Episode 4: The Morality of Molecules

Episode 4: The Morality of Molecules

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CAROL SUTTON LEWIS: Hello, this is the fourth episode of our series about Marie Nyswander. And again, this season is full of adult content. So please listen with care.

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KATIE HAFNER: In June of 1971, Jerome Jaffe was invited to the White House, but he wasn’t sure why. At the time, he was 37 years old and doing well professionally. He was a doctor, running Illinois’s drug abuse program. And the White House had actually tapped him in the past to do some consulting on addiction. But what this particular meeting was about—that was a total mystery to him.

So, when Jerome Jaffe arrived, he was ushered into the cabinet room with the President, along with members of his cabinet, leaders of congress, and the head of the Bureau of Narcotics.

‍JEROME JAFFE: And I was sitting there– I had no idea why I was sitting there, but they had - did invite me in and I thought, well, maybe that's a courtesy, because I gave them advice.

CAROL SUTTON LEWIS: We called up Jerome Jaffe at home a few months ago. And he remembered that the President started talking-

JEROME JAFFE: -about how he's gonna have a new initiative to deal with addiction. It's going to be a major initiative.

CAROL SUTTON LEWIS: Nixon said the US needed to start a new agency dedicated to coordinating federal addiction treatment programs. And then Nixon looked at Jerome and said-

‍JEROME JAFFE: and that man, Dr. Jaffe is going to run it. Well, that came as a shock to me, but I didn't have the- either the courage or the presence of mind to say, who told you that? And so, within about 15 minutes or so, he dr- I was taken out and presented to the White House Press Corps.

RICHARD NIXON: Want to join me here? Won't you be seated please, ladies and gentlemen. Come on, Dr. Jaffe.

KATIE HAFNER: That’s Nixon at the podium in this video we found. And on his left, there’s a fresh-faced Jerome Jaffe in a suit and tie. 

RICHARD NIXON: America's public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy it is necessary to wage a new all-out offensive.

KATIE HAFNER: To do that, the President told the room of reporters, he was creating a new agency, the Special Action Office of Drug Abuse Protection a.k.a. SAODAP—yeah, that’s the best they could come up with—with Jerome Jaffe at the head.

JEROME JAFFE: I was totally unprepared. I was unprepared in terms of dress as well ‘cause I didn't even know I was gonna stay over in Washington, so somebody had to buy me another shirt. And it was a- I think it was two sizes too big. You can imagine how my wife felt about hearing all of this in the newspaper.

CAROL SUTTON LEWIS: Good question.

JEROME JAFFE: Faith, could you pick up? Somebody would like to ask you some questions. Yeah, she's down there. She'll pick up the phone.

CAROL SUTTON LEWIS: After a few seconds, Faith picked up the phone downstairs. 

FAITH JAFFE: It just turned our lives upside down. My husband was put in a very uncomfortable position because you don't turn around and say, Mr. President, who told you I was gonna do that? 

KATIE HAFNER: Before she knew it, Faith’s mild-mannered, academic husband was the country’s drug czar—or at least that’s what the press was calling him. Jerome was off to DC almost right away, scrambling to launch this new agency, SAODAP. And one of his first orders of business as head of SAODAP—a massive rollout of treatment programs across the country, delivering a drug called methadone.

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[THEME MUSIC STARTS]

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KATIE HAFNER: This is Lost Women of Science. I’m Katie Hafner. 

CAROL SUTTON LEWIS: And I’m Carol Sutton Lewis. And this season, the Doctor and the Fix: How Marie Nyswander changed the landscape of addiction.

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[THEME MUSIC ENDS]

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[ADVOCATES OPENING MUSIC]

HOST: Tonight from Boston, coast to coast and in color, the Advocates. 

CAROL SUTTON LEWIS: In 1970, a public television program out of Boston held a debate.

HOST: And tonight the problem is drug addiction. The practical choice is this: Should your city provide methadone to heroin addicts upon their request?

CAROL SUTTON LEWIS: Quick aside, yes, many people say metha-DON, including Marie Nyswander. 

Anyway, by 1970, methadone maintenance was no longer a radical experiment happening inside the walls of Rockefeller University. It was out in the world, making headlines, and people had opinions and a whole lot of questions about it. Was methadone maintenance really the best treatment? What about abstinence? And therapy? And therapeutic communities? Should methadone only be given as a last resort? To some people, like this doctor from Oakland who appeared on the debate that day, methadone was not a solution at all.

DEISSLER: In my opinion, it deprives the majority of human beings who get on methadone of any motivation to do anything else, and they carry on the same social and human problems with them they had before. They are just as lonely, just as alienated, just as miserable, just as sick in some way as they were before.

KATIE HAFNER: So how’d we get here? Well, let’s back up. In the last episode, Marie Nyswander and the Rockefeller team were starting to see results with a handful of patients. By the winter of ‘65, they were confident they were onto something big.

So after that early success with the first two patients, they expanded the sample size to eight and then to a couple dozen. And then more and more and more. Note, by the way, that all of their early patients were men. Vincent Dole’s rationale for this was that they couldn’t risk the possibility of a woman getting pregnant during these experiments. That’s a  common concern with drug trials.

Methadone was exceeding all expectations. Most of the subjects stayed on methadone, and they were doing well. They were going back to school, and they were getting jobs and picking up hobbies. In fact, one of their first two patients got his high school equivalency diploma, and later went on to graduate from college with a degree in aeronautical engineering, which is incredibly impressive, and all of this while taking methadone.

So understandably, Vince wanted to show off their results, and soon, the Rockefeller team started hosting an array of visitors. Vincent made sure they included a lot of VIPs, like councilmen and hospital administrators. He wanted them to talk to the patients directly, to see for themselves how they were doing. Here’s Marie:

MARIE: So the patients were talking, so that the public was getting to see these terrible addicts that had been in jail for years and years, suddenly on methadone, who could work, could speak, were neat, weren’t robbing or stealing. So that it was a very impressive, impressive treatment plan.

KATIE HAFNER: And one day, a visitor arrived whose opinion was particularly important: Harris Isbell, the director of the Addiction Research Center at none other than the Lexington Narcotic Farm, the prison and treatment center in Kentucky where Marie had first encountered drug addiction two decades earlier. Here’s Vincent:

VINCE: I thought that, uh, showing this phenomenon to him might, uh, help advance the, uh, process of research in the field.

KATIE HAFNER: So Harris went in to talk to the patients, and he spent quite a while chatting with them. They actually knew him from their time at Lexington. What would he make of them?

VINCE: And so when he came out, in this nice, gentle way, he said, well, Vincent, he says, I'm sorry to tell you, but you're wasting your time with this. He says, those are not addicts.

KATIE HAFNER: Harris couldn’t believe that the men he’d just met had any substance use problems at all. Apparently, he didn’t remember them from Lexington.

VINCENT DOLE: And after he left, and I went back to the ward, well naturally all these fellas were particularly interested in this interview, because they all knew him well. And when I told them this, they laughed and laughed and they said, he sure didn't tell us that when we were at Lexington.

CAROL SUTTON LEWIS: On August 23, 1965, the team published their preliminary results in JAMA, the prestigious Journal of the American Medical Association. And their paper provoked a strong reaction.

‍VINCENT DOLE: There was an enormous amount of skepticism because naturally this went against the dogma of the field.

‍CARL: That dogma being the abstinence model–where “recovery” meant being off of drugs. Having patients taking another opioid indefinitely upended that model completely. 

EMILY DUFTON: It was hugely controversial. I mean, like, it was bananas.

CAROL SUTTON LEWIS: That’s Emily Dufton, writer and drug historian.

EMILY DUFTON: I mean, they were, they were going against like 50 years, like since like the 1914 Harrison Narcotics Act of a singular response to opioid use, which was detoxify them and then punish them if they use it again. You know, it’s just- it’s don't do it, right? There’s - their response was entirely law enforcement based, and it was quite brutal. And here come Dole and Nyswander, untouchable with their money and their prestige. And they're saying like, no, this is what we've gotta do: we have to give people an opioid every day, but it's legal and it's a medicine. It's like a vitamin, right? And it transforms them into law abiding, tax paying, functioning members of society.

CAROL SUTTON LEWIS: It was an exciting time. In the summer of ‘65, Marie and Vincent started giving interviews, and newspapers all over the country picked up the story. In June and July, the writer Nat Hentoff, the famous jazz writer, published his effusive two-part profile of Marie in the New Yorker. So things were going very well for the Rockefeller team, especially for two of them. Because by this point, there was no more denying it. Vincent and Marie were in love.

KATIE HAFNER: We don’t know much about just how it happened. The only person who was really there, was their research partner, Mary Jeanne Kreek, and when she was asked in 2017 about Vince and Marie, she sort of bristled.

INTERVIEWER: So I wanna ask you about Vince and Marie. Um, what was Vince Dole still like?

MARY JEANNE: He was a- He and Marie were not together, and a lot of people think they were married, and I joined them, and I got very upset when people say I joined them. No, Marie and I came the same month of January ‘64. And Ma- he was married, Marie was married. He had children. Marie was married four or five times, I'm not sure which, no children. Um, she was very quiet and not putting herself forward and yet very much putting herself forward. She was very tough and very much, um, focused on self. I'm- Not a negative comment. It was simply a true comment. And she saw Vince as more desirable than her husband.

CAROL SUTTON LEWIS: Anyway, this turn of events would obviously change the group dynamic, with Mary Jeanne increasingly feeling like a third wheel. But she was also getting pushed out professionally. First, there was the team’s big paper in JAMA. Vince was the first author, Marie was the second, and Mary Jeanne Kreek—not an author. She’s only mentioned in small print at the bottom alongside eight others who made contributions.

KATIE HAFNER: I just think that sucks. And it was only Vince and Marie’s names that were showing up in the press, Marie who was getting the long flashy profile in the New Yorker. Because she seemed to charm reporters. An article in the New York Daily News, opens up with the story of a young man who was able to quit dope and get a job, thanks to methadone, then pauses to let us know that Marie Nyswander, the doctor behind this transformation, is quote an “attractive slender blonde who likes to listen to good jazz.” Okay, now you tell me how that is relevant. But anyway, Marie Nyswander and Vincent Dole were two big personalities that left little room for anyone else, including their spouses.

DAVID: The, um, breakup of the Robinson marriage and her marriage to Dole was very swift. I mean, it was like, boom. Uh, it was something that was surprising to people even in their circle.

KATIE HAFNER: In August of 1965, the same month Vince and Marie published their JAMA paper, Marie told Leonard she was leaving him. Leonard later told David Courtwright that it all happened very fast, and he didn’t see it coming. But what was he going to do? He couldn’t stop her. And so in September, Marie went down to Tijuana to get a quickie divorce, which was very popular back then. And that same month, she married Vincent. 

Leonard was devastated. And later, of course, he would write that novel that we can’t stop reading, The Man who Loved Beauty. I just - I do have to say it’s an- it’s an absolutely great novel, and he was a great writer. And in the book, the Marie and Vincent characters discover something called “Buteglute,” a miracle drug for treating alcoholism—and a not so subtle stand-in for methadone. And as they work together Buteglute, they grow ever closer.

Leonard slash Jonathan discovers that Elizabeth slash Marie has been having an affair with the Thurman slash Vincent character. And when Leonard slash Jonathan confronts her, she flies into a rage, screaming, sobbing. But then, when she regains her composure, she tries to articulate just what made her fall in love with the Vincent slash Thurman character. 

Okay, we don’t need my husband Bob to read this for you. His rates are too high. I’m going to read it to you: 

KATIE HAFNER: “‘He wants to help people, Jonathan', she said very softly. 'It's his passion. Buteglute has given him his chance to be- to be- the most famous-ah- to do a good thing. And I have to help him. I have to. I have to.’ She buried her face in her hands.”

CAROL SUTTON LEWIS: Ooh, poor Leonard.

KATIE HAFNER: Poor Leonard. However, this scorned lover’s over the top account gets at something important about Vince and Marie’s relationship.

DAVID: I think that in addition to the excitement, uh, and the fame that came from working with Dr. Dole, Dr. Dole represented something else. He represented a return to medicine. And I think that in moving into his orbit, not just marrying him, but to repeat, moving into his orbit, uh, associating with his friends, identifying with Rockefeller, all of that, she's moving back into that- that world of proper biomedical research, and she's putting behind her this softer version of medicine with which she has become disenchanted.

CAROL SUTTON LEWIS: And methadone completely changed Marie’s view of addiction. She had, through trial and error, finally ended up in a place that suited her. She scaled back her private psychoanalytic practice, and she embraced this scientific approach to addiction. It wasn’t long before methadone treatment took off in New York City. As we know, things move very quickly when Vincent Dole gets involved.

EMILY DUFTON: Dole’s connections to, like, the director of hospitals of New York City, allows them to start to open addiction treatment wards in places like Beth Israel and various other hospitals throughout Manhattan. 

CAROL SUTTON LEWIS: Emily Dufton again.

EMILY DUFTON: And they institute these programs where people come to live in the hospital for about two weeks, and they get transitioned from street heroin to methadone, and they stabilize the dose. And then from there, they come to the clinic every day to take their methadone in the morning. 

CAROL SUTTON LEWIS: And it’s not just methadone they’re getting. This is key. The programs were meant to help people overcome some of the problems that heroin addiction had created in their lives or that led them to heroin in the first place.

EMILY DUFTON: They're aided in finding jobs or reconnecting with family or finding an apartment. Um, you know, they're kind of just reintroduced to society while they're also, you know, on methadone and having various other medical ailments treated.

CAROL SUTTON LEWIS: But as these early methadone programs spread in New York City and beyond, they also deeply divided people. Was this really a treatment? Could you call methadone medication, or was it just substituting one drug for another? That’s coming up. After the break.

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[AD BREAK]

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LISLE BAKER: Despite what critics of the program will say, it's important to recognize there is a distinction between heroin addiction and methadone maintenance.

KATIE HAFNER: In that TV debate from 1970 we heard earlier, a lawyer named Lisle Baker took up the side for methadone maintenance. That’s how the show worked: two real lawyers, arguing for and against a question in a kind of trial format. And he took pains to explain why methadone is not the same heroin. I mean, both are opioids, yes, but when a person takes heroin, the high—or what doctors call “euphoria”—comes on fast, and then, they crash.

LISLE BAKER: So he swings up and down, and up and down, and he spends almost no time in this zone of normal feeling.

KATIE HAFNER: He’s pointing at a graph with a long pointing stick, even though he’s right next to it and could definitely use his finger, but whatever. At the top of the graph is the green zone: feeling good or euphoric. At the bottom is the red zone, which is feeling sick. And in the middle, this is the yellow zone labeled “normal feelings.” With heroin, the line moves wildly between green and red. And what about methadone?

LISLE BAKER: Now, methadone maintenance given to him in stabilizing z- doses of the glass of orange juice or tang do away with a sick feeling or drug hunger. It's medicine to solve this problem. And in large doses it can block any high or euphoria if an addict decides he wants to go ahead and shoot up some heroin.

KATIE HAFNER: So the methadone side of the graphic is all yellow. No highs. No lows. Just yellow. Just normal feelings. That’s because methadone, like all opioids, attaches to opioid receptors in the brain and activates them, but it does this more slowly than an opioid like heroin, so there isn’t the same rush of feeling, especially in people who’ve already developed an opioid tolerance. And while methadone is squatting on a receptor, other opioids can’t attach to it. So it blocks their action. But in 1970, Lisle Baker kept the explanation simple. Methadone made people feel normal. And then he turns to his guest expert.

LISLE BAKER: I'd like to call one of the country's leading experts on this program, Dr. Jerome Jaffe to the stand. 

KATIE HAFNER: The same Jerome Jaffe we met earlier. This was a year before he was tapped to lead Nixon’s new agency. At that point, he was an associate professor at the University of Chicago and was running Illinos’s drug abuse program. And Lisle asks him the question at the center of the program, the same one that had plagued maintenance from the beginning.

LISLE BAKER: Dr. Jaffe, Many of the people who are watching this program are afraid of using one drug to fight another drug. Can you help us out on that?

JAFFE: Well, I think that the problem is in the way it's expressed. Medicine has for a long time used drugs to fight problems. In this instance, we're using a drug to fight a human feeling, a compulsion to seek out heroin. Uh, we have for a long time accepted the idea of using medication to fight anxiety, to fight depression, and if we could, I think most of us would be willing to find a medicine that would be used to fight the compulsion to smoke cigarettes.

CAROL SUTTON LEWIS: Jerome Jaffe is, as always, measured, soft-spoken, and I think, fairly persuasive. But this is a debate, and he’s not the only one making arguments on this day. The lawyer who’d taken up the opposing side of the debate argued that methadone should only be given as a last resort, after attempts to get off drugs have failed. And he had his own expert witness to help him make his case, a representative from the Bureau of Narcotics.

WILLIAM BAILEY: At this time, I'd like to call to the stand Mr. Gene Haislip, the special assistant to the deputy Director of the Federal Bureau of Narcotics.

CAROL SUTTON LEWIS: As you’d expect, the Bureau of Narcotics rep had concerns—first, that methadone itself was being illegally sold by the people who were supposed to be taking it. This is called “diversion.” And then there was the harm to the patients themselves. 

GENE HAISLIP: Of course, methadone, itself is a highly addicting drug.

CAROL SUTTON LEWIS: Gene Haislip argued that street heroin at the time was cut with other stuff and very diluted, so that methadone might be an even more addictive drug than the one they were trying to fight.

GENE HAISLIP: Second danger, we cut off all possibilities of an early cure in return of individuals to a drug-free existence unless we assure ourselves that far less radical and presently accepted techniques have been first used to see if this can be accomplished.

CAROL SUTTON LEWIS: And it wasn’t just the Bureau of Narcotics making that argument. 

WILLIAM BAILEY: Recently we went to New York City, and we interviewed 24 ex-addicts. And we asked them specifically, What do you think of the proposal in terms of this methadone maintenance program? And I'd now like you to see what they had to say.

CAROL SUTTON LEWIS: By “ex-addicts” he means people who are not currently taking drugs or on methadone maintenance, so by definition, a group that might be inclined against it. 

UNNAMED SPEAKER 1: It's really just a substitute, just another dependency.

UNNAMED SPEAKER 2: I think this is a great shortcoming of a methadone maintenance program is that again they're just treating the symptom, and the public is ready to seize upon it as a panacea that is going to, you know, sort of cure all the ills of drug addiction.

CAROL SUTTON LEWIS: And this feels like what’s at the heart of many people’s objections to methadone. It’s not solving the underlying problem. A person taking methadone, however well they’re living, still has an addiction, and is still taking an opioid every day. And if they have other problems that led them to take drugs in the first place, methadone won’t fix those. 

And at the core of this is a philosophical disagreement that hasn’t gone away. If drugs are bad for a person, shouldn’t the goal be getting people off drugs? If addiction is the problem, then maintenance seems like giving up on a real cure. What about all the people who have successfully stopped using drugs through abstinence programs? Shouldn’t that be the goal?

JUDIANNE DENSEN-GERBER: There's no reason to change a scotch drinker to cheap wine. There's no reason to change a heroin user to methadone. 

CAROL SUTTON LEWIS: One of the most outspoken opponents of methadone was a contemporary of Marie’s named Judianne Densen-Gerber. She was a psychiatrist and lawyer, and she’d founded Odyssey House, a drug treatment program. Unlike the Rockefeller team, Judianne’s approach emphasized complete abstinence. In the early 1980s, David Courtwright sat down with her. 

DAVID: Uh, I'd like to quote you from your book, We Mainline Dreams, again: I rarely miss an opportunity to put methadone maintenance in its proper perspective. It is my view that it is useful in only a small percentage of cases and is far from the panacea that many believe it to be. End quote. Is this still your attitude some seven years later? 

‍JUDIANNE DENSEN-GERBER: Absolutely. Uh I’ve added to it only the fact that I consider certain methadone programs and methadone maintenance programs amoral- or immoral. Immoral probably.

CAROL SUTTON LEWIS: Judianne said she wasn’t flat out against methadone. What she really objected to was when pregnant women were given the drug. But it’s clear her objection ran even deeper.

JUDIANNE DENSEN-GERBER: I am a diabetic. I get very angry every time they talk about the replacement of methadone in the addict-

‍DAVID COURTWRIGHT: -being like insulin

‍JUDIANNE DENSEN-GERBER: Being like insulin, yeah. I become enraged. How dare they discuss a disease, which I happen to know of as a sufferer? Without the insulin, I die. Without the heroin, they do not. There is no comparison. And we diabetics should mount a very strong campaign to get us away. There should be an anti-defamation league for the diabetic every time they use that analogy.

KATIE HAFNER: Marie was unfazed by such criticism. She used the insulin analogy so many times you can’t help but wonder if she did it just to goad this one very goadable peer. 

Marie and those who fell in line with her thinking argued that the problem isn’t fundamentally drugs themselves. What matters is how they affect people. There is no cure for addiction, and if methadone allows some people to live good, full, and by all accounts normal lives, why deny them that?

In the big 1965 New Yorker piece about Marie, we actually see her get into this argument. She’s sitting at the storefront clinic in East Harlem, chatting with a group of patients, and she’s talking about the great stuff they’re doing with methadone, when one patient, a young Black man named Pete, suddenly stands up and declares that methadone is just wrong. He tells Marie they’re just giving people “synthetic heaven,” denying them the enjoyment of life that comes with being normal.

But Marie fires back, arguing basically, well, what’s normal? Patients taking methadone are working or in school. Even some narcotics agents can’t tell they have addictions. 

And then she says this, quote: Is a molecule of methadone more immoral than a molecule of insulin? There’s that insulin analogy again, she’s nothing if not incorrigible, that Marie. Then she says: Look- if you can make it off anything, more power to you. But if you can't, don't confuse medication with immorality.

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[PAUSE]

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CAROL SUTTON LEWIS: Criticisms from the likes of Judianne Densen-Gerber might have rolled off Marie’s back, but pushback from the people she was trying to help? That was harder. And methadone was getting a lot of pushback, especially in some Black communities.

SAMUEL ROBERTS: it's a comment, not about behavioral health, not about psychology, and what needs people have as individuals. It's about politics.

CAROL SUTTON LEWIS: Samuel Kelton Roberts, whom we’d heard in an earlier episode, is an Associate Professor of History and of Sociomedical Sciences at Columbia University.

SAMUEL ROBERTS: When methadone shows up, and its biggest proponents were white people who were unknown to any of the civil rights leaders in the community. Marie Nyswander had a reputation in Harlem because she had worked with black patients. You know, she- you know, her name was pretty good there, but nobody knew Vincent Dole. Nobody knew any addiction doctors really, that were, let alone the politicians who were, you know, really promoting.

And so methadone comes out and I think, understandably, I don't think it was necessarily correct or appropriate, but I completely understand that people would say, you know, you give us bad schools, you give us no jobs, you know, you give us bad housing, we're still being brutalized by police. And as a result of all that, you know, our children are, you know, using this junk. And what do you give us? You give us more junk. Like it- politically, it is illogical if that's your perspective. And it's unfortunate that that was the context in which this happened.

CAROL SUTTON LEWIS: And it was in 1972, right as methadone clinics were opening up across the US, that the country was learning about Tuskegee, the infamous study from the US Public Health Service where Black men with syphilis were lied to and denied treatment so that researchers could study how the disease ravaged their bodies. And yeah, that’s the same Public Health Service that Marie had worked for. So when methadone starts taking off in the late 60s and early 70s, not everyone welcomes it, to put it mildly. 

DAVID COURTWRIGHT: There were some black groups who, irony of ironies, regarded this as a form of genocide. That must have made you terribly bitter.  

CAROL SUTTON LEWIS: David Courtwright asked Marie about this during their interview in 1981.

MARIE NYSWANDER: No, it upset me terribly. Upset me terribly. That they could think—well, you take it personally. You can’t think that about me. 

DAVID: You of all people.  

MARIE NYSWANDER: [Laughs] But I really felt very bad, because here was poor Harlem, which was just  being decimated by drug addiction, destroyed by drug addiction. Perhaps one out of every fifteen, twenty men were drug addicts up there. For some of their medical profession and leaders to turn against the only possible salvation they had- Meanwhile, we have black people going back to school and doing so well, uh, that was a heartbreaker. 

CAROL SUTTON LEWIS: “The only possible salvation they had.” There’s a whiff of that famous Marie savior complex again, along with a good dose of condescension. 

KATIE HAFNER: But in the early 70s, as we heard earlier, methadone was getting a lot of support at the highest level of government with Nixon’s war on drugs. And from the start, methadone was one of the biggest weapons in his arsenal. This wasn’t necessarily because he cared deeply about people with addiction. Heroin addiction was driving crime. Voters didn’t like that. And it was hurting the war effort. In 1971, two congressmen visited Vietnam and came back with a shocking finding: 10 to 15 percent of soldiers were addicted to heroin, and they were bringing their addictions back with them. If methadone could help with these problems, well, it was a means to an end. And so that’s why Nixon brought on the very pro-methadone Jerome Jaffe.

DAVID COURTWRIGHT: That- that was an interesting time. Not only does President Nixon declare a war on drugs, but it's a different kind of drug war. There's a lot of emphasis on treatment as- as well as simply law enforcement. 

KATIE HAFNER: There has always been this tension in the country’s approach to drug addiction—between law enforcement as embodied by federal narcotics agencies versus treatment, as embodied by offices like Nixon’s SAODAP. And as head of SAODAP, Jerome Jaffe moved quickly. When he first arrived in Washington, he had no budget and no staff, but he soon managed to get the agency up and running, and it wasn’t long before he was rolling out methadone maintenance programs across the country. In 1971, there were about 9000 patients on methadone maintenance. By 1973, two years later, that number had grown to 73,000. Methadone wasn’t the only treatment SAODAP was rolling out, but it was a big and highly visible one, and soon, critics were calling Jaffe “the methadone king.”

DAVID: And so that's why the honeymoon ends because with growth comes problems. There’s the so-called NIMBY phenomenon, the not in my backyard phenomenon, uh, where people in the neighborhood don't want a methadone clinic. So you've got a local opposition. 

CAROL SUTTON LEWIS: In neighborhoods with methadone clinics, people started seeing long lines of patients waiting to get their daily dose. And a lot of residents did not want them there. Locals would tell newspapers they were worried about drug users coming into their neighborhoods, coming near their children. And federal regulators were worried about these clinics too. 

DAVID: Not every methadone program was a clean program. There was diversion of methadone into the black market. 

CAROL SUTTON LEWIS: Methadone is still an opioid, and even though it wasn’t as fast-acting and doesn’t produce a high like some other opioids, it still had street appeal. And as more clinics were established, so-called “pill mills” started popping up.

DAVID: People would go to a privately run methadone clinic and the doctor would say, how many pills do you want? And you would be charged on the basis of, you know, the size of the prescription for, um, methadone tablets that he would write for you. And, uh, it’s obvious that not all of those were being consumed by the individuals. They would leave, and they would sell those pills on the street for cash because word got around fast that if you were undergoing withdrawal and you couldn't get a, uh, an injection of heroin, if you could get a hold of some diverted me, that would tide you over.

CAROL SUTTON LEWIS: This development seemed to confirm what the Federal Bureau of Narcotics had been worried about in the first place.

JAFFE: It was an odd situation with methadone, which if left to its own devices, which essentially allowed people to do whatever they wanted, uh, would result in overdoses, uh, and deaths. They wouldn't be overdoses among the addicts themselves, but there would be some. There would also be deaths of non-drug users. You know, you would, your medicine in the refrigerator and an eight year old would take it. Uh, and these were dramatized by the media.

CAROL SUTTON LEWIS: The Bureau of Narcotics seized on these stories, teaming up with the FDA to more strictly regulate methadone. The FDA announced that methadone was an investigational drug in 1970 which meant it could more closely control how these clinics operated. 

KATIE HAFNER: And not long after, federal law enforcement finally got the control they wanted. By that time Jerome Jaffe was no longer in charge, and the Bureau of Narcotics had been superseded by the Drug Enforcement agency.

JAFFE: The drug enforcement agency came to Congress insisting that there was so much overdoseage that Congress ought to give them co-authority over methadone programs. They were given authority to look to the security of methadone at methadone clinics. But often, uh, at least in my experience, they pushed the limits of what they were authorized to do.

CAROL SUTTON LEWIS: By the time Marie sat down with David Courtwright in 1981, methadone was a highly bureaucratized system, bogged down by intense regulations. And Marie was not happy. Why couldn’t patients go to a doctor, get a prescription like they would for any other medication? If a patient is doing well, why can’t they get a one month supply? Why do they have to line up outside a clinic each morning?

MARIE: Many of my patients here get four months or four weeks medication. They travel, no problem, never been a problem for 17 years. So I do think that is the, the future. it is absurd to keep them- It's part of also keeping them isolated or the finger pointed on them, reminding them, uh, of what unreliable people they are that they have to be segregated to methadone clinic.

CAROL SUTTON LEWIS: The thing that Marie had fought so hard against, that stigma, persisted. When David spoke with patients, many of them said that methadone had helped keep them stable, but still, they felt people were judging them.

JOHN B: Nobody in my family knows anything about this type of thing.

CAROL SUTTON LEWIS: John B, who we heard from in the first episode, he was in and out of Lexington for years, and couldn’t find a way out of his heroin addiction. Methadone finally allowed him that, but-

JOHN B: I go to visit my family, uh, yearly and, uh, nobody knows that I am on a methadone program and I have to take medication with me and, uh, the people at the program, uh, suggested that I go to one of the programs in my town and get some methadone. I wouldn't dare do that. My family's too well known in the town.

CAROL SUTTON LEWIS: Another patient, Stella, found methadone helpful too, but professionally, it was causing a problem.

STELLA: I haven't taken any kind of drugs since I'm on the program. In fact, I got a job in the telephone company, and after two months, I had to go for an examination and they found out that I had, uh, methadone in my urine, and they fired me. 

INTERVIEWER: Did you get another job while you were on methadone? 

STELLA: I tried. Being that I can type, I tried, uh, I went to the state building on 125th Street and I told them that I would like to brush up on my typing. But at the same time, I told them I was on the methadone program, and they said they wouldn't take me. They don't take people who are on meth programs.

CAROL SUTTON LEWIS: As Marie saw it, the tight regulation of methadone was feeding this problem. In their conversation, David asked Marie what kind of narcotics policy she’d like to see in the US.

MARIE: Well, hopefully, research would continue to find a better drug than methadone, hopefully a cure, but it’s a chronic disease, and we don’t do very well with any cures in chronic diseases. So that the research would continue to go on, and that the clinics would go on with a kind of understanding that they had when they first opened. We- we didn’t have any federal rules they told us that mandated treatment or urine tests or anything else. The doctor did what- what seemed indicated, and patients could take two or three weeks right at the beginning if they were working and needed it. No problem.

‍DAVID: You’re starting to sound like a Republican.  

‍MARIE: [Laughter] Like a Republican. 

DAVID: Complaining about federal regulations.

KATIE HAFNER: All joking aside, Marie was frustrated. She was a person with strong opinions, and this was something she’d been working on for years and years and years, an intractable problem, and she had found methadone, and methadone was her baby.  It was her game-changing treatment, her legacy, the quote “only salvation” as she saw it. And now, it was finally out there in the world, but not the way she wanted.

CAROL SUTTON LEWIS: Next time: Marie Nyswander really did transform the landscape of addiction treatment. Today, methadone and medications for opioid use disorder are standard treatments. So how’s it working out?

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KATIE HAFNER: The Lost Women of Science podcast is hosted by me, Katie Hafner-

CAROL SUTTON LEWIS: -and me, Carol Sutton Lewis. This episode was produced by Zoe Kurland, and Elah Feder, our senior producer, with help from Alexa Lim. We had fact checking help from Danya AbdelHameid. All of our music is by Lizzy Younan. D Peterschmidt mixed and designed the sound for this episode. 

KATIE HAFNER: As always, I want to thank my co-executive producer at Lost Women of Science, Amy Scharf. We are funded in part by the Alfred P. Sloan Foundation, and Schmidt Futures. Our podcast is distributed by PRX and published in partnership with Scientific American.

CAROL SUTTON LEWIS: For show notes and more about the whole team that makes this show happen, visit lost women of science dot org. 

KATIE HAFNER: And if you like what you heard, tell a bunch of people, and we mean a bunch, right, Carol?

CAROL SUTTON LEWIS: Absolutely. Get them to subscribe.

KATIE HAFNER: How big is a bunch?

CAROL SUTTON LEWIS: Oh, lots of people.

KATIE HAFNER: Like thousands. Tell thousands. Finally, we’re off next week, but we’ll be back in TWO weeks with our final episode! I promise it’s gonna be worth the wait. See you soon!

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