TREATMENT HELPS, IF THOSE WHO NEED IT CAN GET IT

It's easier to get into college than to enter a drug treatment
program -- and stay there.

It's the painstaking hours of assessments and counseling that can
make treatment difficult -- and successful, according to the people
who run such a program in Salisbury.

Rowan Treatment Associates, located in a nondescript office complex
on Jake Alexander Boulevard, operates an outpatient program that
treats people addicted to opiates -- usually by using methadone to
wean them from their drug.

Since the facility opened here in 2001, it has served about 5,500 people.

The facility is privately run, meaning patients fund their own
treatment. They come from all walks of life -- from criminals to
teachers and preachers, young and old, black, white and Hispanic.

Seeking Help Yourself

Some people come to Rowan Treatment Associates on the advice of other
doctors or get family members' support to seek help.

But by far, most patients walk into the center on their own, after
hearing about the center from other patients. "People addicted to
opiates tend to run in the same circles," Treatment Associates CEO
Alan Jamieson said.

Medical Director Dr. Jay Fernando said patients aren't generally
referred by law enforcement or hospitals.

Of the patients who received treatment at the facility in 2006, 98
percent were self-referrals. One to 2 percent receive treatment based
on the referral of a parent or spouse.

"Over the last year, we've seen maybe three or four who were highly
recommended by the court (to seek treatment), but because we are a
voluntary program, we can't make them," Executive Director Ken Haggard said.

Patients who seek help at the facility have typically already tried
other treatment options.

Before Treatment

Before a patient begins any treatment, the staff perform a number of
screening tests to determine if they are suitable for the program and
if so, how to serve them.

A person is eligible for the program if they meet certain criteria
including -- one who is dependent and cannot function without a
psychoactive drug, like heroin, or one whose problem is ongoing for 12 months.

Prescription opiates are morphine, codeine, hydrocodone (brand name
Lortab), hydromorphone (brand name Dilaudid) and methadone, while the
most commonly known illicit opiate is heroin. Opiates like the above
dull the senses, relieve pain, and cause deep sleep.

A counselor first screens the potential patient looking for symptoms
found in the Diagnostic and Statistical Manual of Mental Disorders,
the standard text used by health professionals, hospitals and
psychiatric facilities.

The staff physician also screens the potential patient.

"Sometimes, they've become an addict because of other problems --
mental or physical," Fernando said.

If the prospective patient isn't suitable for the program, the clinic
staff will refer him or her to a detox facility or a 28-day inpatient
drug rehab center.

The nearest such facilities are in Charlotte, Wilmington and Virginia.

How It Works

Methadone works on the central nervous system, through the brain, and
can suppress the respiratory system. It's metabolized in the liver to
a substance the body can use.

Excess methadone is also stored in the liver and blood stream in a
"time release" fashion, which allows it to stay in the body's system
longer without a sudden peak.

Its effects last longer than those of morphine-based drugs.

"It rises slowly and stays in the system for 24 to 36 hours," Fernando said.

Methadone is available in liquid mixture, tablets and injectable
Schedule II formulations. A schedule II substance -- morphine or an
amphetamine, for instance -- is any that has a high potential for abuse.

This facility only uses an oral liquid form.

During World War II, German scientists created methadone for a
potentially less addictive use during and after surgery. Although
methadone is chemically unlike morphine, it produces many of the same
effects. It was introduced into the United States in 1947 as a pain killer.

It is highly regulated for use in clinics and dispensed in pharmacies.

State regulations don't allow the clinic to be open on Sundays, so
most patients after a time are able to take their dose home. It is a
privilege to be permitted to take home doses for days at a time.

Haggard said the highest number of days a person has a "take home
privilege" is 13. It would take a patient two years of solid
treatment to take home their doses.

A Plan

Once a person is admitted to the program, the staff and the patient
map out a treatment plan. There is no time limit for treatment.

"We cannot tell on the outset how long they'll come in," Jamieson said.

State and federal regulations, however, set target dates, Haggard explains.

"They are working off a treatment plan with the initial being 30
days, then 60 days, 90 days and then a year," he said.

Methadone works by blocking the euphoric and calming effects of
opiates. It relieves cravings for and symptoms associated with
opiates. Its use allows patients to function normally.

The clients who participate at this facility receive their methadone
doses in liquid form under the observation of a registered or license
practical nurse.

"A test dosage of about 20 mg is administered, then we go up or down
based on how the patient feels," Fernando said. Drug of choice:
Methadone tablets are prescribed for pain relief. A liquid form is
more commonly used for addicts trying to break the grip of a more
serious narcotic, such as heroin. photo by Wayne Hinshaw, Salisbury Post

During the first two weeks of treatment, a patient can go up or down
on dosage. "Everybody starts at around 30 mg, some 15 or 20, although
30 is the maximum," he said.

Nurses stay in touch with each patient, asking how they are feeling,
if there are withdrawal symptoms or if the person feels drowsy. The
aim is "to find the right dosage that will stop the cravings,"
Jamieson said. This is a patient's therapeutic dose.

"Every day there is an interview and assessment. The patient meets
with a counselor a minimum of once a week," Program Director Amanda
Nieves said.

Once the staff feels a patient has his therapeutic dose, "it would
pretty much stay there at the therapeutic dose," Haggard said.

Every three months for the first year, there is a review and an
annual physical.

"At that time, we determine if they still qualify," Jamieson said.

An average dosage at the facility is 88 mg, and the national average
is 80 to 120 mg, he said.

If a person thinks they are ready to end the program, they discuss it
with a counselor and staff doctor, although the staff would not
recommend to suddenly stop.

"It's a process," Jamieson said.

If a patient asks to increase his or her dosage, the staff conducts
another assessment, looking for a medical or psychological reason.

In addition to daily methadone doses, the facility also conducts
vocational rehabilitation and counseling, which can last from 30
minutes to an hour. Treatment Associates offer recovery skills and
group therapy. Doctors and staff are available to patients 24 hours a day.

"Methadone itself does not constitute the treatment. It's part of the
treatment we give and includes the other expertise that we bring to
the table," Jamieson said.

Overdoses, Deaths

An overdose from a patient who attends a clinic is unlikely, Fernando
said, since patients receive their daily doses from clinic staff.

"It's very safe. The methadone has a slow onset," said Ann Jamieson,
program director of Treatment Associates' Charlotte clinic, Queen
City Treatment Center.

Clinics have become a "scapegoat" for methadone overdoses, Jamieson said.

At times, anti-methadone groups have targeted the facility, saying it
is part of the problem.

But the staff disagrees. "We are doing our best to make sure these
people don't overdose," she said.

If methadone (or any opiate) is taken with another drug, like
benzodiazepiene, it can have a lethal effect, Fernando said.

Benzodiazepiene is used mainly as a tranquilizer to control the
symptom of anxiety or stress and as a short-term relief of insomnia.

Fernando recalled one overdose death in this area, but that person
was not receiving treatment through Rowan Treatment Associates.

Fernando believes more methadone is being prescribed because some
doctors, without carefully screening their patients, write a
prescription. This inattention has a correlation to overdose deaths.

The majority of people who die from overdoses are taking too much of
a prescription or are obtaining the drug from the streets. These
deaths unfairly tar doctors and clinics who are prescribing the
treatment in a healthy way.

Fernando said all doctors prescribing methadone -- whether using it
for pain therapy in a private practice or within the treatment
guidelines of a methadone clinic -- should monitor their patients'
use carefully, make certain they have a contract, set consequences
for patients violating their agreement and conduct random drug screenings.

Relapse

The staff say patients relapse for any number of reasons, including
financial problems or even if a person moves from the area. But
again, since the program is voluntary, the staff cannot force treatment.

"If they do leave the program, they are referred to others for help,"
Alan Jamieson said.

If a person is found to be abusing other drugs, Treatment Associates
reassesses his or her contract, and if problems persist, the staff
will release the person from the program, Fernando said.