CRITICS SAY IND. CENTER DISTRIBUTES ADDICTIVE DRUG TOO GENEROUSLY

GREENDALE, Ind. - The clients begin arriving at 4:30 a.m. - dozens of them,
mostly in vehicles with out-of-state plates, all caught in the grips of
something they can't control.

Like bees to a hive, they're drawn to a brick building with large block
letters over the door: EITC, short for East Indiana Treatment Center. It's
an innocuous name, one that gives no hint of the business that goes on here
or what, exactly, is being treated.

What EITC sells is a pink, cherry-flavored drink originally developed by the
Nazis as a substitute for morphine: Methadone hydrochloride, a highly
addictive Schedule II controlled substance, an opiate, like heroin or
OxyContin, that acts on the same receptors in the brain.

To those trying to get free of opiate addictions, EITC represents hope. In
proper doses, methadone prevents an opiate user from getting high. It
occupies those brain receptors to take away the craving so that a person can
hold down a job, pay taxes - in essence, lead a normal life.

But methadone also has a dark side. It's regularly abused by all sorts of
drug users. In high doses, it can produce a cleaner, more intense high than
heroin for users of heroin and OxyContin, a prescription pain-killer whose
popularity in poor rural areas earned it the nickname "hillbilly heroin." A
strung-out heroin addict also may abuse methadone to take a break from his
habit.

And for those who use non-opiates, such as Xanex or Valium, methadone
turbo-charges the high. The effect has created an illegal market - on the
street, methadone fetches $1 per milligram. A prescribed dose ranges from 30
milligrams to more than 100 milligrams, but a 100- milligram dose - or about
a shot glass-full - is enough to kill the inexperienced user.

Critics say the for-profit EITC distributes methadone too generously - with
not enough supervision and not enough effort to wean its clients off the
substitute drug - and does little to solve drug-users' addictions.

Recently, the Nashville, Tenn., company that owns EITC dropped plans to open
a similar clinic in Florence. Law enforcement officers in Indiana, saying
they're tired of criminal problems with the clinic's clients, say they'd
just as soon EITC leave that state.

"I'd rather have 10 riverboat gambling casinos than one methadone clinic.
(EITC) is just substituting one addiction for another," said one
Lawrenceburg police officer.

Since that comment, former EITC client John Earls was convicted in Dearborn
Superior Court of operating a motor vehicle while under the influence of
methadone, resulting in a fatal wreck. One man was killed, and Earls'
5-year-old son suffered extensive head injuries.

But EITC blames its clients. Administered properly to users who sincerely
want to get free of their habits, methadone immediately eliminates criminal
behavior, clinic officials said.

"Look, no program is perfect,'' said EITC spokesman Brian MacConnell,
executive president of Holland Communications in Cincinnati.

"But think about the people who are trying to help themselves, to get their
lives back to normal. Would the police rather these people weren't in
treatment?''

EITC opens at 5 a.m. The customers pour through in a steady stream - women
with small children, men with mullet haircuts and chains on their wallets,
the occasional suit - until the center closes at 1 p.m.

To get methadone at EITC, you must be 18 or older. You also must test
positive for opiates in a urinalysis, although no one watches you fill the
specimen cup. Additionally, you must claim to be addicted and, according to
EITC's MacConnell, you must show visible signs of addiction and withdrawal.

MacConnell puts the total number of clients receiving methadone here at
"over 1,000 patients,'' adding that "new patients are always being
accepted.'' Mike Townsend, the state of Kentucky's authority on methadone,
was told EITC had a total caseload of 1,400 clients when he visited the
center in the winter. Law enforcement officials in Dearborn County believe
the number is now closer to 1,800.

In any case, an opiate addict must have a pink drink daily to stave off
withdrawal or avoid feeding their habits, which can easily amount to $300 a
day on the street.

EITC charges $11.50 per dose, cash only. When Townsend visited, the center
was collecting $16,100 a day for methadone, seven days a week. In Ohio,
clinics pay $46 for 1,000 milligrams.

"Do the math - that's a big-time for-profit methadone program,'' Townsend
said.

"Their bottom line isn't delivering good treatment. It's about making money.
The day they fail to make money, they're out of business. What incentive
does EITC have to wean someone off methadone?''

EITC dismisses such criticism.

"The for-profit rap is a red herring,'' MacConnell said.

"We're a health-care provider trying to help people who are asking for help.
We're only going to stay in business if we help those who come to us for
help.

"No one objects when a family doctor or a Humana Hospital makes a profit.''

To the people of Greendale, a Mayberry-like burg of about 5,000 residents
between Lawrenceburg and Interstate 275 in Dearborn County, EITC is a
shadowy presence.

Skittish about the topic, police throughout the county refer questions about
EITC to Sally Blankenship, prosecutor for Dearborn and Ohio counties in
Indiana.

"This is something new to us,'' she said.

"We're not a big metropolis. None of our police departments have detectives
or vice squads. And there are confidentiality issues within the federal
regulations governing methadone, specifically in regard to the (Drug
Enforcement Administration), that are open to interpretation.''

Her concern with EITC centers on the fact that it's a for-profit clinic.

"In Dearborn County, we had one bank robbery in which the convicted felon
stated that the motive for his crime was to pay for the methadone to which
he had become addicted,'' she says.

"We've also seen individuals driving in a manner that posed a danger while
under the influence of prescribed methadone, alone or in combination with
other drugs, as well as individuals selling their prescribed methadone.

"We've also seen individuals selling other controlled substances for money,
often to have money to buy more methadone.''

EITC dispenses methadone, but much of it does not have to be consumed on the
premises. Patients can earn the right to have "take-home'' doses based on
how long they've attended the program and how many "clean'' urine specimens
they've provided.

In Indiana, take-home privileges can be granted for up to a 31-day supply of
methadone. During a one-hour mid-morning period in April, 126 adults came
and went at EITC.

Nearly a third left with white paper bags containing take-home doses.

To Ms. Blankenship's point about EITC clients driving under the influence of
methadone, Indiana State Police at the Versailles post report that the
mile-and-a-half stretch of U.S. 50 between I-275 and Lawrenceburg on which
the access road to EITC is located is one of the "highest crash zones'' in
their six-county jurisdiction.

Argosy Casino is also on the highway, but "the clientele traveling to and
from (EITC) is far more of a factor in the high crash rate than the
casino,'' said Indiana State Police Sgt. Ray Otter.

Greendale Mayor Doug Hedrick wishes EITC had never come to town.

A youth soccer coach, he tells of finding five plastic methadone vials in
the grass at a soccer complex directly behind EITC.

"It's like these places at the highway that sell fireworks,'' he said.

"You can have a 1,200-square-foot building filled with fireworks in Indiana,
and you don't even need a sprinkler system, for crying out loud. To me,
(EITC) is a boxcar full of dynamite.''

EITC opened for business in 1996 in a one-story brick building in
Greendale's industrial park. The previous tenant moved out, and EITC moved
in. The center pays no taxes to the city and is not required to apply for
local permits of any kind, Hedrick said.

Nearly a year passed before Greendale police even knew a methadone clinic
had come to town.

Police Chief DeWayne Uhlman learned what the business was about when he
asked a staffer for a night phone number for security purposes and was
denied.

Local police also are frustrated by DEA confidentiality laws surrounding
methadone that, among other things, would require them to notify the EITC's
director before placing an undercover officer on the premises.

But privately, police talk of pulling over EITC clients traveling to and
from the center, finding drugs, drug paraphernalia and even vials of
"clean'' urine, which police say drug users buy in order to pass urinalysis
EITC is required under federal law to administer.

Cincinnati has two methadone clinics: one at the VA Hospital, the other in
Corryville at the Central Community Health Board. Both operate with public
funding, which distinguishes them from the for- profit EITC. Together, the
VA and CCHB serve fewer than 240 clients. The Kentucky-based methadone
clinic nearest Cincinnati is the Bluegrass Treatment Center, operated by the
Bluegrass Mental Health and Retardation Board in Lexington.

Bill Epps, director of adult outpatient services for CCHB, recalls that when
the EITC opened, he began hearing complaints from some clients that the
methadone doses at CCHB were too low, that they could get higher doses at
EITC. Doses at CCHB are determined by the medical director, based on his
assessment of the severity of a client's addiction.

"At our place, you have to show objective signs of withdrawal, including an
increase in blood pressure, runny nose, so forth. Just saying you need a
higher dose is not enough to get a higher dose,'' Epps says.

"One day, I realized they (EITC) were actually recruiting my clients.
Leaflets were turning up on the windshields of cars in our parking lot that
basically said, "New treatment program in Indiana, adequate doses, call this
number.'

"The leaflets stopped just short of saying, "Hey, come get all the methadone
you want."(133)'

Two years ago, EITC was sold to the Nashville, Tenn.-based National
Specialty Clinics.

EITC's MacConnell says NSC operates 12 clinics in West Virginia, Louisiana,
Georgia and Tenneesee and has plans to open three more this year - although
it recently abandoned plans to open a methadone center in Florence in the
Turfway Business Park.

NSC operates five methadone clinics in Indiana. The others are in
Jeffersonville, Evansville, Richmond and Indianapolis. Except for
Indianapolis, the cities border Kentucky or Ohio, states with more rigorous
requirements for methadone clinics than Indiana's.

At the federal level, the DEA and the FDA set standards for the operation of
methadone clinics. At the state level, regulations vary. EITC's MacConnell
says the clinic is located in Indiana because its previous owner "was an
Indiana company that wanted to cover Indiana geographic markets.''

Carl Shipp, the VA's methadone coordinator at the VA, says the reason EITC
is in Greendale instead of Cincinnati is because it's more difficult to get
a methadone license in Ohio.

"In Ohio, you have to run a drug-free drug treatment program for two years
before you can be even considered for a license,'' Shipp says.

Adds the CCHB's Epps: "The Ohio Department of Alcohol and Drug Addiction
Services requires total abstinence as the ultimate goal of a treatment
program before that program can receive funding.''

Likewise, Epps says, clinics in Indiana are quicker to give take-home doses:

.. In Ohio, a client has to be in a treatment program for 90 days to be
considered for a two-day, take-home dose. After two years, a client may be
eligible for a three-day take-home.

.. In Kentucky, 90 days of "clean urine'' and program participation may earn
a client a one-day take-home. It takes 180 days to earn the right to take
home a two-day dosage.

.. In Indiana, a client can get a two-day supply to go the first day he
signs up, according to EITC's MacConnell. After 91 days, a client can take
home three doses. After one year, a client can take home 14 days of doses.
The assumption is the client won't drink up that supply in less than 14
days.

In Kentucky, it's impossible to fake a urine test - a key in determining
take-home eligibility. The commonwealth uses a method involving a computer
technology that "types'' a user's urine so that it can be used to identify
that person, like fingerprints or DNA.

The methadone story has two sides - and a world of gray in between. One
extreme calls for abstinence - total freedom from any drug, including
methadone. The other holds that methadone is to the addict what insulin is
to the diabetic; it keeps people alive, productive and, in the case of
methadone, out of prison.

The VA's Shipp says most people stay on methadone because it takes away the
craving. But while some can wean themselves off methadone, he says they're
the exceptions.

"Methadone is illegal in nine states, which is insane. That totally denies
drug addiction is a disease for which people need treatment.

"That's why I don't want East Indiana to close. I want East Indiana to get
its act together.''

NEXT: Methadone can restore order to a broken life or reduce it to a
shattered ruin.