FRONTIER HEALTH CEO QUESTIONS METHADONE USES

GRAY - Methadone treatment may be a good option for some drug addicts, but
there's no proof that it's the best treatment for addicts in Southwest
Virginia.

That's according to Doug Varney, president and chief executive officer of
Frontier Health, a company that provides substance abuse services to
residents in Scott, Lee and Wise counties.

Varney said he other members of his organization doubt whether the methadone
clinic proposed in Scott County will offer the kind of treatment that
addicts in this region really need, and he fears that the availability of
methadone maintenance programs will prevent some addicts from seeking better
treatment options.

Part of the problem, Varney said, is that methadone was originally designed
to help get people off of heroin - a street drug that is much more common in
large urban areas than in Southwest Virginia and Northeast Tennessee.

"The government operated many of these clinics back in the later '60s and
'70s when we really started having an epidemic of heroin and no one really
knew what to do about it," he said.

At that time, methadone - a legal drug that is chemically similar to heroin
and other opiates - was used to treat symptoms of withdrawal while patients
worked to kick their heroin habits. But in recent years, Varney said, the
treatment has been extended to cover other opiates, including prescription
drugs like OxyContin, and many clinics have gone from what he calls a detox
protocol to a maintenance program, meaning that the main goal of treatment
is not necessarily a drug-free lifestyle.

"I have a major problem with that," he said. "What have you accomplished?
You have simply switched them from one narcotic to another."

"In all fairness, I think there are some people that a detox protocol will
not work for," Varney added. "They are not going to be drug-free. They've
been on the street 20 years, they have the lifestyle, everything. And I
would rather them have access to methadone than be put in prison or be
involved in criminal activity or prostitution and all that ugly stuff. But
we simply do not have the numbers that justify establishing clinics like
that in this area."

Of the 185 people in Frontier Health's alcohol and drug treatment program in
Scott County, only six are opiate dependent, Varney said. And those six are
not addicted to heroin, but to prescription drugs, primarily OxyContin.

Varney maintains that addiction to a prescription drug like OxyContin is
significantly different from addiction to a street drug like heroin, and he
isn't convinced that methadone treatment can be universally applied to all
opiate addictions.

"I know chemically, you can probably say an opiate is an opiate is an
opiate, but addiction is more complicated than just the simple biological
process," he said. "It has to do with the individual, their family
situation, and their own history with substance abuse.

"The people who are caught up in the addiction are different. The
demographics are different, the work history is different, the family
support system is different. There's a lot of social and community factors
that are different.

"And to say that because (methadone treatment) was successful with (heroin
addicts), it would automatically be successful with any other
opiate-dependent person just doesn't make scientific sense to me. I've not
been able to find any studies that really demonstrate success with
prescription drug-dependent people."

Another aspect of the proposed Scott County clinic that bothers Varney is
the for-profit status of the company that would operate it.

"All the financial incentives are for them to keep people maintained on
methadone as opposed to being drug-free," he said. "I have a problem when I
read the applications and one of the goals of the program that measures
their outcome is that the person will still be coming to the clinic two
years later. There's no detox there.

"As I understand it, it's supposed to be $10 or $11 per tablet," Varney
added. "That would be fine if people were getting counseling, support,
medical supervision and all those other things, but if it's just a kind of
minimal thing where people go in and get their pills at $10 or $11 a pop and
they're back out in the community with none of the other things that need to
happen around that, I have a problem with that."

Varney believes methadone treatment - especially when used on a long-term
basis - should be tried only as a last resort.

"I think they should have tried a less invasive kind of treatment program
first," he said. "It would be like the first thing you do is surgery rather
than trying medicine. It just doesn't make sense to jump to the most
invasive, risky, long-term treatment first.

"I'd like to see those programs primarily moving towards an abstinence-based
program with 12-step follow-up counseling, and get people off the narcotic -
at least have that as a goal."

Many Scott County residents are primarily concerned about the social
implications of such a clinic moving into town, but Varney said he wants to
make it clear that his main concern is for the patients themselves.

"This is a difficult position to be in," he said. "I've been on the other
side in trying to get communities, for example, to accept a group home for
mentally retarded adults. I have been in meetings where people have
literally threatened my life because we were trying to get a group home for
kids put together in a community because they were afraid of it.

"I understand people's fear - and sometimes that's irrational fear - about
people who are different or people who are mentally ill or people who have
substance abuse problems. But my job is to try to help people, and I'm more
concerned about the people who will continue to be trapped in that process
of addiction."