BANGOR TORN IN DEBATE OVER METHADONE TREATMENT CLINIC

BANGOR - The contentious debate over a proposed methadone clinic has
divided some of the community's most prestigious leaders and confounded
residents torn between wanting to help those caught in the downward spiral
of substance abuse and maintaining the safety and serenity of their city.

The public has been told that the clinic will bring drug addicts and
dealers to town, making Bangor a "mecca - a farmers market" for drug
dealing. Crime will go up and the heroin problem will become deep-seated
and permanent. Demand for city services such as public housing and police
will increase.

They also have been told that the clinic will reduce heroin use by 70
percent, decrease crime by 56 percent and increase employment of heroin
addicts by 24 percent.

Supporting the clinic is the city's largest employer, Eastern Maine
Healthcare, which encompasses Acadia Hospital, the would-be operator of the
proposed methadone treatment facility. They are backed by EMH's and
Acadia's boards of directors, which include some of the city's most
civic-minded leaders.

Weighing in is a very skeptical city council, school board, police chief
and the state's United States Attorney. It's easy to get lost in the
flurry of words tossed about by those involved. Some call it a battle
between the who's who of the city. Others call it an aggressive democratic
debate. Some call it a methadone clinic, while others insist it is simply
part of the hospital's treatment center and not a clinic. Those who go are
either "clients" or "addicts," depending on who's speaking, and methadone
as a treatment has either a 50 percent success rate or a 50 percent failure
rate, depending on who's presenting the argument.

This much we know from examining methadone clinics around the country and
in southern Maine: Few if any communities have been successful at keeping
methadone clinics out of their cities.

Methadone remains the most effective treatment for opiate addiction, though
new drugs are on the horizon.

And whether clinics result in a crime increase or decrease seems to depend
on where they are located and how they are run. We also know that the
presence of two clinics already in Maine has done little to decrease the
overall opiate and heroin addiction problem in the state.

South Portland's experience South Portland Police Chief Ed Googins has
followed the Bangor debate closely. He knows if he gets a call from Bangor
these days it is most likely someone with questions about methadone
clinics. Googins probably has more experience with methadone clinics than
any other chief in Maine. A clinic opened in his city of 22,000 people in
1995.

So what's happened?

"We have seen a slight decline in most crime, but there is no way to
connect that to the presence of the methadone clinic. Communities across
the country are seeing a decrease in crime. Most of those communities don't
have methadone clinics. Also, it should be noted that in the mall area
[near where the clinic is located] we have seen no decline in crime and
slight increases in property crimes such as shoplifting and car
burglaries," Googins said. "There is also no way to say that's due to the
location of the clinic. " The clinic has not resulted in a reduction of the
abuse of heroin and diverted opiates in the Portland area, Googins
said. "We, like most communities, are seeing an increase in the use of
heroin and opiates," Googins said. "Our biggest increase has been in the
use of heroin and OxyContins. "

In its 1999 report, the Maine Drug Enforcement Agency's Portland office
reported that heroin had increased in both availability and strength in the
area.

"This particular area has always had a core group of [heroin] addicts,
which is estimated to be between 900 and 1,200 in the Greater Portland
area. Some of the noticeable changes are that there seems to be a younger
user of this drug. We have also seen a marked increase of heroin overdoses
," the report states. "This unit has experienced a large increase in the
availability of virtually every type of pharmaceutical drug. " The
increased heroin problem has not been attributed to the methadone clinic,
but raises questions as to whether the presence of a clinic in a community
reduces the drug problem there. Though not necessarily an advocate for
methadone clinics, Googins sees a need for medical treatment for
addiction. "I wouldn't say I'm a fan of methadone clinics. I see the need
for medical treatment. I'm not necessarily an advocate for a clinic
situation. We have had issues with the clinic, but they are not
overwhelming But we have had undercover drug operations that have led us to
the doorstep of thatfacility," he said.

Examining The Clientele

The desire to see a clinic in Bangor drew 37-year-old Karen Dittman to a
crowded public hearing in the city in July. The business owner and mother
from Ellsworth waited four hours for her chance to speak, but finally gave
up as the hearing dragged on. A clinic in Bangor would save Dittman the
two-hour drive each way to the Winslow methadone clinic, which she makes
once a week. It's taken her years of methadone treatment, counseling and
clean urine tests to be entrusted to take a weekly dose of methadone home
with her rather than commute daily. But with a busy 14-year-old daughter,
a husband and a successful candle-making business, the five hours that it
takes for her to get he treatment each week is tiring.

"I'm not complaining because I need to go and I'm lucky I just have to go
once a week. I went every day for a long time and then it was a few times
a week. No matter what, I'll go because I need the methadone. It has
saved my life and allowed me to be a proper mother to my daughter. It
means everything to me," she said. Diagnosed right after her daughter was
born with a painful disease that affects her circulation, Dittman was
prescribed Vicodin. Over time, her need for the drug increased, until the
day came when she realized she was addicted.

"I knew for a long time before anyone else did. I mean, I was living a
normal life. I was working and raising my daughter, but I was an addict
and when I tried to get off them I got so sick. I mean, all I can tell you
is to recall the worst flu you've ever had and multiply by at least 10,"
she said recently from her business located on Route 1 outside Ellsworth.

Dittman never had visualized herself as an addict. She had a nice family
and was raised in a small town in central Maine. "It was an awfully
difficult thing to admit. I mean, no matter how bad it got I was always
looking at other addicts and saying 'That's not me. I'm OK. I'm not like
them. ' Of course I was just like them," she said.

After several failed traditional detoxification and rehabilitation
programs, and one night in jail, Dittman sought help at a methadone clinic
in South Portland.

It seems silly to her that her own doctor can't prescribe methadone to her
to save her the weekly trip. Federal legislation prohibits physicians from
dispensing methadone to treat addiction. The Bangor clinic would certainly
be more convenient.

Location Questions

It's probably not the Karen Dittmans that Alfred Mosca is worried about,
but he's worried nonetheless.

"We have a wooded area that borders the back side of the houses on Dunning
Boulevard [near the Acadia Recovery Community and the site of the proposed
methadone facility]. There are encampments there that are occupied by
these patients from Acadia. We've had at least five incidents where these
people have approached the homeowners and demanded that we give them
alcohol, beer. During the daytime they're free to come out in the back
yards ," Mosca said during a July 19 public hearing.

Ideally, Acadia officials say, clients will come to the clinic early in the
morning to receive their dose and counseling services and then go about
their day.

The proposed clinic will be located on the former Dow Air Force Base, in
the area of University College across the street from the airport.

The South Portland clinic is located in a commercial area nestled between
business offices and retail stores, near the Maine Mall. Chief Googins
said his department is called "regularly but not frequently" to the
clinic. It is not a pedestrian-friendly area, he said, and the complaints
that are made usually involve speeding or dangerous driving of those going
to and from the clinic.

The chief said clients do not hang out around the clinic. "They pretty
much park their cars, go inside, stay for a short period of time, come out
and drive away. That's about it," said the chief. Though undercover drug
investigations sometimes turn up information involving clients of the
clinic or diverted methadone, drug dealing around the clinic has not been
an issue, said Googins. At the same time, even Dittman acknowledges that
some methadone clients continue to use drugs, such as cocaine.

Barbara McCauliff of Portland also says that a number of methadone clients
are still rooted into the drug culture and leave the clinic and head to
Massachusetts to pick up a bag of cocaine. "Some of them are there to get
clean and get their lives back," McCauliff said. "Others are there to get
the methadone, the drug. If they are on Medicaid they can get a free dose
of methadone every day. They are using it as a recreational drug not to
get clean. " Jim Crocker is the morning disc jockey on the WGAN radio
station, located adjacent to the South Portland clinic. "You'd never know
what it was," said Crocker in a recent telephone interview. "There's a
sandwich shop on the other side of the clinic and that clinic could be just
another sandwich shop, except when the people come out they don't have a
hoagie under their arm. "

Crocker said the clients arrive, go inside and then leave. "And I'll tell
you something, a lot of them are driving nicer cars than we are and a lot
of them are in suits and ties," said Crocker. "I have never seen a problem
over there. "

Conflicting Statistics

Margaret Rutan listened patiently as the success and failure rates of
methadone treatment were tossed about during the July 19 hearing at the
Bangor Civic Center.

"Whose statistics will we address to make a final decision?," Rutan asked
the city council.

Mayor Michael Aube's noncommittal answer may sum up some of the frustration
lurking behind the methadone debate.

The purpose of the meeting, Aube responded, "is to raise the
questions. You're doing so. I think that's a very legitimate question for
this council to consider in terms of statistical information, so we'll note
it and move on, but we can't answer that tonight. "

Definitive answers are hard to come by when searching for accurate
statistics involving success or failure rates. The science appears to be
on the side of Acadia Hospital and the state's Office of Substance Abuse,
which wants a clinic in Bangor. There is nearly endless research that
provides strong evidence to support methadone maintenance as the most
effective available treatment for heroin addiction.

Methadone treatment is supported by the American Medical Association, the
American Psychiatric Association, the Center for Substance Abuse Treatment,
the National Institute of Health, and the Institute of Medicine.

The White House not only supports methadone maintenance treatment, but also
introduced legislation to make it more widely available.

The National Academy of Science's Institute of Medicine found that
"methadone maintenance has been the most rigorously studied drug treatment
modality and has yielded the most incontrovertibly positive results. "

Methadone is an opiate that wards off withdrawal symptoms and suppresses
drug cravings among opiate addicts by stabilizing blood levels of the drug
and its metabolites. Experts maintain that methadone lets addicts function
normally, without making them high and can safely be consumed for years.

Some experts have compared it to the nicotine patch used by smokers who
want to quit the habit.

"Both deliver addictive drugs - albeit drugs that pose virtually no health
risks - in a form designed to reduce associated harms to consumers and
others. Both have proven effective in reducing more dangerous forms of
drug consumption," according to a report authored by Ethan Nadelmann,
director of the Lindesmith Center, a drug policy research institute in New
York City.

Gen. Barry McCaffrey, the director of the Office of National Drug Policy.
cites a National Institute on Drug Abuse Treatment Outcome Study that found
that methadone reduced heroin use by 70 percent and criminal activity by 57
percent while increasing full-time employment 24percent.

The study sponsored by the National Institute on Drug Abuse compared before
and after treatment behaviors of 10,010 drug abusers in nearly 100
treatment programs.

The study found that those who used heroin weekly before treatment,
compared to those who did 12 months after treatment, resulted in a 69
percent decrease.

The study did not address whether those clients were using heroin at all,
but instead indicates that the frequency of use had decreased.

Maine U.S. Attorney Jay McCloskey questions all of those statistics because
they are based on self-reporting by methadone clients.

"First of all, the [researchers] set a very low bar for the definition of
effectiveness. Any decrease in the use of heroin is seen as effective
treatment. And they rely on self-reports by addicts. They are not going
to self-report that they themselves are using drugs when they are at a
methadone clinic " McCloskey told city councilors.

The U.S. Attorney further questioned McCaffrey's statistic showing that
full-time employment increased by 24 percent for methadone maintenance clients.

McCloskey argued that in Maine 80 percent of those receiving methadone are
on Medicaid.

McCaffrey's office later corrected the initial figure stating that
full-time employment among methadone clients increased only by 4 percent.

McCaffrey also stated in a recent NEWS article that methadone allows for
175,000 Americans to lead stable lives. Yet it is estimated that only
170,000 people are receiving methadone treatment and at least a significant
percentage of those clients will fail treatment.

Bangor debate goes national Bangor city officials were not pleased when
they read in the paper that Acadia Hospital, at the state's request, had
applied for a license to open a methadone clinic.

While the city has enjoyed a good relationship with Eastern Maine
Healthcare and Acadia Hospital, city officials were clearly put out that
Acadia staff did not inform them of their plans.

What transpired quickly became more of a power struggle over siting a
methadone clinic, than a debate over the effectiveness of the drug and
related treatment programs. Talks between the city and the state were
initiated, then brokedown. Plans to put together a task force to research
the pros and cons of a clinic in Bangor failed when the state and city
could not agree on its membership. Press conferences were called, city
resolutions were passed and often the "debate" stopped just short of name
calling. A national methadone watchdog group picked up on the controversy
and posted local newspaper articles on its Web page. It also called for
action by methadone proponents.

"It's a life or death situation in Bangor, Maine, as local residents fight
to keep a methadone clinic out of their town. Myths about methadone
maintenance is the rule not the exception in this town," states theWeb site.

It further calls upon proponents to "bombard" the NEWS with letters
supporting methadone treatment.

Many did, and letters and e-mails poured into the paper, most to tout the
benefits of methadone maintenance. After two very long and well-attended
public hearings, a committee - made up equally of city and Acadia
appointees - is now researching methadone treatment and is expected to make
recommendations by December to the state Department of Mental Health,
Retardation and Substance Abuse Services, the state agency governing
methadone clinics.

In the meantime, however, the city council at its Sept. 13 meeting is
expected to decide whether to put the methadone clinic issue before voters
in a nonbinding referendum this November. A "citizens' group" has
requested the referendum, which would be strictly advisory, serving only to
show Acadia and the state how people in Bangor feel about having a clinic
in the city. Early in the summer, the Office of Substance Abuse agreed to
delay the clinic opening until Jan. 1, 2001, so the community could become
more educated.

It was a step they did not have to take.

No Legal Recourse

Legally, the city has little ornothing to say about whether a methadone
clinic opens.

Clinics are licensed and regulated at the state and federal levels. Cities
around the country that have tried to fight clinics have been largely
unsuccessful.

Most recently, the city of Covington, Ky., lost its battle in federal court
to keep a clinic from opening there. The city first tried to keep the
clinic out by changing zoning that would prevent the clinic opening near a
school. In an important decision, U.S. District Court Judge William
O. Bertelsmen found that the city violated the Americans with Disabilities
Act when it changed its zoning.

That means such clinics can go any place a physician's office could go, and
must be judged by the same standards. The decision helps establish a
precedent in a relatively new area of law that touches on both the ADA and
zoning laws. In Antioch, Calif., the city sought a court order that would
prevent a clinic from opening there until the court case between the city
and the clinic operators could be settled. The judge denied the request
and construction began.

Opposition to clinics is not new, and it has not stopped 900 such clinics
from opening around the country.

The Office of Substance Abuse and officials at Acadia Hospital say the need
for methadone treatment is great in Bangor, and that a clinic is
essential. Chances are that, barring any licensing problems, a clinic will
open sometime next year, despite the intense opposition.

Addicts' Best Chance

To date, methadone treatment is considered the best chance that opiate
addicts have of beating their addiction. Federal laws governing methadone
prevent physicians from prescribing methadone for addiction. They are
allowed to prescribe it for pain. But that may be changing.

In July, the House approved legislation that would make it easier for
office-based physicians to use federally controlled substances to treat
patients addicted to heroin and other opiates. The bill is intended to
make it easier for physicians to dispense buprenorphine, an alternative to
methadone in treating opiate addiction.

The FDA is expected to approve buprenorphine in the near future. According
to a report from the House Commerce Committee,which approved the bill last
October, buprenorphine, particularly in combination with the drug naloxone,
has been found not only to be effective in helping opiate addicts, but to
have a far lower potential for abuse than methadone.

Allowing physicians to dispense such drugs would be a positive step,
especially in rural Maine, where patients must often drive three or four
hours daily to receive their methadone. There are concerns, however, that
buprenorphine will cost up to 10 times as much as methadone, therefore
putting it out of reach for many addicts.

Meanwhile there is only methadone, and it is available in Maine only
through clinics in South Portland and Winslow for now.