Talking Points: Melody Glenn

Points is delighted to introduce our readers to an exciting new book by clinician-writer Melody Glenn, MD, MFA, an associate professor of Emergency and Addiction Medicine at the University of Arizona. Mother of Methadone: A Doctor's Quest, A Forgotten History, and a Modern-Day Crisis (Beacon Press, 2025) blends a memoir of Glenn's formation as an addiction medicine doctor with a rigorously researched biography of methadone maintenance pioneer Marie Nyswander. The final result is a beautifully written and compelling account that will inspire health professionals and historians alike. (Fun fact for the alcohol and drug historians in the room: on page 22, David T. Courtwright enters the record as a historical actor in a vividly rendered supporting role).

Melody Glenn, MD

Please tell readers a little bit about yourself.

I’m an addiction and emergency medicine physician and associate professor at the University of Arizona, Tucson, with a BA in Latin American Studies and an MFA (Master of Fine Arts) in creative writing. I also serve on the board of directors of Cochise Harm Reduction, a local nonprofit. Outside of work, I’m a mom to young kids, go to CrossFit several times a week, take Spanish classes, and read and write as much as possible. Not only did all of these identities find their way into my first book, Mother of Methadone, I would argue that they were key components (except maybe the CrossFit and Spanish…).

What got you interested in the history of alcohol and drugs?

Before I was interested in the history, I was interested in the drugs. As an adolescent and young adult, I was part of a modern-hippie, new-agey subculture. Fast forward ten or fifteen years, and I became a doctor caring for patients whose substance use had gotten out of control. In early 2020, I interviewed to work at a methadone clinic. The building was surrounded by barbed wire, the parking lot patrolled by a police officer, and inside, all the staff were separated from the patients by bullet-proof, plexiglass windows. The whole thing made me very uncomfortable – no other medical setting felt like this -- so carceral -- and this juxtaposition led to me to a series of questions. Why did the modern methadone clinic even exist? Why couldn’t I just send a patient’s methadone prescription to Walgreens or CVS? Why weren’t more doctors offering this life-saving therapy? Was it just stigma -- stigma against methadone, the people taking it, and the clinicians prescribing it?  If so, where did it come from? Trying to understand, I looked for an origin story, but it seemed like no such book existed. I had no choice but to turn to the archives – and the rest was history.

What motivate you to write this book specifically?

First, I was writing to discover the answers to my own questions, not only about methadone, but also my role as a physician in working with people who use drugs. I wanted to find a new path forward that didn’t simply follow the savior trope so often found in physician narratives.

Second, I hoped that a story might be more impactful that statistics and scientific studies when it came to changing people’s hearts, which is where I believe so much of the stigma against drugs and the people who use them lives. No matter how much I repeated data points and evidence about the value of medications for opioid use disorder, it didn’t seem to convince the skeptics. Maybe a story could.

Third, I had a MFA thesis to write. Initially, my thesis was a horrible, rambling mess about going through medical school and residency. One of my advisors recommended that I instead try writing an essay collection in order to find more focus and structure. Taking her advice, I sat down to write an essay about the radical physician who developed methadone maintenance -- Dr. Marie Nyswander. By the time I got to 15 pages, I realized that Nyswander deserved an entire book.

But instead of writing a straight-forward biography, I wanted to use some of the creative nonfiction techniques that I learned from a writing workshop, breaking the fourth wall and weaving in my own story. I thought showing the modern-day implications of historical events might make the content more relevant to readers, as well as more emotionally prescient. I was also trying to follow the advice of the author Sandra Cisneros, “Write the book that only you can write.” Anybody could write Nyswander’s biography, but not everyone can show how closely it parallels with their own journey as an addiction physician.

Explain your book in a way your bartender won’t find boring.

Mother of Methadone braids the stories of two doctors battling the opioid epidemic half a century apart, Dr. Marie Nyswander – the iconoclastic woman who developed methadone maintenance in the 1960’s – and myself, an addiction physician in Tucson, Arizona, to reveal the origins of today’s public health crisis.

In the 1960’s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin because of its potential to solve the opioid overdose epidemic. Methadone and its sister medication, buprenorphine, halve the risk of fatal overdose and give people their best shot at sobriety. 

Yet, due to stigma, politics, and over-regulation, methadone was never given a real chance to be successful. Today, less than 2% of physicians prescribe it, and it is easier to find the poison than the cure.  Not surprisingly, we are in the midst of the worst opioid epidemic our country has ever seen.

With Nyswander as my guide, I take readers along on my own personal journey as I confront philosophical quandaries around bias, ambition, and saviorism in the medical field, bringing the modern-day implications of historical events to life.

Did you uncover anything particularly interesting or surprising during your work on this project?

Oh my goodness, I discovered so many things! Did you know that this is not our country’s first opioid epidemic? In 1863, around 4% of the US population suffered from addiction. Or that in the early 1900s, we had maintenance clinics that dispensed heroin and cocaine? Or that an unintended consequence of the 1914 Harrison Act was that addiction was removed from medicine’s wheelhouse, instead becoming the purview of quacks,  charlatans, and law enforcement? That the war on drugs can be considered one of the greatest civil rights issues of our time? Maybe you already knew all of this – you a drug historian – but as an addiction doctor, I did not. So much of today’s media coverage around the opioid epidemic acts as if Americans’ predilection for opioids is something novel, but we’ve been here before.

Also, I was shocked by Nyswander and Dole’s involvement in mutual-support groups, since so many of them are biased against methadone treatment today. Nyswander was an early board member of Narcotics Anonymous, Inc, and Bill Wilson, the founder of Alcoholics Anonymous, asked Dole to develop a treatment as effective as methadone for alcohol use disorder.

I am also very surprised that I had never heard of Dr. Marie Nyswander before starting my research. She was a groundbreaking, charismatic, go-getter who propelled addiction medicine forward time and time again. Why had only one book-length biography been written about her, and not since 1968? She was exactly the kind of role-model I had been searching for as a young woman in medicine.

But all those discoveries aside, it was a series of intimate, somewhat concealed, and often contradictory details about Nyswander as a person that most fascinated me.  In 1959, she published a very anti-feminist book, The Power of Sexual Surrender, that espoused a lifestyle completely at odds with her own. Although she had been Sarah Lawrence’s first premedical student, one of Columbia’s only female medical students, and a childfree, successful physician, she argued that women shouldn’t work outside the home, instead gaining pleasure and purpose from serving their husband and kids. Why in the world would she write something like that, did she actually believe it?

Similarly, many of Nyswander’s colleagues believed that methadone maintenance had been primarily (if not entirely) her husband’s idea, and that she was no more than a pretty face along for the ride. Knowing the details of her career, I couldn’t understand how anyone would think that Nyswander was anything less than the driving force behind the development of methadone maintenance.

What do you think is the most important takeaway from your book?

There is a very effective and safe treatment for opioid use disorder: buprenorphine and methadone. They halve someone’s risk of death from overdose and are by-far the most effective medications we have for any chronic disease. Unfortunately, stigma, history, and regulation have made these treatments largely inaccessible for most people. If we really want to turn the tide of America’s fatal overdose epidemic, we need to make these medications much more available. But even that still won’t be enough – we also need to incorporate the philosophy and practice of harm reduction into everything we do. Without this critical piece, we will continue to repeat the same mistakes of the past.

Based on your research and experience, what do you see as the future of the field (of alcohol, drugs, and pharmacy history)?

I don’t know so much about the future of drug history, but in terms of the future of clinical addiction treatment, I share Nyswander’s hope that, one day, we will stop treating addiction as a moral failing or crime and instead treat it like the medical condition it is. In the six years that I have worked in Tucson, I have already seen so much progress in how the medical system treats addiction, but we still have a long way to go. Additionally, just like Nyswander, I dream of a future in which patients can get their methadone from any clinician at any pharmacy – not just at the methadone clinic.