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 long-term improvement of quality of life amongst heroin users enrolled in methadone maintenance treatment (MMT).


The sample contained 553 heroin-dependent individuals from 4 hospitals in northern Taiwan who enrolled in MMT for an average of 184 days. Each patient signed a consent form and was assessed prospectively 3 times semi-annually. Quality of life was measured using the WHOQOL-BREF questionnaire, 26 items of which were scored by the participants. The WHOQOL-BREF consists of four domains: physical, psychological, social, and environmental. 285 and 155 participants completed 6-month and 12-month follow-ups respectively.


After controlling for demographic and clinical characteristics, there were statistically significant improvements in the psychological and environmental domains between baseline and 6 months. Significant improvements were found in psychological and social domains between baseline and 12 months.


It is concluded that methadone maintenance treatment improves heroin users’ long-term quality of life in the psychological and social relationship domains.¹

The Acela train runs adjacent to the methadone clinic on a block spanned with rusted grey buildings in South Bronx, the sort of block that has no legal, only self-cobbled, housing. The train passes above the road, southbound. This one’s probably the 4 p.m. from Boston, holding businessmen in suits traveling home from days spent clutching lukewarm coffee in mid-week meetings. They probably attempt one last email before being carried underground into Manhattan.

Below, addicts filter into and out of the clinic, in need of their day’s end pink-bottled methadone. Once in the morning, once in the afternoon. Clockwork. If you were to wait for someone inside, you would wait about 10 or 15 minutes.

Takeesha is among them, clean of heroin for months now. This clinic is a few subway stops from Hunts Point, where, earlier, she made snow angels next to semis and recounted tales of what men tell her on dates: their obsessions with dirty panties or dirty feet.

Takeesha in the Snow: Hunts Point, Bronx. Courtesy of Chris Arnade.

The nights before had been ones of snow, too much snow for her to go outside to catch johns. Enough snow to, instead, watch "Snow White and the Huntsman" in an apartment stagnated by cigarettes, a room-for-rent where her girlfriend pays the crazy tenant in sex. A film that makes her decree that white is always better than black while first crushing, then smoking, white rocks of crack.

On the way to the clinic, she meets her boyfriend outside of the apartment. They fight, and his usually composed figure rocks, loosened by a rare haze of substance. Before, she lived with him in an abandoned building. Before, it was just them.

Takeesha, Abandoned Building Home: Hunts Point, Bronx. Courtesy of Chris Arnade.

He goes with her to the clinic to be near her for a little, hunches over outside its grime-smeared wall.

On the street, a woman exits a car, dropping her animal-print scarf and ski glove in the road’s black sludge. A man points from under an overhang. The woman teeters from foot to foot, a small metronome. She struggles to walk.

The clinic sign’s is missing its “L”. In its place, a shadow remains with two bolts.

Another train passes. Northbound. Maybe the 5pm to Boston, where men in suits can stretch and have martinis. It's a hard day.


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