Aaron Gilbreath. I’m a new patient.” The pale nurse welcomed me and searched the computer for my info. I’d called the previous week, scheduled an appointment with a staff member, and been granted “guest privileges.”
After a few moments reading the screen, the nurse hit a button and a mechanism clicked. The tube released a tiny drop of red fluid into a cup: one milligram. She peered into it and smirked. “Not much in there,” she said. The average patient took between eighty and one hundred and twenty milligrams. She slid the cup under the glass and I emptied the contents into my mouth, placing the drop on the back of my tongue to make sure every bit slid down my throat. I had an unscientific idea of the process. I imagined that if those precious methadone molecules got caught on any surface other than my tongue, they would spread across my cheeks, dissipate in saliva and end up somewhere outside of my bloodstream. This is why I always brushed my tongue before visiting the clinic and didn’t eat for exactly two hours after dosing.
I rinsed the cup with two squirts of water, drank that, then tossed the cup in the trash. “Mmm,” I said, “Is this cherry?”
“Tropical punch,” she said.
My second day of work started in four hours, so I returned to my apartment and crawled back into bed. I lay beside my two cats but failed to drift to sleep. Outside the morning sky was gradually lighting blue. My tired itchy eyes made me wish that I could sleep in late. As I did most mornings, I looked forward to the day when I no longer had to drag myself up to dose before sunrise, a time when I could rely on myself rather than medication for sobriety, could eat a bowl of cereal upon waking and never have to bury the take-out bottles deep in the garbage bin where no one would spot my name printed on the label. Soon, I thought, very soon.
The first time I tried heroin, I smoked it off of tin foil. My close friend JT scored ten dollar’s worth from a guy he worked with at the copy shop. Three friends and I were hanging out at Chris’ house, as we did nearly every day, and together we filled our virgin lungs with JT’s quarry. If any of us found this a troubling milestone in our adolescent development, we showed no sign of it.
It wasn’t something I bragged about or was even remotely proud of, but by the time I turned twenty, my friends and I had tried nearly every chemical in the modern street pharmacopeia. But I hadn’t done heroin yet, and I was curious.
The gooey brown tar came smeared across a square of white cellophane. Following his coworker’s directions, JT sliced the wad into tiny bits with a knife, placed the bits on the foil and brushed a flame beneath it. In the heat of his Bic, the tar instantly liquefied, sliding sideways across the foil. The way it sizzled and moved atop the aluminum seemed terrifying and unpredictable, almost a wholly new element with no familiar earthly properties. As the liquid vaporized, we inhaled its sour plume through a section of cut soda straw. After a few puffs, our pupils constricted to tiny points. The world turned sepia. We talked a congenial rapid fire, marveling at this new sensation and the low croak in our voices. We smoked until the wad was gone. We sat on the living room couch and talked through a euphoric languor. Then I got queasy.
I excused myself and lay on Chris’ mom’s bed. Her room was dark. All the curtains were pulled. A swamp cooler filled the air with dense, intrauterine moisture, and I fought the urge to vomit while experiencing a turbulent ecstasy. Neither able to sleep nor stand, I sprawled on my back for nearly an hour. I wondered why people liked doing a drug that made them so ill. I wondered when I would do it again.
I wasn’t drawn to drugs by some romanticized sense of squalor. The mythic allure of the junkie living in a burned out tenement in 1970’s Manhattan, the boozy down-and-out musician playing dive bars while trying to make a name for himself—none of the iconic stereotypes of drug users attracted me. But drugs were recreation, and because I lived so close to the Mexican border, they were easy to get.
My friends and I were seventeen, eighteen, nineteen. Drugs seemed harmless because we thought they were fun. Like the time we took acid on vacation in a southern California motel room and stayed up all night cackling at Richard Pryor movies. And the time we ate mushrooms and took photos beside animated Sesame Street characters in a toy store in the mall. And the times we tripped on mushrooms while camping outside of Sedona’s famous red rock formations, and the head of an ax flew off while Jason chopped wood.
I also lacked purpose. I was preoccupied by the pressure to choose a profession and a practical major. Because I’d been drawing all of my life, I started college as a drawing major, which I considered as useful a degree as having no degree at all. Poultry science students had more career opportunities. Walking past the university’s buildings everyday only drew my dilemma into sharper relief. Other students buzzed around these buildings with a sense of purpose. Here were America’s future DNA researchers, oil company employees, and CPAs. What would I become? I had hobbies, but none of them provided such promising career tracks. I liked to hike, to read, to journal, draw, take photographs, identify native animals and plants, and see bands play. If anything, I had too many interests.
My parents tried to help me focus. “Is there a link between them?” my dad would ask. “An umbrella category to haul them all under?” As encouraging as he and my mother were, their involvement only added to my stress because I recognized the subtext: sometimes you just had to pick something and go with it. Dad never liked any of his jobs in construction or retail clothing, but held them because he had to support his family, and he did so without complaint. Information like that only fueled my agitation.
After two years of study, I accepted the limitations of my drawing major and searched for other options. I entertained the idea of becoming a National Park ranger, since that’s what my favorite writer Ed Abbey had been. It sounded cool to work outdoors all day, to maintain trails and answer visitor questions, or whatever park rangers did. Unfortunately, research revealed that those were highly coveted positions that often required a wildlife biology degree. I couldn’t earn that degree. It required math too complicated for my lopsided brain. I considered becoming a wilderness guide in some mountainous place like Colorado or Montana, until I realized that I couldn’t handle the snow. And because I’d grown up in Phoenix where the most water I had contact with was in chlorinated pools, I didn’t feel qualified to run rivers. At one point I considered putting my personal experience to use as a drug counselor, but first I needed to quit using them.
Eventually I switched the drawing major to an Ecology/Evolutionary Biology major, figuring that fit my love of hiking and nature. When I discovered how much calculus the profession required, I switched to a Philosophy major, keeping
the science as a minor as if to further round out my unmarketability. I pictured myself wiping restaurant tables with a wet rag at age forty, discussing Sartre and the fate of the spotted owl with waitresses with library science degrees.
In addition to sleep, inebriation gave me my sole respite from worry. Weed and beer had initially made funny things funnier, and boring things bearable. Now they were medicine to still my mind: suck down the smoke and replace anxiety with laughter. Heroin, though, proved to be the best thought-blotter of all.
Contrary to popular belief, methadone doesn’t get you high. In reasonable amounts, it simply prevents the onset of opioid withdrawal when addicts quit using other drugs. Although methadone acts on the same basic opioid receptors as morphine and heroin, methadone behaves differently in the human body. First of all, methadone is rarely injected; it is primarily swallowed. Once ingested, it is rapidly absorbed by the gastrointestinal tract. From there it diffuses widely into other body tissues, particularly fatty tissue, where it is stored and then released into the plasma as quickly as thirty minutes following consumption. Half-life is the period of time it takes a decaying substance to decrease in volume by half. Although metabolism rates vary greatly between individuals, morphine has an elimination half-life of four to six hours. Methadone has a half-life of fifteen to sixty hours, with a mean of about twenty-two, and therein lies its magic. Methadone’s prolonged metabolism allows clinics to administer the medication once every twenty-four hours, a marked improvement from the five to eight daily heroin injections or intranasal squirts the average addict administers themselves.
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