An early-morning ritual of which most new Yorkers know very little plays out every day on sidewalks across the five boroughs, riling neighbors but bringing relief to some of the city's saddest cases.

While commuters queue at their local Starbucks for their first cardboard growler of coffee, addicts often don't have to leave the city's choicest neighborhoods to get their daily paper mouthwash cup of hot-pink methadone.

Six mornings a week, beginning well before the crack of dawn, methadone users gather in front of an unmarked, grimy metal door at 253 Third Avenue in Gramercy. like a Prohibition-era speakeasy, a methadone dispensary often acts under the cover of ignorance, and passersby typically have no idea Gramercy Park Services is even there.

But every day the clinic serves as many as 400 people from different strands of the city's tapestry. “People from Wall Street, rock group people, you see fire men, policemen, you name it,” according to Raymond Sanchez, a consultant who has worked at the clinic since 1994 and says meth clinics offer a vital public service.

Like us on Facebook

“We're the good guys. we give them the medicine to treat their addiction, their mental health problems, we treat other illnesses when they get sick, and we check for HIV and STDs,” Sanchez told the IBTimes in his second-floor office at Gramercy Park Services.

The methadone clinic has long been a mainstay in the gritty new York drug scene lying just below the town's glitzy surface. Its clientele gets up early for their fix, smoking cigarettes and hanging out along well-travelled blocks in Gramercy and Midtown–not just South Bronx and South Jamaica.

Methadone clinics attract not the high and mighty but the down-and-out, people who have hit rock bottom on heroin who are looking to find a safe buzz, and maybe even wean themselves off opiates for good.

But they also have a well-deserved reputation for drawing people who don't fit the accepted mold of the model citizen. Many heroin addicts are unable to hold jobs, have other health problems, or most visibly, exhibit the negative symptoms of using not only dope but also a whole range of other drugs.

So the clinic directors and workers undertaking the difficult job of trying to help these people, who have found themselves at the end of life's rope, find themselves constantly and understandably at odds with the people who live and work near the facilities.

But Sanchez argues that without places like his facility, opiate addicts would instead turn to crime and illicit behavior to pay for heroin or other more expensive drugs.

“You have a family, you're worried about your three kids, but here comes a person, he's not a part of a cartel. He's not selling, he's not going to try to get your child to do drugs, he's not a criminal, he's just here to get treatment, he's bettering his life,” he explained. “We want to put people back on a good track, get their lives back together.”

That line of argument does little to allay the fears and concerns of many workers, residents and business owners who live or work near such facilities.

A worker at Adriana Pizza, two doors down from Gramercy Park Services, says its patients are rude and threatening, and she wishes it would close down or move elsewhere.

“They stand in front of our door smoking cigarettes. I ask them to leave and they say it's public property and I can't say no to them,” she said while waiting for a customer's grandma slice to heat up. “'I'll find you later,' they say. They're just nasty people, about 75 percent of them. I've been here 26 years and it's always been a problem. Would you want your children growing up with people walking around the street like this? I don't think so.”

A barista at Fête Coffee, located on the same block as the clinic said employees have found syringes in the shop's bathroom, where many of the clinic's patients use the facilities and sometimes smoke cigarettes, to the chagrin of the shop's owner. She said the patients have scared some customers away as well.

“Some of the customers are not very pleased. They see these people and sometimes they're afraid to come in,” the barista said. “From a business perspective, I don't see anything positive.”

The irony is that Gramercy Park Services actually wants to pull up its roots and move to a new location. Its facility is dingy and small, and it is too small to allow for the installation of an elevator, meaning it does not comply fully with the American Disabilities Act, and is therefore not able to offer as wide a range of medical services as its ownership would like it to.

But NIMBYers have kept them from being able to find a site in Manhattan where they can relocate without causing an uproar from neighboring residents and workers.

It's the ongoing struggle of the methadone clinic: they are performing a necessary service, which large swaths of people agree needs to be done, as long as it takes place far from where their families lay their heads, says Nicholas Papageorge, office manager at Gramercy Park Services.

“If we were an abortion clinic, there'd be no problem, and an abortion clinic is dedicated to taking lives. We're in the business of making lives but we get a lot of problems. It's because people are ignorant of what we do,” Papageorge said. “We perform social miracles. we literally save lives and people don't understand that. If it wasn't for us, who knows how many people would be dead.”

To report problems or to leave feedback about this article, e-mail:

To contact the editor, e-mail:

For Immediate Release Thursday, December 9, 2010

Babies born to women addicted to opioids fare better when their mothers are treated with either the addiction medication buprenorphine or methadone than babies whose mothers are not treated at all. In this comparative effectiveness trial, buprenorphine was found to be superior to methadone in reducing withdrawal symptoms in the newborns, according to a recent study funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. the study, conducted by a multi-disciplinary team of researchers from North America and Europe, was published today in the new England Journal of Medicine.

Methadone is currently the recommended treatment for opioid-addicted pregnant women, and when properly used is considered relatively safe for the fetus. however, it is associated with neonatal abstinence syndrome (NAS) — a cluster of symptoms stemming from opioid withdrawal in the newborn — often requiring medical treatment and extended hospital stays. Buprenorphine is a more recently approved medication for treating opioid addiction, but less is known about its effects in pregnant women and their babies. This study found that, compared to methadone, buprenorphine resulted in similar maternal and fetal outcomes, yet had lower severity of NAS symptoms, thus requiring less medication (1.1 versus 10.4 milligrams) and less time in the hospital for their babies (10 versus 17.5 days).

"Finding medications to help an addicted mother and her newborn is crucial," said Dr. Nora D. Volkow, director of NIDA. "By comparing two effective medications for treating opioid addiction, this study will give health care providers and their patients vital information that will help them choose the treatment offering the greatest benefits."

The research project, called the Maternal Opioid Treatment: Human Experimental Research (MOTHER), was one of the first to prospectively follow opioid-dependent pregnant women from enrollment until at least 28 days after giving birth. Women who volunteered for the study were addicted to opioids, such as heroin or prescription painkillers, with low rates of other illicit drug use, which meant the NAS could be clearly attributable to the opioids. In all, the eight-site international study included 131 mothers and their newborns.

"In addition to providing support for the viability of buprenorphine to treat pregnant women, we were able to closely examine the severity of NAS following prenatal exposure to methadone or buprenorphine," said Dr. Hendree Jones, the primary study author. "We were pleased to be able to identify a medication that lessens the withdrawal distress to newborns, and gets them out of the hospital more quickly." Dr. Jones is a senior researcher at Research Triangle Institute International and professor in the departments of Psychiatry and Obstetrics and Gynecology at Johns Hopkins University, Baltimore.

The study can be found online at nejm.org.

A similar study titled Revised Dose Schema of Sublingual Buprenorphine in the Treatment of the Neonatal Opioid Abstinence Syndrome was published Oct. 6, 2010 in Addiction, by Kraft et al. To read the abstract, please go to onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03170.x/abstract.

Methadone maintenance treatment has been used for more than 40 years. When properly used, it can safely and effectively treat heroin addiction. In the United States, its use as a treatment for addiction is restricted to specialized opiate treatment programs. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin and other opiates and return to more stable and productive lives.

Buprenorphine is a newer medication, approved by the FDA in 2002, for the treatment of opioid addiction in non-pregnant patients. It has weaker opioid effects than methadone and is less likely to produce overdose. Buprenorphine also produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than do individuals who stop taking methadone. Buprenorphine can be prescribed to treat opioid addiction in the privacy of a certified physician’s office.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world?s research on the health aspects of drug abuse and addiction. the Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at drugabuse.gov. To order publications in English or Spanish, call NIDA?s new DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or gov Online ordering is available at drugpubs.drugabuse.gov. NIDA?s new media guide can be found at drugabuse.gov/mediaguide.

The National Institutes of Health (NIH) — the Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. for more information about NIH and its programs, visit nih.gov.