Pubdate: Sun, 20 Jul 2003
Source: Columbus Dispatch (OH)
Copyright: 2003 The Columbus Dispatch
Contact:  http://www.dispatch.com/
Details: http://www.mapinc.org/media/93
Author: Geoff Dutton
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

WAITING LIST PUTS METHADONE ON STREETS

Homeless, estranged from her family and fearful that her addiction to
heroin would kill her, Heather Bara finally sought treatment two years
ago at CompDrug, the city's only methadone clinic.

Clinic officials told her to get in line.

In the 18 months Bara waited for an opening in the treatment and
counseling program, she twice overdosed on heroin and tried to stave
off the constant cravings by buying methadone from street dealers.

"I'm very lucky to be alive,'' the 25-year-old Columbus woman said.
"It's a very long time to wait.''

Now the wait is even longer -- about two years and growing, according
to CompDrug.

Methadone chemically blocks an addict's drive to get high from heroin,
morphine, OxyContin and other opiates.

The state, though, has resisted any major expansion of its methadone
program, citing philosophical and budgetary reasons.

Addiction experts say this has led desperate users to pay $50 or more
for a dose of methadone on the black market -- sometimes outside
public clinics that dispense it to patients for about $8.

As more people self-medicate, the number of methadone-overdose deaths
has grown. Three years ago, there were none in Franklin County. There
were 14 in 2001, and the same number again last year.

Because methadone is released slowly into the bloodstream, experts
say, people unfamiliar with the drug can become impatient and take
excessive doses.

Most are quiet tragedies that go largely unnoticed outside the
person's circle of family and friends.

Then Carl Upchurch died.

The nationally known author and social activist from Bexley overdosed
on methadone on May 2.

In the months leading up to his death, Upchurch repeatedly visited the
Columbus methadone clinic at 156 Parsons Ave., two acquaintances said,
and bought methadone from a street dealer outside.

"If it hadn't been for that waiting list, I believe Carl would still
be alive,'' said Evelyn Gregory, a clinic patient who said she saw
Upchurch outside CompDrug at least 10 times and frequently chatted
with him about his book, movie and family.

Gregory and another patient, a 53-year-old Columbus man, said they saw
Upchurch buy methadone pills from a dealer outside the clinic about a
month before his death. (Clinics typically dispense liquid methadone,
but street dealers also sell the drug in pill form.)

"If he would have had treatment on demand, I think it would have saved
his life. No doubt about it. He would have been maintained on a dose
that's safe,'' said the man, who didn't want his name used for fear
that his 17 years in methadone treatment would embarrass his family.

Upchurch's relatives declined comment through a family attorney. When
his death was ruled an overdose last month, his sister-in-law said
only that it was "a complete surprise to the family.''

An official at CompDrug said Upchurch wasn't on the clinic's waiting
list. But that's not unusual, said Ron Pogue, a senior vice president
and director of CompDrug's methadone program. "A lot of people who
call and are told how long the waiting list is don't even bother to
get on the list.''

Conflicting views

That Upchurch or anyone else would purchase a dose of methadone
illegally on the doorstep of a public methadone clinic, Pogue said,
"is symptomatic of a much greater problem.''

Nationwide, methadone has been the source of emotional debate since it
was introduced as a treatment for heroin addiction more than 30 years
ago. Although also an opiate, methadone is created in a laboratory and
satisfies addicts' cravings without getting them high.

Proponents say it allows addicts to live stable and productive lives
without enduring physically and psychologically painful withdrawal.

"You use it because it works,'' Pogue said.

Opponents characterize it as a crutch that amounts to trading one
addiction for another. Although it was intended as a means for
gradually weaning addicts from drugs, many methadone patients take the
drug for years -- sometimes for life.

For years, Ohio has had a reputation for having one of the
more-restrictive methadone policies in the nation.

"We have been criticized for that, but as a department we stand by our
standards,'' said Stacey Frohnapfel Hasson, spokeswoman for the Ohio
Department of Alcohol and Drug Addiction Services.

The department's goal, she said, is to help addicts "become drug-free
- -- not drug-dependent on methadone.''

Nationally, heroin use has been on the rise. About 205,000 people are
seeking treatment for heroin addiction, nearly double the number of
patients 10 years ago, according to government statistics. The federal
government endorses methadone treatment and expanding it where 
necessary.

"There is not a question in the scientific community that it's
extremely effective,'' said Leah Young, spokeswoman for the Substance
Abuse and Mental Health Services Administration, the federal agency
that regulates clinics.

As for the argument that methadone treatment amounts to trading one
drug for another, she said, "This idea that you can 'just say no'
resonates with the public, even though it doesn't resonate with
treatment professionals.''

Dr. H. Westley Clark, director of the federal Center for Substance
Abuse Treatment, said the physiological and psychological damage of
opiate addiction can't always be overcome merely by "bent of will.''

Funding shortage

CompDrug currently treats about 525 people. Pogue said the clinic
could immediately fill 1,000 slots if it had the funding. State and
local money for treatment statewide more than doubled between 1998 and
2001, to $8.8 million, but still hasn't kept pace with demand.

Nationally, waiting lists aren't an issue, said Mark W. Parrino,
president of the American Association for the Treatment of Opioid
Dependence, which represents treatment programs. Private, for-profit
clinics typically fill the need.

But of the 44 states with methadone programs, he said, Ohio is the
only one that requires clinics to be state-certified, nonprofit
operations. There are nine such clinics statewide.

Patients generally must go to the clinic every day to drink the
cherry-flavored dose, though some can take home doses twice a week if
they continue to pass drug tests and attend counseling sessions.

The lack of take-home privileges and increased clinic restrictions
were enacted to keep profiteers from exploiting addicts and to prevent
methadone from getting into the hands of dealers. But combined with a
methadone-leery state administration, they also have created waiting
lists and a migration of Ohioans to clinics in neighboring states.

Ken Tressel, regional director of six for-profit Discovery House
clinics in Pennsylvania, said Ohio residents account for a third of
the 300 patients at a clinic about 12 miles from Youngstown.

They often arrive carrying a Medicaid card, but Ohio's insurance
program for the poor doesn't cover methadone treatments in
Pennsylvania unless the clinic negotiates a contract with the state.
Tressel said he has tried unsuccessfully for four years.

Even so, many Ohioans sign up for the $95-a-week treatment and pay
their own way. Under Pennsylvania law, stabilized patients can
eventually take home as much as two weeks' worth of doses at a time.

"You've got to give the patients all the credit in the world,''
Tressel said. "What needs to happen is for Ohio to take care of their
own.''

Burkey Lynn, counselor and methadone coordinator at Meridian Services
in Mahoning County, credits the Pennsylvania clinic for his lack of a
waiting list. Ohio, he added, officially favors other treatment 
approaches.

"There's the old school that doesn't look at methadone as a medication
but just another drug,'' Lynn said. "We know, for the majority of the
folks, it's a lifesaver. But there are some folks that believe that's
not the way you should save lives.''

Unanswered questions

Upchurch's 1996 autobiography, Convicted in the Womb, makes passing
references to his drug use during his years on the street and in
prison but doesn't suggest he ever struggled with addiction. He was
released from prison in 1986 at age 36, and his personal turnaround
and autobiography inspired a Showtime movie last fall about his life.

His autopsy noted needle-track scars on one arm, though there were no
illegal drugs in his system. If he had taken heroin within the
previous 10 days, Coroner Brad Lewis said, it would have shown up.

Whatever the circumstances of Upchurch's death, advocates say, it was
unusual only to the extent that he was such a recognizable figure.

Gregory, the methadone patient who said she got to know Upchurch
outside the clinic, named several friends who died from drug overdoses
while waiting to get treatment.

Gregory said she sought -- and immediately received -- methadone
treatment in 1992. The 59-year-old grandmother and dispatcher for a
cab company wonders what might have happened if she had encountered a
two-year waiting list.

"I'd probably be dead,'' she said.

Bara, who now has a job and and an apartment, also credits the clinic
with saving her life. She had repeatedly fled detoxification programs,
and the wait for admission into the methadone program was grueling.

She bought methadone -- liquid and pills -- from dealers, she
said.

"I did god-awful things just to survive.''
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MAP posted-by: Larry Seguin