Part Three

COMING CLEAN

Editor's note: This is the third in a three-part series examining the
debate about a possible methadone clinic in Champaign.

Ever since University student Kendric Speagle proposed starting a methadone
clinic in downtown Champaign in late 2000, residents, business owners and
service providers have offered considerable opposition.

"This is a Herculean project, and there are many, many details to work
out," says Speagle, a senior in LAS who operates Harm Reduction Resource, a
program that provides local addicts clean needles in exchange for used ones
to limit the spread of diseases such as AIDS.

Opposition to a methadone clinic is rooted in the politics of how drug
treatment is administered as much as it is in the tendency of people to
oppose the location of an unpopular, yet arguably necessary facility in
their community.

Proponents of the methadone clinic, including Speagle and the
Champaign-Urbana Public Health District, adhere to a harm-reduction model,
which says that methadone is the only way some heroin addicts will ever get
clean.

But many opponents to the clinic, including the area's primary drug
treatment service providers, adhere to the abstinence model, which says the
only way to get off drugs is to stop taking them altogether.

"I think the philosophy here is a drug is a drug is a drug," says Cher
Jones, a registered nurse and certified addictions counselor at the
Pavilion, 809 W. Church St., Champaign.

At the Pavilion, all addicts undergo the same treatment: a rigorous 12-step
program that advocates abstinence and self control. Jones says patients are
told to attend 90 meetings in 90 days of 12-step groups such as Narcotics
Anonymous or Alcoholics Anonymous.

A similar philosophy for the treatment of heroin addiction is in operation
at the Prairie Center, 122 W. Hill St., Champaign, the area's largest drug
treatment organization.

"The disease (of addiction) is progressive. ..." says Thomas Gilbert, an
addictions counselor at Prairie Center's residential facility in downtown
Champaign. "And at some point you're gonna lose everything, get clean,
overdose or die, or you'll get arrested and go to jail."

But Julie Pryde, director of social services for the Champaign-Urbana
Public Health District, says the abstinence-based treatment offered by
Prairie Center and the Pavilion doesn't help heroin addicts much.

"There is no adequate treatment (for heroin addiction) in this area," Pryde
says. Pryde says most heroin addicts know they can't get treatment so they
don't bother going to local hospitals, which makes it hard to determine how
many heroin users are in the area.

Another problem for many area heroin addicts is that by the time they want
to go clean, they are often broke and have few resources to obtain the
immediate treatment they need.

The Prairie Center receives funding from the Illinois Office of Alcohol and
Substance Abuse, so it is mandated to take all clients who need help. But a
private drug treatment facility such as the Pavilion can refuse treatment
to those who can't pay.

"But if someone's health is in danger we don't turn people away," Jones says.

A heroin addict who needs to withdraw at the Pavilion will be monitored by
a nurse and doctor 24 hours a day. The doctor can prescribe medication to
ease the pain of withdrawal.

Methadone eliminates the painful withdrawal symptoms of heroin use, which
include cramps, diarrhea, nausea and flu-like symptoms.

Pryde and her fellow Champaign-Urbana Public District workers say that
methadone can be used to keep addicts off heroin and to reduce the spread
of HIV and AIDS because addicts won't be swapping needles.

"The less people inject, the less people are likely to be infected," Pryde
says.

The National Institute on Drug Abuse endorses methadone treatment and
reports that methadone is non-addictive, reduces cravings associated with
heroin addiction and has been used to treat heroin and opioid addiction for
more than 30 years. But the NIDA also noted that less than 20 percent of
the nation's heroin addicts are in methadone treatment programs.

That might be because many proponents of the abstinence-based treatment
model, including drug counselor Michael Langley of L.W.'s Place, a drug
treatment center in downtown Champaign, don't approve of methadone treatment.

"It's plain and simply a cop out," he says. "Methadone is a more powerful
opiate than heroin. We're substituting one addiction for another."

Joyce Schmidt, director of homeless programs for the Transitional
Initiatives Men's Emergency Services Center, a homeless shelter in downtown
Champaign, has had experience directing and working at two methadone
clinics in the Chicago area and one in Medford, Ore. She says many drug
counselors view methadone negatively.

"Methadone has taken a long time to be accepted for that reason because
you're trading an illegal addiction for a legal addiction," she says.

Some drug counselors also resist methadone because they may be recovering
addicts who were successful with abstinence.

"They believe the way they got clean is the way," Schmidt says.

John Peterson, an emergency room doctor at Provena Covenant Hospital in
Urbana, has seen an increase in heroin addicts in the emergency room in the
last 18 months. He says methadone can help those people.

"It is in fact an opiate," he says of methadone, "and we are acknowledging
(addicts') dependence on opium, but they're not out stealing your car
stereo. They're working jobs, and they're getting their lives together
using this crutch."

"Is there something wrong with treating a disease with medicine?" Kendric
Speagle asks. "Because that's what methadone maintenance is."

Jasper Jay Jones, who supervises methadone treatment at the Duane Dean
Center in Kankakee, Ill., where many Champaign County heroin addicts go for
treatment, says using methadone isn't a "moral" issue.

"You wouldn't tell a person with cancer to stop chemotherapy," Jones says.
"And you definitely wouldn't tell a person with diabetes to stop using insulin.

"Why would you tell a person to stop using a medication that helps them
lead a productive and normal lifestyle?"

But Jones acknowledges that he and the Duane Dean staff are constantly
working with addicts, the community and even each other to overcome the
stigma of methadone.

"We cannot be biased about methadone," Jones says, "because a lot of
counselors are biased."

He also tries to teach his fellow counselors not to get overwhelmed by
clients' problems.

"We've got to understand to let it go ourselves because we can be burned
out," he says.

Part of letting things go, he says, is realizing that relapse is an
inevitable part of the recovery process. But Jones is proud that 65 percent
of methadone clients at the Duane Dean Center are free of opiates after 90
days.

"That's a pretty good outcome right now," he says.

But Langley says abstinence gives heroin addicts a more effective base to
rebuild their lives upon.

"Wouldn't it be better to get them detoxified and then give them the skills
to get better?" he asked.

Opponents to methadone treatment also don't like that the treatment can go
on for years. The NIDA states that methadone is medically safe even when
used for 10 years or more.

"They might be on it for life," Langley says.

Gilbert does not oppose methadone treatment for addicts who can't find any
other way to get off heroin, but he sees a danger in getting "emotionally
and physically dependent on this thing."

"The way some (methadone) clinics are run, (they) are unsuccessful because
they're not looking at the end goal of getting (addicts) clean," Gilbert says.

But Pryde says abstinence-based treatment methods work about as well as
telling kids not to do drugs or to have sex.

"We know from experience and common sense that that does not work," she
says. Peterson says abstinence works with only about 20 percent of
substance abusers. He also says abstinence and 12-step groups work best
with professional people who have an existing support network.

"You're not going to have a lot of success with somebody who's used a long
time and used up all their resources," he says.

But Bruce Barnard, the Prairie Center's associate director for Champaign
and Ford counties, says the relapse rate of most drugs is high and wonders
what the alternatives to abstinence are.

"You'd get run out of town if you suggested alcohol maintenance or crack
maintenance," he says.

While he says that abstinence has worked for "millions of people," he also
accepts that methadone has helped many heroin addicts.

"I won't dispute that both models work," he says.

Schmidt says both models can work together.

"I know many, many people who have used methadone to detox, and they're
leading normal, functional lives with the help of 12-step meetings," she says.

"I think there are some folks in this town that are purposely saying
abstinence doesn't work because they think it will get them what they
want," Barnard says.

Barnard says Prairie Center is not interested in starting a methadone
clinic because the center concentrates on abstinence-based treatment.

Sandy Lewis, CEO of Provena Behavioral Health, which administers the TIMES
Center and the Mental Health Center in downtown Champaign, has also
expressed reluctance to support a methadone clinic. Lewis says she fears a
methadone clinic downtown would put too much of a concentration of certain
services in one area.

Pryde wonders if Prairie Center and the Mental Health Center are resistant
to a methadone clinic because there is a "revolving door" of heroin addicts
who come in and out of treatment at those facilities.

"People's lives should never be a competition," Pryde says.

Barnard says the revolving door is a trend he "would love to see end" even
if it meant Prairie Center went out of business.

Prairie Center has been a non-profit organization since it was founded in
the late 1960s.

"Every penny that we've ever earned has been invested back into the
services we provide," Barnard says.

Some years Prairie Center barely breaks even.

"This is not a lucrative business we're in," Barnard says, adding that many
for-profit treatment centers in town have closed. "The privates were all in
this business in the '70s, and they're all gone."

If Prairie Center opens a methadone clinic and it's not financially
successful, money might have to be cut from other programs, which serve
2,000 Prairie Center clients in Champaign County.

"We don't have the capacity in treatment centers in this community to serve
all the people who need services," Barnard says. "The issue is: How do you
allocate resources you have?"

He also wonders if there are enough heroin addicts to justify opening the
clinic.

"It's not a huge number if you look at our total number of clients,"
Barnard says. Barnard says that even if Prairie Center started a methadone
clinic, it wouldn't be located at the downtown residential facility.

"I don't think it's appropriate to mix abstinence-based treatment with
methadone treatment in the same facility," he says.

Schmidt initially had doubts Speagle could run a methadone clinic. But she
now says that if he and clinic staff were trained properly by a
"world-renowned" treatment facility like the Center for Addictive Problems
in Chicago, then she would support Speagle's efforts to open a clinic.
Schmidt also says that Prairie Center would be capable of running a
methadone clinic.

"I think Prairie staff may need some education on methadone, but they are
trusted in the community," she says.

"Public health and Prairie Center need to be involved in whatever solutions
the community comes up with," Barnard says.

Speagle and the other four members of the board of directors of Harm
Reduction Resource have given up on the downtown Champaign location
originally identified as a home to the clinic at 12 E. Washington St. in
Champaign. Speagle says a contractual dispute with the building's landlord
about renovation costs of the first floor space for the clinic have forced
the board to pursue other alternatives.

"We are investigating much more closely a comprehensive association with
one of the well-established agencies in town," Speagle says.

While discussions about a methadone clinic continue, Champaign resident and
heroin addict Katy Kalman has given up on traveling to the Duane Dean
Behavioral Health Clinic in Kankakee six days a week. Kalman, who has been
traveling to Kankakee for more than six months, had to ask clinic officials
four times if she could go off the methadone before they agreed.

"They think anybody who goes off is going to be using," she says.

Kalman can't honestly say she won't use heroin again.

"I dunno," she says. "I hope not. All I know is I'm going to be so relieved
to sleep in one morning and not have to go anywhere."