Daily Methadone Clinic Dosing Creates Rural Transportation Nightmare

Heather Strong lives in a rural area of Maine, and can’t afford a car. She also uses methadone. So to attend her methadone clinic—the only place she can obtain her essential medication—she has to rely entirely on transportation provided through Medicaid. No transportation, no methadone.

I met Strong in Portland, at a screening of my film, Swallow THIS: A Documentary About Methadone & COVID-19. During the panel afterwards, she shared her history with methadone: beginning in 2011, tapering off it completely in 2017, then starting back on the medication in 2022.

She also spoke powerfully of her nightmarish challenge of securing daily transportation, when her clinic requires her to attend six days a week to dose. This continually complicates her family life, and leaves her feeling frustrated and punished. Other people at her clinic face similar circumstances.

In a perverse Catch-22, the unreliability of Strong’s transportation prevents her from “earning” the take-home doses that would reduce her reliance on that transportation. SAMHSA criteria demand that patients demonstrate “regularity of attendance for supervised medication administration” to receive take-homes.

In our devastating opioid-involved overdose crisis, making it this hard for people to get a medication that cuts overdose risk by 50 percent or more is indefensible. Strong agreed to continue our conversation for Filter.