in front of the methadone clinic 1. Credit: D.C. Atty

in front of the methadone clinic 1. Photo: D.C. Atty

Methadone is a federally-regulated medication that, by law, is dispensed only by licensed treatment settings when used to treat opioid addiction. It has been studied exhaustively and many of its benefits are undisputed in the research literature.  The Centers for Disease Prevention and Control reports that the benefits of methadone maintenance therapy include:

  • reduced or stopped use of injection drugs;
  • reduced risk of overdose and of acquiring or transmitting diseases such as HIV, hepatitis B or C, bacterial infections, endocarditis, soft tissue infections, thrombophlebitis, tuberculosis, and STDs;
  • reduced mortality – the median death rate of opiate-dependent individuals in MMT is 30 percent of the rate of those not in MMT;
  • possible reduction in sexual risk behaviors, although evidence on this point is conflicting;
  • reduced criminal activity;
  • improved family stability and employment potential; and
  • improved pregnancy outcomes.  

Many studies also show that methadone maintenance is a cost effective treatment.

So the benefits to society at large seem pretty significant.  But ask most of the public where they’d like to house a methadone clinic, and you’ll hear “Not in my backyard.”

That’s because methadone clinics (known in the field as Opioid Treatment Programs or OTPs) are widely-regarded as crime magnets.

The logic goes like this: if you build a methadone clinic in an area, it will attract “the addicts” and “junkies”; “the addicts” and “junkies” are the ones who commit crimes; murder, rape, and theft will increase, and the neighborhood will then go to pot.

News articles feed this narrative, from reporting on neighborhoods protesting methadone clinics to sensationalizing crime in areas where OTPs are located.

methadone clinic protest sign. Credit: RJ vandalog

Methadone clinic protest sign. Photo: RJ vandalog

Negative attitudes about heroin, in particular, have a long history in our country.  Captions like this, that announce to readers “See if you can pick out the stabby drug addicts!” continue to dehumanize people who use heroin, including–unfortunately–those who seek treatment for it.

Perhaps the last decade’s massive growth of recreational prescription opioid use—people who are essentially abusing the same drug as heroin users and, as such, may benefit equally from methadone treatment—will help ease our vague, but powerful fear of OTPs.  Or maybe the recent death of Phillip Seymour Hoffman, which has provoked a string of online articles by people openly discussing family and friends who have used heroin, will dampen long-held prejudices against clinics designed to treat heroin addiction.

In many cases, methadone treatment becomes connected with the conditions surrounding the drug addiction it actually treats.  Methadone is equated with heroin—and drugs in general.  This spirited online debate over the placement of an OTP in Portsmouth, Virginia, shows how “methadone clinic” and “meth lab” are often conflated–and in this case, the local ABC affiliate contributed to the confusion.)

Emmett Velten, a longtime methadone advocate, points to the catch-22 that has contributed to the persistent attitudes of prejudice around methadone treatment:

“The emotionality surrounding methadone largely causes the lack of information about it. What causes the emotionality? Prejudice!”

And of course, if you build it, they will come.  As you might expect, it is primarily people with opioid addictions who are interested in the services that an OTP offers. But will the clients commit crimes in its vicinity?  Or somehow attract criminal behavior?

Here’s where science can address ideas based in emotionality and prejudice

The January issue of NIDA Notes, an e-publication of National Institute on Drug Abuse, reports on a well-designed study that suggests OTPs do not bring crime.

The study, led by Dr. Susan Boyd and researchers from the University of Maryland School of Medicine in Baltimore found that “crime rates in the immediate vicinities of that city’s [methadone treatment centers] were level with the rates in the surrounding neighborhoods.”

Not only that, but they found that crime rates in the vicinities of OTPs were lower than that of convenience stores with the same demographic characteristics.  Researchers attributed the “high volume of foot traffic around these stores” as a contributing factor in crime opportunity.

To obtain and analyze information, the researchers used global positioning data and Baltimore City Police Department records from 1999‒2001 to track the distribution of homicides, rapes, robberies, aggravated assaults, burglaries, larceny thefts, motor vehicle thefts, and arson within a 100-meter radius of 15 out of the 16 Baltimore OTPs.

Analyses of the plots showed that crime frequency did not increase with proximity to OTPs; crimes were “no more frequent within 25 meters” of the OTPs “than they were 75 to 100 meters away.”

“There’s no evidence from our study of increased reports of crime around the methadone clinics,” Boyd concludes.

Boyd and her colleagues are now working to analyze data on actual arrests around the 15 OTP sites to determine whether drug sales and possession  increase in the vicinity of OTPs.

Resources

Methadone Research Guide (NIDA)

MAT with Methadone or Buprenorphine: Assessing the Evidence for Effectiveness (AT Forum)

Commentary: Countering the Myths about Methadone (Join Together)

Is Maintenance the Best Therapy for Opiate Addiction? (Substance Matters)

Recovery-Oriented Methadone Maintenance (William White)