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Patients interviewed by CL claim they can easily work the system to get more methadone. State rules say clinics can start a patient on a maximum dose of 30 milligrams and can increase the dosage until signs of withdrawal disappear. (A 50 milligram dose can kill someone who hasn't built up a tolerance to opiates.) A physician is supposed to approve dosage increases, and it's pretty standard to get five or 10 additional milligrams every few days until the dosage reaches between 60 milligrams and 100 milligrams, or until the patient no longer craves heroin.
Some patients say upping their dose is as easy as returning to a dealer to get more dope. If they complain of leg cramps, insomnia or other withdrawal symptoms, the dose goes up. Those symptoms can't be proved -- or disproved.
"The first week or two that you get on it, you're still high. You don't get that big rush on it, but when you sit down you're nodding out," says one patient, who asked not to be named for fear of relatives recognizing him or of clinic retaliation. "The 30 milligrams helped me, kept me from getting sick. I asked for more only because I wanted more. I wanted to keep getting high."
His counselors said he could keep getting increases until he didn't want them anymore. The counselors told him to be sure not to use other drugs so that his tests would be clean and he would be a candidate for take-home doses. He said they never warned him that methadone, used with other drugs, could be lethal. And they didn't warn him about how addictive methadone is, or how painful its withdrawal symptoms can be.
"I'd rather kick heroin 10 times than kick methadone once," he says of his attempt to quit. "I didn't sleep for 16 days. All that shit's trying to come out of your joints and muscles. I broke my tailbone twice, while racing motorbikes and skateboarding. That hurt less."
He warned his friend, who had been addicted to heroin less than a year, not to get hooked on methadone. The friend opted to use methadone to mask the first week of heroin withdrawal. After a week on methadone last November, the friend quit both drugs.
"I really didn't want to be addicted to methadone," the friend says. "I saw the people coming in and they were just as desperate as people on the streets. It's like you've got an internal clock. It's either go to the dealer every day or go to the clinic every day. What's the difference?"
Not much, according to the current patient.
"They come across that they want to help you, but it's a trap," he says. "You're doing [methadone] because you want to help yourself, but you're doing something that's worse. They don't stress how hard it is to come off it. It's like legal dope. It's like government dope."
Patients with clean drug screens sometimes are rewarded by getting a dose or two to take home. After a year of clean urine tests, a patient can get up to a week of take-home doses (although inspection reports show that many clinics don't routinely drug test or that they dispense take-home doses to people who fail drug tests). That privilege can be abused. Giving an addict take-home drugs can be akin to giving poker chips to a compulsive gambler.
Because the high lasts so long, methadone can be more desirable than heroin. Reeves says it sells on the street for between 50 cents and $1 per milligram in liquid form. A 40 milligram tablet, which clinics are supposed to dilute in water but often don't, goes for $50.
Neither Atlanta police nor the Georgia Bureau of Investigation keeps drug statistics on methadone busts. The DEA's Bob Williamson says federal and local narcotic investigators don't crack down on methadone street sales because the drug moves in such tight-knit circles. Mark Burns, head chemist in the GBI crime lab, says arresting officers have sent him only two methadone samples to test in the past year. Those two samples and samples from years past have typically been the liquid methadone that comes from clinics.
"You can't give junkies extra dope, dope to walk with," says Reeves, who used to sell two doses a week so that he could buy other drugs. "I can't think of anybody with take-home [doses] who hasn't sold them."
The rapid growth of the methadone-clinic industry -- and the public health and illegal-drug issues that surround it -- have prompted a response from the federal government. As a result, the state may play a smaller role in methadone regulation or no role at all. But it's unclear whether new federal regulations, which begin to take effect next month, will solve the problems or simply shift them.