TREATING ADDICTION: THE METHADONE DEBATE

Every day, Jennifer Altman drinks a shot-sized cup of cherry-flavored
liquid that she says allows her to lead a normal life.

If not for methadone, the Surfside Beach resident said she would still
be hooked on OxyContin, a powerful time-released pain reliever. The
addiction cost her as much as $250 a day, and ended with her buying
the pills off the street. She calls methadone a miracle, one which she
must regularly drive to Columbia to buy.

Now, methadone has touched off a firestorm in Horry County, where
plans for the Grand Strand's first methadone clinic have outraged
local residents and officials. They say the narcotic treatment will
bring more drugs and crime to the area, without actually curing
anyone's addiction.

On Monday, the county's Board of Adjustments and Zoning Appeals
decides whether it will reconsider its approval of the clinic. The
board approved plans for Center of Hope in July 2002, and the center
is projected to open near Fantasy Harbour this month.

That is, unless Republican S.C. Rep. Thad Viers and others can
convince the board it ignored key facts about the clinic's proximity
to schools and residences.

Addicts say the reaction is hypocritical coming from a county that,
for a time, was the nation's largest source of OxyContin
prescriptions. Many of those prescriptions came - illegally - from
Comprehensive Care and Pain Management Center, run by Dr. Michael Woodward.

The controversy has forced the community to face the problem of
addiction to prescription narcotics - a condition that has affected
football star Brett Favre and broadcaster Rush Limbaugh.

In Horry County, the pain clinic was closed, the drug ring shut down
and Woodward and some of his partners put in prison. But the addicts
remain.

Experts disagree about methadone's effectiveness in treating those
addicts. Proponents say it reduces emergency room visits and crime by
eliminating the need for addicts to buy illicit drugs.

Critics say methadone is merely another addictive opiate, and that
users would be far better off kicking the habit than substituting one
drug for another.

Without the clinic, the estimated 200 methadone users on the Strand
will continue to get it wherever they can: Charleston, Columbia or
Wilmington, N.C. Many must make the trip daily, rising early and
driving two hours to get their doses in time to get back before the
workday begins.

If nothing else, the controversy illustrates the need for some
solution, experts say, any solution.

"We've always had clients who drive down from Horry County," said Ed
Johnson, program coordinator for the Charleston Center for drug and
alcohol addiction, which dispenses methadone. "But when Woodward went
out of business, it was like somebody stepped on an anthill. I think
you need a methadone clinic up there. But even if you disagree, you've
got to see that you have a serious problem."

Pitfalls of prescription drugs

Opponents of the clinic would be hard-pressed to identify Altman as an
addict. The bright, smiling 27-year-old with three children looks like
any other young mother.

She began using OxyContin at age 22 after a doctor prescribed it for
chronic pain. Altman, who was referred to Woodward's clinic, quickly
became tolerant and needed greater doses to get the same results,
which is typical for an opiate user..

"Everybody knew you could get what you needed as long as you paid,"
she said.

Science has created painkillers so effective, and medicine made them
so accessible, that widespread addiction was almost inevitable, Graham
said.

"Pain is a part of life, and it should be viewed as that," he said.
"Pain is your body telling you something is wrong. But instead of
talking to patients to find out what's wrong, too many doctors just
prescribe a pill, make some money, and move on to the next patient."

The government estimates that more than 2.6 million Americans
regularly abuse prescription drugs. That's more than the number of
regular users of cocaine, heroin and crack.

OxyContin is the leading prescribed narcotic, and most experts say it
is the most commonly abused prescription drug. Since it was introduced
to treat pain in 1996, hundreds of users have died of overdoses, and
thousands more have become addicted.

The Drug Enforcement Agency identified Myrtle Beach as a major source
for OxyContin that was later illegally distributed throughout the
Southeast. Known as a "pill mill," Woodward's clinic attracted addicts
from hundreds of miles away.

"This area is a fertile crescent for addiction," said Dr. James
Graham, a local physician who specializes in addiction treatment. "You
remember those old movies, where people would fall into quicksand?
That's addiction. You get in, and you can't get out. It's quicksand."

The prevalence of prescription narcotics has changed methadone's role,
as well.

Until recently, methadone clinics treated mostly heroin addicts.
Johnson of the Charleston clinic estimates that as recently as 10
years ago, 70 percent of clinic clients were heroin addicts and 30
percent were addicts of other opiates such as morphine.

However, that changed as use and abuse of OxyContin, Vicodin, Codeine
and Percocet became prevalent. Now, the majority of methadone users
are former OxyContin addicts.

"Rush Limbaugh is the classic example," said Dr. Clifford Bernstein,
medical director of the Waismann Institute, an addiction treatment
center in Beverly Hills, Calif. "They think, 'A doctor gave the
prescription to you - how can it be that bad?' These narcotics are so
good, they give people such a good feeling, you don't know you're
hooked on it until it's too late."

Altman said she never would have turned to methadone if she hadn't
become pregnant. Whereas OxyContin could jeopardize the unborn child,
methadone is considered less risky. So what she wouldn't do for
herself, she did for her son.

"I knew I had to make a change," she said. "I knew I had to get off
the pills. Methadone was the only option."

Oliver Altman was born three weeks ago, perfectly healthy and not
addicted to any drugs. Altman said those who say methadone is hardly
better than OxyContin should see Oliver.

"They say [methadone] could lead to crime," she said. "But the real
crime would have been if my baby hadn't been born healthy."

Altman said she intends to wean herself off methadone. She doesn't
want to plan her life around trips to a clinic, even if one opens in
Myrtle Beach.

"I want to have another baby," she said. "I don't want to have another
one on methadone. I want to do it the normal way."

Treatment or trap?

Over the years, methadone clinics have opened across the state, but
methadone providers found little sympathy in Horry County. Now the
county is the state's most populous area without a clinic. Many
officials hope to keep it that way.

"We don't need this in Horry County," Viers said. "We should support
the resources we have for getting people off drugs. What we don't need
is another source of drugs."

An attempt to open a clinic in Socastee in 1998 failed after the
community objected.

But to many addicts who became hooked on prescription drugs after
receiving prescriptions from doctors, opposition to methadone is naive
and hypocritical.

"I'm not a heroin junkie," Altman said. "I'm not a
criminal."

Methadone was invented by German scientists during World War II and
first used as a pain reliever. The drug is an opiate - a type of
narcotic made from the active ingredient in poppies.

It wasn't until 1968 that doctors learned the drug could be used as a
substitute for heroin, morphine and other opiates. They found that
methadone blocked an addict's ability to get high on their opiate of
choice, but because methadone is an opiate itself, the addict suffered
no symptoms of withdrawal.

Methadone clinics soon sprung up in urban areas, where patients can
receive it for between $10 and $15 a dose. Most clinics insist that
patients take the dose at the clinic to ensure they do not sell it
illegally. But once a patient establishes a relationship with a
clinic, they are often given a supply to last a week or a month.

Methadone's power to mimic other opiates and prevent withdrawal is
beyond dispute, experts say. But the danger is that methadone, like
its chemical cousins, is highly addictive, and it requires higher and
higher doses to achieve the same results. Many clinics offer therapy
and group sessions to help addicts lower their doses and slowly get
off methadone. But many clients need years to transition off
methadone. If they ever do.

Vickie Johnson of North Myrtle Beach has been on methadone for 15
years. Altman has been on it for almost a year. Both turned to
methadone after becoming addicted to pain pills.

"Isn't my life better on methadone than OxyContin?" Johnson said.
"It's allowed me to be a mother for my children. It's allowed me to
work."

But Graham and Bernstein say substituting one opiate for another is
not a cure and barely a treatment. Bernstein said he has treated
dozens of patients for addiction to methadone - including two
methadone clinic directors - after they turned to methadone clinics to
get off another opiate.

"I would tell people they have another option: freedom from opiates
altogether," Graham said. "No one should need opiates on a daily
basis. How can you say you have a normal life if you have to drive two
hours every day to get methadone? It sounds like slavery."

These addiction specialists say a life on methadone is barely better
than a life spent on heroin or OxyContin.

"The job of a clinic is to stabilize, not to cure," Bernstein said.
"These clinics have their clients by the short hairs. They profit
because they know the addict has to come back."

But at the Charleston Center, Ed Johnson sees it another way. He said
he has seen too many people destroyed by addiction. By eliminating the
cycles of highs and lows, methadone frees addicts to hold down jobs,
pay bills and raise children, he said.

"Addicts are not swayed easily," Johnson said. "If your choice is
using heroin or OxyContin until you die, or methadone maintenance for
the rest of your life, I don't care what you say. Methadone gives
these people hope."