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.

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“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.”

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