Pubdate: Mon, 15 Dec 2003
Source: Birmingham News, The (AL)
Copyright: 2003 The Birmingham News
Contact:  http://al.com/birminghamnews/
Details: http://www.mapinc.org/media/45
Author: Joseph D. Bryant, News staff writer

METHADONE CLINIC PLAN MEETS RESISTANCE

None of Bernard Brown's old friends and family wanted anything to do
with him a year ago, with good reason. If he wasn't high on
painkillers, Brown spent his time searching for the next score of
whatever else he could find.

Finally, after failed sobriety attempts and a stint in prison, the
Birmingham man had enough. "I'm almost 40 years old; I ain't 24
anymore," he said one recent morning, shortly after getting his daily
dose of methadone.

For the last year, Brown has come to a Jefferson County clinic in the
mornings before work, waiting in line for the synthetic narcotic that
he said suppresses the commanding urge to get high.

The man who once spent days looking for drugs now spends them working
as a painter.

"I have no desire anymore to go cop any Dilaudid," he said. "I believe
I'll be on this for the rest of my life."

A deep schism:

That's just what some people are afraid of. An application to open a
methadone clinic in Calera - Shelby County's first - has revealed a
deep schism over the use of chemicals to treat drug addiction.
Opponents say methadone replaces one form of dope with another that
could bring a criminal element to the community. Others call that an
offensive and ignorant characterization.

"I look at it as medication," said 25-year old Billy Bryant, who
drives almost an hour and a half from Montevallo to one of Jefferson
County's four methadone clinics. "I don't look at methadone as a drug.
It just makes you normal."

Such clinics usually distribute liquid methadone. Taken by mouth, it
must be prescribed by a doctor and administered by health
professionals. Patients come in daily or can graduate to receiving a
weekly amount.

When Susan Staats-Sidwell and Dr. Glenn Archibald applied to the state
Health Planning and Development Agency for permission to open a
methadone clinic in Shelby County, they were met with resistance from
county officials.

Staats-Sidwell said the clinic would serve Shelby County addicts who
have to drive daily to clinics in Bessemer, Homewood or Roebuck or at
the University of Alabama at Birmingham.

In November, the Shelby County Commission adopted a letter of
opposition to be sent to state evaluators. The parties are awaiting
the agency's decision.

"I do not see substituting one substance abuse medication for another
addiction," said Commissioner Earl Cunningham, who has a degree in
agency counseling. He said the most appropriate way to treat addiction
is through a 12-step process, such as Narcotics Anonymous.

"To me, methadone is like placing a Band-Aid over a major surgical
scar on a daily basis. You're not getting any better," Cunningham said.

The fight against the proposed clinic is similar to arguments made to
close a clinic in northeastern Pennsylvania in the 1970s. That fight
was led by Bud Angst, then chairman of a drug and alcohol commission.

Long-term program:

His main problem with methadone was that it was a long-term program.
"You become your friendly neighborhood drug pusher," Angst said. He
said the clinic also attracted dozens of addicts from neighboring
states. He couldn't say whether they affected the area's crime rate,
which remained relatively low.

Shelby County Sheriff Chris Curry argued that such clinics could add
to the drug problem they claim to help remedy. He mentioned a recent
overdose that resulted from a mix of methadone and OxyContin.

Instead of taking methadone to supplant the desire for other drugs,
some take it to supplement their illegal habits, Cunningham said.

Arguments against methadone as a legitimate treatment are based on
misinformation, said Dr. Norman Huggins, director of substance abuse
programs at UAB. Overdoses can happen, he said, but that's the case
with all medication if it's abused.

"Why just single out methadone?" Huggins said. "People who are opposed
to it lack sufficient information regarding what methadone treatment
involves and the effectiveness of methadone."

Huggins said the image of a desperate drug addict hovering in the
clinic's shadows is unfair. Most of his clients are addicted to
prescription pain medication, not heroin.

He said the addiction to opiates is a brain disease that requires
chemical treatment. The brain chemistry in addicts has been altered by
drug abuse, and the methadone helps restore what was lost, eliminating
the urge for more illegal drugs.

While traditional counseling is effective for alcohol and other drugs,
Huggins said it is not the sole cure for opiate addiction.

"Diseases require medication for chronic treatment," he said.
"Methadone has been shown to be the most effective medication that is
currently available."

Methadone isn't free and generally is not covered by health
insurance.

Brown said he doesn't mind. "Eleven dollars a day compared to $100,
$150 a day is nothing," he said. "If I'm not coming to this clinic,
I'm not going to work every day, so I'm going to be out there breaking
the law."

Evidence for both:

In the debate over the use of chemicals to treat drug dependency, Dr.
Joseph A. Troncale has evidence for both sides. He's medical director
for The Caron Foundation, a Pennsylvania-based drug treatment center
that focuses on a 12-step approach to recovery. Yet there are
exceptions for opiate addicts.

"The ideal is for people to be abstinent," he said. "But we also
realize there are a group of people out there who are not going to
stay abstinent. If you can't do that, then the second line is the
(methadone) maintenance."

Troncale said it's safer for recovering addicts to use methadone than
take chances on their illegal habits. He said addicts face a 64 times
greater risk of death than nonaddicts because of overdoses and violence.

The treatment's success depends on the addict's willingness to stay
sober, he said.

Motivation is something Bryant said he found after an addiction to
Lortab nearly destroyed his family. With his wife preparing to leave,
Bryant got help.

Now on methadone, he said he's "the responsible parent that I needed
to be to start with. I got a car. I got a steady job. My family's
getting along good." 
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