TWIST OF THE HOOK

State Budget Ax Poised Over Methadone Clinics

In a musty trailer beside the highway, hidden on a small road wedged
between the South End and South Boston, Dan Granger takes his place among
the steady throng of early-morning visitors.

When the 52-year-old auto-body worker gets to the front, a nurse reaches
into a bowl of chalky white tablets, dissolves one in hot water, and hands
him a plastic cup filled with a Tang-flavored solution. Like a growing
number of heroin addicts, Granger swills the orange cocktail with relief,
elation, and gratitude - that his addiction is again diverted.

"There's no way I would make it without it," he says, noting how he rushes
for his morning fix to keep from throwing up. "If it was cut off, I don't
think my heart could take it."

At a time when heroin use is increasing - the number of Boston residents
seeking treatment in area hospitals almost doubled in just the last six
years - lawmakers in the House have cut nearly all the money to help wean
Granger and more than 11,000 other Massachusetts addicts off heroin.

Last month, for fiscal and philosophical reasons, the House Ways and Means
Committee eliminated more than $25 million that pays for 40 health clinics,
including the trailer Granger visits every week, where heroin addicts are
treated with methadone, a controversial opiate that blunts the effects of
heroin.

"If the cuts go through, the consequences will be terrible," said Deborah
Klein Walker, associate commissioner of substance abuse services at the
Department of Public Health. "The cost for the state would be far greater
in the long run."

Methadone, which stimulates the brain's endorphin receptors and prevents
users from getting a high from heroin or going into withdrawal without it,
has sparked controversy for years. Critics see it as replacing one
addictive drug with another and prolonging the process of becoming
drug-free. Heroin addicts often take methadone for years, slowly decreasing
the miligrams.

Many methadone clinics, critics argue, also have become a beacon for crime.

Norwood Democrat John Rogers, the chairman of the Ways and Means Committee,
called the clinics a "nightmare" for neighbors. And lawmakers in
Springfield, which has several methadone clinics, are lobbying strongly
against efforts on Beacon Hill to restore the methadone treatment funds.

"It's not that I don't feel for these people, but there are programs that
are drug-free and that work better than just giving people another drug,"
said Representative Cheryl Rivers, a Springfield Democrat who believes
detox or other cold-turkey withdrawal programs may work better. She also
complains that the two clinics in her district have spawned a surge in
crime. "We're no better now than the addict on the corner. A lot of these
people just end up spitting up the methadone and selling it after we give
it to them."

The cutbacks come at a trying time. Available for as little as $4, a bag of
heroin today costs about as much as a pack of cigarettes or a couple of
beers. Unlike the heroin of decades ago, the drug today doesn't have to be
taken with a needle (it can be snorted) and its purity has leaped from 15
percent on average to as high as 80 percent - making nearly any hit far
more powerful than ever before.

The low price has made it much more accessible. The percentage of heroin
arrests in Boston has risen over 10 percentage points in the past decade,
with heroin accounting for more than one in every four drug arrests.

The consequences are clear to public health officials.

Nearly 40 percent of all residents arriving at state hospitals for
treatment of substance abuse come for heroin addiction, making it second
only to alcohol. In Boston, the number of residents hospitalized for heroin
addiction rose from 6,851 in 1995 to 10,333 last year - rivaling the number
coming in for alcohol treatment.

"The shift to heroin in recent years has been dramatic - it's the highest
it's ever been," says James O'Connell, who as president of Healthcare for
the Homeless has seen countless heroin addicts. "This is a huge public
health problem, and methadone is the most effective way to treat it."

Like other illicit drugs, heroin disproportionately affects the poor.
Almost all those hooked on heroin rely on state support to overcome their
addiction. And the problem is getting worse locally.

Underscoring the need for methadone, public health and law enforcement
officials say, is that four of eight homeless people found dead this year
in Boston died of a heroin overdose.

"When these people want these drugs, they're going to get it - the
addiction is that great," says Lieutenant Frank Armstrong, commander of the
Boston Police Drug Control Division. "What is the better good: that
hundreds go to methadone clinics or that they're about town scurrying for
more drugs?"

To Dan Granger, it's about life and death.

The grizzled addict started using heroin at age 17 while serving in
Vietnam. About six years ago, after a life spent doing anything to feed his
habit, he began methadone treatment - and he says he has been clean ever since.

Now, Granger is working, has an apartment, and he has cut his methadone
dosage in half.

"This is how I survive," he says.