I first enrolled in a methadone program in Slovenia in 1997, after about a year and a half of intense heroin use. I started injecting after losing my regular job as a TV producer, which closed operations. After being half-forced and half-convinced by doctors, I signed up to enter a detox and methadone programme in Ljubljana.
They told me that detoxing directly from heroin is difficult, so it would be better for me to go on methadone for a while. This was, of course, a blatant lie.
While I knew the pressures that people who use drugs faced in Slovenia, I didn’t realise that my own journey through treatment would be so defined by harassment, surveillance, and lack of control over my own treatment and desires. I’m sharing my story with others to highlight how I was not given a choice as a patient – a daily reality that many across drug treatment systems face.
Journey into and through methadone
I realised I needed to enter Ljubljana’s detox programme to get my life in order. With only one centre in the capital housing around 14 patients, there was an expectedly long waitlist. While waiting for admission, I was encouraged to get on quite a high dose of methadone – a common Slovenian practice to ensure patients are “calmer on it,” as my doctor explained. I was on 65mg daily, with some fellow patients on 180mg.
Once in, detox lasted the regular three-month period. After leaving, I used this chance to return to university, graduating with a degree in social work with a thesis on the “demystification of drug use.” By that point, I had postponed my studies for almost 15 years, and I was glad to have gone back to school after working in TV; I never thought that I would become a social worker. After completing my degree, I opened the first homeless shelter for people with drug-related issues in Slovenia, researching drugs and working with the communities that use them.
Looking back at this time, my only regret is having been so open about doing drug-related social work. In a small country like Slovenia, with a “village” of 250,000 people for a capital, word travels around fast about who people were, are, and intend to be. The social condemnation that people who use drugs face in such societies is intense: we’re seen as sinful people with ill-intent, a reputation that is kept for a lifetime.
I stayed on the methadone programme for a few years, until I could no longer deal with rude staff and unethical procedures – sadly a reality for many in treatment across Slovenia. At the clinic, all urine drug testing happens in one corridor, lined by open doors with staff listening in on patients’ consultations. You always had to be on the lookout for who was around you or who could be listening to you – a difficult task in a small clinic.
I couldn’t deal with this constant feeling of control and humiliation. After almost three years of treatment, I left the clinic in 2000, abandoning methadone with it. I did not have the time nor patience to deal with people who were in total control of my treatment, yet treated me poorly throughout it.
However, In 2011, after life complications, including some time in prison, I returned to treatment. I felt like I had no other option. I had tried to create an environment that was healthier and more open for people who needed help and still used drugs. But the Slovenian drug policy system does not look kindly on those challenging the status quo, and who propose alternatives from the ground up. For the next few years, I endured the surveillance and constant testing that is part of treatment, resigned to my fate; all I could do was hope to improve my relationship with those in control of my medical fate.
Cycling through treatments
By 2018, I was travelling a lot for work, meaning I had to warn the clinic 14 days in advance to ensure I could travel with a stock of methadone. This was always a lengthy process, as they weren’t used to having travelling patients. As a result, the clinic recommended I try buprenorphine.
8mg buprenorphine tablets made me feel wonderful. I was happy on it; I could even occasionally smoke heroin when I strategically did not take pills for a day or so before. I always made sure that I had a negative urine test when I visited, which was not difficult for me. I had to be careful when I indulged in “dessert.”
However, in the middle of the pandemic, my doctors “suggested” to me (in the same half-forcing half-convincing as usual) to switch to monthly buprenorphine injections. I finally acquiesced after much pressure – much to my regret.
With these injections, my mood was always in flux – a world apart from the daily buprenorphine feeling. They made me feel dopesick, as if I was quitting “cold turkey.” I was repeatedly told it would get better, with the doctor even increasing my dose, but it never did. Even though I wanted something else and knew it would be better for me, my wishes weren’t respected.
All humans are different, and for some reason I responded better to oral buprenorphine. My medicine should have never changed; there was no reason to modify what had been working well for me. As a patient, they cycled me through treatments, regardless of what I liked, wanted, or was interested in.
I began using heroin to treat the “cold turkey” symptoms, and I was punished when I failed urine tests. With the return of frequent urine tests, I struggled to pass them and was frequently disciplined. As punishment, my injectable buprenorphine dosing regime went from monthly, to bi-weekly, to monthly, depending on my urine results. This zig-zag dosing went on for a year.
The final straw
In May 2024, I had the chance to travel to Kyiv in Ukraine to record some interviews with the Eurasian Harm Reduction Association and community organisations like VOLNA. It was a draining trip. By the time I returned to Ljubljana, I was emotionally and physically exhausted. I reached for the familiar comfort of brown to relax me… And went to the clinic the following day.
As I walked into the clinic and made my way down the corridor for a urine test, I could see doctors sitting behind partitions in rooms, listening in to patient’s meetings with other clinicians. As I sat in my own clinical meeting and handed in my urine sample, I admitted that the results would be positive, as I had smoked the day before.
As if she had heard me speak, a doctor walked into the room.
“Give him one week!” she said, once more slashing my injectable buprenorphine dose from monthly to weekly.
I was floored. Not only was she openly listening in to our conversation, but she was now punishing me by restricting my access to medicine that was making me feel sick, without even waiting for the results of the urine tests. Why would she do this? Was this for “my own good”?
I pleaded my case. I said I would be travelling for work in Ukraine for a few more weeks and needed a larger dose. She didn’t listen, nor change her mind. My fate was sealed.
There and then, I was done with the clinic. I was done with the control. I was done with the constant humiliation of exposing my life to these clinicians, who punished me with no sympathy for my situation. The same doctor would later criticise me for “wasting” expensive doses of injectable buprenorphine – the same medicine I had never wanted in the first place, and which was fully covered by insurance.
For the final time, I left the treatment clinic. I had had enough.
Doctors as Gods
As patients in treatment, you’re left to deal with doctors playing God. When I challenged their wishes, I was seen as “difficult” and “negative.”
My doctor could have worked out an arrangement with me; she could have issued a letter confirming my involvement in treatment, which would have meant I could get treatment by visiting clinics in Ukraine while there on work. Because of the war, all private clinics were closed; public clinics rejected foreigners, but they may have helped me with a letter from my doctor. I guess we’ll never know.
You can imagine what my return from Ukraine was like. I am now left with no formal treatment – in some ways free, but at a cost. While working in Ukraine, a friend helped me source buprenorphine/naloxone pills, which helped me through the following two weeks. During the three-day bus ride back to Slovenia, I did not eat or drink so as not to have diarrhoea.
I am furious at these arrogant Slovenian doctors who have turned the public substitution therapy programme, an essential component of low-threshold harm reduction interventions, into a monster I couldn’t bear living with anymore. The lack of choice and control over my treatment was humiliating; I didn’t feel like any of my wishes around the medicine I got were ever respected or listened to.
Now, I am good. I am no longer being seen in an environment where I am constantly on the alert that something will go wrong and I will be punished. In Slovenia, we have a very controlling environment that you don’t see in other European countries, where people give one urine test when they enter treatment and then receive three months’ of treatment. Here, the norm is harassment, punishments and “controls”, simultaneously with no control ourselves over our on treatment.
Now, out of treatment, I just need to figure out my future: a future of navigating treatment, medications, and complicated doctors.
