METHADONE HIGHWAY

Ohio Drives Recovering Addicts Across State Lines

Every day hundreds of Greater Cincinnatians drive Interstate 275 west to
Lawrenceburg, exit at U.S. 50 and turn left toward the Argosy Casino -- but
not to gamble.

Just before the casino entrance, they turn right onto Rudolph Way and head
for an unremarkable office building at the end of the short road. There an
aging security guard kindly opens the front door, revealing snack and pop
machines, Ansel Adams and Successories prints on the wall and two windows
dispensing daily doses of methadone.

To advocates, methadone -- a synthetic narcotic administered in tablet or
liquid form -- is a lifesaving alternative to heroin and other illegal
drugs. To others, methadone is little more than a substitute addiction.

Early one Saturday morning in January, most of the recovering addicts at
the East Indiana Treatment Center wear flannel shirts, jeans, sneakers and
baseball caps. An older woman shuffles across the floor with the aid of a
walker. A young couple stands in line, looking as if they could be waiting
for a bank teller or a new driver's license. It's impossible to tell the
clinic's patients from its counselors.

Recovering opiate addicts go to the East Indiana Treatment Center to end
their daily searches for heroin or their doctor-shopping for prescription
painkillers such as OxyContin, Percocet and Vicodin.

The center's patients more than doubled from 689 in 1998 to 1,420 in 2000,
according to state records. Only 91 of those patients lived in Indiana.
More than half, 748, were from Ohio and most of the others, 581, were from
Kentucky.

Taking Medicine Is Not 'Using Drugs'

The center doesn't attract a methadone caravan because its services are
free. Patients pay an average of $11.50 for each daily dose of methadone at
this private, for-profit clinic.

Nor do many patients from Cincinnati drive to Lawrenceburg because it's the
closest clinic. A public methadone clinic, Central Community Health Board
(CCHB), operates in Mount Auburn.

But they might drive to Lawrenceburg because of CCHB's street reputation
for ineffectively low methadone doses and for limited treatment availability.

"We are under-serving our population, there's no doubt about that," says
Dr. Roberto Soria, former director of TriHealth's drug and alcohol rehab
program at the former Bethesda Oak Hospital.

The Ohio Department of Alcohol and Drug Addiction Services (ODADAS) --
which regulates the state's nine methadone clinics, including CCHB -- knows
Ohioans are going to Indiana for methadone treatment. But treatment
providers say ODADAS isn't interested in increasing the size or number of
public clinics in Ohio, despite growing support for methadone treatment
among federal officials, grass-roots advocates and medical professionals.

An ODADAS spokesperson says at least two private parties have asked about
starting new clinics in the last year, but none of the requests came from
county drug treatment boards. Maybe they know not to ask.

Many in the conservative Midwest, especially law enforcement officials,
still regard methadone as just another drug of addiction. Luceille Fleming
- -- ODADAS' director since the department was created in 1989 -- shares that
belief, according to Sherry Knapp, executive director of the Hamilton
County Alcohol and Drug Addiction Services Board (ADS).

"She sees it as a kind of substitute drug," Knapp says. "She would not
allow (its use) to grow -- ever -- even if the demand grows."

Total abstinence from all drugs is ODADAS' ultimate goal and a requirement
of state law. Methadone is allowed, but only in "short-term cases where it
is absolutely necessary," says Lisa Generette, a spokesperson for ODADAS.
This total abstinence philosophy encourages clinics to gradually reduce
methadone doses to wean addicts from all opiates.

But multiple relapses are common for long-term, chronic opiate addicts who
try to stay off drugs completely.

Furthermore, studies show at least some opiate addicts benefit greatly from
steady methadone doses, or methadone maintenance treatment (MMT). This
approach has allowed many recovering addicts to put aside chronic
addictions to heroin, pain pills and other substances with few adverse
health effects.

"Methadone still seems to be the best for the most," says Mac Bell, an
administrator of the Kentucky Narcotics Treatment Program.

No cure exists for opiate addiction, but methadone is the best treatment
available, according to Dr. Gene Somoza, a psychiatrist for 130 methadone
patients at the Cincinnati Veteran's Administration Hospital, the only
other clinic in the Tristate. Somoza also heads the Cincinnati Addiction
Research Center at the University of Cincinnati.

"We don't have anything better right now," he says. "Until we find a cure,
we have no choice. Everything else is illogical when you know all the facts."

Root Canals For A Fix

Most Tristate opiate addicts don't use needles to get high, according to
Soria. Instead they snort heroin or abuse pain pills such as Percocet,
Vicodin and OxyContin. Cincinnatian Brian Wilson's story might represent a
typical Tristate case.

Wilson, 32, grew up in Bright, Ind., eight miles from Lawrenceburg and
three miles from Harrison, Ohio. His dad has been a supervisor at a
chemical factory for 35 years. Wilson's family treated him well and he
never had to worry about material comforts.

At age 19 a doctor removed Wilson's tonsils and prescribed Percocet for
pain. He took one and went to his part-time job at a fireworks stand the
next day.

"It lifted me up and made me feel like I was in a good mood," Wilson says.
"It put me on top of the world."

The next day he took two pills. When his prescription ran out, he looked
for more. His friends pointed him in the right direction.

"In six months you can have a strong habit," Wilson says.

He always kept a job, despite his addiction. Compared to other drugs, pills
were easy to hide. As time passed, the highs decreased and his daily dose
increased. Soon the pills were just a way to feel normal again.

Three times Wilson was so desperate to avoid the severe, flu-like opiate
withdrawal, he underwent unnecessary root canals just to get painkillers.

"Anything is better than having to go through the sickness (of
withdrawal)," he says.

Many doctors don't have the training to recognize when addicts are getting
a fix, he says. Others know but don't care.

"Some doctors are in it for the money," Wilson says.

Eventually, his wife of four years left him, granting joint custody of
their son. One night he went out to drown his sorrows in alcohol. Before he
made it home, he was arrested for drunken driving and lost his license for
one year. Still on drugs, he drove anyway and ended up in the Dearborn
County Jail for three months in 1999.

The jail term was the first time Wilson completely withdrew from opiates.
The sickness lasted two weeks and included rounds of sweating, chills,
fevers, vomiting and body-wrenching muscle cramps.

"You can't keep food down," he says.

Wilson had been to abstinence-based programs. He could stop using for a few
days, but never longer. It was good to hear other addicts' stories and get
their support, but he still had a physical craving for drugs.

"I've tried it," he says. "I've gone through 12-step programs four or five
times."

By January 2000 Wilson was back on drugs but couldn't find pills, so he
smoked heroin. Soon he was snorting it. He realized needles were next. With
needles came the likelihood of hepatitis and AIDS.

Some of his friends had been talking about methadone. They said
Cincinnati's public methadone clinic, CCHB, had a four-month waiting list.
They offered to take him to Lawrenceburg.

Wilson met all the criteria for treatment, which he received almost
immediately. He began with 30 mg, a standard first dose for a new patient.
His tolerance required more, however, so now he takes 150 mg a day. Finding
the right dosage is more about how the patient feels than numbers, he says.

The correct dose can be affected by diseases, such as hepatitis C,
contracted by as many as 85 percent of heroin addicts, according to Somoza.
Hepatitis-positive patients need a higher dose than others.

"It depends on weight and height and what they were doing on the street,"
Bell says.

The average effective dose in Kentucky's clinics is 80 to 120 mg, he says.
Nearly all clinics start at about 30 mg and increase until reaching an
effective dose. Wilson knows of people on as much as 1,500 mg.

Soria says most studies say that low-dosing isn't as effective as higher
doses. If the dose doesn't satisfy an addict's craving for opiates, he'll
use something else as well. Nor does a low dose block the effect of other
opiates.

"If you want to ensure failure, you use a low dose," Goldstein says.

Marcie, a former CCHB patient who now lives in Northern Kentucky, relapsed
five times while under its care. Marcie, who asked that only her first name
be used, later learned she had received as little as 13 mg of methadone per
day. Marcie, who has hepatitis C, now takes 150 mg a day from the East
Indiana Treatment Center. She relapsed once early in her recovery, but not
since.

"I always wanted to be clean," she says.

Marcie says she never knew how much methadone CCHB was giving her -- a
practice known as "blind dosing." Wilson says that's another reason people
don't go to CCHB.

About one-third of methadone clinics use blind doses, according to Silvany.
They do it because recovering addicts sometimes try to brag to friends
about how high a dose they take.

"It's kind of a badge of courage," Silvany says. Some patients do know
their doses; it's up to the counselor, he said.

Soria says it's important for recovering addicts to believe their doctor
and counselor. Blind doses aren't a good way to build this trust, he says.

"You're treating them like an adolescent," Soria says.

Toles says some people who go to Lawrenceburg just aren't interested in
getting treatment with counseling and therapy.

Cooper, whose father was a supervisor in the Ohio prison system in the
early 1970s, says recovering addicts sometimes need a confrontational style
of treatment. Talking too much about doses can be a distraction, he says.

Both clinics have counselors. The major problem at East Indiana, Wilson
says, is its high counselor turnover rate. The counselors there are
inexperienced in general; state rules require only a bachelor's degree in
any subject, he says.

But even Toles agrees the state is under-serving parts of southwest Ohio --
specifically Butler, Warren and Clermont counties. The next-nearest
methadone clinic is in Dayton.

Cooper, who once had Toles' job, used to believe indefinite methadone
treatment wasn't a solution, even if it kept addicts out of jail and off
other drugs. Now he doesn't draw such a hard line.

"I would consider that a partial success," Cooper says.

See No Evil, Treat No Evil

In 1997, Kentucky drug treatment officials were working with MX Group Inc.,
an Erie, Pa. company, to open a clinic in Covington. Six other private
clinics opened all over the state in the late 1990s to meet a growing
demand for methadone treatment. The state runs two public clinics that
offer less-expensive services.

But the Covington Board of Adjustment denied the application and the city
has been fighting the clinic in court ever since. The issue is headed for a
hearing March 19 in the U.S. Sixth Circuit Court of Appeals in Cincinnati.
The dispute is over whether MX Group has a constitutional right to open a
clinic in Covington.

MX Group's attorneys, William Oldfield and David Davidson of Covington,
believe opiate addiction is covered under the Americans with Disabilities
Act (ADA) and the city must allow a clinic under the its current zoning.

"The big issue is whether the ADA applies," Oldfield says.

Methadone clinics have won similar cases in White Plains, N.Y., and in
Antioch, Calif. In August 1997, MX Group applied for a site at an old West
Pike Street train depot that had been converted to office space. The city's
zoning administrator says the site met the city's legal requirements, but
the clinic would have been two blocks from a school. Predictably, the city,
the Covington Business Council, parents and others were upset.

Almost everyone who went to a September 1997 public hearing about the
clinic had their minds made up, according to Melissa Fabian of Fort Wright,
who has degrees in psychology and coursework in criminology and would have
been the clinic's director.

"They just wanted to show us how angry they were," Fabian says. "They just
did not want a treatment facility there."

Fabian completed the state-mandated demand assessment survey that justified
opening a clinic, in part by checking arrest records and hospital
admissions. The nearest Kentucky clinics are in Lexington and Louisville,
90 miles away. CCHB only can treat Hamilton County residents.

"We just didn't haphazardly decide we're going to plop down here and see if
people will come," says Fabian, who now works for the Jewish Native Fund in
Blue Ash.

Fabian talked about Kentuckians having to drive to Lawrenceburg for
treatment. But opponents focused on the likelihood that a new clinic in
Covington would attract addicts from Ohio.

"I just think it would create more of a criminal element," says Covington
Mayor Butch Calley.

Calley supports taking the case to the U.S. Supreme Court. Money isn't an
issue, he says.

But the whole matter might soon be moot. Kentucky is processing an
application for a methadone clinic in Florence, Bell says. The applicant,
who Bell declined to disclose, has finished some of the work but still
needs approval from the U.S. Drug Enforcement Agency (DEA) and final
approval from Kentucky.

Methadone Beats Dying

Those who don't flinch when social services are cut should consider some
numbers. The DEA's budget in 2000 was more than $1.55 billion -- 20 times
what it was in 1973. Fifty-five percent of federal prisoners and 20 percent
of state prisoners are behind bars for drug-related crimes. At least 70
percent of the inmates at the Hamilton County Justice Center violated drug
laws or have drug problems, according to Knapp.

Yet no state prisons in Indiana, Ohio or Kentucky offer any methadone
treatment; nor does the Hamilton County Justice Center. All insist on
abstinence-based treatment. Kentucky prisons can only provide general drug
treatment to 17 percent of prisoners, according to Dr. Rick Purvis of the
Kentucky Department of Corrections.

Kentucky, which suffered an outbreak of OxyContin abuse in recent years,
allowed six new private, for-profit clinics to open since 1995 to
complement its two state-funded clinics, according to Bell.

Indiana began a five-year moratorium on new clinics in 1998, but it already
had 13 -- almost three times the number per capita in Ohio.

But don't expect Ohio to allow new private clinics to complement its nine
public ones. The state's methadone regulations effectively prevent this
from happening, according to Soria, who researched the possibility while
working at Bethesda. Any clinic that wants to dispense methadone must first
offer non-methadone drug rehab for two years -- a hurdle that private
clinics can't clear, he says.

ODADAS is concerned that for-profit clinics will exploit recovering addicts
and wants them to establish a track record, according to Generette.

Getting a new public clinic might not be any easier. At least four local
hospitals have cut or reduced their drug treatment programs, according to
Soria. Knapp says the Hamilton County addiction board's funding allows it
only to maintain existing programs.

Ohio is not proactive about methadone, according to Bell.

"They just don't want to deal with it," he says.

Treating addiction requires more than handing out methadone, Soria says.
Recovering addicts need counseling.

"We need treatment, not just dosing," Soria says. "Dosing isn't treatment."

Although states are still left to manage their own programs, the federal
government is in the middle of standardizing some parts of methadone
treatment, including the availability of take-home methadone doses.

The National Institutes of Health have called for increased access to MMT.
Advocacy groups such as the American Methadone Treatment Association are
joining the call. Even Barry McCaffrey, former director of the White House
Office on National Drug Control Policy, said in 1998 he supports making MMT
more available.

Bell is still fighting for acceptance of MMT. State legislation ending MMT
might be proposed in the Kentucky Senate soon.

Methadone is a powerful drug that can be abused if handed out too freely.
One person died from a methadone overdose in Hamilton County from Jan. 1,
2000 to Dec. 31, 2001, according to the Hamilton County Coroner's Office.
But 25 others died from overdoses or likely overdoses of heroin or other
opiates.

A few of those who died had recently been released from prison, and a few
had received methadone treatment at East Indiana in Lawrenceburg or the
Veteran's Administration Hospital, but they were exceptions.

Most of those who died had jobs, including a 30-year-old waiter at a
downtown hotel, a 20-year-old legal secretary who had finished a
non-methadone treatment program and a 51-year-old construction worker. Many
were white males in their 30s and 40s.

It's impossible to say if treatment would have saved any lives. But Wilson
knows one thing for sure -- getting heroin is easier than getting methadone
treatment.

"I could take you downtown and could get heroin in 10 minutes." He says.
"Take it from somebody who knows from being there. And it's getting cheaper
and cheaper and cheaper."

Drug Abuse Links

. National Institute on Drug Abuse: www.drugabuse.gov

. Substance Abuse and Mental Health Services Administration: www.samhsa.gov

. Ohio Department of Alcohol and Drug Addiction Services:
www.odadas.state.oh.us

. Central Community Health Board: for treatment, call 513-559-2929

. National Alliance of Methadone Advocates: www.methadone.org

. Advocates for Recovery Through Medicine, Ohio Chapter: write
armoh@aol.com or 3334 Gerold Drive, Box 29, Cincinnati, OH 45238.

Drug Abuse, By The Numbers

14 million -- number of Americans who used some form of illegal drugs in 2000

130,000 -- estimated number of opiate (heroin, etc.) users, age 12 and
older, in the United States today

33,000 -- estimated number of heroin-related emergency room visits in the
U.S. in 1990

96,000 -- estimated number of heroin-related emergency room visits in the
U.S. in 2000

5,211 -- number of OxyContin-related emergency room visits in 1998

10,825 -- number of OxyContin-related emergency room visits in 2000

$21,140 -- average annual cost of keeping an inmate in a state prison in 2000

$2,941 -- average cost of drug rehabilitation of all kinds, per treatment
episode in 1999

$2,575 -- average cost of an outpatient methadone program, per treatment
episode in 1999

$11,462 -- average per addict cost in crime in the year before treatment of
any kind

$2,851 -- average per addict cost in crime in the year after treatment of
any kind

20 percent -- U.S. state prison population arrested for drug-related
charges in 1999

3,384, or 16.3 percent -- number of people in federal prisons for
drug-related charges in 1970

75,625, or 55 percent -- number of people in federal prisons for
drug-related charges in October 2001

31 percent -- amount above capacity federal prisons were operating in
December 2000

$74.9 million -- Drug Enforcement Agency's annual budget in 1973

$1.55 billion -- Drug Enforcement Agency's (DEA) annual budget in 2001

2,898 -- number of DEA employees in 1973

9,132 -- number of DEA employees in 2001

SOURCES: Drug Abuse Warning Network, Criminal Justice Institute's 2000
Corrections Yearbook, Bureau of Justice Statistics, U.S. Drug Enforcement
Agency, Center for Substance Abuse Treatment.