"Managing Life on Methadone"

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This is not a new article, but thought it could spark an interesting discussion about methadone treatment. (posting here as is protocol, and will hopefully add to Recovery and Addiction forum with redirect?)

Managing life on methadone
By Jesse J. Smith, Freeman staff
02/20/2005

THEY ARE ex-convicts and college students, white collar professionals and the chronically unemployed. They attend PTA meetings and their kids' little league games.

And they have one thing in common: They all belong to Ulster County's only methadone maintenance program.

"There is no 'them and us,'" Al Nace, who runs the Ulster County Mental Health Department's methadone clinic at the county's Golden Hill complex, said of his clientele. "They are us. They're the guy working next to you."

Methadone is a synthetic opiate, created in Germany during World War II as a morphine substitute. In the 1960s, researchers in New York City began using the drug to treat heroin addicts. They found that methadone could effectively replace heroin and allow addicts to reintegrate into society. And while methadone is an addictive narcotic that causes regular users to suffer withdrawal symptoms - similar to those caused by heroin - if they do not get their dose, advocates say that, when taken under medical supervision, methadone causes none of the harmful side effects associated with street drugs.

TODAY, some 115,000 people nationwide, including 40,000 in New York state, rely on daily doses of methadone dispensed from clinics regulated by state and federal authorities. The Ulster County clinic has been operating since the early 1970s and today treats 144 men and women.

Clients come to the clinic, run by Kingston Hospital under a contract with the county Mental Health Department, as often as every day or as little as once a month, depending on how long they have been sober as determined by regular drug testing. Liquid methadone is served in paper cups and taken on the spot, or, for those who have earned "take home" privileges, in small plastic bottles that they must carry out in a locked container.

Clients who are eligible for Medicaid pay nothing for the program, while others pay a small fee, which may be as little as $1, based on their weekly income.

NACE AND other methadone advocates say the program allows addicts to function in society, hold down jobs, repair relationships damaged by drug abuse and stay out of trouble with the law.

"The proof is in the pudding," Nace said. "Fifty to 60 percent of our people are doing well long-term. I would challenge any other (treatment method) to match that."

According to statistics compiled by the program, 79 of 144 patients are employed full- or part-time, another 38 are on disability, and the rest are unemployed, full-time students, homemakers or enrolled in vocational training programs.

As for sobriety, Nace estimates about 50 percent of the clinic's clients are drug-free and working.

"They're kind of invisible," he said. "Nobody at work or on the streets knows they are (on methadone). Some of them are very prominent professionals, and some of them are laborers."

Another 25 percent, Nace said, are making progress but still struggle with addiction and, like most addicts, may relapse into drug abuse.

And the rest: "They're the people that people know about. They aren't doing so well."

EVERY methadone client is tested regularly for drug use, but testing positive for illegal drugs does not mean automatic dismissal from the program.

Counselors at the clinic work with struggling addicts, offering or mandating referrals to detoxification and other treatment services. The willingness to work with clients who continue to abuse drugs, Nace said, is necessary in a field where relapse is common and any improvement is regarded as better than none.

"JENNIFER," a 46-year-old mother of three and former heroin addict, says the program saved her life. And her story illustrates the circuitous path to stability that many of Nace's clients must take.

The California native said she began abusing opiates in her mid-30s, when she was diagnosed with lupus, and became addicted to painkillers prescribed by her physician. When the Vicodin and hydrocodone stopped working, she started using heroin, first sniffing it, then injecting it directly into her veins.

"When I started (taking heroin intravenously), I knew I was in trouble," said Jennifer (not her real name). "Everything started going downhill. I lost a good job, I started losing friends. I started hurting family members. I was a single mom, and I knew I was on a dead-end road. I had to get help."

JENNIFER enrolled in the methadone maintenance program in 2001 and gave up heroin. But she was not done with drug abuse. The former bartender began using cocaine as well as tranquilizers like Xanax, known in drug circles as "benzos," which combined with methadone give a powerful high.

When she began failing her drug tests, clinic staffers began the process of getting her into treatment.

"They could have thrown me out ... but they didn't. They worked with me for a whole year," she said.

REFERRED from the clinic, Jennifer first went to Kingston Hospital's detox ward, where she spent a week getting the benzos out of her system.

Next, she began an intensive program of inpatient rehabilitation, also at Kingston Hospital, which she described as an all-day 12-step program.

Today, Jennifer said, she still goes to counseling at the hospital's "Bridge Back" program three times each week and has earned enough "clean time" to start getting take-home bottles of methadone, which she carries around in a stylish chrome case.

JENNIFER and other methadone users report that, once they settle into a regular dose, the drug does not produce a high and prevents them from suffering withdrawal symptoms.

"Don't get me wrong - methadone can get you high if you abuse it," Jennifer said. "But when I take my dose, I just feel normal. I can do what I need to do just like anybody else."

JENNIFER said the attitudes of the clinic staff members, from the security guard who greets clients by name to the counselors who helped get her into treatment and a job training program, are vital in helping addicts regain some dignity lost in the years of drug abuse.

"When I went in there the first time, I didn't want to leave," she said, "They treated me like a human being. And When you're a drug addict, you're used to being treated like something subhuman."

METHADONE treatment is not without its critics. Some treatment professionals, particularly those using a 12-step Alcoholics Anonymous-type model, argue that methadone treatment fails to address the root causes of drug abuse and leaves patients just as dependent on methadone as they were on heroin.

"(Methadone maintenance) is just an alternative way of fulfilling a habit," said Curtis Potter, director of Rhinebeck's Daytop Village, a treatment center that uses intensive psychological and vocational therapy to treat addicts. "I don't see how you can call it a victory if you are still dependent on a substance that takes you away from reality. I really think abstinence is the only way."

METHADONE programs also have been criticized for becoming places where addicts can congregate to buy and sell methadone and various pills.

One former client of the Ulster County clinic, Daniel Callahan, told a court recently that, the day after he allegedly killed his girlfriend's mother, he went to a clinic in the Bronx and bought enough methadone and Xanax from an addict hanging around outside to keep him in a stupor for 48 hours.

Employees and patients at the Golden Hill clinic, however, say that those types of problems most often happen in large metropolitan areas, where fierce competition among methadone clinics for clients may encourage some administrators to be less strict in enforcing regulations.

"If people are going to bring the streets into the program, they don't last long," said "Pete," who has been coming to the Golden Hill program for several years. "The staff here don't play that. You'll be out the door."

METHADONE maintenance advocates say that the stigma attached to the programs within the treatment community has lessened over the years as more and more data supports their efficacy. But public perception of methadone remains an obstacle.

"I can't say that society in general has a very positive view of (methadone)," said Marshall Beckman, head of the Ulster County Mental Health Department. "Unfortunately, the general public is not interested in mental health or substance abuse issues until it impacts them or a member of their family. Stigma is our worst enemy."

FOR BECKMAN and other advocates, methadone maintenance is one of many increasingly popular "harm reduction" strategies that acknowledges drug addiction always will be a problem but seeks to reduce the damage addicts do to their communities, their families and themselves.

Other harm-reduction methods include clean needle programs, intended to prevent addicts from getting and spreading HIV and other diseases that needles can carry. and drug courts that emphasize treatment over incarceration for drug-addicted defendants.

"Twenty percent of all hospital costs are related to substance abuse," Beckman said. "The cost to society is unbelievable. (The methadone maintenance program) helps society avoid that cost."

PETE (not his real name), who is in his 40s and has spent most of his adult life in prison for a drug-related crime, said that with methadone, he has been able to hold a job, get married, stay off drugs and stay out of trouble.

"For me, methadone is the answer," said Pete, noting that he tried unsuccessfully to get clean at five different non-methadone "therapeutic communities" before he was locked up. "All it does is replace something in my body's chemistry that, if I didn't have, I wouldn't be able to function.

"I'm not looking to be the stereotypical TV junkie who's drooling all over himself and has his head in his lap 94 percent of time. It's the normalcy that we want, that everybody wants."

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