By LAURENCE HAMMACK
THE ROANOKE TIMES

Archives Reprint

Ralph Cockrill has just taken his daily dose of a drug that killed 44 people in Western Virginia last year.

And he's never felt better.

Cockrill is on methadone - a double-edged narcotic that can be a curse for the drug abuser he used to be and a cure for the recovering addict he is today.

Four days a week, Cockrill drives 90 miles from his West Virginia home to the Life Center of Galax, where he is a patient at the center's methadone clinic. He drinks 80 milligrams of methadone from a plastic cup, then chases it down with water.

Methadone stops Cockrill's craving for OxyContin, the prescription painkiller that once ruled his life. Before he got hooked on OxyContin, Cockrill did about every drug imaginable: marijuana, cocaine, heroin, PCP, Dilaudid.

"My life was a gutter," he said. The 53-year-old tried treatment and detoxification programs, but nothing worked. Then he started taking methadone in April.

"I'm normal, just like I am now," he said earlier this month at the Galax clinic, clear-eyed and coherent after being "dosed" for the day. "Everybody here has treated me like gold," he said.

Despite such testimonials and studies that show methadone is an effective way to treat addiction to opium-based drugs, its use remains controversial.

Critics say methadone clinics substitute one addictive drug for another. And methadone can be deadly when abused.

Fatal overdoses from methadone shot up from four in 1997 to 44 last year in the western half of Virginia, according to the state medical examiner's office. However, there is no evidence that the methadone involved in the deaths came from a treatment clinic.

Two months ago, the Life Center of Galax announced plans to open a satellite clinic in either the Roanoke or New River valley. An exact location has not been proposed. But if history is any indication, there will be opposition.

Emily Jennings was once one of the doubters.

Jennings, director of clinical and professional services at the Life Center of Galax, was skeptical two years ago when officials at the drug treatment center decided to start a methadone clinic.

The concept of giving drugs to drug abusers seemed to violate the center's mission. But the more Jennings learned about methadone, the more accepting she became.

First, there was the need:

In the 1998-99 fiscal year, 28 people who came to the center listed opioids as their drug of choice. The following year, that number jumped to 148. The year after that, it was 349. Most people were addicted to OxyContin, a prescription painkiller dubbed "hillbilly heroin" for its widespread abuse throughout Appalachia.

Then Jennings looked at solutions:

After three months of taking methadone, less than 10 percent of clinic patients used heroin daily or weekly, according to a study by the National Institute on Drug Abuse. After two years, the study found, heroin use declined by an average of 85 percent. Crime by addicts also was down, as they no longer had to rob or steal to support their habits.

"If you look at the facts, there is overwhelming research to prove this is the only thing that has had any success rate," Jennings said.

Methadone is a synthetic narcotic developed by Germany during World War II when its morphine supply was running low.

The drug comes in two forms: as a painkiller prescribed by physicians, and as a treatment for addiction supplied by federally licensed methadone clinics.

When properly administered, methadone blocks receptors in the brain that make opioid addicts crave their next fix. It also prevents them from going into withdrawal. The treatment is effective only for opioids, which include heroin, morphine and OxyContin.

Methadone does not create a high when used properly, Jennings said, nor does it impair a user's ability to drive or operate machinery. In 1975, a methadone patient who was fired from his job as a New York City bus driver filed a lawsuit and was reinstated to his position.

The drug is not for everyone; addicts must have a documented history of abusing an opioid for at least a year before they are admitted to the Galax clinic. Each patient is evaluated by a doctor who is part of the clinic staff.

Clinic patients remain on methadone for at least two years. National studies show that 85 percent of methadone users can be weaned off the drug within three years, Jennings said. The rest must take daily doses indefinitely.

At first, patients are required to visit the clinic every day. Under the close watch of counselors, they enter a locked room alone and drink methadone from a cup. They then must drink a cup of water and speak to counselors to ensure they are not concealing the drug in their mouth.

If patients do well in the program - which includes counseling, drug testing and other services - they are allowed to take a dose for the next day home with them in a metal lock box.

About 115,000 people are enrolled in methadone clinics across the country, according to the National Institutes of Health, which has called for greater access to the treatment.

The Galax program has about 350 patients, and another 450 get their methadone from a clinic the center opened last year in Tazewell County.

Galax and Tazewell County have the state's only methadone clinics west of Charlottesville.

"There's a treatment gap between Tazewell and Charlottesville," said Jay Clarke, president of the Virginia Alliance of Methadone Advocates. "That's a big gap. I get people calling me from that area and asking: 'Where do I go for help?' "

The shortage forces many patients to drive long distances for treatment. And when they finally get to the clinic, they are often placed on waiting lists.

About 200 people are waiting to enroll in the Tazewell clinic, Jennings said.

Between 50 and 70 patients at the Tazewell clinic are from either the New River or Roanoke valleys and would likely be transferred to the new clinic when it opens, Jennings said.

So far, the only location mentioned for a clinic has been a former Jehovah's Witness hall in Troutville. Those plans were dropped, but not before stirring concerns among some in the community.

"I don't think we need it here in the county," Botetourt County Sheriff Ronnie Sprinkle said of a clinic. "You take somebody off of heroin and you're going to get them hooked on methadone, and you're going to have them coming in from all areas of the state to this area."

The Life Center of Galax, which faced community opposition to its Tazewell County clinic last year, is not elaborating on plans for its newest location, except to say that a lease has not been signed.

"Corporate policy does not allow discussion of business transactions while in development and negotiation," CEO Tina Bullins said in a prepared statement.

The Life Center of Galax is a two-story, brick building that looks more like a college dormitory than a temporary home for drug addicts.

The 50-bed private facility has been a haven for alcoholics and addicts since 1973. Patients can stay at the facility for up to 28 days as part of an intensive detoxification program, or they can come and go for counseling sessions as outpatients.

Some people who live nearby on Painter Street said they noticed a change two years ago, when the center's services were expanded to include the methadone clinic. Out-of-town patients would arrive as early as 4 a.m. to get in line. Many of them seemed to be in a hurry, said Opal Poff, who noticed an increase in traffic and speeding.

"Early in the morning, we hear them," Poff said. "They come up here just zooming. We don't get any sleep hardly. It's just zoom, zoom."

Other Painter Street residents have no problems with the clinic.

"They don't bother me," Mamie Osborne said. "I think it's a great place to have people get treatment."

So far this year, police have been called to the center 10 times for reports such as disturbances, noise complaints and thefts from cars. That's not an unusually large number of calls, Galax Police Chief Rick Clark said.

"Overall, I would say that they have been a good corporate neighbor," he said.

Other police agencies say that while they have not been overwhelmed with clinic-related problems, they have run into their share of thefts, traffic violations and drug offenses associated with patients. In Tazewell County, a man looking for drugs was charged with trying to break into the methadone clinic, Commonwealth's Attorney Dennis Lee said.

Illegal use of methadone is up in Tazewell and other parts of Southwest Virginia. Lee, who serves on a state task force examining prescription drug abuse, says that recent crackdowns on OxyContin appear to have made methadone more popular as a street drug.

"Basically, it's something our addicts will fall back on," he said.

The high number of fatal methadone overdoses - 44 last year, compared to 40 from OxyContin - does not appear to be directly linked to the clinics. Methadone clinics supply the drug in liquid form; most of the illegal use seems to come from pills prescribed by physicians that are turned over to the black market.

In Montgomery County, a woman was charged with murder after her infant son died from methadone she allegedly gave him. In Roanoke, a physician faces federal charges and lawsuits claiming that his copious prescriptions of methadone killed at least one of his patients.

But of the more than 1,000 people treated at the Life Center's methadone clinic, not one has died from an overdose, Jennings said. Nor was she aware of anyone selling methadone obtained from the clinic.

Clarke, of the Virginia Alliance of Methadone Advocates, said most people who use methadone illegally are addicted to another drug such as heroin or OxyContin. They are not trying to get high, he said, but simply are seeking relief from either constant drug use or withdrawal symptoms.

Patients in methadone clinics not only have no craving for their old drug, he said, they have no incentive to sell their new one.

"I wouldn't give you my medication for anything, because that's what it takes for me to function," said Clarke, who got hooked on heroin as a high school dropout. Now on methadone, he makes good grades at Old Dominion University.

Methadone advocates say the stigma associated with drug addiction makes treatment hard to get for many people.

Most insurance plans do not cover methadone treatment for drug addiction, even though it is prescribed by a physician, Clarke said. The large majority of the patients in Galax and Tazewell pay $70 a week for their treatment.

And six states still have laws that prohibit using methadone to treat drug addictions, according to Holly Cantini of the Baron Edmond deRothschild Chemical Dependency Institute of the Beth Israel Medical Center in New York.

If a methadone clinic opens in Roanoke, it will be the city's first since the early 1970s.

Graham Stephens, an emergency room physician at Roanoke Memorial Hospital at the time, said that clinic was formed after authorities broke up what amounted to an unsanctioned methadone operation run by a local doctor and pharmacy.

With addicts desperate for treatment, the hospital, a group of doctors and the Roanoke Academy of Medicine joined forces to create a methadone clinic.

"It was not the most fun thing that I've ever done in medicine," said Stephens, who directed the clinic and has since retired.

"This was the 1970s, remember," Stephens said. "I'd sit there in group therapy, and they'd cuss each other and be filthy-mouthed and get into fights. Their behavior was such that it would horrify the vast majority of polite society."

But in the end, he said, the clinic was able to help many of the addicts, who were hooked on the prescription drug numorphan or heroin. "They came to the Roanoke Academy and expressed a need, and we responded," Stephens said. "I think we did some good."

The clinic - which was in the hospital's Rehab Center on Jefferson Street - closed several years later, after its patients either completed the treatment or dropped out.

Thirty years later, people like Cockrill say they are proof that the need for a methadone clinic still exists.

"I'm 53 years old, and I've been doing drugs since I was about 13 years old," he said. "The only thing that works so far is the methadone."

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