DOWN EAST DRUG USE CREATES LASTING PROBLEMS

MACHIAS - The clinical supervisor of the new methadone clinic at
Acadia Hospital in Bangor came to Washington County on Tuesday, but he
was unable to offer much hope to the mental health workers who
gathered to hear him speak.

The county's epidemic of prescription drug addiction is going to cause
problems for decades to come, Scott Farnum told the Washington County
Consortium of Mental Health Providers.

Paraphrasing former drug czar Barry McCaffrey, Farnum said, "We're not
talking about an acute illness that spikes in a community and can be
dealt with . If I'm a chronic addict at 16, you're going to be dealing
with me for the next 30 years."

Farnum, who has worked with addicts since 1979, said opioids - the
medical term for all kinds of painkilling medication - include natural
substances such as opium and morphine as well as semisynthetics such
as heroin and OxyContin.

Although OxyContin may be the current drug of choice in Washington
County, the addict population will turn to heroin when OxyContin
becomes difficult to obtain, he said. Farnum said he's seen that
dynamic in Bangor.

And along with addiction to opioids and intravenous drug use come HIV
and hepatitis C, he said.

"Forty to 45 percent of the people coming to us at Acadia are
[hepatitis C] positive," he said. "We're going to have people with
significant long-term health problems." Hepatitis C is a chronic,
life-threatening liver disease that is the leading cause of liver
transplants in the United States.

Farnum said approximately half of the people who experiment with
opioids end up with a problem. Dependency can develop within a couple
of weeks, and very few people take OxyContin as a pill for very long,
he said.

They progress to crushing the pill and snorting it. Snorting "almost
always" progresses to intravenous drug use, he said.

"It's a lot more economically efficient because you don't need as
much," Farnum said. "And you get a lot higher."

The drugs cause substantial changes in brain chemistry, shutting off
the production of endomorphins in the pleasure center of the brain.
The addict's only pleasure comes from the drug, and because OxyContin
and heroin are short-acting, the addict is always anxious about
withdrawal, he said.

"They'll do anything to get back to that euphoric state," Farnum said.
"It's a hellish lifestyle when you think about it. The amount you need
keeps growing, and you're spending more and more."

The changes in brain chemistry are long-term so even when addicts stop
using, they still have a physiological need for the drug, he said.

Detox programs by themselves or incarceration are not effective
treatment for opioid addiction, he said. Nationally, 90 percent of the
people incarcerated for trafficking or other opioid-related crimes are
using within a year of being released, he said.

"And up here, at least, most of the people who sell the drug are
addicted themselves," he said. "Law enforcement cannot do this alone."

Farnum, who helped set up Portland's methadone treatment clinic in
1993 before coming to Bangor, said he does have a bias and is an
advocate for methadone as a replacement drug.

Methadone essentially acts the same way as heroin, but at a slower
pace, so the person can have a sense of well-being without being high,
he said. Only 5 percent of the people who go into methadone treatment
stay longer than 10 years, he said.

Results of national studies indicate that enhanced methadone treatment
and therapeutic communities - live-in facilities where a person stays
for six months to a year - are the most effective treatment options,
he said.

Washington County has neither.

Farnum had more bad news. A medication called levomethadyl acetate, or
LAAM, which some at Acadia believed could be the answer for Washington
County's addicts, is causing heart rhythm abnormalities that can be
fatal, he said.

Unlike methadone, which must be distributed by a licensed methadone
treatment facility under federal law, LAAM can be prescribed by a
doctor trained in administering the medication.

Farnum said the average age of opioid addicts is decreasing. Most
addicts used to be 30 to 45, he said, but most of the people he sees
in Bangor are 21 or 22, he said.

Opioid use is easy to hide from parents, Farnum said. Unless a person
has just gotten high, the effects are not obvious, he said.

Signs of opioid use and dependence include loss of appetite or weight,
nodding, pinpoint pupils, drooping eyes, impaired night vision, dry,
itchy skin or skin infections, constipation, and slowed or slurred
speech.

Withdrawal symptoms are similar to the flu and include nausea and
vomiting, gooseflesh, sweating, restlessness, tremors, watery eyes and
a runny nose, he said.