AFTER DECADES OF 'WAR,' HEROIN STRUGGLE TURNS TO TREATMENT

Do you think drug addiction hasn't affected your life?

Odds are you haven't been hooked on anything beyond caffeine or
nicotine, so we'll rule that out.

Maybe a friend or relative has had a problem with illegal drugs more
likely, but still not a given.

How about this: Has your house ever been robbed? Your car broken into?
And even if you've been lucky enough to avoid those fates, you still
pay taxes, right?

Heroin use is on the rise in Massachusetts. And one way or another,
it's taking money out of your wallet.

In an interview with The Sun, Massachusetts Lt. Gov. Kerry Healey said
addiction's cost to society is "constantly underestimated."

Faced with an escalating heroin epidemic, Healey recently visited
Lowell, New Bedford, Springfield, Pittsfield, and Fitchburg to meet
with law-enforcement officers, hospital employees, and school
officials those on the front lines of the battle with drug abuse.

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Healey's tour was spurred by an April report from the Governor's
Commission on Criminal Justice Innovation, which examined the root
causes of criminal and gang activity.

"It always looped back to the issue of drug addiction, and in
particular heroin addiction," Healey said. "Law enforcement officers
make it very clear that 80 percent of people in our jails and prisons
came in under the influence of drugs and alcohol, and the majority are
addicted. If we could tackle drug abuse, we would have emptier prisons
and safer streets."

In 1997, the U.S. Department of Health and Human Services estimated
the social cost of drug and alcohol use in the United States at about
$294 billion. Using the 1997 population of 268 million, that averages
out to nearly $1,100 per citizen.

American leaders haven't ignored the problem, but have been
hard-pressed to find a solution. Presidents, starting with Richard
Nixon in the 1970s and continuing with Ronald Reagan in the '80s, have
famously declared "war" on drugs with minimal success. Much of the
resources in that fight have been devoted to seizing drug shipments
and arresting dealers and, to a lesser extent, users.

In Massachusetts, politicians and police officers are currently
looking at treatment and education, rather than investigation and
incarceration, as a cure for the current heroin epidemic.

"We're not going to solve the problem by putting people in jail," said
Lowell police Sgt. James Trudel.

Trudel, 47, is the head of Lowell's narcotics department. He joined
the police force 17 years ago, eager to track down and arrest drug
users and dealers. Now older and wiser, he counsels young cops not to
view drug offenses in black-and-white terms.

Lowell Capt. Robert DeMoura, a 20-year veteran who oversees the
criminal bureau and Trudel's unit, also believes something needs to
change.

"The resources spent surpass anything positive we get in return,"
DeMoura said. "We need to save (addicts) instead of sending them
through the revolving door."

Two years ago, Lowell police teamed up with the Lowell House addiction
agency to launch the Substance Abuse Diversion Initiative of Lowell.
The program, which receives $100,000 a year from the Greater Lowell
Community Foundation, is aimed at helping drug users ages 17 to 25.

SADIL has focused on training Greater Lowell police to take a more
treatment-oriented approach to drug-related incidents. The latest
tactic is the hiring of a full-time clinician, who will soon set up
shop at the Lowell Police Department to work with young drug addicts
who are taken into custody.

"We need to turn kids' lives around at this critical point," GLCF
Executive Director David Kronberg said. "(When they're arrested),
that's the moment of truth for them when they enter the tunnel that
goes down into perdition."

But even if addicts agree to seek help, the road to recovery is long
and complex.

The state Bureau of Substance Abuse Services (part of the Department
of Public Health) has in recent years sustained steep budget cuts,
reducing the availability of treatment statewide. Detoxification and
residential programs both have a shortage of beds, and cuts to state
insurance programs have left some unable to pay for methadone treatment.

Of the 115,896 people who did gain admission to Massachusetts
substance-abuse treatment facilities in fiscal year 2003, nearly
50,000 had taken heroin in the past 12 months. Of those users, 68
percent were admitted to short-term residential services, the majority
of which are quick-fix detox programs that last a maximum of five days.

"Detox is now basically medical stabilization," said Michael
Botticelli, assistant commissioner at BSAS. "The longer people are in
treatment, the better level of success."

A minority of heroin users entered outpatient services like methadone
or counseling (24 percent) and long-term residential services that
last more than 30 days (8 percent).

A six-month stint at a place like the Lowell House recovery center (an
18-bed facility on Appleton Street in Lowell), or an extended stay on
a controlled methadone program, are the best options for heroin
addicts, Botticelli said. BSAS funds residential programs around the
state, and state-provided health insurance covers methadone treatment
(although most private carriers do not).

Methadone clinics are the least painful way to stop using heroin, and
the most controversial. Methadone is a drug that stops agonizing
withdrawal symptoms by stimulating the same parts of the brain that
heroin does, without the mind-altering euphoria. Critics point out
that heroin users simply transfer their addiction to methadone.
(Clinics slowly reduce patients' methadone dosage over time the
ultimate goal is for clients to become drug-free.)

In Lowell, hundreds of methadone patients line up daily at the Habit
Management Institute on Suffolk Street. They walk down a ramp and up
to a desk to receive photo identification, then proceed to one of
three "dosing windows," where a nurse punches their names into a computer.

Behind the window, the computer terminal relays information to a
dispenser, about the size of a coffee maker, that spits methadone out
of a plastic tube. The red liquid looks and tastes like cherry syrup,
according to HMI Lowell Director Jerry Myers. (Methadone is available
to clients from 6 a.m. to noon, and is otherwise kept in a safe behind
a locked door.)

Addicts are assigned a dosage when they enter the program, and are
eased off the drug as treatment progresses. Dosages can range from 1
milligram to 400, Myers said the typical dose is about 120 mg. After
about two years of traipsing to the clinic every day, patients can get
up to 13 "take-home bottles" at a time and self-administer the drug.
Some stay on methadone for up to 10 years treatment costs $133 a week,
Myers said.

HMI is a privately owned, for-profit company with 12 clinics (and more
than 4,000 clients) in Massachusetts and New Hampshire.

Business has been good lately.

Seven years ago, HMI Lowell had 350 patients and operated out of a
small building down the street. The operation moved into a more
spacious office five years ago, and the clinic now has 605 patients
and 32 full-time employees.

"Lowell probably could use another methadone program," Myers said.
"The need out there is so great."

The Department of Public Health estimates that in fiscal year 2002, a
year of methadone treatment cost $4,970. That compares with $6,600 for
admission to a long-term residential program, and about $1,000 for a
stay in detox. (DPH is also looking at a new drug, buprenorphine, as a
possible alternative.)

BSAS's budget of about $80 million down from nearly $100 million four
years ago is not enough to help the tens of thousands of heroin
addicts in Massachusetts, according to DPH figures.

Making matters worse, Botticelli said, treatment costs suck up
virtually all of his bureau's budget. The massive expense of treatment
has pushed to the back burner what many see as the key to nipping
heroin addiction in the bud: Education.

In fiscal year 2004, the bureau spent less than $2 million a bit more
than 2 percent of its budget on prevention, Botticelli told The Sun.

A lack of good information on drugs can have dire consequences.

"I don't think kids understand just how bad drugs are on the street
today," said Sgt. Trudel. "They don't understand the cycle people go
through the prostitution, the stealing, the lying."

But with DARE drug-education programs dropping like flies after a
recent loss of federal funding and cash-strapped police departments
reducing the size of their forces, local officials have the same
problem as BSAS the financial resources just aren't there.

"I don't have a magic pill we can take to make this go away," lamented
Pepperell Police Chief Alan Davis, who has seen a recent rash of
heroin overdoses in his small town. "These things take money."

Help could be on the way. A recent brightening of the state's
financial outlook has cities and towns thinking their slimmed-down
budgets could be ready to grow. In addition, Healey said the
governor's office is prepared to cough up an additional $9 million for
BSAS in the current fiscal year (2005) although that increase would
still leave the bureau's budget below its fiscal year 2002 level.

Dr. Wayne Pasanen, chief of emergency medicine at Lowell General
Hospital and medical director of HMI clinics in Lowell and Lawrence,
said that government is paying attention to the heroin epidemic is a
ray of hope.

(In October 2003, Pasanen blasted political leaders for their "lack of
awareness" of the heroin problem and said the issue was being "swept
under the rug.")

"We're on the verge of a more enlightened period of dealing with
people," Pasanen said.

Pasanen is talking about people like Jim Switter, a 53-year-old heroin
addict who is on the road to recovery after 35 years of addiction.
Switter entered the Lowell House recovery center after serving the
latest of multiple jail sentences (6 1/2 years for trafficking cocaine).

Switter grudgingly entered the program as a condition of his parole.
For all of his adult life, Switter's primary concern had been tracking
down his next fix regardless of who he hurt along the way.

When he spoke to The Sun in mid-August, Switter was about halfway
through his six-month stay at Lowell House.

"The epidemic stops right here," the gray-haired Switter said with a
quiet intensity. "You hear about funding being cut and you sometimes
wonder, do the powers that be actually know what's going on?

"Citizens want the junkies off the street and their houses to be safe.
Let's focus on recovery."