Dealing drugs the legal way 

Methadone clinics were supposed to save people from the ravages of heroin addiction. Why, then, did five people die here last year of methadone-related causes? And why isn't the state bothering to regularly inspect clinics?

On January 3, 1996, Chris Brackett walked into a methadone clinic and met the woman who would counsel him through his treatment. She noted on an intake form that Brackett was 27 years old and a Methodist. He had finished three years of college and was starting work that week as a stagehand at the Fox.

The counselor also wrote that Brackett shot up heroin at least twice a day, and popped at least one Valium and one Xanax. Brackett agreed to a urine test, which, according to court documents, confirmed traces of those drugs. The clinic then started him on a 30 milligram dose of methadone. The intent was to curb his heroin cravings and withdrawal symptoms.

When Brackett returned to the clinic at 7 a.m. the next day, court documents say, a nurse gave him a 40 milligram dose, presumably because his cravings and symptoms hadn't ceased. He went home, to Canton, to rest. Brackett's live-in girlfriend walked into their apartment at 6 p.m. She found him dead on the couch. His autopsy listed the cause of death as "intoxication by multiple prescription medications, including methadone." The drugs allegedly had slowed Brackett's breathing until it stopped.

Brackett's parents, Barbara and Johnny, have filed a wrongful death lawsuit against the clinic, Lakeland Centres Atlanta. In their supporting affidavit, the Bracketts include testimony from Dr. Donald Jasinski, head of the Center for Chemical Dependence at Johns Hopkins Bayview Medical Center. "The treatment center should have known that he was not a suitable patient," Jasinski's affidavit reads. "It is medically well-documented that benzodiazepines [Valium and Xanax] adversely and sometimes fatally interact with methadone."

If the court finds the clinic erred, it wouldn't be the first clinic in metro Atlanta to make so egregious a mistake. A Creative Loafing examination of state inspection and autopsy reports, along with interviews of government officials, clinic workers and patients, shows that some local methadone providers regularly disregard government regulations, endanger the lives they're supposed to improve and seldom face even the mildest penalties. Among the findings:

There were five methadone-related deaths in Fulton County last year (heroin deaths numbered 14). Four of the people who died were current or former patients at methadone clinics, including a 20-year-old who had been kicked out of a clinic the day before his death. The fifth victim died from the combined effect of methadone and Ecstasy.

Clinics regularly give methadone to patients who haven't proved an addiction, increase dosages without a physician's approval and provide take-home doses even to patients who were caught selling previous take-home doses on the street.

Some of metro Atlanta's 10 methadone clinics have gone up to four years without state inspections, and some have faced no penalties or follow-up visits despite reports of multiple violations of state and federal regulations. One was skewered in a 1995 inspection report citing "serious violations," but the state didn't get around to visiting again until last year.

"It's an open-air drug market in those clinics," says Bill Reeves, a former heroin addict who spent three years in a methadone treatment program. "They're worse than dope dealers. The way it's dispensed is wrong."

The German pharmacists who developed methadone during World War II didn't intend for the synthetic narcotic they created to be dispensed as a substitute for heroin. They were looking for a non-addictive painkiller to give soldiers during surgery. Methadone hydrochloride wasn't the alternative they had hoped for. It caused nausea and vomiting, and there was no indication that people wouldn't get hooked.

But soon after the war, American drug companies saw potential profits in methadone. An uneasy argument was born between the new narcotic as a therapeutic panacea and as just another dangerous addiction. Commercial production and clinical trials of the new painkiller began in 1945. Two years later, an article in the Journal of the American Medical Association warned: "We believe that unless the manufacture and use of methadon [methadone] are controlled, addiction to it will become a serious health problem."

In 1963, two American psychiatrists began using the drug to treat addicts of heroin and other opiates. The psychiatrists theorized that once someone becomes addicted to an opiate, he suffers a disorder like diabetes and therefore needs his respective "insulin." With methadone, a patient could reach a "maintenance" dose, usually between 80 milligrams and 150 milligrams, where he was addicted -- but would crave neither heroin nor an increase in methadone.

The U.S. Bureau of Narcotics threatened to shut down the experimental treatments, stating that they were illegal. Instead, the Food and Drug Administration and Drug Enforcement Administration passed strict regulations that would allow clinics to use the drug to treat opiate addicts. The logic was to pull the addict off the street -- away from crime and disease -- and into a "maintenance program" in a medically supervised clinic.


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