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By 1970, methadone clinics had opened across the country. Approximately 800 clinics operate today; they have 115,000 patients.
Many of Atlanta's 1,500 methadone patients wake before dawn to stand in line for the dose that will get them through the day. The names of the clinics -- Atlanta Metro, Southside and Georgia Therapy Associates, for example -- are as nondescript as their locations, sometimes just a discreetly-marked house or a few rooms behind a door in a sterile office park.
Inside, patients step up to the dosing window. They drink their drug out of a plastic cup, spiked with Tang or cherry flavoring. They pay either $3 per dose at one of two public clinics in Atlanta, or between $9 and $12 at one of the area's eight private clinics.
The high is not as intense as heroin's, but it does create a euphoria, starting with warmth in the stomach and spreading to a pleasant heaviness in the arms and legs. Methadone's effects last 36 hours, versus heroin's 12.
"For somebody [not an addict] who wants to get high, 20 milligrams will pretty much waste you for a day and a half," says Reeves, 41, who quit methadone four months ago.
Until the late 1980s, methadone clinics in Georgia were almost entirely publicly-funded and operated. Methadone stayed out of the domain of regular doctors' offices partly because of the FDA, DEA and, later, state restrictions. But in the 1990s, private clinics began appearing. The business was proving profitable. Addicts pay up to $300 a month for methadone versus $100 a day for heroin. A clinic saves the addict money -- and has the potential to bring a fair chunk of change to its owners as well. A private clinic with 200 patients is guaranteed a monthly income of almost $60,000.
"Now there are these programs competing with one another," says Dr. Thomas Hester, head of the state Department of Human Resources division that oversees methadone clinics. "Some of them are advertising, offering enticements if you brought somebody else in, giving you your dose cheaper. They were recruiting people."
With entrepreneurs capitalizing on people's addictions, the DHR to rethink the way it regulated clinics. Based on the growing number of private methadone programs and on the fact that the FDA had quit inspecting clinics, in 1997 Hester rewrote the state rules. He planned to enforce both his new rules and the unenforced federal ones.
"There's a risk for someone who's not an ethical provider to just give people what they ask for to keep them coming back and paying," he says. "We thought that it was very critical that there be credible regulations to protect the field, to be there for patients."
But the rules, which went into effect in April 1998, haven't always been enforced. In those three years, only six of the 10 metro Atlanta clinics have been inspected. Another three clinics have not been looked at since 1997. One more clinic has not been inspected since 1996. (There is nothing in state law that says how often the DHR must inspect clinics.)
Hester acknowledges that the clinics are not his top priority. He has other responsibilities. He oversees all eight state hospitals and is the chief administrator for 13 regional DHR offices. In fact, methadone clinics appear to have slipped through something of a crack in the state's regulatory structure. Other private medical facilities are now overseen by the separate DHR Office of Regulatory Services, which specializes in setting standards, regularly inspecting, enforcing regulations.
"We have not been in an ideal position to be as timely as we like," Hester says of the DHR's methadone program. "And unfortunately, there have been times when we've gotten much further behind in following up than I would prefer."
Of course, follow-ups haven't forced any improvements anyway. No Georgia methadone clinic has ever been fined. Indeed, there's no mechanism in state law to fine a methadone clinic. The state can revoke a clinic's license, but only once has threatened to revoke one in the metro area; that clinic changed ownership before the state followed through. With such minimal oversight, clinics are left to run as they please, with little more than their consciences- and the threat of lawsuits -- to guide them.
DHR inspection reports, which CL obtained through the state's Open Records Act, reveal that at six of 10 Atlanta-area clinics, patients have been dosed, or have gotten dosage increases without the physician's required approval. At four clinics, patients have walked in for the first time and been given methadone without proving they suffered an opiate addiction. At four clinics, patients who failed urine tests for illicit drugs were allowed to take home supplies of methadone (a clinic in Texas was shut down in 1993 when state inspectors cited the same violation). Three clinics have stored their methadone in plain view and within access of staff and patients. And patients at two clinics have been caught selling their doses; still, their take-home supply wasn't cut off.
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