Six days a week, about 300 people funnel through the nondescript EJAL Health Services building in Glen Burnie to take the dose of pink liquid methadone they depend on to keep withdrawal at bay.
They're of all ages, races and backgrounds - dentists, used-car salesmen, undertakers. Some bring their small children with them, making a few of the clinic's neighbors in the Crain Highway warehouse strip assume it's a day care.
But residents, business owners and elected officials in Baltimore's suburbs are mobilizing against methadone clinics, fearing that they will attract crime and drugs to their neighborhoods. Residents in Elkridge and Columbia's Oakland Mills recently promised protests if proposed treatment centers open, and the Baltimore County Council passed legislation last year prohibiting methadone clinics in residential areas.
Communities in Louisiana and Ohio are setting up roadblocks to keep out methadone clinics. Even Dr. Leon Flemembaum, who owns EJAL and another methadone clinic in Ellicott City, can understand their anxiety.
"I'm also a father. I wouldn't take a chance on my children," he said. "I wouldn't take a chance on anybody's children."
But substance abuse experts say heroin use is growing in Maryland's suburbs. Demand for treatment is increasing as well.
Nationwide, more than 1,200 clinics distribute methadone, which relieves withdrawal symptoms for those addicted to heroin or prescription painkillers such as OxyContin and Percocet.
Developed in the 1930s in Germany as a synthetic substitute for morphine, methadone is still prescribed as a painkiller. In the late 1960s, treatment centers began to treat opiate addictions with methadone, said Dr. Jerome Jaffe of the University of Maryland's School of Medicine, who was appointed during the Nixon administration as the nation's first "drug czar."
Methadone advocates compare the drug to those used to control high blood pressure, heart disease and other ailments. They contend that drug addicts are no less deserving of medication to treat their condition.
But groups such as Drug Watch International frown on long-term dependence on any narcotic.
Wayne Roques of Drug Watch International said encouraging people to use methadone treats only the physical symptoms of addiction, not the problems that drive them to drugs. Even if someone is able to work while using methadone, he said, they're only working to pay for their next dose.
"There is nothing crueler than keeping a person addicted to drugs," said Roques, a former agent with the federal Drug Enforcement Administration. "It's the most pathetic thing in the world."
Maryland, with 43 methadone clinics, ranks among the top 10 states in the nation, said Robert Lubran, a director at the federal Substance Abuse and Mental Health Services Administration. Baltimore, with 18 clinics, has the highest concentration of facilities in the state; Montgomery and Harford counties have four each; Baltimore and Anne Arundel counties have three each; Howard has one with another proposed; and Carroll has one.
Heroin is among the top four drugs mentioned by those seeking treatment in the counties surrounding Baltimore, according to data from the Center for Substance Abuse Research at the University of Maryland. And more people in Anne Arundel, Baltimore, Harford and Howard counties are dying of overdoses - 140 in 2001, up 47 percent from 1997.
Experts say that as addiction to heroin spreads from city to suburbs, treatment has to follow. Only about 20 percent of the more than 102,000 people who need drug treatment in Baltimore's surrounding counties receive it each year, according to the substance abuse center. In contrast, 41 percent of the 58,000 addicts in Baltimore are treated.
"We see our kids leaving Howard County, driving to Baltimore, buying the heroin they need and taking it back," Howard County Police Chief Wayne Livesay said at a recent community forum.
And clinic operators say opponents of methadone clinics probably know someone affected by drug abuse.
"I guarantee you, if you shook the family trees, someone with an addiction problem would have fallen out of them," said clinic operator Neal Berch after a contentious recent meeting with those protesting his proposed methadone treatment center in Elkridge.
Methadone, now manufactured generically, is available for less than 50 cents a day, said George E. Bigelow, a professor at the Johns Hopkins University's Behavioral Pharmacology Research Unit. But other services required by law - counseling, regular urinalysis - cost more. Publicly funded clinics offer treatment on a sliding scale based on one's ability to pay, but the increasing number of private, for-profit clinics are more expensive.
Richard Coleman, 49, of Dundalk pays $90 a week to get methadone at EJAL. He has been clean for two years after using heroin since he was 12.