NO EASY ANSWERS TO DRUG PROBLEM, U.S. OFFICIAL SAYS

Dozens of Montana health care professionals, educators and others spent
Thursday morning at two meetings to tell a top U.S. drug control official
about the severe gaps they see in preventing drug abuse and in getting
treatment for addictions.

They didn't have to convince Dr. Donald Vereen Jr., deputy director of the
White House Office of National Drug Control Policy, about the importance of
prevention and treatment. Vereen is a psychiatrist and public health expert
with extensive experience in drug addiction and treatment.

But he didn't offer any quick or easy solutions to the myriad of problems
stemming from the methamphetamine epidemic that has swept Montana and other
Western states.

After being introduced by U.S. Sen. Max Baucus, Vereen addressed a
standing-room only crowd of more than 100 people at the MSU-B teleconference
center and dozens more at teleconference rooms in Miles City, Bozeman,
Havre, Butte, Missoula, Great Falls and Kalispell.

The ONDCP is responsible for coordinating drug programs among some 50
federal agencies. Of the 150 people working at the ONDCP, Vereen is among
only four staff members who have clinical experience in addiction treatment.

Vereen said the national drug control strategy has set a goal of cutting
Americans' drug use by half over 10 years.

He offered community grants and "technical assistance" to help Montanans
develop an anti-drug strategy and ways to measure its effectiveness.

"In such a large, rural state, we're aware of the challenges you face," he
said.

After Vereen and about 70 audience members moved to the Billings Education
Association office to continue their discussion, Montana chemical dependency
treatment experts talked briefly about their efforts to deal with
methamphetamine.

Bonnie Pipe, a chemical dependency counselor at the Northern Cheyenne
Recovery Center's in Lame Deer, described how she and colleagues from around
the state started a methamphetamine task force two years ago. It was a
response to an alarming jump in the number of severely ill people needing
treatment for methamphetamine addiction.

In the last two months of 1997, Pipe saw seven "psychotic, paranoid and
violent people" who were addicted to methamphetamine. Rimrock Foundation in
Billings agreed to admit all of them and they each needed several weeks of
treatment. That episode with seven clients exhausted the Northern Cheyenne
Recovery Center's entire budget for the year, Pipe said.

From that first brush with crisis, the methamphetamine task force was
formed. It now has more than 150 members in five states. Members share
information in a joint effort to "end the widespread problem of
methamphetamine abuse/use that is occurring in our communities," according
to the group's mission statement.

Mona Sumner, chief operating officer at Rimrock Foundation, also is a task
force member. She told Vereen about the difficulty in getting coverage for
addiction treatment - even when the clients have health insurance that is
supposed to include substance abuse treatment. Managed care companies deny a
substantial number of claims to save money, even when the patients meet
treatment criteria set by the American Society of Addiction Medicine, Sumner
said.

"Today, in my facility, every bed is full and the outpatient program is
full. A third (of patients) have been denied insurance coverage," she said.

Federal employees covered by federal insurance plans also have been denied
addiction treatment benefits, Sumner said. Vereen said that the federal
government soon will require chemical dependency treatment coverage in all
policies covering federal employees.

Employer self-funded plans created under ERISA, the federal Employee
Retirement and Income Security Act, also avoid paying for addiction
treatment because they are not subject to state mandates on insurance
benefits, Sumner said.

When private plans don't cover care, there is a cost shift to public
programs and an increased need for free care from facilities such as
Rimrock, Sumner said.

"There's a great need for reform," Sumner told Vereen. "We'll take all the
help we can get."

Vereen said federal funds for drug abuse prevention and treatment have been
increasing. But he said that most money comes in block grants to states, so
the states have to determine how to allocate it.

"You need to lobby, not only for more money, but for the strategic use of
those funds," the doctor said, adding later: "We have a treatment gap in
this country that has to be closed."

Vereen's talks with health care professionals preceded the scheduled arrival
in Billings of his boss, Gen. Barry McCaffrey, director of the ONDCP.

How did the nation's drug czar and his top staff members come to plan a
two-day trip to Billings?

It started at a dinner in Washington, D.C., last fall. Both Vereen and
Baucus credit Pat Butterfield, a registered nurse from Bozeman, for bringing
the Montana methamphetamine problem to McCaffrey's attention. Butterfield, a
public health nurse who teaches at the MSU College of Nursing, has a
fellowship from the Robert Wood Johnson Foundation because of her interest
in environmental health. Vereen's assistant, Kate Maliarakis, is a nurse
practitioner and Robert Wood Johnson fellow. At the dinner to discuss
nursing research, Maliarakis brought her boss as her guest. Butterfield
brought Baucus' health issues aide as her dinner guest.

Methamphetamine poses environmental health hazards for people, including
children, exposed to the poisonous production process for this illegal drug,
Butterfield explained Thursday in Billings. Once methamphetamine has been
"cooked" in a makeshift lab in an apartment, motel room or other place,
dangerous chemicals remain in the furnishings and walls, creating hazards
akin to "mini Superfund sites," Butterfield said. In addition health
concerns, there are community problems about the costs of removing or
cleaning up this contaminated structures, she said.

The idea of a series of Montana methamphetamine meetings grew when the
dinner guests discussed the issue with McCaffrey and Baucus.

Although McCaffrey's flight into Billings was delayed for several hours
Thursday, Vereen and Baucus had already promised they would return for
followup meetings. No dates were announced.

"This is just the first meeting," Vereen told the group at MSU-B. "It
doesn't make sense for us to just come out one time."