METHANDONE QUESTIONS

Richard Mitchell Shrum, a 24-year-old University of Montevallo student,
struggled for years with emotional problems and drug addiction, relatives
say. But last fall, he moved in with his mother and grandmother in Grand Bay
to seek treatment at a methadone clinic.

He was going, he said, to kick his painkiller habit once and for all.

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Three days after starting the treatments, Shrum came home, went to bed and
never woke up. He died from what an autopsy report termed "methadone
intoxication."

Now, state authorities have begun an inquiry into the methadone clinic, Gulf
Coast Treatment Center Inc., because of Shrum's death and several complaints
about the clinic, state records show.

The state Department of Mental Health and Mental Retardation, which oversees
addiction-treatment clinics, last month asked a federal agency, the
Substance Abuse and Mental Health Services Administration, part of the U.S.
Department of Health and Human Services, to assist in the probe.

"It's more of an examination than an investigation," said John Ziegler,
spokesman for the mental health department. "Our internal investigative unit
is not involved."

The agencies eventually may ex pand the review to include other deaths
possibly related to methadone clinics around the state, officials said.

"We are receiving an increasing number of complaints regarding the amount of
methadone that is available on the streets, consumer complaints about
take-home restrictions, pain management clinics, applications for new
clinics, and numerous deaths reportedly related to overdose of methadone,"
said the July 22 letter from department commissioner Kathy Sawyer to the
federal agency.

Shrum's sister and some Alabama addiction experts say the examination is
long overdue. They hope it will bring daylight to what they call a poorly
regulated treatment network that appears to land people in for-profit
clinics that provide methadone without properly screening the clients for
other dangerous drugs.

Methadone, a synthetic opiate, was once used almost exclusively to help
heroin addicts, but is now also used for a number of other addictions and
for pain management, doctors said. Methadone allows addicts to satisfy their
cravings, but is considered safer and less debilitating than other drugs.

"The whole system is wrong," said Shrum's sister, Theresa Shadrix of
Anniston, who has pushed for months for an investigation into her brother's
death.

Patricia Weatherby, the owner of the 7-year-old Gulf Coast Treatment Center
in Grand Bay said she had not been notified by the state that the clinic is
under any scrutiny, but she welcomes a review.

"I can assure you that no action on our part contributed to anyone's death,"
said Weatherby, who also operates a methadone clinic on Springhill Avenue in
Mobile. "We've never lost a patient to methadone that came from here."

A physician who treated Shrum at the clinic also said the case had been
handled properly, "just like thousands of other cases there."

Dr. Jeffrey Caylor of Foley, who said he no longer works for the methadone
clinic, declined to comment further on Shrum's case. He did say that many
people on methadone maintenance programs sometimes overdose by secretly
abusing methadone or other drugs away from the clinic.

"We bend over backwards to help these people, but sometimes they don't help
themselves," Caylor said.

Clients always start out on the methadone tablets at very low doses, clinic
officials said. But Shadrix said her brother's body may not have built up a
tolerance for the narcotic and that he may have had other drugs in his
system that the clinic did not check for.

Clinic officials acknowledged that they do not screen clients for other
drugs every day, just every 10 days, in keeping with state regulations.

"It's a matter of clinical judgment," Caylor said. "If the person who (seeks
treatment) is not messed up and drooling or falling down and looks OK, you
can initiate treatment without a drug screen.

"It doesn't matter anyway, because we start them on very small doses," he
said.

"That's true," said Dr. Matt Barnhill, a toxicologist with the state
Department of Forensic Sciences. In many cases of overdose, the victim may
have obtained extra methadone or another drug, Barnhill said.

Shadrix, who is a social worker, and a local doctor who specializes in
addiction treatment have said that regardless of the methadone dose, a drug
screen should always be conducted -- to make sure the client is sticking to
his regimen and to prevent dangerous drug interactions.

"You absolutely need a drug screen. The effects of the drugs are cumulative
and can build up in your system," said Dr. Christopher Jenkins, a
psychiatrist who operates Recovery Medical of Mobile.

Jenkins contends the state's review highlights a growing debate about
Alabama's 16 methadone clinics, three of which are in Mobile County.

"These methadone clinics are all about profit," Jenkins said. Instead of
rehabilitating addicts or putting them through a weeklong detoxification
program, the clinics have a vested in terest in keeping them on methadone
indefinitely, he said.

Jenkins acknowledges that he, of course, could be accused of having his own
bias, since he earns a living helping people to get off drug dependency,
including methadone.

The state Department of Mental Health does not track the number of deaths
related to methadone clinic treatment, nor does it track complaints. But the
Montgomery-based Council on Substance Abuse does, to some degree.

From October through June, the council received 23 telephone complaints
about the clinics. The Grand Bay clinic was the subject of seven complaints,
more than any other clinic, said Alice Murphy, director of the nonprofit
council, which serves as an advocacy group for treatment programs and
patients.

Across the state, the majority of complaints were from clients, who said the
clinics would not offer them a detoxification program to stop taking
methadone, said Murphy, who helped Shadrix in her quest for a probe into the
clinics.

Shrum decided he needed help, because he felt like he was addicted to
Lortab, a narcotic that he was prescribed for back pain, his sister said.
She said family members were confounded, though, when Shrum's doctor and a
mental health counselor recommended a methadone program.

Jenkins and Murphy, based on their knowledge of the case and painkiller
addiction in general, also felt Shrum's treatment course may not have been
appropriate.

"Methadone clinics came about in the 1960s for hard-core addicts who had no
real hope of being rehabilitated, so they were put on methadone
maintenance," Jenkins said.

But many drugs, such as Lortab, can be kicked with a proper detoxification
program in less than a week, he said.

Weatherby said that's not necessarily true. Most of the 170 clients treated
at the Grand Bay clinic feel like they are hooked on Lortab, a brand name
for a drug known generically as hydrocodone. A maintenance program lets them
satisfy their cravings, but lead a normal life without the trauma of
withdrawal, she said. The cost is $11 per day, and most clients start out on
a 90-day program.

The amount of methadone in Shrum's body at the time of his death was
unclear. The full autopsy report was unavailable, only a summary record of
the cause of death. Dr. Les Chrostowski, the medical examiner who performed
the autopsy, said the term "methadone intoxication" most likely means an
overdose. The death also could have resulted from an interaction with other
drugs, he said.

"He didn't get an overdose from us," Weatherby said.

It took eight months for the state to begin its review of the case, Shadrix
and state officials said, because the family was gathering evidence,
including Shrum's autopsy results. Medical examiners' offices across the
state have complained of huge backlogs and low staffing and funding levels.

State officials said they did not know how long the probe may last or what
the outcome could be. Shadrix, Murphy and Jenkins said that ultimately, they
hope the outcome will mean that the state will do a better job of
scrutinizing methadone clinics in the state.

The Department of Mental Health certifies the clinics and inspects them once
a year, said Ziegler, spokesman for the department. All of the inspections
have shown high marks, Weatherby said.

"I'm not afraid to go to court about any patient treated here," she said.