STATE STOPS TESTING FOR METHADONE MISUSE

Decision Comes As Authorities Report Increase in Overdoses

A decision by the state health department to stop running laboratory
tests for Maryland's methadone clinics has removed a primary safeguard
against misuse of the drug, potentially worsening what police and
health officials say is a growing problem.

Methadone is a heroin replacement medication used by about 13,400
recovering addicts in Maryland. To start on the medication, addicts
must go to one of the state's 40 approved clinics. Under federal law,
though, clients who have gone through months of daily visits without
relapse can earn the opportunity to take home at least some doses.

For at least 20 years, clinics have had one reliable way of making
sure take-home doses don't end up being abused for a high by the
clients or resold on the street: They have randomly called some
clients and ordered them to return their doses within a day.

Because it's not always possible to tell whether the returned bottles
holding the syruplike drug have been tampered with, clinics have sent
them to a state lab to make sure they match the dosage given to
clients. If the lab found a mismatch, as occurred in about 10 percent
of the 4,000 samples it checked annually, the client lost his or her
take-home privileges.

But last month, clinics received a letter from the Laboratories
Administration of the Department of Health and Mental Hygiene stating
that, because of budget cuts, the state would no longer do the testing.

Clinic directors across the state say the move will make it much
harder to ensure that clients are using their take-home doses as directed.

The lab testing "is the only tool we have with which to determine that
the people we're giving the bottles to are making responsible use of
their medication," said Carol Butler, director of the Reach clinic,
which serves 450 clients at a van parked in Baltimore's Barclay
neighborhood. "We take our jobs seriously, and we have no other way to
enforce to make sure that the people we think are doing well really
are."

The move occurs at a time of growing concern about the risks of
methadone abuse. Fatal overdoses involving methadone increased
five-fold in the state between 1998 and last year, to 124, a rise
attributed to the diversion of methadone from clinics and of methadone
prescribed as pain medication.

At a meeting last week at Lexington Market, city police and market
security personnel told clinic directors that the biggest problem
around the market, a focal point of the city's west side
revitalization plans, is the resale of methadone and prescription
pills used to enhance methadone's effect. In the past three months,
there were 24 arrests outside the market for methadone dealing, police
said.

Clinics, which range from 100 to 600 clients, generally offer some
take-home privileges to close to half their clients. The idea is to
offer an incentive against relapse and make it easier for committed
clients to go to work or care for their families without making daily
clinic visits.

The clinics issue random recalls to about 10 percent of these clients
every month, directors said, to try to catch those who may have used
the doses ahead of the prescribed time or sold them. Clients who fail
to return their doses or return an obviously tampered-with bottle lose
their privileges.

But sometimes, directors said, clients disguise what they've done.
They may refill the plastic bottle with, say, methadone bought on the
street or with water colored with food dye, sometimes using a needle
to make an undetectable puncture in the container. In those cases, the
only way to prove the dose has been tampered with is to have it tested.

"We rely on it completely," said Gary Sweeney, program manager at the
Man Alive clinic in Baltimore's Charles North neighborhood.

The director of the Laboratories Administration, John M. DeBoy, said
in an interview that his office has suffered a 2.5 percent budget cut
for the fiscal year starting in July and the loss of three or four of
its 278 positions. The office conducts hun dreds of kinds of tests,
for infectious diseases, water contamination and more, and has
recently been given new mandates involving bioterrorism, food safety
and cystic fibrosis. But its manpower is down from 325 employees five
years ago, he said.

Faced with the cutbacks, DeBoy said, the office looked to eliminate
lab tests that were seen as outside the core public health mission for
which the office is funded. It decided, with approval of the health
department's leadership, to eliminate the lab position that handled
the methadone tests, as well as hematology tests done for local health
departments to check for bleeding disorders.

"These are a few of the minor things we had to drop in favor of more
major testing," he said. "We'd been doing it for years without
[earmarked] funding so when push came to shove, there was no longer
any money to support the program."

DeBoy said clinics that want to continue testing methadone doses could
pay private labs. But clinic directors estimated it would cost them a
few hundred dollars a month, money they don't have after years of flat
government funding. The savings achieved by cutting one state lab
position, they said, would be outweighed by the added risks of ending
testing.

"It's penny-wise and pound-foolish. I don't understand it," said Frank
Satterfield, director of Glenwood Life, in Baltimore's Govans
neighborhood.

Clinic directors said they could cut back on take-home doses, but that
too many of their responsible clients rely on occasional take-homes to
get the rest of their lives in order.

What worries clinic directors most is that in the absence of lab
testing, more of their clients who had previously been deterred by the
tests will start to abuse or resell their doses.

"Patients knew about the recalls, and that helped them become more
accountable," said Tom Taylor, director of the Joppa Health Services
clinic in Harford County and the We Care clinic in Glen Burnie.
"That's the whole thing about treatment -- we want to help them become
accountable."