CAREGIVERS ACCEPT LONG-TERM STRATEGY IN METHADONE USE

Ross Chaban is blunt when he talks about his previous thinking that most
heroin addicts don't need lifelong methadone medication to prevent them from
abusing heroin.

"I was an idiot," Mr. Chaban said.

It's not an easy admission for the executive director of Toledo-based
Substance Abuse Services, Inc., northwest Ohio's only methadone clinic for
heroin addicts. But it was clear that Toledo's strategy for treating addicts
dependent on heroin, Oxycontin, and other opiates was not working.

After a year or so of treatment, all addicts were cut off from methadone,
leading many to abuse drugs again or seek treatment elsewhere.

So, on July 1, SASI switched to methadone "maintenance" to treat heroin
abusers - making Toledo the last of Ohio's nine methadone clinics to switch
to this treatment approach. Addicts can now stay on methadone for as long as
they need.

The change, while in line with the rest of the state's clinics and
nationwide standards, is still controversial.

Some critics believe all addicts should be weaned off methadone.

"Tony," however, is grateful for the change in SASI's treatment approach.

A quick-talking man in his 40s with a firm handshake, a wife, and a child,
he is proud of his successful career as a foreman for a Toledo
transportation company.

He is also a former heroin user.

He abused the drug for five years during his youth and eventually turned to
methadone to pull out of what he said was a downward spiral of depression,
sickness, and drug abuse. He would skip work and spend entire days chasing a
heroin high.

"I believe it saved my life," Tony said of methadone.

Tony, a SASI client, asked that his real name not be used because he feared
how friends and co-workers might react. He was put in contact with The Blade
through SASI officials, who verified his treatment and related information.

Methadone, a federally approved medication, has been used to treat heroin
addiction for decades. A synthetic narcotic, methadone is usually swallowed
in liquid form. It does not produce a "high" like heroin, but does prevent
the cravings of heroin addicts. It is also used to treat other opiate
addictions, including abuse of narcotic painkillers such as Oxycontin or
Dilaudid.

Tony had been on methadone treatment in another state before moving to
Toledo a few years ago. He was nearing the mandatory cutoff for methadone
treatment at SASI this summer and was contemplating traveling to Detroit for
it until SASI switched to a maintenance program. Regular use of methadone is
invaluable for addicts, he said.

"I've been able to lead a normal life," he said.

SASI's change in methadone treatment came after the organization merged with
another drug-treatment agency, Comprehensive Addiction Services, where Mr.
Chaban is also executive director.

Mr. Chaban said the statistics alone showed a need for change.

Drug abuse involving heroin, Oxycontin, and other opiates is climbing state
and nationwide. In just two years, from 2000 through last year, the number
of heroin addicts seeking help at Ohio methadone clinics jumped 42 percent
to 6,878 patients, according to state drug-treatment officials.

But while abuse rates were growing, the number of people seeking methadone
treatment in Toledo had fallen to approximately 40 annually from a high of
about 250 in previous years. Akron, a city similar in size to Toledo but
with a different treatment strategy, has almost 400 people per year
receiving regular methadone treatment.

Cutting addicts off of methadone after a year or so of methadone treatment
just did not work, Mr. Chaban said of SASI's approach.

"It was a complete failure," he said. "It's like telling a diabetic taking
insulin you don't need insulin any more and you can eat Twinkies."

Many local addicts began abusing heroin again, which often led to them
getting in trouble with the law, losing their jobs, or causing problems for
their families, he said. Some addicts traveled to clinics elsewhere for
methadone. Mr. Chaban estimated 150 or more former SASI patients traveled to
Detroit for methadone.

Still, he was not surprised at SASI's previous resistance to methadone
maintenance given that even he used to feel that way.

Some in the criminal justice system and drug-treatment field likewise
continue to view methadone with suspicion. Critics believe that methadone,
if it is used at all, should be used onlyfor short-term, "detox" use. Using
methadone long-term just substitutes one addictive narcotic for another,
they argue.

In fact, the former director of Ohio's Department of Alcohol and Drug
Addiction Services, which certifies the state's methadone clinics, did not
believe in methadone maintenance, said Mr. Chaban and other drug-treatment
officials in the state.

"The leadership at the state was resistant to the concept [of long-term
methadone use]," said Ted Zigler, chief executive officer of Community
Health Center in Akron, which SASI has now modeled its methadone program
after. "But, in fact, 45 years of research and science have demonstrated
that methadone maintenance is the single most successful treatment of
narcotic addiction on the face of the earth."

Officials with the Substance Abuse and Mental Health Services
Administration, the federal agency that oversees methadone clinics, said Mr.
Chaban and Mr. Zigler are smart to use long-term methadone treatment
methods.

Robert Lubran, director of the division of pharmacological therapies at the
agency, said methadone maintenance is usually the best option for heroin
addicts, and detox-only strategies "are much less effective." Mr. Lubran
said the relapse rate in detoxification-only programs is so high it's almost
"wasteful" to try it.

Stacey Frohnapfel, spokesman for Ohio's Department of Alcohol and Drug
Addiction Services, disputed that the state or the department's former
leader, who left in July, opposed methadone maintenance.

While the state supports methadone maintenance, Ms. Frohnapfel said the
department maintained - and still maintains - that only a small percentage
of heroin addicts will always need methadone treatment.

"For the majority of heroin users, it's possible to become drug-free," she
said.

Mr. Zigler said that is not true, at least for those who have abused heroin
long enough to become addicted. He said while many heroin addicts won't need
methadone for life, most need to be on it at least two years, many for years
longer, or permanently.

Dr. Gerry Steiner, SASI's newly hired medical director, said nationally only
10 to 20 percent of heroin addicts can be weaned off methadone.

Dr. Steiner said scientists today have a much better understanding of opiate
addiction than in years past. Heroin, if used extensively, damages the brain
and overloads the body's natural opiate system.

The body has its own pleasure reward system that includes natural opiates
such as endorphins. These chemicals help regulate everything, from hunger
and thirst to stress and immune function. Heroin can damage that natural
system permanently and cause a host of problems, including drug cravings,
Dr. Steiner said. Methadone helps bring the body's opiate system back in
balance.

"Methadone is medicine. It helps break the cycle of trying to chase highs,"
he said.

Mr. Zigler said he likes to refer to methadone treatment as "turning tax
liabilities into tax assets" to convince those concerned about the cost that
treatment makes sense. Dr. Steiner agreed, saying the $10 daily cost for
methadone - which is covered by clients, Medicaid, or insurance - is much
cheaper than the financial costs associated with drug abuse and drug-related
crime.

But beyond the financial savings, Mr. Zigler said methadone maintenance is
humane for the addicts and their families.

"People who aren't treated are buying drugs on the street, stealing stuff,
or prostituting," he said. "We're giving people a chance to get their life
back."