Cure or just another addiction? Methadone providers say opiate keeps scores of addicts off heroin
Editor's note: This story originally ran on Dec. 5, 2001 as part of the Daily Herald's "Hidden Scourge: Heroin in the Suburbs" series.
Cathy, a 45-year-old Palatine resident, used heroin steadily for 10 years before she sought treatment from a methadone clinic.
By the time she did, she was living in a run-down trailer with no running water. Her husband had been killed in a hit-and-run accident and she had been hit and injured at the same intersection. Cathy had tried one other treatment program before without success.
For about a year, Cathy, who asked that her last name not be used, kept using heroin while she took doses of methadone. But about three years ago, she called her mom and stepfather in Palatine, moved back in with them and has been "clean" since.
She takes methadone she gets from Therapeutic Interventions, a clinic in Rolling Meadows.
"It was hard for me to say goodbye to the drugs because it was like saying goodbye to my husband, as stupid as that sounds," she said.
Cathy is not alone. She is one of nearly 1,000 suburban clients who travel to five separate locations throughout the Northwest and West suburbs for doses of methadone. That patient base likely is a fraction of the heroin-dependent population locally. The National Institute of Drug Abuse estimates less than 20 percent of heroin addicts nationwide are treated with methadone. Two of the suburban clinics also report keeping waiting lists.
Like heroin, methadone is a narcotic. Because of that, methadone maintenance programs have critics who argue they are a drug substitute; not a cure for addiction. Methadone clinic operators say methadone can be an effective way to stem heroin use, which, in turn, reduces related crime and disease from dirty needles as well as stabilizing family and job situations.
Methadone is an opiate and analgesic that has been prescribed by physicians since the mid 1960s to people addicted to heroin and pain medications. Directors of suburban methadone maintenance programs say the overwhelming majority of their clients are heroin addicts. Many of their clients have tried other treatment programs and failed, several say.
When prescribed at proper daily dosages, methadone blocks the high heroin provides without providing one of its own, prevents withdrawal symptoms and suppresses cravings for a 24-hour period. Methadone maintenance programs are regulated by the federal government. The drug can only be administered to adults or to 17-year-olds who have parental permission and who have met other requirements.
Younger patients
Still, directors of the five suburban methadone clinics, say they have seen a significant trend toward younger people seeking help for their heroin problem in the past few years.
"We're getting younger and younger patients and some of the 18-year-olds had been on heroin three or four years before they got here," said Victor Zapatka, program coordinator at the Rolling Meadows clinic.
Marie Angelico, program director at the Center for Addictive Problems which operates clinics in Chicago and Downers Grove, said heroin use among white suburban teens will continue to spiral.
"I don't think it's peaked yet," she said. "It's become very attractive to experiment with heroin now."
The five suburban clinics in Aurora, Des Plaines, Downers Grove, Rolling Meadows and Waukegan are a mixture of public and privately-funded operations. Most also offer other treatment programs for drug and alcohol abuse. They draw methadone clients from a 10- to 15-mile radius. Their client populations are one-third female and two-thirds male. Four out of five of the sites serve a majority white clientele. The majority of the clients at the Lake County substance abuse program are black.
Those seeking methadone as a treatment are evaluated by a physician and started on a dosage that cannot exceed a federally recommended maximum. Generally, they must travel to the clinic six days a week for the first 90 days of treatment, talk to a nurse about withdrawal symptoms and drink - in front of a nurse - a cup of methadone dissolved in some juice or other fluid. The medication must be swallowed in front of someone in an attempt to assure it is not hidden for illicit sale elsewhere.
Initially, methadone can cause side effects for some people including weight gain, flu-like symptoms and sexual dysfunction, but some people take it for decades with no long-term problems, experts say.
The different suburban clinics also offer clients varying amounts of group and individual counseling, encouraging them to make lifestyle changes including staying away from "drug buddies." Some of the five clinics do not require counseling long-term.
Clinic operators follow guidelines that eventually allow some clients to take home bottles of methadone once they have proven through random urine testing they are heroin free. Those who "earn their carries" then are not required to make near-daily trips to the clinic for their methadone.
Treatments last years
Dr. Massarat A. Bala, on staff at the Rolling Meadows clinic, said clients whose drug tests come up positive for heroin while they are on methadone are confronted about that and are restricted from taking medication outside the clinic. They also are encouraged to get more counseling, he said.
Some suburban clinics are mainly publicly funded by federal and/or state government; others are partially tax-supported and one is not publicly funded at all. Most require some payment from clients, partly so they are invested in their treatment, and several use a sliding income scale.
Payment for a week's worth of methadone at the five suburban clinics runs from a low of $8 to a high of $60. Angelico said methadone programs are underinsured.
Some methadone patients eventually are successful at reducing their dosage and withdrawing from it altogether, but many stay on it for years, even decades.
"Methadone could be considered as a chronic medication like we treat diabetes and hypertension," said Bala. "We cannot say, 'My blood pressure is now normal and I'm going to stay off of the blood pressure medicine.' "
But others dispute those kinds of analogies.
Angelo Valdes, who operates H.E.L.P.S. ministry out of his home in St. Charles, objects to the notion of addiction as a disease that cannot be cured or controlled. "It's a choice. Nobody would choose diabetes or kidney disease or cancer," said Valdes, himself a former cocaine addict.
"If you have a problem with chocolate cupcakes and I switch you to Twinkies am I really helping you with your problem? I'm interested in life change. I'm not interested in people being in bondage forever," he said.
Peter M. Palanca, regional vice president for Hazelden Foundation's drug treatment facility in Chicago, said that organization also does not support the use of methadone for heroin addiction. Both he and Valdes said they have helped people who have developed methadone addiction.
"Methadone is really exchanging one addictive substance for another," Palanca said, but added, "There are some people who've had such a difficult time getting off heroin that methadone has worked for them."
Norwig Debye-Saxinger, vice president of New York-based Phoenix House treatment centers, says that organization, like Hazelden, promotes in-patient treatment and does not distribute methadone. He takes a practical view. "What would we do with the ... methadone patients if we shut down that option? There are not enough treatment providers as it is."
Dr. Marc Shinderman, medical director for the Downers Grove facility and one in Chicago who has operated methadone programs since 1973, suggested people who try to encourage addicts to wean themselves from both heroin and methadone may mean well, but could be offering "a homicidal prescription."
He notes just about all of his patients have first tried and failed with other treatment methods. "It may be philosophically controversial, but it's medically incontrovertible," he said.
James Schaiper, clinical coordinator for the Lake County clinic, said, "It's the best treatment so far and it works if society will let it work."
Villa Park resident Kim Stachon, 36, was determined to get off methadone in one year. No one would ever guess Stachon, who asked that her maiden name be used in these stories, was a heroin junkie. She sits in a coffee shop in a sleek lavender suit with matching purple painted nails and describes how she quickly developed a $200-a-day heroin habit a few years ago after fighting chemical dependencies and addictions of one kind or another since her teen years.
She had tried twice to quit heroin cold turkey and ended up hospitalized. Through it all, Stachon managed to provide for her two young sons. In one year she succeeded in getting her methadone dosage down to a bare minimum and took herself off of it so she could be drug free just as old family pressures with her parents and siblings peaked at the Christmas holidays.
She quickly turned back to heroin.
"I threw away a whole year in two weeks," she said. "It's amazing how quickly your life can be gone."
Stachon says the methadone program she returned to restored her life. "With heroin, I lost my self-respect and my dignity. I lost so much more than that in such a short period of time ... I wish it was hard, but it wasn't," she said.
Stachon now says she may be taking methadone for the rest of her life. "I'll take the trade - in a heartbeat."