Second In Ongoing Series

DIRECTOR: CLINICS HELP PATIENTS

Editor's note: This story is the second in a series on methadone, a
controversial narcotic painkiller often used to treat opiate addictions.
Pick up the March 4 edition of the Princeton Times for more on methadone
maintenance treatment and the government guidelines that lay out the law.

PRINCETON - Casey Aust runs a clinic that treats more than 700 patients at
any given time, and she said they all just want to "feel normal."

Aust, administrator at Beckley Treatment Center, said the methadone
maintenance treatment administered at the Beaver clinic helps individuals
who are addicted to opiates lead productive lives.

Methadone, a powerful narcotic prescribed in pill form for patients with
chronic pain, has become a popular way to treat addictions to heroin and
prescription medications such as OxyContin , Percocet , Dilaudid and more.

According to Aust, methadone decreases withdrawal symptoms, reduces opiate
cravings and acts as a blockade, preventing the euphoric effects of other
opiates.

"It's a very functional medication," Aust said. And, unlike other opiates,
it has few side effects, she said.

Individuals undergoing methadone maintenance treatment (MMT) are still
addicted to opiates, but the methadone keeps their bodies out of withdrawal
without the highs and lows associated with other illicit drugs.

"Opiate addiction is a very physical addiction," Aust said, making it a
very difficult one to break.

"Addiction is a disease," she said, and maintenance could take a lifetime.

Explaining processes at the clinic, Aust said all the patients arrive at
the Beckley center voluntarily, and word of mouth appears to be the
greatest referral method.

Upon intake, every potential patient must meet eligibility requirements
before receiving treatment, and the center's medical director makes the
final decision on whether to administer the MMT to any patient, Aust said.

According to the Beckley clinic director, all patients must exhibit a
dependence on opiates and have a physical tolerance for the drugs. In
addition, all patients are required to take part in counseling sessions and
a undergo a complete physical, including blood work and urinalysis.

"For a lot of them, that is the only physical they'll ever get," Aust said.

The comprehensive treatment costs $12.50 per day in Beckley. That fee
includes the methadone, nursing and physician services, drug testing and
counseling sessions, she said.

Patients may see their counselors as often as they wish, but they are
required to speak with the mental-health officials at least once a week,
Aust said.

The methadone, administered mostly as a red liquid taken orally, must be
ingested daily at the clinic in front of a nurse for new patients. The
exception is a take-home dose for Sunday, when the clinic is closed, she said.

"As patients progress and make positive progress" in their treatment, Aust
said, they may earn more take-home methadone.

She said it would take a patient "progressing perfectly" at least nine
months to earn a week's worth of take-home methadone.

While opponents of MMT say the take-home doses are dangerous and likely
lead to more drugs on the streets, Aust said they are crucial for the
patients. Since many of the people seeking MMT are active members of
society, or attempting to become such, Aust said the take-home allotments
allow them to function and continue with their day-to-day lives.

"The majority of my patients drive at least 45 minutes each way," she said.
"It would really encumber their treatment to never be able to take the
medicine home."

Although Aust defended her patients' ability to take methadone out of the
clinics, she said everyone at the Beckley center is committed to making
sure the drug is administered correctly for therapeutic purposes.

In accordance with federal guidelines, she said there is a series of rules
patients must adhere to in order to take methadone home.

Patients must prove themselves to be free of illicit drug use, keep
counseling sessions, exhibit no behavioral problems, have no current legal
issues, display a stable home life, demonstrate the ability to administer
medication correctly and possess a locked bag in which to store methadone.

In short, Aust said, patients must prove that the "benefits of the
take-homes outweighs the risk of diversion."

Still, she said her center operates under a diversion control policy.
Patients must lock their medicine in the bag before leaving the clinic;
they must return the methadone bottles with labels intact; and the clinic
regularly calls patients in randomly for bottle checks to make sure all the
methadone may be accounted for.

Plus, she said the center routinely tests for other drugs in patients'
systems. Violating any of the rules could result in losing take-home
privileges.

"We don't want methadone on the streets," she said. "Nobody wants that."

Because opiate addiction takes such a physical toll, treatment requires a
lifestyle change, Aust said, adding that some of her patients will never be
able to discontinue MMT.

She said the goal of the treatment is to stabilize patients physically so
they may address personal or mental health issues such as family life,
employment and education.

"If they are in withdrawal and are not physically feeling well, they cannot
focus on fixing what's wrong in their lives," Aust said.

If MMT keeps her patients "functioning and keeps them being productive
members of society, then it's worth it," she said.

Controversy has put MMT in the spotlight, due in part to the growing
presence of methadone for sale on the streets and indefinite detoxification
process, but Aust said she hoped the public would try to understand the
plight of individuals addicted to opiates.

"Opiate addiction is not choosy," she said.

Many of her patients first became addicted after an injury required
painkillers. "Before they knew it, their body was addicted," she said.
"They come to us after they've crossed the road ... when they've hit rock
bottom."

Aust said she routinely participates in community outreach and education
projects. She encouraged anyone with questions concerning MMT to contact
her at (304)254-9262.