Kicking a Heroin Habit : Methadone Treatment Is Plentiful--but Only for the Addicts Who Can Afford It

Richard, 35, wins sales awards as manager of a supermarket meat department. He owns a $600 suit, two mountain bikes and a new Chevrolet.

Twice a week he wakes up at 4:30 a.m. to drive from his Westminster home to a clinic in Stanton to pick up his supply of methadone, which he takes to kill the urge to shoot heroin.

Researchers and operators of clinics that dispense methadone point to people like Richard, who has been on methadone for two years, as examples that the drug works. His rap sheet before starting on methadone included 26 arrests and 17 convictions, with six felonies for such things as forging checks and dealing drugs--all before he gave up his $300-a-day heroin habit.

In response to demands from heroin addicts and concerns about the public health threat that such addicts represent, treatment centers in Orange County have greatly expanded their services in the past decade. Five years ago, the state relaxed admission criteria and increased patient capacity in the methadone programs to make treatment more accessible to people at risk of contracting AIDS.

In Orange County, the number of people in long-term methadone programs swelled from 803 in 1991 to 1,418 in 1992, in part because of the addition of 570 treatment “slots” to meet the HIV crisis.

However, even as the HIV threat worsens among intravenous drug users and the recession continues to stress the personal finances of everyone, including addicts, a federally funded program to reduce the waiting lists for subsidized methadone treatment has ended, eliminating 170 subsidized treatment spots in Orange County over the past two years.

While there is plenty of space for people able to pay for methadone treatment, private clinics in Stanton and Fullerton have 80 addicts on waiting lists hoping to get new government assistance. And, there are 49 others trying to get into the county administered program for indigents.

Bill Edelman, division manager in charge of the drug program for the Orange County Health Care Agency, bemoans the shortage of government money for methadone and other drug programs. “If we are in the business of combatting addiction, we should help people who ask for help,” he said.

Advocates of methadone programs said they are also needed because they protect the public by finding and treating addicts with other communicable diseases such as tuberculosis and hepatitis.

“I am convinced our programs are providing a safety net for the general public to stop the spread of disease,” said Joy Jarfors, manager of the state’s methadone licensing branch.

Methadone, a synthetic narcotic, has been controversial since the beginning of its use as a heroin substitute in the early 1960s by a team of physicians in New York City.

Operators of the methadone programs have said over the years that they have learned that methadone is no cure. Only a small percentage of their patients will be able to break their dependence on methadone and live drug-free lives.

But they also said they have discovered that methadone, combined with counseling, can get people off street drugs that lead to crime and decrease their exposure to disease, especially HIV--the virus that causes AIDS--which spreads among addicts through the use of contaminated needles. Unlike heroin, which is taken intravenously, methadone is swallowed in liquid form. Also, patients on methadone get a consistent daily dose in a measure designed to ward off the sickness of withdrawal rather than give them a high.

Methadone programs report that more patients are taking advantage of free testing they offer for HIV--and an increasing number are testing positive.

Jennifer, a former heroin user, said she and some of her peers are determined to stay on methadone programs after learning they have the AIDS virus.

The Santa Ana woman who, like Richard, asked that her last name not be used, said she hopes methadone will help her live longer by giving her a healthier lifestyle.

“I was scared for my life,” she said. “People (who are HIV-positive) using cocaine and heroin die so fast.”

That doesn’t mean that methadone treatment is readily available to any addict who wants to reform. Orange County, like other parts of the state looking to cut the cost of government, has since 1981 encouraged private clinics to be established by private agencies that provide methadone and counseling to clients who can afford to pay for it.

As a result, three for-profit methadone clinics now operate in Stanton, Fullerton and Tustin.

While the state regulates various treatment aspects of all methadone programs, it has no control over the fees that the private programs charge, which are $170 and $180 a month in Orange County.

The county operates one methadone outpatient clinic in Santa Ana that gives free or reduced-cost treatment to indigents. Of the 190 patients in the county program, 59 are HIV-positive, reflecting the preference given them. The majority of the 128 women in the program were pregnant, and thus also high priority, when they were admitted.

William C. Wilson, administrative analyst for Western Pacific Re-Hab, a Glendale company that operates the methadone clinics in Stanton and Fullerton, estimates that if enough government assistance was available, those clinics could double the size of their caseloads.

When methadone treatment was instituted in the early 1970s in California, many program operators were adamant about requiring patients to immediately stop using illicit drugs or risk losing access to methadone.

Edelman said most programs now are more lenient with patients, especially in the first weeks of treatment, with the realization that it may take time and counseling as well as methadone to help them change their lives.

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Taking a more positive approach, clinics reward clients who stay “clean” of illicit drugs by granting them the privilege of taking some methadone doses home so they don’t have to come to the clinics as frequently. By contrast, those who fail to show compliance have to come daily.

Edelman said the county program is reluctant to drop a patient from treatment, although it will discharge a patient whose urine tests repeatedly show evidence of heroin use.

“We don’t want people out in the street hurting themselves and hurting other people and if the door doesn’t exist, they can’t come in,” Edelman said.

Most addicts are introduced to methadone treatment by participating in detoxification programs, which by state law are limited to 21 days.

Many program directors and addicts say these detoxification programs are ineffective because they are too short to break the drug habit of addicts who are transferred from heroin to methadone and then quickly weaned off the methadone.

Methadone program managers acknowledge that short-term methadone detoxification may be used by addicts simply to supplement their heroin habit, allowing them to grab a few days of relief from the grind of stealing and prostitution.

Patients who are considered “success stories” at methadone clinics commonly relate long histories of broken attempts at methadone and other rehabilitation programs before resolving to change.

Theresa Chard, 34, of Orange, said: “I tried to detox six or seven times. At the end I would start to get sick and start using (heroin) again.” Finally, she said, she joined a longer-term maintenance program. “You just get sick and tired of being sick and tired,” she said in explanation of what drives heroin addicts to treatment.

Another consideration that prodded her into a methadone program, she said, was her discovery that she was four months pregnant. She said she worried about the baby’s health because she had taken heroin during her pregnancy.

Virginia Rich, the nurse in charge of the prenatal program at the county methadone clinic in Santa Ana where Chard sought treatment, said the medical attention expectant mothers receive there improves the baby’s chances for a normal delivery.

It is dangerous to the child to take a heroin addict off all drugs during pregnancy, Rich said. Methadone is given in as low a dose as possible to keep the expectant mother feeling well. While some babies of methadone mothers experience withdrawal after birth, Rich said the babies don’t suffer long-term drug-related problems.

Like other patients who stay clean of illicit drugs, Chard, who has been on methadone a year, credits the dedication of her counselor. “She has called me up on days she was off work because I asked her to and to me she has made the world of difference,” Chard said.

When Chard was on the street, she slept beside railroad tracks and in vacant cars and would forget to eat so that her weight dropped to 99 pounds. Now she is employed as a waitress, has regained her self-esteem and is thinking about joining Weight Watchers to slim down from 145 pounds.

Many people on methadone treatment won’t tell employers or friends about it for fear of putting friendships and jobs in jeopardy. But Chard said she confided to her supervisors at work when they inquired why she couldn’t work an earlier waitress shift on weekend mornings, before the county methadone clinic opened. She said she found them to be very understanding, even impressed by the turnaround she had achieved in her life.

Support from family and 12-step programs like Narcotics Anonymous are also cited by patients who make strides with methadone programs.

Richard, the supermarket meat department manager, said that “methadone is a tool to enable you to feel right about yourself so you can concentrate on doing things normal people do.”

The biggest payoff, he said, came from his mother, when on her deathbed eight months ago, “she said: ‘Son, you finally made it.’ . . . That made my whole life. She never gave up on me.”

The downside is that studies provide little hope that many methadone users can kick methadone and become drug-free for the rest of their lives, in part because the heroin is believed to create a chemical imbalance in their bodies.

“Naive members of the public think methadone is a panacea to cure narcotic dependency. But those involved have found that success isn’t the discharging of patients but keeping them on therapeutic doses to correct a biochemical imbalance,” said Robert Kahn, president of the California Organization of Methadone Providers and chief executive of Preferred Management Services, the company that operates the Tustin clinic.

“Most of my people don’t even want off” methadone, said Rosalie Steffenson, the Tustin clinic coordinator. In the five years she has worked at the clinic, Steffenson said, only about a dozen of the hundreds of patients treated there seem to have succeeded in becoming drug-free. She added that she has no way of following them to know if they are still off drugs.

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Richard Brown of Huntington Beach, a methadone maintenance patient for a year, complained that “the programs are not set up to empower you to get off but to maintain you.” With the exception of his current counselor, Brown said he has discovered that counseling provided by the programs is perfunctory and patients are treated “like cattle.”

Brown, 41, noted that all the achievements gained from methadone treatment can be taken away if the patient no longer has access to the drug. He said he has seen other patients fall apart when they can’t pay for the methadone and are detoxified in 15 days.

Brown said he lost his job as a construction worker about two months ago and recently received an eviction notice because he can’t pay his rent. “I have $107 left in my bank account and I am up against the wall,” he said.

This month he could afford to pay only half his methadone maintenance bill at the Stanton clinic, Brown said, and he won’t be able to pay the rest unless he gets a job.

He said he has begun to reduce his methadone dosage so the withdrawal will be more gentle if he can’t afford to stay on the maintenance program.

“Right now I feel very insecure,” Brown said. “But I am a survivor.”

The Heroin Alternative

During fiscal year 1990-91, the most recent year for which information is available, 803 people were admitted to outpatient methadone maintenance programs in Orange County. A profile of methadone clients:

Sex

Male: 56.3%

Female: 43.7%

Age

18-30: 28.0%

31-40: 52.4%

41-50: 16.6%

51 and older: 3.0%

Ethnicity

White: 60.1%

Latino: 37.0%

Black: 1.0%

Other: 1.9%

Employment Status

Employed: 35.6%

Unemployed: 64.4%

Education

Less than high school: 38.4%

High school graduate: 40.4%

Some college: 17.2%

College graduate: 4.0%

Treatment Centers

In early January, more than 1,200 people were either receiving methadone or in a 21-day detoxification program in the county’s four methadone clinics.

Methadone 21-day maintenance detoxification County clinic, Santa Ana 190 35 Western Pacific Re-Hab, Stanton 221 104 Western Pacfic Re-Hab, Fullerton 218 50 Preferred Management Services, Tustin 446 56

What Is Methadone?

Methadone hydrochloride is a synthetic narcotic developed by the Germans during World War II as a painkiller and alternative to morphine.

It is addictive but can block the craving for heroin. Unlike heroin, which prompts craving about every four hours, methadone is effective taken just once a day.

Long-term methadone therapy for heroin addicts was developed in 1964 by two American physicians, Vicent Dole and Marie Nyswander.

Source: California Department of Alcohol and Drug Programs; individual clinics; Researched by Leslie Berkman