ON PERMANENT PAROLE: A SPECIAL REPORT

DAYS ON METHADONE, BOUND BY ITS LIFELINE

Shortly after 9 A.M., Pamela Carlo arrived at the tiny, nondescript clinic
in Chinatown for her daily deliverance. It was a cool day, with a packed
gray sky. The tang of fish was in the air.

She displayed her ID card at the check-in window, consulted the blackboard
to see who had to give a urine sample (she didn't), then waited on the
scuffed linoleum floor until her name finally crackled over the loudspeaker.

At the third of four dispensing windows, a nurse proffered a plastic cup
partly filled with the reddish liquid known as methadone. The nurse was
required to watch her drink it. Ms. Carlo diluted it with water to mask the
taste and swallowed it in three gulps, grimacing and stamping her right
foot. "Oh, that's evil," she howled. "It never tastes any better."

The nurses ask patients to say something, to insure they aren't "slagging,"
stowing the liquid in their mouths so they can sell it on the street. One
man used to conceal a plastic bag in the hood of his sweatshirt; he would
raise his cup past his ear and pour the methadone in. The nurses trust Ms.
Carlo; in any event, she is rarely quiet for two seconds. "O.K.," she said.
"That's that."

Days on methadone begin like this -- this ordered, schoolmarmish protocol
at the clinic window. The grinding privations of life on methadone are why
the former heroin addicts who take it speak of being "tied by a rope" or
"on permanent parole." They love the drug, and they hate it -- for the vise
grip of its rules, and for its vise grip on them. Methadone frees, but it
also imprisons. It is magical at blocking the yearning for heroin, but much
less effective against the simple craving to get high. It is highly
addictive in its own right, with fiendish withdrawal symptoms. At more than
moderate doses, it can leave some patients in a barely functional daze.
Methadone is one bridge to a new life, but there are many other rivers to
cross.

All of which helps to explain why methadone has long been caught in the
crosscurrents of social policy, though never more so than right now in New
York.

Over the years, methadone has become the favored treatment for heroin
addiction, and the Federal Government has lately pledged to make it more
accessible. That view was endorsed by a recent report in The Journal of the
American Medical Association, which said that methadone can help curb crime
and reduce the spread of infectious diseases like AIDS.

Mayor Rudolph W. Giuliani, on the other hand, has declared his desire to
eliminate methadone-maintenance programs in New York and instead wean
patients quickly to abstinence, though it is unclear how much power he has
to do that.

Like others scornful of methadone, the Mayor feels that addicts too weak to
confront the pathology of their past are simply shedding an illegal habit
for a legal one. Indeed, to many people in mainstream society, there is
something unsavory and almost contemptible about methadone. But, in truth,
few people uninvolved with it know much about it. And then there are the
patients, for whom methadone is virtually an occupation.

In the community of methadone users (population 115,000 nationwide, 36,000
in New York City, according to Federal and state officials), there is a
continuum of dependence. On this day in the autumn of 1998, Pam Carlo
occupied the vast middle; methadone allowed her to work on and off, but the
employees at the clinic doubted she would ever leave it behind.

Beth Griffin, a fellow patient, was almost weaned from methadone; she could
already taste life on the other side. Jamil Muhammad continued to abuse
drugs; he was what the clinic workers call a "resistant" patient, who
requires great effort but gives little in return.

Mostly, they were simply three people who took methadone to stop wanting
heroin. They couldn't possibly untangle all the arguments. But they could
illustrate something of the nuanced complexities of life on methadone, of
what it can do and what it can't. As for the policy debate, each of their
lives holds powerful arguments for both sides.

Their weeks revolve around 46 and 62 East Broadway, the methadone treatment
units of the Lower Eastside Service Center, a nonprofit substance abuse and
mental health agency. One of the better regarded methadone programs, it
offers a full array of counseling and detoxification services. And yet its
aspirations are limited by the vagaries of addiction and methadone itself,
by those who continue to take other drugs and who can't find a renewed
life. The clinic would like people to achieve abstinence, but it imposes no
time limit; many patients may be on methadone forever. The accent is on
avoiding heroin, not graduating from methadone, an emphasis that sometimes
frustrates patients who dearly hope to stop.

Every social class is represented on methadone, but those low on the social
index are predominant. About 30 percent of Lower Eastside's 950 clients
work, and pay $2 to $56 a week, based on their income. The others,
including Ms. Carlo, Ms. Griffin and Muhammad, are covered by Medicaid. No
private insurer pays for methadone. About 65 percent of the patients are
men; about 20 percent are H.I.V. positive. Roughly a quarter leave in the
first year: they return to other drugs, are arrested or simply vanish.

Ms. Carlo, Ms. Griffin and Muhammad lead lives that intersect on East
Broadway and then radiate in very different directions. Methadone
punctuates their days; it goes down in a gulp but seeps slowly into
everything they do. Though they are not proud they are on it, they are
persuaded of its necessity.

"Society has made methadone into an evil, and that's tragic," Ms. Carlo
said. "If Giuliani got rid of methadone, there would be tens of thousands
of people on the street with guns in their hands."

The Veteran: A Warm Glow For 20 Minutes

Methadone's effect lingers for 24 to 36 hours, and Pam Carlo likes to take
it soon after she awakens. Most patients do. Even before the clinic opens,
there is a line outside. This is methadone rush hour.

At first, she senses nothing. After about a half-hour, she feels no actual
high but a sort of warm glow that endures for 20 minutes. Her speech slows.
Otherwise, she is more or less her effusive, chatty, insouciant self.

Ms. Carlo is one of methadone's elder stateswomen. She is 54, the last 28
on methadone. Even after all those years, she still feels like a specimen
under glass. Methadone gives a lot, but it also takes a lot. There are many
rules to being on methadone, perhaps the most tightly controlled drug in
the nation.

All methadone patients take it every day. Because of fears about diversion,
patients, with few exceptions, must go to a clinic to get it. At Lower
Eastside, one starts by visiting six days a week (the clinic is closed
Sunday) and getting a take-home bottle on Saturday. This can fall to as
little as one pickup a week (and six take-home bottles) if one has been on
the program for three years, is working and has been "clean" from drugs for
at least a year. (Pam Carlo goes three days a week.)

Patients are forbidden to drink alcohol or use any other addictive drug.
They are required to see a counselor at least once a month. Group therapy
is mandatory at first, then voluntary. (Ms. Carlo skips it. "I've heard it
all," she said.) A patient who goes out of town is limited to a two-week
supply. Because of community anxiety, the clinic does not let clients
loiter within a four-block radius.

Habitual offenders can be dropped from the program, though few are.

Pam Carlo did not linger. She and her fiancé, Earl Meares, headed east to
his room in the Greenpoint section of Brooklyn. The sky hung low over the
city. Meares will be husband No. 6. Ms. Carlo has had poor luck with
husbands. One died of a heart attack and two of AIDS (by sheer luck, she
never got the virus); the others were mistakes.

Back at his room, they made themselves comfortable. They got out their
artwork. She is a freelance commercial artist, and has been illustrating a
book on mice. Meares, who is on workfare, sweeping up around the court
buildings in TriBeCa, has been laboring on a comic strip called "Heroin
Chic," based on Ms. Carlo's life.

Meares has never had a drug habit. He doesn't fully understand addiction.
She does. Her vision of drugs is dark. "See a sunny day like this?" she
said. "I hated sunny days when I was using. I thought everything was so
black. I thought there was no way out."

She was born in Jamaica, Queens, an only child. Her mother lived off an
inheritance. Her father, who was in the cemetery business, abandoned her
mother for his secretary before Ms. Carlo was born. Growing up, she and her
mother bickered constantly.

"My mother hated everything that wasn't high class," she said. "And so I
had to try everything that wasn't."

She was smart, skipping two grades, starting college at 16 at Texas Western
in El Paso. She felt too young, and drifted into the wrong crowd and into
heroin. "When I found heroin, I thought it was what I was searching for my
whole life," she said. "It was like drowning in a big black sea. And it was
warm and comfortable and safe and nobody could touch me. I thought I had
found God."

A weekend thing evolved into a daily habit. She enrolled at Cornell
University Medical College, she said, and met a doctor who was addicted to
morphine. She moved in with him. She gave him sex; he gave her morphine. A
year and a half short of graduation, she nodded out during a lab and
collapsed onto a cadaver. She was suspended for using drugs.

Furious, she sank into the shadows of the East Village and the unthinkable.
Desperate to support her habit, she turned $10 tricks on the "day shift."
She was a streetwalker for four years. She got just about anything you
could get, including syphilis and jaw cancer. She shrank to 80 pounds and
was less in demand.

Homeless, she visited Woolworth's and bought a sign that read, "Bathroom
Out of Order." At night, she trooped to the Albert Hotel in the West
Village and affixed the sign to the door of a hallway bathroom. She
arranged her fur coat in the bathtub, wiggled in and went to sleep. The
next night, she chose a different bathroom. She did this for six months.

In 1970, with no foreseeable future, she was drawn to a new treatment that
was all the talk: methadone. "Methadone got me to feel again," she said.
"We used to hear about the ring concept. People who are addicts, our lives
are rings. There is a link that is either missing or improperly attached.
With methadone, the ring is whole."

Ms. Carlo drinks 66 milligrams a day. (The dose is determined by the
patient's physical characteristics and the quantity and longevity of drug
abuse.) Early on, her dosage was as high as 180. "I was wasted," she said.
"I was walking into walls."

Outside Meares's room, the sky had darkened. How did his fiancée's being on
methadone affect him?

"Sometimes she will take her dose and freeze in place."

"Yes," she said quietly. "We'll go to the coffee shop and I'll reach for my
tea and I'll just freeze in that position. Methadone freeze. It's
embarrassing to him. I realize that."

She does not like to discuss her condition. "I don't tell squares," she said.

Once, visiting a friend of Meares, she slipped. She said she was on
methadone. "His face froze," she said. "So did his wife's. Suddenly,
disaster had struck. They had a junkie in the house."

The ones who understand are her friends from the program. Methadone
mornings, they get together at the Aten-Ra International Gourmet Deli,
walking distance from the clinic. She sometimes refers to them by their
names and doses: JoAnn, 60 milligrams; Tony, 8; James, 70, the size of the
dose fixing them in the hierarchy of methadone.

On a recent day, a couple of former members of the klatch tried to intrude
but were ignored. They abused pills and were not welcome. James uses pills,
too, but was down to half a pill a day from six, so he was O.K.

"Anxiety," he said in explanation.

Ms. Carlo said: "Anxiety problems are common for people on methadone. They
have agoraphobia and claustrophobia. It's caused by their life styles."

Pam Carlo has taken methadone for 28 years, 18 years longer than she took
heroin. To an extent, she has made it a career. Chris DeLuca, the clinic's
assistant director, doubts she will ever retire. She hopes he is wrong.

"Before I die, I want to know what it feels like to be clean," she said.
"You see, I don't remember. Imagine that: forgetting what it feels like to
be straight. But I don't remember. And I want to feel it. I really do want
to feel it."

The Rule-Breaker: Admitting 'I'm Not A Prime Example'

In the landscape of methadone are many people who straddle the world of
drugs and the world of treatment, who continue to live by their own rules
rather than methadone's. Jamil Muhammad is one of them.

He is a lanky, hard-bitten man of 46, with a neatly trimmed beard and
mustache. He has his own story of a defeated life, and he knows exactly
where he stands. "I'm not a prime example of an addict who has gotten it
together," he said.

He went to Lower Eastside five years ago, and in every sense he got off to
a bad start. At first his concept of being on the program meant to get his
methadone and then take pills and shoot cocaine. He robbed apartments. He
sold his methadone on the street. Several times, he ended up on Rikers
Island. "I was crazy," he said. "Maybe I had a death wish."

Addicts are used to being high, and once on methadone often gravitate to a
substitute for heroin, generally cocaine or pills. Some pills combine with
methadone to produce a euphoria. These days, the pill of choice is the
sedative Xanax. "It makes you feel better with your meth," Muhammad
explained.

Methadone stops the thirst for heroin, but nothing more. Escape from
addiction involves a protocol of methadone and counseling and ambition.
Lower Eastside offers counselors and weekly group sessions to help
resurrect aspirations, but patients take what they want, and sometimes it
isn't much. Muhammad goes to group meetings with some regularity, but often
sits there with a vacant look.

"You have to deal with a lot of ignorance," he said. "I don't like it when
someone starts running their mouth." He doesn't much like his counselor,
either. The counselor, Anthony Badger, does nothing for him, he said.

Badger said Muhammad had not accepted what had happened to him.

"He tends to play people against people and put himself in the role of the
victim," he said.

Badger also said he had 56 patients. The state finances only one counselor
for every 50. Badger said he monitored himself so he didn't burn out; he
can do only so much.

Over a burger at Rokka's Coffee Shop near the clinic, Muhammad gave a
capsule version of his road to methadone.

He was born in Orange, N.J., and raised mostly by his grandmother, who
owned a prospering antique store. Talented at basketball, he received a
scholarship to Providence College, but in his third year was caught dealing
marijuana and expelled.

He became a Muslim. He married and moved to Brooklyn. He went to Saudi
Arabia and studied Arabic, hoping to teach it in American mosques. He had
two sons. Back in Brooklyn, he taught Arabic for a while. He got hooked on
pills and his marriage cracked apart. After the divorce, his descent was
fast. "I was losing everybody," he said. "And so I turned to drugs."

He snorted heroin and then he shot it, his life draining into his arm. He
lived on the streets. He dealt heroin to make money to shoot it. He used it
steadily for five years, as much as nine bags a day.

In 1993, unable to support his habit, wanting to be useful again, he sought
out methadone.

These days, he tends to follow a cycle of being clean for several months,
then taking cocaine or pills, then staying clean for several more months.
Between August and the end of October, however, cocaine showed up in five
consecutive urine samples. He was punished by having to show up five days a
week instead of four. Even so, he drinks two or three cans of beer a day,
in violation of clinic rules.

"I have moments when I get frustrated at myself," he said. "Sometimes it
gets so bad in my mind I feel like screaming. When I get disgusted, I'll go
out and get high."

Chris DeLuca said the clinic was highly permissive with patients who
violated the rules. If you are caught selling your methadone or other
drugs, you are generally dismissed, but the clinic grudgingly puts up with
patients abusing drugs. Probably 30 percent do, DeLuca said.

"We have a lot of patience because we found that if we kick them off, they
go to another program or they go to the street and start shooting and
sharing needles," he said. "We try to work with them on behavior
modification. Sometimes this takes years. We can't succeed 100 percent."

A flat, dull day. Muhammad was stacking books at the Angel Street Thrift
Shop on West 17th Street. The Lower Eastside Service Center owns the shop
and Muhammad works there three days a week, at $6 an hour. Mostly he waits
for some stroke of luck, some act of legerdemain, to turn his world around.
He had a lottery ticket in his pocket, banking on "587" to return him $500.
He has played the same number for three years. It was the street address of
a high school friend who was killed in a car accident on her prom night.

His dosage is 100 milligrams, and it hasn't changed. Because of the stigma,
he doesn't tell people about being on methadone, he says. "People have
heard the stories about selling methadone and about still doing drugs."

Of course, he still does drugs. Of course, he has sold his methadone. When
he is broke, which is fairly often, he is tempted to sell it again. He can
get $30 for a 100-milligram bottle, a lot when your pockets are empty. "I
was tempted last week," he said. He doesn't want to get arrested. "If a
friend of mine wanted some, I'd sell it to him," he said. "Not to a
stranger."

Muhammad has tumbled from Providence College to the Providence Hotel, a
$10-a-night flophouse on the Bowery. He put some books in order and a
doubtful look came across his face. He did not pretend to have any answers.
"I'm not standing here and saying I'm outside of the problem," he said.
"Maybe I'm the cause of the problem. I don't know. Maybe I'm the cause of
it."

The Fighter: 'People Stay Zombies For a Long Time'

The Power of Hope group therapy session began at 10 A.M.

Jamie Holder, the group leader, talked about the recovery process: "It is
as complicated as the relapse process. Beth, you've spoken of what pressure
you're under from your mother and your brother -- 'Are you still on that
thing?' "

"Yes," Beth Griffin said. "They want to know am I well yet." Her mother,
she said, kept telling her, "I hope you'll be off methadone soon so I can
put you back in my will."

When the hour was up, Ms. Griffin headed for the East Village. She is 36,
with frizzy blond hair. There are scars on her face; once when she was on
speedballs she cut her face open with a razor because she thought there
were spiders and worms beneath her skin.

She trudged up the three flights to a studio she shares on East 9th Street.
She does her art there, collages and paintings built around words and
numbers. After a while, she went over to the Margaret Bodell gallery, where
she had recently had a show and sold some of her work.

"I'm starting to get a little following," she said. "Most of my life I've
had really good jobs and stuff. More than anything else, I want to support
myself again."

She grew up in Laurence, S.C., where her father ran a gas station and her
mother was a secretary. She graduated from the Ringling School of Art in
Sarasota, Fla., and became an art director at Dancer Fitzgerald Sample in
New York, working on Luvs diapers, Wranglers, Almond Joy. She said
Advertising Age anointed her one of the 10 brightest young people in
advertising. She butted heads with her boss and quit after nine months. Her
resignation letter said, "Enough." She modeled for art students and
sculptors, and then did typography for ad agencies.

In 1988, she went with a friend to the Mars Bar in the East Village. Her
boyfriend had just left her. She had had an abortion. Her parents had just
divorced. At the bar, her friend asked her, "You want to do some?"

In the bathroom, Ms. Griffin snorted half a bag of heroin.

The first thing she did the next day was go out to get more. In four
months, she knew the face of addiction.

For nearly four years, she only snorted heroin because needles terrified her.

But in time, to get a better high, she began to shoot. In the bathrooms of
some of the city's best-known ad agencies, she shot up.

Her sister, Laura, a drug- and alcohol-abuse therapist in South Carolina,
tried hard to get her off. Heroin was more persuasive. Three times she
quit, but it didn't last. Her life traced the familiar downward path. In
December 1993, she looked to methadone and hoped it would be a lamp to
another life.

"When I came to the clinic I felt about as bad about myself as you could
feel without killing yourself," she said. She kept taking Valium and Xanax.
Even without pills, her dose of 90 milligrams a day knocked her out.
Mainly, she slept, often 18 or 19 hours a day.

Two years later, her sister was killed by a car while jogging. The driver
was a lawyer high on drugs and alcohol. Ms. Griffin contemplated taking her
own life. She sought therapy and took sedatives. The world moved on, while
she slept.

"I was a zombie for like four years," she said. "That is the dirty secret
of methadone -- a lot of people stay zombies for a long time, for years.

Not until you get below a certain dose does the fog lift."

Methadone, she said, has saved her, but the drill has grown old. "I'm sick
of being a slave to methadone," she said. "I'm sick of going down there and
seeing all the same old faces."

If Ms. Griffin has a criticism of the program, it is that no one ever
pushed her to get off. "I know a lot of people who told them they wanted to
come down in their dose, and they would say, 'We don't think you're ready,'
" she said. DeLuca, at the Lower Eastside methadone clinic, said perhaps 20
people a year get off methadone there, though patients say far fewer truly
do. Methadone is a psychological crutch as well as a physical one. It is
something going in the body, day after day, a palliative routine that is
hard to shake.

Ms. Griffin said it took her own initiative for the clinic to start
reducing her dose a milligram or two a week in pursuit of getting off. By
Thanksgiving, she was down to three milligrams a day. She was feeling some
withdrawal symptoms, but with her dose so low, it was as if she had been
rebuilt. "It's like I'm on a faster speed setting," she said. "I do in a
day what I did in a month."

She lives with a cat named Amtrak in the Times Square Hotel, a single room
occupancy hotel. She plays the piano in the lobby almost every morning. She
was on welfare for about two years and is on S.S.I. now because she was
classified with a psychiatric disability after her sister's death. She has
been painting a lot, and hopes one day to live off her art.

Soon she was planning to drink the red liquid for what she hoped would be
the last time. She was going home for the holidays and would be gone a good
three weeks. She didn't want the methadone rope pulling her back.

On Wednesday, Dec. 2, Ms. Griffin drank a one-milligram bottle of
methadone. It was her final dose. The removal of methadone from her life
led to a nightmarish week. She found herself waking up by 4 A.M. She was
achy and twitchy. Every second seemed like an hour. She felt old yearnings
for heroin. On Sunday, she dragged herself down to the Museum of Modern
Art. She stayed exactly 17 minutes. "I had no attention span," she said.

As the days passed, she perked up somewhat, though she remained jittery and
restless. "There are times I feel I can't get through this," she said.

When they go off methadone, ex-addicts often feel a profound sense of loss.
State rules allow six months of post-methadone care at the clinic. And so
she will continue to go there. She will give her weekly urine sample and
see her counselor.

A few weeks ago, she wrote down some ramblings about methadone: "For me it
was impossible to jump from dope life to straight life. I needed the gray
shades of methadone in between. Dope life and straight life are as
different as animals being in a cage or out in the jungle. I'm not sure
which one is really 'free' but it takes a while to switch from one to the
other. Without methadone, chances are I would be dead now."