Addicts try eased access to treatment

In Baltimore study, methadone dispensed in take-home form

August 26, 1999|By Kate Shatzkin | Kate Shatzkin,SUN STAFF

Every month, a group of ordinary-looking working men comes to the same West Baltimore doctor's office and leaves with the same kind of large prescription bottle, full of a secret called methadone.

They rush in during breaks from their jobs and take it home like any other medication, in orange tablets that resemble chewable vitamin C.

The men, participants in a research study, are among the first to try out what could become a common practice in the distribution of methadone, an enduring stepchild of drug treatment.

Last month, the U.S. Department of Health and Human Services proposed liberalizing the rigid regulations that for decades have forced addicts to line up every day at clinics for a stabilizing dose of the cherry-red liquid narcotic. Clinics would begin treating addicts under more flexible rules -- much as doctors look at patients, one on one -- and would be subject to national accreditation.

Eventually, the proposed rules are expected to pave the way for methadone to be prescribed by doctors and taken home by addicts who have stayed off heroin for a specified period. The move has support from a growing chorus of scientists intent on making treatment more available for the nation's 800,000 heroin addicts.

"I think it will be a real breakthrough, because it helps to bring substance abuse treatment into the mainstream of health care," said Dr. Peter L. Beilenson, health commissioner for Baltimore. "It allows the successful people to get on out of [the clinic] and into the world."

Charlotte Lane, another participant in the Baltimore study, counts herself as one of those people. "I would just love the thought, at some point, of being able to go by the pharmacy and get my meth," Lane said. "We're closer to it now than we've ever been."

Methadone, a synthetic narcotic developed as a painkiller in Germany during World War II, has become widely accepted as the nation's most reliable -- and controversial -- treatment for heroin addiction. Without making addicts high, scientists say, it reduces withdrawal symptoms and allows people formerly bent on getting more heroin to hold jobs and function normally.

Clinicians call the treatment "methadone maintenance," because more often than not, patients once addicted to heroin never fully wean themselves from methadone. In Baltimore, there's one methadone slot for every 10 of the city's estimated 40,000 heroin addicts, and many are permanently filled by patients for whom methadone has become a routine of many years.

That's why methadone still has plenty of passionate detractors. To many, using the drug to wean junkies from heroin simply substitutes one addiction for another.

New York City Mayor Rudolph W. Giuliani tried briefly last year to institute a 90-day detox program for methadone patients. Although he backed off after a clamor from medical researchers, he has said he is committed to seeing that methadone is used as a short transitional stop on the road to abstinence.

But methadone advocates point to people like the group being studied through Man Alive Research Inc. in Baltimore. Man Alive, which opened in 1967, is one of the country's oldest methadone clinics.

The experimental group started in 1985 with 21 addicts, each already on methadone with five heroin-free years. Since then, two patients have died of natural causes, six have returned to the structure of the clinic, and one has weaned herself from methadone. The remaining 12 work, keep families together and, by all indications, have neither returned to heroin nor sold any of their take-home methadone, said Dr. Michael G. Hayes, who has overseen their treatment.

The patients -- most of whom asked that their last names not be used to keep their methadone use secret from family members and employers -- say the study has been a godsend, allowing them to avoid the stigma attached to methadone.

"I take blood pressure pills," said Steve, 56. "They're both much the same. One I can talk about. One, I can't."

With a $240,000 grant from George Soros' Open Society Institute in Baltimore, the Johns Hopkins School of Medicine, the University of Maryland and Man Alive have embarked on a wider study that also will examine what happens when patients visit clinics just once a month.

Newer Man Alive clients like Courtney Walker, who still must come to the Charles Village clinic for his dose five days a week, long for the day doctor treatment is widespread.

"They need these people on these programs to do good and show those politicians," said Walker.

But Peter Jackson, another Man Alive patient, said he might prefer to get his dosage in a clinic, where he takes part in group therapy. "They take an interest in a person," he said. "They know when something's not right. It's not just a gas-and-go."

Some advocates of expanding access to methadone have similar worries -- that the proposed federal treatment standards could lead to the disappearance of some clinics.

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