Opioid use disorder is, as the name suggests, a health condition, but it has for centuries struck a discordant note which has separated it from other medical disorders. Illicit drugs and their use have a magical dimension in the popular imagination. Associated with decadence and the erosion of prescribed societal ideals of productivity, self-sufficiency, and profit, they are also highly lucrative commodities whose distribution goes untaxed and consumption unregulated, offering opportunities for unchecked profit to those who traffic in them. Drugs and the stigma of drugs weave a paradoxical path through capitalism. People who use drugs illicitly are often seen as aberrations, parasites who depend on others rather than following the righteous path to self-realization. Middletown is a congruent microcosm of the national opioid crisis, and the cultural, political, and social contours of Middletown’s health policy elucidate many facets of the complex relationships between governing bodies and people who use drugs (PWUD) on a broader scale. This makes it a particularly useful petri dish in which to consider how we understand and allot responsibility for the pain and suffering that underpins the crisis, and also the entangled concomitant comorbid crises of housing, racial and class discrimination, and drug stigma. This thesis surveys the specifics of opioid use and drug policy in Middletown through the lenses of history, culture, and politics in order to provide context for Middletown’s 1989 prohibition on methadone clinics and the Middletown Planning and Zoning Commission’s October 2020 decision to reject the construction of a methadone treatment center. It examines the perspectives of the residents who spoke out against the opening of a clinic, and those of the disenfranchised drug-using stakeholders, and considers the ongoing legal repercussions that have ensued from this decision, concluding with a recommendation for policy going forward. We must not allow the perfect to be the enemy of the good. Harm reduction practices advance the health and human rights of people who use drugs without wholly stopping drug use in its tracks. They are an evidence-based way to reinstate dignity and humanity to the overdose response system, reduce criminality and enhance the quality of life, and facilitate change rather than coerce it. We must acknowledge methadone to be a form of harm reduction. I argue that it is unfeasible and inhumane to urge opioid abstinence upon populations for whom illicit opioid use is a form of self-medication, unless we relieve PWUD of the conditions which elicited such use in the first place. The results of my community-based participatory research study demonstrate the complex web of forces which drive illicit opioid use, among them homelessness, unemployment, chronic pain, mental health conditions, and destitution. Until services aimed at ameliorating these conditions are provisioned, methadone-maintenance treatment is a necessary component of this ecosystem.