Tuesdays—I meet with Dr. Ira in Hackney, East London, to ensure that the flow of methadone remains uninterrupted. Methadone gives and methadone takes away—rather like God, in a way. If methadone is God then Dr. Ira is His gin-soaked St. Peter, sitting at the gates, checking boxes, deciding if I have been naughty or nice in the week since he last passed judgment on me.
Sterile, airless atmosphere in the waiting room. Smell of detergent and junk sickness wafting out from aching muscles and creaking bones. Old woman behind the reception desk with a white, starched, severe face eyes me with obvious condescension. The good doctor owns me, for all intents and purposes. I am sure the pursed-lipped old receptionists and nurses are in love with Dr. Ira’s twisted pipe-tobacco-stained old bones in their own dried-up, pent-up way.
Dr. Ira is a repulsive old specimen.
Stink of professional arrogance and brandy all over his sweating, leering, ruptured old face. After thirty years in the service, junkies are his life now. He has the same love-hate ambivalence toward us as we have toward the drugs that constitute our lives.
“Fuck Hannah,” a male voice says from behind me.
“Martin,” says a shrill East End harpy, “she’s pregnant. We can’t leave her wivout nothing.”
“That fucking cunt will take all of our fucking gear and leave us sick. She’s a fucking liberty taker. Fuck her and that fucking fetus she’s dragging around.”
“Martin—she’s all right—you’ve got her all wrong.”
“No I fucking don’t! Tell her she can’t fucking crash with us. Who knocked her up, anyway?”
“Denzil.”
“That paki cunt? Tell her to stay with that fucking bastard then!”
“He fucking raped her. She can’t stay wiv him.”
“Raped her, my arse. She fucked him for rock. She’d fuck anyone for rock.”
“I know she would. But that sick cunt raped her.”
“Did he give her a pipe?”
“Well, yeah, but—”
“Then she fucked him for rock. End of.”
The East End harpy has her blond hair, black at the roots, tied back in a severe bun. It is pulled back so tight that it accentuates the harsh contours of her skull. She has a black eye that has faded to the color of autumn leaves. Her boyfriend is a skeletal old jailbird, bathed in sticky coagulating withdrawal sweat. He nervously clenches and unclenches his inked fists and stares at the polished tile floor.
Last night I had a dream that Dr. Ira told me to suck my methadone out of a rubber phallus protruding from the fly of his dandruff-sprinkled brown slacks. It was part of my treatment plan, he told me, laughing.
In the dream, I did it.
Wouldn’t you?
“Now,” Dr. Ira is saying to me, rustling his papers up and down and coughing phlegm into his palm, “take those child molesters, hum? They say that they can’t help it. Chemical castration doesn’t help. It’s a medical condition that they have. There aren’t many reformed child molesters out there.”
The child molester speech. I hate the way his lips seem to grow wetter and thicker, redder and mushier, when he talks about child molestation.
“There is evidence to suggest their claim that they can’t stop what they are doing. But your claims that you can’t stop…well, frankly my boy…they are contraindicated.”
“And how is that, Dr. Ira?”
“Well, because there are innumerable ex-addicts out there. They are legion.”
“You mean the God-botherers.”
Dr. Ira smiles his practiced old predator’s smile.
“Well, yes, the Narcotics Anonymous people, of course. But others also.”
“And how long do they stay clean?” I ask. “I mean, when do you consider them clean? After a year? Two years? Five?”
“Any time away from drugs would be considered a period of clean time.”
“But how long do they stay clean for?”
It is the old chicken-and-egg scenario that we always get into. This is the game. Dr. Ira wants me to reduce my methadone. Even if I were to reduce it by just five milliliters, he would be happy. In reality, if I reduced by five milliliters a day I would not feel the deficit. But once I reduce, there will be no way—bar buying the methadone off the black market—for me to ever get my dose put back up. It will never happen. The inflexible authority of the clinic can never be overexaggerated.
If I remain at Homerton Drug Dependency Unit for twenty years on a methadone program, never again use street drugs, hold down a job, buy a house, start a family—all of that kind of happy shite—I will still be considered a failure for Dr. Ira. For me to qualify as a success to his superiors, I must reduce my dose over a period of time until I am opiate-free, allowing me to leave the program. If I do that, but then return to using street drugs and eventually kill some old bastard for his pension money so I can score, I will still be considered a roaring success by the hospital’s standards. There is no follow-up treatment. As soon as I walk out the door—clean, for however short a period—I am judged a success.
So we carry on this dance, week after week. Dr. Ira gives me his little speeches. I listen, respectfully decline his offers of dose reduction, and walk out with a prescription for one week’s supply of methadone. And then it starts all over again.
My daily routine has evolved over the past year. Today I receive my prescription once a week, take it to a chemist, and then return every morning to the same chemist to pick up a bottle of sticky, sickly sweet methadone linctus. I can take the bottle home and use it whenever I need it. I can save it up and use heroin instead. I have approximately two thousand milliliters, stored in medicine bottles around my flat. It makes me feel secure. The King of Purgatory, with all of his adornments.
After six months at Homerton I underwent my review. No dirty urines. This was quite simple to achieve. For that whole period I was piss tested regularly, observed by a nurse. So I injected black-market methadone, the kind that comes in ampoules specifically for that purpose. It is impossible to get by prescription unless you have a private doctor. The only way most junkies can afford a private doctor is to play up their habit and sell the excess ampoules. It was a shitty high, but better than nothing. After three months I was allowed to piss alone. Then I used other people’s piss.
Most opiates are out of the bloodstream in three days. At the clinic people would take turns using heroin or staying off. After three days off, they were pissing good, clean urine again. Then they filled up a bottle and distributed it to everyone else they were friendly with. Everybody involved could use heroin most of the time and pass the urine test all of the time. After the first six months, the piss tests became less regular, so as long as I was careful I could do as I pleased. It is all about working the angles at the methadone clinics.
Does Dr. Ira believe I have been off heroin for a year? No. Does he believe any of his patients have? No. Does he care, as long as he doesn’t have to explain the dirty urine samples to his higher-ups?
No, no, and no.
Walking out of the clinic with my prescription I feel like a lottery winner. The bastards are off my back for another seven days. Back to Murder Mile, Susan, and my cold-water flat. Back to the old gray-haired pharmacist and the old black cleaner Leroy, who walks around the shop floor dazed, broom in hand. There are more shootings per capita on Murder Mile than anywhere else in Great Britain. The drug trade is to blame, mostly the Yardies who control the crack trade. Scoring crack around Upper Clapton can be a risky business. Junkies can get caught in the cross fire of turf wars and displays of machismo. DC, a young kid I bought from on occasion, was found dead in the back of an abandoned Vauxhall Astra last month. One day his mobile was turned off and then a day later I saw it on the news: another dead kid on Murder Mile. Turns out he was fourteen. I remember absently thinking that kids are looking older these days. I suppose a gun and a bag of rocks can make anyone look like a man in poor light.