CLINICAL CONTROVERSY

Julie LaFrance, 33, travels from her apartment in Framingham to Fitchburg's
Habit Management methadone clinic every morning at 5:45 a.m., just to get
her daily methadone dose.

"There are no sick days, no vacation days, no snow days," LaFrance said.
"Every 24 hours you're in the same place. There is no time out or pause
button." LaFrance first became hooked on prescription painkillers when she
was 19 years old. A doctor prescribed Percocet for her after minor surgery.
She didn't know at the time that the feeling the drug gave her would keep
her hooked for the next 15 years.

"I got married young, had a baby at 17, so part of my problem was that I
didn't get to grow up like everyone else," LaFrance said. "By giving myself
to that child, I forgot about me."

By the time she turned 23, LaFrance had three children and her marriage was
dissolving.

But her love for Percocet continued, escalating to the point where she
would take seven or eight pills at a time just to get high. "I would find
myself going to the doctor and complaining of pain to get more," LaFrance
recalled. "I didn't seek them out, but if someone I knew had them, I'd ask
for some."

LaFrance knew she had a problem when she ran out of her pills the morning
she left for a week's vacation in Florida with her mother and went through
withdrawal.

"It was supposed to be a nice week in Florida, and I spent it not feeling
good," LaFrance said. "It's all chills, shakes, leg cramps, sweats -- your
whole body is muscle cramps. You feel like you're going crazy. When you're
in withdrawal, the country could go to war and you don't care, you're just
the most miserable person."

Eventually, she realized she had to stop taking Percocet. "I wanted to stop
because I couldn't get high anymore," LaFrance said. "I wanted to have a
life for my kids."

But after so many years of continuous opiate dependency, LaFrance found it
impossible to cut the pills out of her life entirely. She turned to
methadone therapy instead.

Getting some pleasure "Methadone allows your body to get some pleasure
while you work things out," LaFrance said recently. "The easiest way is to
let the drug be in your body." LaFrance ended up at the Airport Road
methadone clinic in Fitchburg because there was a waiting list for the
clinic in Framingham. LaFrance takes 275 milligrams of methadone a day, she
said, more than double the average dosage.

She has participated in Habit Management's counseling programs and hopes to
start lowering her dosage soon, but she knows it will take a long time.
"The only reason I haven't started to taper down is because I haven't
gotten myself back into life. I'm stuck in a rotating circle," LaFrance
said. "I don't have a car to get me to a job to afford a house. You can't
just snap your fingers and do it."

LaFrance stands by the help she's received from the methadone clinic. But
many city officials in North Central Massachusetts say it, and other
nonprofit agencies catering to drug addicts and homeless people are
bringing drug users into the region, who then commit more crimes once they
get here. Once here, they say people who try but can't kick their
addictions end up breaking into homes or businesses and committing
robberies to pay for their drug habits. "That's always in the back of
people's minds, that drugs brings in crime," said Leominster Ward 2 City
Councilor Wayne Nickel. "If you have facilities for drug treatment, then
you're going to see a higher number of drug users. It draws its own customers."

Leominster Ward 4 City Councilor Robert Salvatelli agrees. "The more bars
you have, the more drunk driving you have," Salvatelli said. "If you have
these types of things within your community, it's obviously going to
attract that kind of clientele."

Drugs and property crime City officials say the connection between drug use
and crimes, particularly property crimes, could not be clearer.

"All of our (breaking-and-entering offenses) are drug and alcohol related,"
said Leominster Mayor Dean Mazzarella. "It's not someone who needs money to
go to the school dance."

But LaFrance becomes frustrated when people complain about the methadone
clinic. "Methadone treatment is a program for people who are willing to do
something to change their lives," LaFrance said. "If you take away the
methadone clinics, you're going to have (countless) criminals on the road,
breaking into places and stealing just to get drugs, because they're going
to be going out of their minds on withdrawal."

But Fitchburg officials feel the city is shouldering more than its fair
share of nonprofits that serve drug users and homeless people. They feel
people who don't live in Fitchburg come into the city to use one of the
drug clinics or homeless shelters, instead of getting help where they live.
"For some reason, people are allowed to take taxis from Worcester to
Fitchburg to get methadone," said Jody Joseph, a Fitchburg city councilor.
"We the taxpayers are paying for those taxi rides. That's where the abuse
is." An unfair burden?

Stephen L. DiNatale, an at-large Fitchburg city councilor, believes the
city is being asked to do too much to help deal with a regional drug
problem. "We provide more than our fair share of the services for a problem
that is arguably a regional one," said DiNatale. "The fact that they're in
Fitchburg perpetuates the perception that Fitchburg has more of a problem
with drugs than other communities, and I'm not sure that's accurate." In
fact, a quick review of nonprofits geared toward drug users, the homeless
and people suffering from a mental illness or condition, shows most
agencies operate in Fitchburg.

A list of the nonprofits in the area and where they're located includes: *
Gardner Visiting Nursing Association, Inc., 35 Main St., Fitchburg; * Habit
Management Institute, 155 Airport Road, Fitchburg; * Montachusett
Opportunity Council, 430 Main St., Fitchburg; * Our Father's House, Inc., 4
Leighton St., Fitchburg; * Valiton House, 198 Fairmount St., Fitchburg; *
LUK Crisis Center, 99 Day St., Fitchburg; * Three Pyramids, 66 Day St.,
Fitchburg; *Montachusett Addictions Council, Inc., 51 Central St.,
Leominster; * Common Sensitivity, Inc., 1 Main St., Leominster; * Herbert
Lipton Community Mental Health Center, Inc., 100 Erdman Way, Leominster;
and * Montachusett Interfaith Hospitality Network, 10 Wachusett St.,
Fitchburg. The agencies provide jobs to local residents and offer services
to those who need them, but many say they hurt the city more than they
help. Hurting Main Street No agency has been the focus of more attention
during the past two years than the GVNA's Main Street community services
center, which sits in a nondescript storefront in Moran Square.

The center is wedged in a strip between Dunkin' Donuts and Store 24. Its
hours are limited, and on most days the curtained windows are dark. Its
backers say prostitutes and homeless people no longer congregate outside
its doors. But both Fitchburg Mayor Dan H. Mylott and Police Chief Edward
Cronin called for the center to be closed down after a man walked in and
stabbed a client in March 2004.

Employees at the center distribute needle-cleaning kits in an effort to
curb the spread of HIV and AIDS.

But Mylott said the clinic attracts the wrong crowd to Main Street. "It
created a clientele that uses drugs, a byproduct of which was to allow them
to continue drug use," Mylott said. The needles "create a safety hazard for
the whole neighborhood."

GVNA took steps to curb crime at the center after the stabbing, installing
security cameras and keeping closer tabs on the people it serves. "To their
credit, they have been very cooperative with the city," Mylott said. "But I
still don't believe they should be providing needle kits in Moran Square."
Mylott teamed up with Cronin and state Rep. Emile Goguen, who runs a
homeless shelter in Fitchburg, as they fought unsuccessfully to cut the
center's funding after the stabbing, or at least move it off of Main
Street. The center receives its funding from the state Department of Public
Health, and its contract doesn't expire until June 2006.

GVNA maintains it is essentially a referral service, offering counseling
and education about HIV/AIDS.

"We're here to provide HIV treatment and to prevent the spread of the
virus," said Gail Dorval, director of Community Programs for GVNA. "The
behavior (of intravenous drug users) is what causes HIV, so we put them in
touch with someone who helps eliminate that behavior."

Elaine T. Fluet, CEO of the Gardner Visiting Nursing Association, said the
organization is constantly working to improve its image in the Fitchburg
community, and it is still looking to move to a location off Main Street. A
new location would only be considered, however, if it was accessible to
those who need it.

She also mentioned the possibility of starting a mobile clinic, where
clients could receive the same services from a counselor in a van. "We want
to be a good neighbor, and we want to work with the community," Fluet said.
"If it's good for the community, it's good for everyone involved." Time to
go But Mylott just wants the center out of Fitchburg.

Distributing needle-cleaning kits "is wrong and doesn't belong on Main
Street," Mylott said. "If they're going to do that, I don't think they
should be in Fitchburg."

Roughly 300 people made 5,700 visits to the Main Street center in 2004,
according to Fluet.

The center employs six people, making it a small operation in comparison
with other services in the area.

The wrong approach? Mylott also disagrees with the approach taken at the
methadone clinic. He feels they are trying to solve one drug problem by
starting another. Weaning a person off drugs completely is the only
effective way to address the problem, he said.

"That answer (methadone) to drug use is not the right answer," he said.
"Maybe it's a better drug. Maybe it doesn't destroy your system, but it's
still a drug and you have to have it. If methadone clinics are so great,
then why aren't they everywhere?"

Officials at the clinic refused to respond to numerous requests for interviews.

Habit Management Institute is the only methadone clinic in North Central
Massachusetts.

The next closest methadone clinics are in Lowell and Worcester. Habit
Management benefits from its Airport Road location, which is less visible
and farther away from heavily traveled areas in the downtown. Surrounded by
industrial buildings, Habit Management is only busy in the early morning
hours when users line up outside its door to receive their daily dose of
methadone, LaFrance, who receives treatment at the clinic, told the
Sentinel & Enterprise.

Their services include AIDS testing, assessment, case management, HIV
counseling, mental health, tuberculosis testing and urine testing.
Methadone users are drug tested every day, LaFrance said, but oftentimes
the clinic will still give a patient their daily dose even when their drug
test is positive. "People come up positive all the time, but they'd rather
have you keep trying," LaFrance said.

Patients also must meet with a case manager and are encouraged to
participate in the various counseling programs the clinic provides, she
said. The private company provides statistics that contradict the commonly
held assumption that drug treatment centers attract crime. For every dollar
spent on methadone, their Web site states, society accrues $4 in economic
benefits from reduced crime and related problems. Hurting Fitchburg's image
But Mylott is not convinced.

"It's a waste of taxpayers' money, hurts our city's image, and encourages
the perception that this is a city riddled with drugs," Mylott said. "I
hope that we can have recovery programs that would be successful without
hurting our image." Several city officials stressed Fitchburg is unfairly
dealing with more of its share of the drug problem.

"The city of Fitchburg has a certain percentage of its population with a
problem with drugs, so henceforth the services appear," said Ralph A.
Romano III, Fitchburg city councilor at large. "When the services come in
one location to service the entire region, it becomes a magnet for all the
people who want to utilize the services."

City officials feel Leominster and other cities should do more. "Heroin is
an epidemic in the entire country; it's not just specific to Fitchburg,"
said Joseph. "It needs to be addressed everywhere." The problem is not
being addressed in Leominster, Fitchburg officials say, bringing those who
need treatment to Fitchburg.

Helping the homeless Our Father's House, a homeless shelter, counts people
from Fitchburg, Leominster, Gardner, Ashburnham and other towns among the
700 it serves a year, according to Barbara Garneau, its director.

"Some say, 'Let those places put up their own shelters,' but then it
becomes an issue with cost effectiveness," Garneau said, explaining that
more shelters would only spread the funding thinner.

Our Father's House in Fitchburg offers emergency and transitional housing
to low-income people who can't afford to live on their own. Many find
themselves in shelters because of drug and alcohol problems or mental
illness, Garneau said, but shelter officials require that people be drug
and alcohol free to stay there.

"We don't believe that if you're chemically dependent that you'll be a
responsible tenant," Garneau said. "You just can't afford to be using." Our
Father's House has taken a zero-tolerance policy against substance abuse,
requiring tenants to be substance-free for 30 days before entering
transitional housing.

Methadone users can't use the shelter. "Using methadone causes problems
with other residents," Garneau said. "If they see another resident who's
out of it, they want to use themselves." The shelter's approach relies on
creating a supportive community to discourage relapse.

"It's still very difficult for them to live alone again," Garneau said.
"They learn more from each other than they would get from us." The
shelter enjoys a 10 percent recidivism rate, impressive compared with the
national rate of 80 percent, Garneau said.

The live-in house manager at the Leighton Street men's transitional housing
facility is himself a graduate of the program, Garneau said, which helps
residents. "It's purposely meant to be individual living," Garneau said.
"We oversee it, but we don't hold people's hands."

Despite the criticism that has fallen on the area's drug treatment
facilities and homeless shelters, those who work in the field say success
stories keep them going.

"Success varies by individual," said Garneau, telling the story of one
elderly man who came to Our Father's House toward the end of his life. He
had lived in his car in Leominster for years and was finally persuaded to
seek shelter by a church pastor who feared he had grown too old to weather
the winter outdoors.

Shortly after arriving at the shelter, the man was admitted to the hospital
for pneumonia.

When he died, Garneau felt satisfaction mixed with sadness. "I consider
that a success," she said. "He did not die in his car or in the woods."
Another man has struggled with drug abuse for years and finally arrived at
Our Father's House already sick with a terminal illness. His recovery and
treatment has been so successful, Garneau said, he now plans to reunite
with his family in Colorado.

"He told me the best part is that my family doesn't want me to come back,
they need me to come back," Garneau recalled. "I know he doesn't have long,
but when he does die, he'll die in peace."

Garneau, like most who devote their lives to helping the less fortunate,
understands that often a full recovery is not possible. Any steps toward
regaining a functioning life are to be celebrated. "Success is in the eye
of the beholder," Garneau said. "Making amends with family and becoming a
productive part of society is important."