The Business of Methadone

Photo credit: AP

Photo credit: AP

“And I guess what really happened was I was just exhausted. Heroin lasts you what, six hours? I mean every six hours you’ve gotta go make more money. After ten years of it I was like, ‘Oh my God, I can’t do this anymore.'”

I’m sat with Lauren in her East Vancouver apartment. We’ve just returned from the Shopper’s Drug Mart across the street, where I accompanied her on her daily methadone trip. At the back counter, the pharmacist gave Lauren a small plastic cup of what looked like juice (methadone comes diluted in a fruit-flavoured solution and often must be taken under the supervision of a pharmacist), which she drank in one gulp before initialling a sheet on the counter. As we talk, she pats at her face with a white towel. The sweating, she tells me, is a side effect of her decreasing methadone doses, which have her in a constant state of slow withdrawal. Against the advice of her doctor, she’s attempting to end her eleven year methadone dependence within the next few weeks.

They say you should go off like one, two mils every two weeks. Do you know how long – I was on a hundred and twenty mils – do you know how long that would take me to get off it? I need open-heart surgery. I got trial coming, I might do ten [years] – I need to get off now, not five years from now. So I started going off like five mils a week. So that’s why I’m suffering like this.”

Before she began filling her prescription at Shopper’s Drug Mart, Lauren was getting her methadone from a small independently-run pharmacy, also in East Vancouver. It was one of the many pharmacies, she says, that offer cash incentives to addicts in exchange for handling their prescription. It’s a practice expressly disallowed by PharmaCare, which pays pharmacies to dispense methadone through the Methadone Maintenance Payment Plan (including a $7.70 fee paid for each face-to-face interaction – which is to say, the process I saw earlier of a pharmacist handing Lauren a cup of diluted methadone). By paying addicts for their prescriptions, the pharmacy gets to grow their client base for the drug, and take home whatever the difference is between the PharmaCare payment they receive for dispensing methadone and their payment to the addict.

I ask her how the arrangement works – who approaches whom?

We don’t even talk. Pretty much, it goes by whoever the first person is – I don’t know how [the pharmacies] start it. You know, you can tell who you can make a proposition to. It starts like that. And then they’ll tell them, ‘Bring all your friends.’”

And how much do they pay?

They’ll give you whatever you’ll take. Some will give you twenty bucks for your whole prescription if you’ll take it, but most will give you twenty dollars per week for your prescription.”

PharmaCare’s guide to the MMPP states as a requirement for participation that pharmacies, “agree not to offer cash or incentives of any kind to methadone clients.” Despite this, she says it’s common and that there are many pharmacies all over the city that will pay cash to fill methadone prescriptions. She claims to have broken off her relationship with the last pharmacy when her treatments and payments became erratic as the owners panicked over a police investigation.

It got to like, [the pharmacist saying,] ‘Oh my God, I’m being investigated. You’ve got to work with me.’ And then eventually I was like, ‘I don’t have to do shit. This is your problem. I can’t get clean with your methadone all over the place.”

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