This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.
This study examined the effects of contingent vs. non-contingent delivery of a methadone dose supplement on relapse to illicit opiate use in the context of a methadone outpatient detoxification program. Following a 3-week methadone stabilization period on 30 mg, patients (N = 39) were randomly assigned to a contingent, a non-contingent, or a control treatment group. All patients received identical gradual reductions in their assigned methadone dose. During the dose reduction period (weeks 4–11), members of the contingent (N = 13) and non-contingent groups (N = 13) could obtain daily methadone-dose supplements up to 20 mg, but contingent group members could obtain supplements only if their most recent urinalysis results were opiate negative. Control subjects (N = 13) did not have dose increases available. The contingent group presented significantly lower opiate-positive urines during weeks 8–11 (14% positive) of the detox than the non-contingent (38% positive) or control (50% positive) groups. Additionally, the availability of extra methadone improved treatment retention and increased clinic attendance above levels observed in the control group. The potential for further use of methadone's reinforcing properties in the treatment of opiate dependence is discussed.
Sarah: Hunts Point, Bronx. Courtesy of Chris Arnade.
The italicized, quoted statements below are from a friend of Sarah and Ramone. The couple was present for all remarks.
Sara clicked the turquoise stud in the center of her tongue against the roof of her mouth. Her hands wrapped in hot pink fingerless gloves twitched and pulled at a folded business card in her palms. Her legs tapped.
She had left her in-patient detox that day, the place meant to propel her through the net of the criminal justice system, the start of her journey to get her kids out of foster care. She and her husband Ramone both ran away after a day and a half of treatment, across the Bronx in Friday afternoon rush hour, back to Hunts Point.
At intake, before today's frenzy for drugs in Hunts Point, before the eventual wide-eyed bliss of the needle, Sarah asked for someone to retrieve the possessions she lost in an arrest from the 44th police precinct. She repeated this question in the waiting room, at the nurse check-up, in the admissions line and when collecting luggage. A tic of nervous speech.
She didn't want the purse or jumble of items in it, just the memory card from her phone, the device's only significance being that of a photo library containing her kids. She and Ramone have two daughters: one, a toddler, and the other, under a year old. That's why she wants to get clean: for them, to prise her children from foster care. She needs to be reminded of why she's going through process hell. She needs evidence of the visceral drive on her person.
Before admission on the first day, she and Ramone shot up and drank beer in Hunts Point, and thus, arrival to detox went smoothly. The next day brought the problem: doctors would only give the pair 15 milligrams of methadone each, which wasn't cutting it. They had to leave, no choice.
"She's lying. They always give you 30 milligrams of methadone. She just wanted to get out. Even a little methadone gives you a high like heroin doesn't. That's how I know she wasn't serious about getting clean. Right?" A bystander, one who had been through the recovery system, nods.
Back in the neighborhood, Sarah's leggings are too white, their middle bisected by a panel of lace that creates an overhanging eave of skin into stretchy fabric. Finery out of cheap material, the uniform for cheap, necessary dates.
Sarah's footsteps are frantic. "I need to get straight, like…" Half cry-half laughter mix. Eyes to the sky. Inexpressibility.
A list of men's phone numbers to cold call. She and Ramone need $20. They get it after a time; Sarah's a pretty girl.
She and her husband shoot in a hidden backyard on a concrete slab divided from the outside world by mosquito netting and a hung bedskirt. Sarah rolls up a single white legging to the place where her leg connects to her body, finds a vein in the inner thigh above her knee.
"You're going to lose your kids for good. I hope you're happy."
Only silence and anticipation fill the space.
Ramone takes a more traditional pose, a crouch, finding the vein in the black bruise in the crook of his arm. His posture, low to the ground, appears as a beckon for a child or small dog.
Ramone: Hunts Point, Bronx. Courtesy of Chris Arnade.
Done, Sarah rolls the white fabric atop the red smear. She leans back, arms resting above her head in a chair. She sighs, smiles.
"I'm not helping the two of yous anymore. If you're sick from withdrawal, I'm going to leave you sick. You deserve it."
Days pass. Words of hope don't pass from Sarah or Ramone again. Somewhere in the collection room of police precinct across the Bronx, a memory card with photos of children remains.
Higgins, Stephen T., Maxine L. Stitzer, George E. Bigelow, and Ira A. Liebson. "Contingent Methadone Delivery: Effects on Illicit-opiate Use." Drug and Alcohol Dependence 7.4 (1986): 311-22. ScienceDirect. Elsevier. Web. 29 July 2013.