Pubdate: Sat, 27 Apr 2002
Source: Portland Press Herald (ME)
Copyright: 2002 Blethen Maine Newspapers Inc.
Contact:  http://www.portland.com/
Details: http://www.mapinc.org/media/744

CLINICS SHOULD RETHINK DRUG TAKE-HOME POLICY

A recent spate of drug-related overdoses in Portland is causing law 
enforcement officials and city leaders to take a critical look at area 
methadone treatment clinics. While such scrutiny is warranted, we hope that 
the focus remains on the illegal use and sale of methadone and doesn't 
interfere with the drug's legitimate use in the comprehensive treatment of 
opiate addiction.

We do believe, however, that the evidence already shows that clinics should 
end the practice of permitting addicts to take methadone home with them 
until a better screening process is put in place.

Since the beginning of the year, police have opened investigations into 10 
Portland deaths that appear to be the result of drug overdoses. Last year, 
there were 16 overdose deaths in Portland and 54 statewide. In many of 
those cases, police say they found doses - in some case stockpiles - of 
methadone dispensed from southern Maine clinics.

METHADONE BY ITSELF is probably not responsible for the overdose deaths, 
Portland Police Chief Michael Chitwood says, but it is being used illegally 
- - and in combination with other drugs - by addicts who are not seeking 
treatment from clinics. The chief has ordered a department investigation of 
overdose deaths in the last 16 months to find out how many involved 
methadone and where it is coming from.

"Methadone is being found in apartments throughout Portland," Chitwood 
says. "It's being acquired by other users and it's being sold on the 
street. . . . We're creating methadone addicts."

"I can show you hundreds of bottles of methadone that we've seized during 
arrests or bought off the street and none are from doctors," adds Sgt. 
Scott Pelletier of the Maine Drug Enforcement Agency. "The majority of 
methadone we find are in take-home doses."

Both Chitwood and Pelletier say they're not against using methadone as a 
treatment method to fight heroin addiction. They do admit, however, that 
their faith in the approach has been shaken by mounting problems within the 
community.

A pain-killer developed by German chemists during World War II, methadone 
doesn't cure drug-users of their addictions. Instead, it blocks opiate 
receptors in the body that crave heroin. Although users may experience a 
mild high from normal doses, the drug permits most users to function well 
enough to hold a job, maintain a household and look after their families.

Two for-profit clinics in southern Maine - CAP Quality Care in Westbrook 
and Discovery House in South Portland - offer methadone treatment. Steve 
Cotreau, program director at CAP Quality Care, says treatment goes beyond 
dispensing the drug. Federal and state regulations forbid what critics call 
drive-by clinics, where addicts simply buy methadone doses whenever they 
need it.

"Counseling is a required part of methadone treatment," Cotreau says. 
"Individual counseling is required, and group counseling is an option."

However, for addicts with strong support networks in place - families, 
health insurance and professions - clinics are permitted to dispense 
advance doses of methadone that users can take without a daily visit to 
counselors. Both clinic and state officials sign off on every case in which 
weekly doses are dispensed. "The goal is to make people functional," 
Cotreau says. "Carrying doses for medication allows them to do that."

ADVANCED DOSING also allows some unscrupulous users to sell their methadone 
to other addicts. Pelletier says that in most cases, methadone users are 
actually trading doses for heroin, amphetamines, cocaine and other drugs. 
"We find that about nine out of 10 heroin users are also dealers," the MDEA 
agent says. "They'll trade for methadone for those days when they can't get 
their own heroin fix."

Even the clinics acknowledge there's a problem. "Diversion," admits Steve 
Gumbley of Discovery House, "is certainly an issue."

Nonetheless, state officials are defending the clinics. Lynn Dube, 
commissioner of the Department of Behavior and Developmental Services, says 
the presence of methadone accompanying overdose deaths doesn't mean the 
clinics are dispensing the drug casually. She says she's comfortable with 
the process of advancing doses when it is done by the rules.

While clinics may be complying with existing regulations, we believe that 
methadone's presence on the street is evidence that the rules aren't strict 
enough. In fact, regardless of an addict's background, entrusting such 
potent drugs to a person with a history of drug abuse seems irresponsible.

THERE ARE MANY dangers in permitting methadone on the street. The most 
obvious, of course, is that a black market develops that not only puts 
methadone into the hands of street addicts, but also may keep some people 
from seeking methadone at clinics where they would be forced to get some 
counseling.

Its presence at overdose scenes also could create a backlash against 
comprehensive methadone treatment.

That would be the greatest danger of all. As Bill Lowenstein, associate 
director of the state Office of Substance Abuse, notes: "Methadone is a 
proven treatment option for many addicts."

With methadone, many heroin addicts have been able to reclaim their lives, 
find meaningful work and raise families. Its stabilizing qualities have 
allowed many Maine men and women to free themselves from the grip of far 
more dangerous drugs and the risk of overdose and disease.

Denying methadone to people who legitimately benefit from it would thus be 
a grievous error. Unless the state works with drug clinics to severely 
tighten advance dosing policies, however, we fear that the treatment 
clinics themselves may be at risk.
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MAP posted-by: Larry Stevens