The Addiction Connection

They'll bust you for using heroin. They'll sell you the more addictive methadone for a nominal fee at a local clinic--legally. This makes sense?

Michelle's mother and sister also called frequently, and her mother mailed her scientific studies detailing the dangers of the drugs she was using. In 1985 Michelle broke up with her dealer boyfriend, and her use declined from a $400 daily habit to what she could afford on her own: 100 milligrams of Dilaudid, which cost $100. She finally stopped using illegal opiates in 1989. She had been high on Dilaudid, cocaine, or heroin nearly every day for the previous decade. Finding money for her next injection had preoccupied her life. "You go for years and you're doing something illegal and addictive and kind of immoral," she muses. "You lose your self-respect, you lose your dignity. It would have ended up with death for me. There wasn't any jail or any institution about it. It would have been death.

"I just kept thinking, 'What do I have that's so bad in life?' and I started counting the good things, and the good outweighed the bad, and I was like, 'Why do I want to continue on like that?'"

Ruiz's NW 183rd Street clinic occupies a portion of an unprepossessing one-story office building. No external sign indicates its presence. The interior is drab and virtually windowless. A dull brown rug covers the waiting room floor; a row of plastic chairs lines the walls. Patients rarely dawdle here. It smells of dust and disinfectant. This is where Michelle comes six days a week (no Sundays) to get her methadone.

According to Dave Delesdernier, a former addict who used to be a client at the Comprehensive Psychiatric Center but is now under treatment at the Village, Ruiz discourages patients from lingering anywhere near the clinic, his reasoning being that it can be a magnet for the sale of illegal drugs. "You can score anything in the parking lot," Delesdernier contends.

A receptionist sits at a desk behind bulletproof Plexiglas near the entrance. She determines if Michelle has paid her current bill (it costs her ten dollars per day). Signs on the walls of all Ruiz's clinics issue the stern warning "Clients Behind in Their Payments Will Be Detoxed." Other signs provide a schedule for gradual weaning from the drug. If Michelle doesn't owe any money -- and today she doesn't -- the receptionist hands her a tiny paper ticket stamped with a number.

Michelle waits for a buzzer that unlocks the door to the treatment area. Once inside she makes her way down a hallway to a room where a nurse breaks three methadone tablets into a small paper cup and places it on a counter. (Michelle started her treatment taking 30 milligrams per day and is now up to 70.) The nurse pours hot water over the methadone. Michelle stirs the mixture and downs the sweet liquid in one gulp. She must speak to the nurse to show that she actually swallowed her "medicine." For the past three years, Michelle's urine tests have been clean, which means she can take her weekend doses home if she wishes. (State law requires that the clinic test a client's urine for six substances: tranquilizers, barbiturates, amphetamines, cocaine, heroin, and methadone. Tests for marijuana, hallucinogens, and Rohypnol -- the latter a sedative commonly mixed with alcohol -- are not required. A positive test for any of the six above-mentioned substances -- with the exception of methadone, of course -- does not result in a penalty. It means only that CPC clients are not allowed to take their weekend methadone doses home.)

Methadone sells for a dollar a milligram on the streets. Delesdernier says that while he was a patient at Ruiz's clinic he used to earn money to supplement his heroin habit by selling his weekend methadone supply. "Ruiz is easy, very easy," Delesdernier relates. "You can write your own ticket. You get take-home on the weekend -- for every month you have clean urine, they'll give you a day's take-home. After two months I had two bottles. By five months you have a five-day supply. I could sell [the bottles] for $45 each as soon as I walked out the door." (Ruiz says that he has no control over what happens outside his clinics.)

After taking her medication, Michelle heads out for some breakfast; she isn't allowed to eat until after she doses. Over the years a half-dozen of Ruiz's patients, including Michelle, have routinely congregated at a cafeteria in a North Miami strip mall on U.S. 441. There she chain-smokes, sips Cuban coffee, and catches up. Just as her life once gathered its force and purpose from illegal drugs, it now centers on this affable group of users and ex-users who have come to represent a family of sorts. One of them, a stocky man in his forties, often gives her money for the medication and buys her breakfast. Usually she repays him right away.

They gather at the restaurant because Ruiz has forbidden them to chat in the clinic's waiting room or hanging around the parking lot. Michelle won't violate the rules. In fact, during the course of her methadone-maintenance treatment she has acquired an almost religious reverence for the clinic owner and his staff. She consults Ruiz about financial and personal problems and bares her troubles to CPC counselors each week.

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