A PRESCRIPTION FOR BEATING HEROIN

Methadone gains credibility as way to end addiction to street drugs or
pain-killers

Before dawn each day, they start lining up outside Dr. J. Thomas Payte's
clinic on the edge of downtown Dallas. When the doors open at 5:30 a.m., the
doctor's patients file in for their fix of a narcotic they say they can't
live without.

Most of these men and women, of all ages, classes and colors, used to be
addicted to heroin. Some abused prescription painkillers. They've traded
those drugs for a daily dose of methadone, a legal but highly regulated
substance that advocates say turns junkies into productive citizens.

"For me, it's the answer," said Klyndia Smith, 45, as she waited for the
clinic to open. "It enables me to maintain some semblance of a normal life."

Methadone, which blocks the addict's craving for heroin and painkillers
without producing a high, isn't new. It has been around for more than 35
years and has been criticized by some in the medical mainstream because it's
not a true cure. It, too, is addictive, and many patients stay on methadone
for years. Some are hooked for life, as hooked as they would be on any
street drug, without all the negative side effects.

But methadone, long dispensed from nondescript clinics that keep a low
profile, is gaining credibility. Prominent government officials and
scientific organizations have recently touted it as a safe, effective weapon
in the fight against heroin use, which is on the rise nationally.

Federal drug czar Barry McCaffrey surprised - and angered - some drug
opponents by calling for wider use of methadone. The National Institutes of
Health concur, saying methadone "significantly lowers illicit opiate drug
use, reduces death and crime and enhances social productivity."

In Texas, the number of methadone clinics has increased from 55 to 70 in the
past three years, according to the state Health Department, which licenses
clinics.

"The literature is very, very comprehensive that methadone is an effective
treatment," said Dr. Jane Carlisle Maxwell, chief researcher for the Texas
Commission on Alcohol and Drug Abuse. "There are an awful lot of people who
are using methadone, doing well and maintaining normal, crime-free lives.

"We want people to be abstinent, but one of the things we're learning is
that. . . for some long-term drug users, their brain chemistry has literally
changed. They may never be able to be abstinent because their brain is
telling them, 'You've got to provide this chemical to me.' "

The increase in methadone use coincides with a spike in heroin-related
deaths. In 1998, the most recent year for which figures are available, a
record 374 people in Texas died from heroin overdoses, according to the
commission on alcohol and drug abuse. In Plano alone, 13 teens have been
killed by heroin since 1994.

McCaffrey endorses

More addicts should be persuaded to shift to methadone, according to the
Office of National Drug Control Policy, which Mr. McCaffrey, a former Army
general, heads. Currently, at least 810,000 people nationwide chronically
use heroin, and 170,000 receive methadone, the office says.

"Only a fraction of those addicts who can benefit from methadone treatment
do so," said a written statement from the drug office. "There is a
substantial body of knowledge and a rare scientific consensus on both the
utility of methadone treatment and its appropriateness for many addicts. . .
. Methadone treatment must be more widely available to those who need it."

To methadone user Tommy Romine, there's no debate on the drug's merits.

"It's been fantastic," said Mr. Romine, 37. "It got me off dope. It's really
changed my life for the better."

He and many other addicts tell painfully similar stories. They turned to
crime to support their habit. They lost jobs and families. Their health
deteriorated.

On methadone, users say, their lives stabilized. A quick swig of the
cherry-flavored liquid in the morning is all it takes. No cravings. No
withdrawal pains. No shooting up.

The nine Dallas-area methadone clinics open early so people can get their
fix before work. Their clientele defies stereotypes.

"We've got people who live under the bridge, and we've got people who own
the bridge," said Rick Bingham, a counselor at D. Gonzalez and Associates, a
Garland methadone clinic.

On a recent morning at Dr. Payte's modest, white-brick office at Market
Center and Turtle Creek boulevards, a plethora of occupations were
represented: Realtor. Cook. Architect. Painter. Waitress. Mechanic.
Telecommunications manager. An attorney who is a patient wasn't there.

Dr. Payte, who opened a methadone clinic in San Antonio 33 years ago, has
275 patients in Dallas. Many say they have tried repeatedly without success
to kick heroin on their own.

One of the doctor's youngest patients is 19-year-old Veronica Miles of
Waxahachie. (To get methadone, a person must be at least 18 and have been
addicted to heroin for a year or more.) She visits the clinic with her
father, Rodney Miles, also a recovering heroin addict.

"I can't function without methadone," said Mr. Miles, 45. "It changed my
lifestyle totally. I'm productive now. It turned me into a normal person."

The oldest methadone user in Dallas County may be Lee Jackson, 77, who has
taken it for 36 years. His health prevents him from visiting a methadone
clinic, so a caseworker delivers it to his North Oak Cliff nursing home.

"I can't say enough about methadone," he said. "Without it, I'd be dead or
in jail somewhere."

Use carries stigma

Most methadone users want to remain anonymous. They say reliance on the
drug, even though it's legal, carries an enormous stigma.

A 40-year-old architect, the mother of two young children, hasn't told
anyone but her husband.

"I'm fearful of what people might think," she said. "If I told my friends,
I'm afraid they wouldn't let me around their children."

Another methadone patient is a physician who wouldn't give his name or age.
He said he became addicted to prescription painkillers four years ago,
trying them out of curiosity.

"I made a horrible, horrible, horrible decision in my life, and I paid a lot
for it," he said. "It's horribly embarrassing to talk about. It's so hard
for me to put into words what the term 'powerless' is until you get addicted
to a substance. You will do absolutely anything to get it."

A man who gets methadone at West Texas Counseling & Rehabilitation in Irving
recently built a $250,000 house in a Dallas suburb. He hasn't told his two
young sons about his past heroin use or his 18 years on methadone.

"Some day they'll find out, but I want them to find out when they're a lot
older and they can deal with it," said the 47-year-old.

"They see me as a regular dad, seemingly successful."

Some disappointments

But methadone is no panacea, and it doesn't work for everyone.

Brandi Gray is an addict who has been on and off heroin many times. In her
third week of methadone treatment not long ago, she said she was determined
to succeed.

"This time I really am sick of heroin," said Ms. Gray, 21. "Every other time
I said I was sick of it, but I really wasn't."

However, she acknowledged later that she continued to use heroin
sporadically and dropped out of the methadone program. She then checked into
a mental hospital to become free of all drugs and has recently started
methadone at another clinic. Again, she said she's optimistic she can stay
off heroin.

Estranged from her parents because of her long history of drug abuse, she'd
been living with her grandparents. But they, too, kicked her out after a
recent relapse. After that, she was staying in her car.

"I screwed up everything - my whole life, my relationship with my family.
There's no going back," she said. "I can mend it a little bit, but not all
the way."

A walking anti-drug ad, she urged others not to get hooked.

"The high you get is not worth what you lose," she said. "Heroin is
terrible. I wouldn't wish it on my worst enemy."

Not only does methadone block heroin cravings, it also prevents the
excruciating withdrawal symptoms - intense cramps, sweating, nausea and
diarrhea.

Methadone was developed in Germany during World War II as an alternative
painkiller to morphine. It belongs to a class of drugs, called opiods, that
includes morphine and heroin. In the early 1960s, two New York researchers
discovered that methadone could be used to treat heroin addiction.

Some people wean themselves from methadone, but many say they're afraid to
even try. They worry that they'll immediately revert to heroin, and their
lives will again careen out of control.

Advocates maintain that giving methadone to heroin addicts is no different
from giving insulin to diabetics. The drug's only known side effect is minor
constipation for some people.

"I don't want to even talk about" getting off methadone, said another
47-year-old man who asked not to be identified. "I don't think it'll ever
happen for me. I will go to my grave being a methadone addict. I've come to
realize that I have an addictive personality."

That many users can't give up methadone provides ammunition for critics.
Even though it's safe and tightly controlled, they say, methadone is still a
drug. And users are still addicts.

"I think if it's used as a conduit from heroin with the eventual goal of
getting off methadone, that's fine," said Ed Cinisomo, vice president of
Daytop Inc., a national, abstinence-based drug treatment chain that has a
facility in Dallas.

"Some people certainly need that. But I know people who are on methadone for
a very long time. It becomes a lifestyle. People deserve better than that.
You're conditioning them that this is the only way they can survive.

"These poor folks are like lemmings showing up at the clinic every day. It's
a whole subculture."

How it works

At most clinics, people receive drug counseling along with methadone.
They're encouraged to participate in support groups such as Narcotics
Anonymous.

Patients usually start on a low dose, 30 milligrams. That's about a
quarter-inch in a small disposable cup.

After three months of regular visits to a clinic, most patients are allowed
to take home four doses a week so that they don't have to come in every day.
After three years of good attendance, some users are allowed six take-home
doses and visit the clinic only once a week.

Patients are given random urine tests. If they continue to fail, they can be
kicked out of the program.

Methadone isn't cheap. Most clinics charge $50 to $60 a week. Of course,
that's a bargain compared with the $300 to $400 a day that some junkies
spend on heroin.

Heroin users typically need four to six fixes a day. By comparison, one dose
of methadone stabilizes a person all day long.

Private insurance sometimes covers methadone treatment, but many people
don't file claims because they're afraid their employer will find out about
their addiction and fire them. Low-income patients receiving public
health-care benefits may be able to receive methadone for a nominal charge.

One Dallas executive said methadone helped lift him, literally, out of the
gutter. Hooked on heroin, he was once homeless and "damned near selling my
soul." Now, he owns a company in the medical field.

"I have lived a very normal lifestyle for many years," said the 50-year-old
man, who wouldn't give his name. "This is something that should be
well-accepted. It's got a very big stigma and it's wrong. Methadone is not
the root of all evil.

"If anything, it has been many people's saving grace. It has for me and my
family and numerous associates and friends."