Jen Jeffries was arrested on drug charges back in 2007. She was 21 years old, living on the streets in San Francisco at that time, and injecting heroin several times a day. She no longer wanted to get high but needed the drug to avoid going into withdrawal.
“You have a runny nose, watery eyes, yawning, sneezing, diarrhea, and horrible stomach cramps,” Jeffries said.
Jeffries landed in jail, where a doctor offered her methadone. The medication reduces opioid craving and withdrawal and blunts the effects of opioids. But, after she was released, Jeffries had a hard time staying on the daily medication. California state law mandates that new patients can only get a single dose at a time and only from a licensed clinic. That remains true today.
State law has allowed these clinics, formally known as opioid treatment programs, to maintain exclusive rights to distribute methadone since the drug’s approval in the early 1970s during the Vietnam War. Today, primary care physicians are still prohibited from prescribing the medication.
Patients often find themselves having to conform to the clinics’ dosing schedules, and they are required to engage in regular counseling and drug screenings.
On good days, Jeffries slept on the sidewalk near the clinic’s front door so she could take methadone in the morning, but she said most of the time her life was too chaotic to plan ahead.
“When you’re on the streets, and you don’t know when you’re going to sleep,” Jeffries said. “You don’t know when you’re waking up. It’s not feasible to be at a specific place at a specific time.”
Jeffries yo-yoed between heroin and methadone for years while she struggled to stabilize her life.
With more and more Americans dying from opioid overdoses, the federal government updated its methadone regulations this year for the first time in two decades and is now allowing people to receive more take-home doses of the medication.
However, California has not followed the federal example. A new bill introduced by Assemblymember Matt Haney would align the state with the new federal guidance.
“It is infuriating and mind-boggling that during the worst drug crisis in history, as thousands of Californians die every year, that we would keep one of the most effective treatments for addiction locked away where people can’t access it,” Haney said.
The state has one of the most restrictive methadone policies in the world, according to Dr. Leslie Suen, an addiction medicine physician at UCSF. She is not allowed to prescribe take-home doses of methadone to patients discharged from the emergency department. The same rules restrict family doctors in California.
“In other countries like Canada, the United Kingdom, Australia, methadone is widely available in primary care settings,” she said. “So anybody walking into their primary care doctor’s office is able to enroll into methadone treatment.”
Suen said more flexible policies would save lives. “When someone is on methadone, they are able to stabilize their lives, they are able to get jobs, they are able to reconnect their families, and that chaotic addiction cycle goes away.”
In 2015, Jeffries was still living on the streets and panhandling to support her drug habit when she discovered she was pregnant at 29 years old.
“Thankfully, when I found out I was pregnant, I was able to stop injecting heroin and just stayed on the methadone,” she said. “Because if you’re in withdrawal when you’re pregnant, the baby’s in withdrawal before you are, and it’s a very good way to lose your child.”
California’s restrictions are lighter for patients carrying a baby. For the time, Jeffries could take several doses of methadone home from the clinic, and she said it was much easier to kick her habit.
“It was the hardest thing I’ve ever done,” Jeffries said. “I was on the streets until I was six months pregnant.”
But she managed, and eventually, she gave birth to a healthy newborn.
“Today he is nine years old,” Jeffries said. “He is amazing. He is just the best little boy in the world.”
Jeffries still takes methadone each day, and she said it keeps her family’s life stable. She attends regular drug counseling and passes her drug tests — both enable her to pick up her medication every 27 days rather than attend the clinic daily.
“It helps me get to work,” she said. “It helps me take care of my son. It helps me get through the day. I don’t have to worry about being sick.”
But she said there needs to be fewer barriers to recovery. “A lot of our folks on the streets change their minds really quickly. You have to catch them and then keep them, not make it hard for them. Most can’t go every day.”
Assemblymember Haney’s new proposal would expand methadone access in California in the following ways:
However, opponents to the proposal have suggested numerous amendments to these new recommendations, pointing out that a person can overdose on methadone if improperly used.
“We’re concerned that this bill doesn’t have reasonable safeguards that will prevent people from misusing the medication or prevent them from selling the medication to people and resulting in more overdose and death,” said Jason Kletter, president of California Opioid Maintenance Providers — a group of 120 treatment centers in the state.
He said specialized clinics prioritize comprehensive care to patients, including counseling, drug testing, and monitoring for potential drug interactions. He said that expanded access could compromise quality care by reducing the frequency of patient interactions and oversight.
Today, Jeffries works full-time for the San Francisco Department of Public Health as a peer counselor for the city’s post-overdose engagement team.
On a blustery Wednesday morning this year, she wandered through the Tenderloin neighborhood in San Francisco, approaching folks on the street holding fentanyl pipes. She kneeled down to stroke a man’s large black and white shepherd dog. She offered the group fentanyl test strips, clean needles and other harm-reduction supplies.
A man with stringy blond hair, a thin blue flannel shirt, and bloodshot eyes took a box of naloxone or Narcan out of her hand, thanking her. She explained how to use the medication to reverse an overdose.
“My name’s Jen. I work over there,” she said. “If you ever need anything, you can come ask for me. Have a nice day. Love your doggy.”
To learn more about how we use your information, please read our privacy policy.