METHADONE ACCESS STILL NOT GUARANTEED

Despite A New Law, Some Counties Won't Offer The Controversial
Treatment.

LOS ANGELES -- Arthur Rivera returned from the Vietnam War with a heroin
addiction that drove him to crime.

He burglarized houses, stole from relatives and robbed people at
knifepoint to support his habit.

His life in crime finally came to an end 10 years ago, when he started
taking methadone instead of heroin.

"It saved my life," said Rivera, a 48-year-old father of two. "No more
overdoses, and I don't want to hurt anyone anymore."

Methadone, a painkiller taken daily to ease withdrawal symptoms, is a
proven treatment for addiction to heroin and other morphine-like drugs.

But not all counties will offer methadone to those sentenced to
treatment under Proposition 36, a situation that has incensed methadone
providers and some other drug treatment specialists.

"There are going to be people denied access to the most effective
treatment for heroin addiction," said Dr. John McCarthy, executive
director of the Bi-Valley Medical Clinics Inc. in Sacramento. "Why
should they be singled out?"

Proposition 36, which mandates treatment instead of prison for
non-violent drug offenders, names "narcotic replacement therapy," as
methadone treatment is formally known, as one way of meeting those
requirements.

Methadone will continue to be available in most large counties, such as
Sacramento. But 36 of the state's smaller counties don't offer publicly
funded methadone treatment, and some of the counties that do have
methadone clinics available either won't offer the treatment because of
Proposition 36's funding limits or because of local opposition.

"There is this absolute avoidance of methadone," said Douglas Anglin,
director of the University of California, Los Angeles, Drug Abuse
Research Center. "We have coined the term 'methaphobia' to describe it."

Methadone remains one of the most controversial drug treatments, despite
studies showing it reduces criminal activity and illicit drug use. It
also can eliminate the risk of hepatitis, AIDS and other illnesses
contracted through sharing contaminated needles.

The chief complaint is it keeps addicts addicted, albeit to the
less-dangerous methadone. As a result, it hasn't been used by most of
the state's drug court judges, and many of them will be the judges who
handle Proposition 36 cases.

Even judges who plan to offer methadone treatment under Proposition 36
said forcing someone to stay on methadone could be difficult.

"As a practical matter, it would be hard to compel someone to hold their
nose and take a pill," said Los Angeles Superior Court Judge Ana Maria
Luna.

Proposition 36 provides funding for up to one year of treatment and six
months of aftercare. But methadone treatment usually takes more than a
year. That's why some counties, like Fresno, have eliminated it as an
option under Proposition 36.

"We are definitely not opposed to (methadone)," said Dennis Koch, Fresno
County senior substance-abuse specialist. "But that is the way the
initiative is written."

Joe Pendry, the San Benito County substance-abuse coordinator, called
the funding issue a red herring. "A lot of people don't believe in
methadone and don't want to use it," he said.

Methadone treatment costs an average of $2,700 annually, and the
counties that intend to use it said they will get Medi-Cal or other
public funds to pay for treatment after Proposition 36 funds run out. Or
patients -- who often resume working once they're stabilized on
methadone -- could pay for their own medication.

Frank Lewis, Riverside County substance-abuse program manager, said he
plans to use methadone for short periods to help addicts kick their
habits.

But Robert Kahn, president of the California Organization of Methadone
Providers, said the short-term use of methadone to kick a heroin habit
does not work. "It never has," he said.

Most methadone clinics offer detoxification programs, he said, to lure
addicts into longer-term treatment where they can get counseling and
other services.

Arthur Collier said patients have successfully withdrawn from methadone
at the Sepulveda Veterans Administration program he runs in the Los
Angeles area -- but only after they completed at least two years of
methadone treatment and counseling.

Patients tend to be more like Linda Galloway, who has taken methadone
for 20 years and considers it an essential medication: "like insulin is
for diabetics."

Without it, Galloway is afraid she'd return to the heroin addiction that
drove her to crime and prostitution.

"I had thought I would die turning tricks and chasing the bag," she
said.

At age 52, Galloway has returned to college, cares for her invalid
mother and doesn't "hate myself and everybody else anymore."

She's lucky to live in a highly populated region of the state, where
there's an abundance of methadone programs.

In the state's more rural counties, such as Calaveras County, there are
no methadone clinics.

A law enacted last year sought to increase access to methadone by
removing the requirement that only full-fledged clinics could dispense
the medication. The new law lets doctors give it to their patients in
their offices.

But obstacles remain. McCarthy, who is helping a Shasta County doctor
set up a methadone operation, said federal regulations require new
methadone patients to come to the office every day for the first 90 days
of treatment to ensure they're taking the medication. But doctors'
offices aren't open seven days a week.

"Right now, it's like trying to fit the Titanic in a bathtub," McCarthy
said. "They are springing huge regulations on these small doctors'
offices."