Treatment or illegal drug?
Boone County man speaks out, officials defend

Therese Smith <therese@dailymail.com>, Daily Mail health reporter

Tuesday February 17, 2004

At first, it all seemed so perfectly legal and innocent.

A naive Travis Barker swallowed what he thought was a harmless prescription pill, just 20 mg of a popular painkiller called OxyContin.

He was told that day about four years ago it would produce a satisfying euphoria and banish his worries.

Barker, now 26, reasoned that taking a pill approved by the federal government wasn’t a horrible thing. Certainly, it wasn’t like scoring heroine, cocaine or some other illegal drug — lessons his parents had taught him well growing up in Peytona in Boone County.

“I never dreamed it would be that addictive,” the Sherman High School graduate said recently.

When Barker tried to stop, he thought he had the flu. But he later learned he was experiencing withdrawal. Since then, he has slogged through three years of daily treatment with methadone, a synthetic narcotic, to break his addiction to OxyContin.

But his growing unrest with the local methadone clinic’s practices sent him searching for help to get away from the narcotic. He found the Coleman Institute in Richmond, Va., and just completed an eight-day stint in detoxification.

Barker finally is escaping the clutches of methadone.

“I feel like I lost four years of my life completely,” he said. “I was 22, owned a Mustang GT convertible and was a bartender. I was as happy as anyone could be.”

Barker said he is glad the West Virginia Health Care Authority recently imposed a 180-day moratorium on accepting any more applications for methadone clinics so state health officials can write standards for evaluating them.

Since 1999, eight methadone clinics have opened in the state. Private companies have proposed five more.

“Most in West Virginia are for-profit,” said Sonia Chambers, authority chairwoman. “Is that the best way to treat people who are addicted?”

Delegate Marshall Long, D-Mercer and a physician, said clinics make a substantial profit from selling methadone.

He has co-sponsored a bill to direct the state Department of Health and Human Resources to write rules for methadone clinics.

Long envisions that new regulations would require methadone clinics to use the profit to offer an array of supportive services, including a tapering-off option, so patients won’t be on methadone for life.

“The most important thing to me is making sure the clinics provide counseling, physical health services, vocational training, legal assistance — things that insure continuity of care,” Long said. “We want to make sure drug and alcohol counselors are board certified.”
Between 1995 and 2002, hospital emergency department visits involving methadone rose 176 percent across the country, according to the U.S. Department of Health and Human Services’ Drug Abuse Warning Network.

But federal officials earlier this month reported that the methadone causing deaths is coming from its use as a prescription painkiller rather than from treatment programs.

Still, Long is concerned about diversion — clinic patients selling methadone on the street. The methadone clinic regimen requires patients to submit to urine tests to confirm they’re ingesting the synthetic drug, not selling it to others.

“There is the potential for people to go to a pain clinic to get methadone for pain and at the same time they could be going to a methadone clinic,” Long said. “They would show up positive, so there is the potential for diversion.”

Appropriate treatment
Dr. Peter Coleman founded the institute in Richmond five years ago. For 18 years, he has treated patients for substance abuse, including using methadone. He said the federal government hatched the idea of legal methadone clinics as a way for addicts to avoid committing crimes to get illegal narcotics.

“It’s better than breaking into pharmacies,” he said.

Coleman believes methadone can be an appropriate treatment for those not ready to make the commitment to recovery.

“I don’t like methadone as a treatment philosophy in general terms because it is keeping people addicted to a mood-altering drug,” he said. “It has side effects. You stand in line with other substance abusers every day. You see yourself as no good. People try to sell you drugs. That is not a healthy environment.”

Further, the success rate to get off methadone is “abysmal,” he said, or between 2 percent and 5 percent.

“Withdrawal from methadone is horrendous, unbelievable,” he said.

Coleman’s approach to detoxification varies with each patient.

Barker spent eight days in Richmond, supported by his father. He saw Coleman and a counselor every day and took three prescription drugs under their guidance. On the last day, Coleman implanted a small Naltrexone pellet under the skin on Barker’s belly, where it slowly will impart its opiate antagonist into Barker’s system for several weeks.

Naltrexone blocks any kind of opiate from reaching the brain, so it is impossible to relapse. Barker will get continuing doses for about 12 months, helping his brain to recover physically.

3 years, $25,000
Barker and his wife spent more than $25,000 over three years on methadone. A doctor examined him just once, he said. He went six months without talking to a counselor. For several months, he was given two weeks’ worth of methadone to take home. Sometimes, he said, patients sell their take-home methadone for $1 a mg.

But when Barker asked to ratchet down his dosage so he eventually could stop taking methadone, he wasn’t allowed, he said.

“It’s awful the way it’s run,” he said, about the Charleston Treatment Center, located on Greenbrier Street beyond Capital High School. “I don’t understand how it’s been done this long.”

Phil Herschman is president of the opioid treatment program division of CRC Health Group, which operates six of the methadone clinics in the state, including the one in Charleston. He said counselors would rarely recommend supervised withdrawal.

“(Methadone) manages a disease for which there is not a cure, like high blood pressure,” Herschman said. “How often does a physician suggest you stop insulin?”

However, a clinic would try to work with an individual who wants to try, he said. It would take from six to 10 months by reducing amounts very slowly.

Later this year, Herschman’s company plans to introduce a “methadone-to-abstinence” program. It will take an addict two to three years to complete.

Though he’s disappointed in the moratorium imposed by the state Health Care Authority, Herschman said he understands the need to step back and evaluate.

Gerard Schmidt, chief operations officer of Valley HealthCare System, plans to ask the state for permission to open a methadone clinic in Morgantown in partnership with a Pennsylvania company.

He said methadone can be an appropriate maintenance drug, if the clinic also provides “wrap-around” services such as counseling, family therapy, screening and monitoring — services Valley plans to offer along with methadone.

“But I also believe there has to be a schedule for bringing these people off methadone,” Schmidt said. “I don’t believe it should be used long term.”

‘Legal drug dealer’
Barker, who was named Boone County’s basketball player of the year in high school and then spent three years studying at Concord College, paid $3,200 for the detox program with Coleman.

“He’s been great, very professional, top-notch,” Barker said. “It’s unbelievable how I’m doing. It’s indescribable to wake up and not feel like I have to depend on something to function. Why doesn’t the methadone clinic offer this as an option? Is it because of the money?

“What aggravates me, at the clinic, they say they are a treatment center. And they call you a patient. I don’t think I’m a patient. I’m a client. I’m buying drugs from a legal drug dealer.

“I’ve got two girls, 7 months and 2 1/2 years. You get on the right path and then there are forks in the road. Sometimes you take the wrong fork. I made that mistake. I’ve been paying for four years. I’m never going back. It’s over. It’s done.”

Writer Therese Smith can be reached at therese@dailymail.com.

© Copyright 2004 Charleston Daily Mail