Pubdate: Sun, 07 Dec 2003 Source: Sun News (Myrtle Beach, SC) Copyright: 2003 Sun Publishing Co. Contact: http://www.myrtlebeachonline.com/mld/sunnews/ Details: http://www.mapinc.org/media/987 Author: David Klepper Note: apparent 150 word limit on LTEs Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) TREATING ADDICTION: THE METHADONE DEBATE Every day, Jennifer Altman drinks a shot-sized cup of cherry-flavored liquid that she says allows her to lead a normal life. If not for methadone, the Surfside Beach resident said she would still be hooked on OxyContin, a powerful time-released pain reliever. The addiction cost her as much as $250 a day, and ended with her buying the pills off the street. She calls methadone a miracle, one which she must regularly drive to Columbia to buy. Now, methadone has touched off a firestorm in Horry County, where plans for the Grand Strand's first methadone clinic have outraged local residents and officials. They say the narcotic treatment will bring more drugs and crime to the area, without actually curing anyone's addiction. On Monday, the county's Board of Adjustments and Zoning Appeals decides whether it will reconsider its approval of the clinic. The board approved plans for Center of Hope in July 2002, and the center is projected to open near Fantasy Harbour this month. That is, unless Republican S.C. Rep. Thad Viers and others can convince the board it ignored key facts about the clinic's proximity to schools and residences. Addicts say the reaction is hypocritical coming from a county that, for a time, was the nation's largest source of OxyContin prescriptions. Many of those prescriptions came - illegally - from Comprehensive Care and Pain Management Center, run by Dr. Michael Woodward. The controversy has forced the community to face the problem of addiction to prescription narcotics - a condition that has affected football star Brett Favre and broadcaster Rush Limbaugh. In Horry County, the pain clinic was closed, the drug ring shut down and Woodward and some of his partners put in prison. But the addicts remain. Experts disagree about methadone's effectiveness in treating those addicts. Proponents say it reduces emergency room visits and crime by eliminating the need for addicts to buy illicit drugs. Critics say methadone is merely another addictive opiate, and that users would be far better off kicking the habit than substituting one drug for another. Without the clinic, the estimated 200 methadone users on the Strand will continue to get it wherever they can: Charleston, Columbia or Wilmington, N.C. Many must make the trip daily, rising early and driving two hours to get their doses in time to get back before the workday begins. If nothing else, the controversy illustrates the need for some solution, experts say, any solution. "We've always had clients who drive down from Horry County," said Ed Johnson, program coordinator for the Charleston Center for drug and alcohol addiction, which dispenses methadone. "But when Woodward went out of business, it was like somebody stepped on an anthill. I think you need a methadone clinic up there. But even if you disagree, you've got to see that you have a serious problem." Pitfalls of prescription drugs Opponents of the clinic would be hard-pressed to identify Altman as an addict. The bright, smiling 27-year-old with three children looks like any other young mother. She began using OxyContin at age 22 after a doctor prescribed it for chronic pain. Altman, who was referred to Woodward's clinic, quickly became tolerant and needed greater doses to get the same results, which is typical for an opiate user.. "Everybody knew you could get what you needed as long as you paid," she said. Science has created painkillers so effective, and medicine made them so accessible, that widespread addiction was almost inevitable, Graham said. "Pain is a part of life, and it should be viewed as that," he said. "Pain is your body telling you something is wrong. But instead of talking to patients to find out what's wrong, too many doctors just prescribe a pill, make some money, and move on to the next patient." The government estimates that more than 2.6 million Americans regularly abuse prescription drugs. That's more than the number of regular users of cocaine, heroin and crack. OxyContin is the leading prescribed narcotic, and most experts say it is the most commonly abused prescription drug. Since it was introduced to treat pain in 1996, hundreds of users have died of overdoses, and thousands more have become addicted. The Drug Enforcement Agency identified Myrtle Beach as a major source for OxyContin that was later illegally distributed throughout the Southeast. Known as a "pill mill," Woodward's clinic attracted addicts from hundreds of miles away. "This area is a fertile crescent for addiction," said Dr. James Graham, a local physician who specializes in addiction treatment. "You remember those old movies, where people would fall into quicksand? That's addiction. You get in, and you can't get out. It's quicksand." The prevalence of prescription narcotics has changed methadone's role, as well. Until recently, methadone clinics treated mostly heroin addicts. Johnson of the Charleston clinic estimates that as recently as 10 years ago, 70 percent of clinic clients were heroin addicts and 30 percent were addicts of other opiates such as morphine. However, that changed as use and abuse of OxyContin, Vicodin, Codeine and Percocet became prevalent. Now, the majority of methadone users are former OxyContin addicts. "Rush Limbaugh is the classic example," said Dr. Clifford Bernstein, medical director of the Waismann Institute, an addiction treatment center in Beverly Hills, Calif. "They think, 'A doctor gave the prescription to you - how can it be that bad?' These narcotics are so good, they give people such a good feeling, you don't know you're hooked on it until it's too late." Altman said she never would have turned to methadone if she hadn't become pregnant. Whereas OxyContin could jeopardize the unborn child, methadone is considered less risky. So what she wouldn't do for herself, she did for her son. "I knew I had to make a change," she said. "I knew I had to get off the pills. Methadone was the only option." Oliver Altman was born three weeks ago, perfectly healthy and not addicted to any drugs. Altman said those who say methadone is hardly better than OxyContin should see Oliver. "They say [methadone] could lead to crime," she said. "But the real crime would have been if my baby hadn't been born healthy." Altman said she intends to wean herself off methadone. She doesn't want to plan her life around trips to a clinic, even if one opens in Myrtle Beach. "I want to have another baby," she said. "I don't want to have another one on methadone. I want to do it the normal way." Treatment or trap? Over the years, methadone clinics have opened across the state, but methadone providers found little sympathy in Horry County. Now the county is the state's most populous area without a clinic. Many officials hope to keep it that way. "We don't need this in Horry County," Viers said. "We should support the resources we have for getting people off drugs. What we don't need is another source of drugs." An attempt to open a clinic in Socastee in 1998 failed after the community objected. But to many addicts who became hooked on prescription drugs after receiving prescriptions from doctors, opposition to methadone is naive and hypocritical. "I'm not a heroin junkie," Altman said. "I'm not a criminal." Methadone was invented by German scientists during World War II and first used as a pain reliever. The drug is an opiate - a type of narcotic made from the active ingredient in poppies. It wasn't until 1968 that doctors learned the drug could be used as a substitute for heroin, morphine and other opiates. They found that methadone blocked an addict's ability to get high on their opiate of choice, but because methadone is an opiate itself, the addict suffered no symptoms of withdrawal. Methadone clinics soon sprung up in urban areas, where patients can receive it for between $10 and $15 a dose. Most clinics insist that patients take the dose at the clinic to ensure they do not sell it illegally. But once a patient establishes a relationship with a clinic, they are often given a supply to last a week or a month. Methadone's power to mimic other opiates and prevent withdrawal is beyond dispute, experts say. But the danger is that methadone, like its chemical cousins, is highly addictive, and it requires higher and higher doses to achieve the same results. Many clinics offer therapy and group sessions to help addicts lower their doses and slowly get off methadone. But many clients need years to transition off methadone. If they ever do. Vickie Johnson of North Myrtle Beach has been on methadone for 15 years. Altman has been on it for almost a year. Both turned to methadone after becoming addicted to pain pills. "Isn't my life better on methadone than OxyContin?" Johnson said. "It's allowed me to be a mother for my children. It's allowed me to work." But Graham and Bernstein say substituting one opiate for another is not a cure and barely a treatment. Bernstein said he has treated dozens of patients for addiction to methadone - including two methadone clinic directors - after they turned to methadone clinics to get off another opiate. "I would tell people they have another option: freedom from opiates altogether," Graham said. "No one should need opiates on a daily basis. How can you say you have a normal life if you have to drive two hours every day to get methadone? It sounds like slavery." These addiction specialists say a life on methadone is barely better than a life spent on heroin or OxyContin. "The job of a clinic is to stabilize, not to cure," Bernstein said. "These clinics have their clients by the short hairs. They profit because they know the addict has to come back." But at the Charleston Center, Ed Johnson sees it another way. He said he has seen too many people destroyed by addiction. By eliminating the cycles of highs and lows, methadone frees addicts to hold down jobs, pay bills and raise children, he said. "Addicts are not swayed easily," Johnson said. "If your choice is using heroin or OxyContin until you die, or methadone maintenance for the rest of your life, I don't care what you say. Methadone gives these people hope." - --- MAP posted-by: Larry Seguin