METHADONE CLINICS GET MORE TRAFFIC AS PILL ABUSE INCREASES

Each morning, nearly 300 people file into a nondescript building on
East Washington Avenue to receive their daily dose of methadone, a
synthetic form of heroin used since the late 1950s to treat opiate
addiction.

For them, this daily trip helps arrest the indignities that come with
being a drug addict.

"I've tried going off it several times, but I always go back to
heroin," says Roman, a recovering addict who asked that his last name
be withheld. "I can get a year or two clean, but something goes wrong
in my life, and I go back. I relapse here and there, but my life goes
pretty good on methadone."

Roman, 45, has been a patient at Madison Health Services -- one of two
methadone clinics in Madison -- for just more than a decade.

Over the last several years, the Madison clinics have undergone some
significant changes, including a surge in patients addicted to
prescription painkillers, a shift toward more comprehensive treatment
and, most recently, the introduction of a new withdrawal-curbing
medication called suboxone, hailed by many as more effective than methadone.

The long-lasting effects of both drugs permit addicts to bypass the
excruciating detoxification process as they begin recovery. Unlike
methadone, which often has unpleasant side effects, suboxone's side
effects are minimal. Furthermore, it can curb emotional cravings and
ease depression.

"It's proving to be an unbelievably fantastic drug," says Karen
Romonouski, clinical director for Madison Health Services. "The more
they use it, the more they're finding out how good of a drug it is.
You literally lose all of your desire to use."

Methadone clinics, according to addiction expert Dr. Mike Miller,
benefit communities by helping to reduce crime, unemployment,
homelessness, disease transmission, family dysfunction and other
addiction-related social disorders. The clinics are regulated by the
State Methadone Authority, a division of the Department of Health and
Family Services, and each clinic undergoes a biennial recertification
review to ensure regulatory compliance and patient safety.

Miller, the American Society of Addiction Medicine's president and
medical director for Meriter Hospital's NewStart Alcohol and Drug
Treatment Program, says that Madison Health Services' shift toward
comprehensive treatment is a significant advance in opiate-addiction
treatment.

"They've kept me out of a lot of criminal activity," says Roman,
referring to the counselors he's worked with at Madison Health
Services. "The people here care about you. I know they've dealt with
me and my problems, and I had a lot of problems."

Pills Push Demand

CRC Health Group, which owns 62 methadone clinics nationwide,
including five in Wisconsin, purchased Madison Health Services five
years ago. Since then, the traditional "dose-and-go" model of
treatment has been replaced by a broader approach aiming to address
the underlying causes of a patient's addiction. Methadone clinics
nationwide have taken similar steps.

"It gets back to providing the good, quality care that makes us a more
successful company," says Phil Hershman, CRC's regional director. "The
for-profit part allows us to provide comprehensive treatment."

He adds that the new approach moves addicts through the program
faster, opening room for others wanting treatment. Demand for
treatment, he says, has been spurred by significant increases in the
number of prescriptions written for opiate painkillers.

Though he can't speak for Madison Health Services specifically, he
says that at some clinics up to 50 percent of patients are addicted to
painkillers. "Especially in the last two to three years, we've seen
much more pill abuse," he says.

The $14 patients spend daily (currently, only five patients take
suboxone, which costs $18), covers not just methadone, which costs
less than $1 per dose, but the cost of providing counseling and case
management services. Roughly two-thirds of patients have insurance
that covers the treatment. Those who don't pay out of pocket.

"We do an all-inclusive, very intensive broad snapshot of all of the
different issues our clients have struggled with," says Romonouski.
"We also look at strengths, because we can build on those while we try
to decrease the areas that are giving them problems."

Madison's other methadone clinic, Quality Addiction Management at 902
Ann Street, still uses the dose-and-go maintenance model. About 10
percent of patients are discharged for infractions like selling their
take-home dose or continued use of other drugs. Most patients, she
says, complete their treatment plans. And, a rare few, like Roman,
will likely take methadone for life.

Patients nearing the end of their treatment taper slowly off the
drugs.

Misconceptions

Romonouski, an addiction treatment specialist for nearly 20 years, was
hired by Madison Health Services in late March. It was her first
involvement with methadone. Like many people, she had several
misconceptions about methadone clinics.

"My image of a methadone clinic was that they were dirty, that there'd
be dirty needles in the parking lot, that basically it was a legalized
drug abuse," she recalls. "That's proven to be very false."

Contrary to pop culture's portrayal of methadone clinics as legalized
drug parlors, Madison Health Services is similar to any medical
facility. After checking in, patients wait their turn to visit the
medication-dispensing nurse. Informational materials on topics ranging
from AIDS to addiction and pregnancy adorn its walls.

Patients receive a take-home dose on Saturdays, which they are
required to keep in a lockbox until Sunday, when the clinic is closed.

Patients are tested for drugs frequently and meet regularly with one
of the clinic's six counselors. A treatment plan is developed to help
patients develop better life management and coping skills. Romonouski
says environmental factors often trigger relapses, so counselors help
patients develop ways to thwart them.

"Counselors will even help patients find housing in a safe
neighborhood, where people aren't going to be pounding on their door
at three in the morning saying, 'Hey, I've got some money, let's go
get some coke,' " says Romonouski. "Even if you're in recovery, that's
an awfully hard invitation not to take."

'Scary Without It'

Late last year, Jesse, who also asked that his last name be withheld,
was released from the Dane County Jail, where he'd spent eight months
on a shoplifting conviction. Because the sheriff's department doesn't
provide methadone to incarcerated addicts, Jesse, who was hooked on
OxyContin, endured horrific withdrawals during his first several weeks
in jail.

Upon his release, Jesse, 29, felt emotionally ready to stay clean, but
stepped back into a circle of drug-using friends, including his
girlfriend, whose daughter he'd help raise for nine years. Last
December, the two decided to get clean, but it wasn't long before
things fell apart.

"I'm not with her anymore," says Jesse. "She started the program, but
isn't really changing things. She's still using."

An addict for nearly a decade, Jesse has cut loose many of his
friends, found a new girlfriend and plans on taking some art classes
at Madison Area Technical College. Going into his ninth month of
treatment, Jesse isn't sure how long he expects to be on methadone.

"It'd be scary without it," he says. "I'd probably lose my mind
without it."