When my sister Ellen died on Christmas Eve of 2011, weeks shy of her 61st birthday, she had been on methadone maintenance treatment (MMT) for her heroin addiction for nearly 40 years. Or almost as long as her ancestors wandered in the desert awaiting entry into the Land of Milk and Honey.
My sister wandered back and forth to the methadone clinic twice a week, with no interest whatsoever in entering the land of Clean & Sober. Through the years, she was shuffled from one clinic caseworker to another (this is not a job one holds to retirement). No doubt they each posed to Ellen the obligatory question — would you like help in kicking the habit? And my sister, operating on autopilot, would spit back her mantra of despair — I can't hack recovery. And so her little circle of hell was unbroken.
Don't get me wrong here. I'm angry, but I'm not stupid. As a social service case manager, I understand that if the client doesn't want to get well, no power on Earth, let alone a social worker, can successfully intervene. I also know that within the medical community at large, MMT is almost universally regarded as a safe, effective and essential long-term treatment option.
"Think of heroin addiction as what it is, a chronic disease," offered one renowned and compassionate addiction specialist, trying to help ease my troubled mind. "Treating this brain disease with methadone is akin to treating diabetes with insulin, or hypertension with beta blockers. There is no time limit on the treatment."
And, finally, I appreciate the unassailable fact that MMT saved my sister's young life. As a 20-year-old junkie, she was a lethal overdose waiting to happen. I would even venture to say that MMT saved my parents, who were as much victims of this plague as my sister. The initiation of MMT meant an end to their dreaded wee-hour treks from Long Island to drag Ellen out of the shooting galleries of the East Village and West Harlem. How much longer could they have managed that routine without resorting themselves to mother's little helpers?
I get all of that. Yet, 40 years on synthetic heroin sticks in my craw. And this is the reason: While MMT stopped the craving for heroin, keeping my sister out of drug dens, jail cells and the cemetery, it did not stop her craving for a panoply of other controlled substances. I was not close enough to Ellen in her middle years to know the full extent of her various and sundry addictions, but in the last 10 months of her life alone, she experienced at least two near-fatal overdoses — of Seroquel, a mood stabilizer, and Tylenol, which attacked a liver already ravaged by mainlined heroin.
When I visited Ellen in the hospital on those occasions, she refused to see me, overcome as she was by shame and self-loathing. Methadone maintenance did nothing to quell those twin demons. So while the autopsy report referenced "a heart event," it was most certainly shame and loathing that killed the girl.
I look back now with sadness and regret, for there were points along the way, very early along, when the circle could have been broken. I remember a bright spring morning, hope and flowers in bloom, when my mom, dad and I bundled Ellen into the car and hustled her up to some rustic rehab in the southern Catskills. We left her in her room, crying for mercy. By the time we arrived home, my mother's resolve had crumbled and we all got right back in the car to fetch her, over my vehement protestations.
The handful of hours Ellen spent in that room was the closest she ever came to recovery.
Yes, MMT kept her alive, and gave her a purpose. The clinic visits were the only constants in a life filled with anxiety and chaos. But what about making her life worth living in the first place?
I sang Ellen's sad song for Bill Moyers Jr., a recovering addict and writer, and one of the more thoughtful and insightful people working in the addiction field. Over the phone, I could almost hear the gears in his mind try to reconcile the conundrum. MMT was a smashing success. The patient lived and managed a functional existence, however marginal. But, clearly, the therapy also kept her chained to a life of dependence and hopelessness.
"I don't know what to say," said Moyers, himself a proponent of MMT. "You would like to think there was something that could have been done for your sister, some way of helping her turn her life around."
Was it just a simple case of medical economics, with my sister and millions of other cash cows keeping the industry's pistons pumping with Medicaid dollars? Did anyone at the clinic ever take the time to get to know my sister and make a sincere attempt to crack her veneer of failure? I don't know. I wasn't there. I watched my sister's life unravel mostly from a distance.
Forty years in a desert of her own making, and never a deliverer in sight. Please, somebody, tell me there's a better way.