Getting Their Daily Dose
Clinics serve up hope, care and methadone
By Mark Cromer
[A look back at dope sick junkies seeking relief more than three decades ago. First published on August 28, 1993, by Thomson Los Angeles Newsgroup: Pasadena Star-News, Whittier Daily News and San Gabriel Valley Tribune, the feature took a closer look at the addicts seeking to avoid getting back on smack by using Methadone. Given the Night of the Living Dead that has since unspooled across the cities, suburbs and across the rural heartland, it seemed worth a revisit to life before the onslaught of junkie hives where needle-freaks are slamming spikes out in the open of here, there and everywhere. There is clearly no longer a Panic in Needle Park.]
It’s early on a Thursday morning and the lobby of the Cornerstone Health Services clinic in Pico Rivera is slowly coming to life.
As they shuffle in from the streets, a dozen or more men and woman line up under the sterile glow of the fluorescent lights bathing the clinic’s interior.
Their faces represent a cross-section of America: Mothers with children, fathers on their way to work, prostitutes winding down their night shift and unemployed immigrants hoping to start a new life.
Most have at least two things in common: a heroin habit and, apparently, the desire to kick it.
They come to Cornerstone every day for a legal fix of methadone hydrochloride. A synthetic opioid, methadone is supposed to ease the craving for heroin.
It’s a scene that’s played out every day in more than 35 locations across the county, including at least 11 clinics in the San Gabriel Valley and Whittier area.
But those clinics are only serving the tip of the proverbial iceberg. Officials like Kristine Gebbie, the Clinton administration’s new AIDS czar, say there is a nationwide need for more programs like the one in Pico Rivera. Gebbie said in a recent published report that at best the United States has only one third of the treatment slots its addicts need.
“We’ve focused enormous attention on arresting drug dealers, but we haven’t looked at breaking the addictions that keep demand alive,” she said.
Proponents of methadone, which surfaced during the early 1960s, contend that the controversial treatment is the last chance for anything close to a normal life for addicts.
There has been encouraging news about the use of the substitute drug. A six-month study of 92 male intravenous drug users showed that methadone alone can cut opiate use by addicts. The results, published in a recent edition of the Journal of the American Medical Association, also showed that to have a significant effect, counseling has to be available to those in methadone programs.
Yet skeptics, including many law enforcement officials, argue that methadone programs are little more than legalized drug dealing. Such programs ultimately fail to make addicts clean and sober, they say.
In Pico Rivera, the county Sheriff’s Department has staged numerous sweeps in neighborhoods around Cornerstone, arresting dozens of addicts at a time.
As the drug war rages, the debate around methadone treatment has polarized. Recent news reports of methadone being smuggled out of a Hollywood clinic and sold on the street have fueled the fire.
Locally, there is a shortage of good methadone treatment programs, especially for the poor. The numbers surrounding methadone treatment in the county indicate what critics of the current drug rehabilitation system have long maintained: if you have the money, help is readily available. If you don’t, get in line and wait.
The approximate 9,000 licensed methadone “slots” available in Los Angeles County today – including both long-term maintenance and short-term detoxification programs – are roughly 80 percent full, said Richard Browne, a contract supervisor with the county’s Drug Program Office.
Government-funded slots, however, are swamped beyond capacity.
An addict can wait up to two years before a funded slot opens up, Browne said. Despite the vast demand, other than a brief infusion of federal funds several years ago, Browne said there has been virtually no increase in space during the past 10 years.
Cornerstone’s 275 slots are not full, but addicts hoping to get into one of its 50 funded slots better be prepared to wait. “Two years would be a hopeful estimate,” said clinic administrator Loretta Quenon.
How long addicts must wait depends on their circumstances, Quenon said. HIV-positive and pregnant addicts receive priority.
Some of the men and women who file into Cornerstone each morning are in the clinic’s 21-day detox program, which substitutes methadone for heroin and then weans users off methadone.
Clinic co-director Barbara Casucci said the number of addicts who go back to shooting heroin after detox exceeds 90 percent. But she said that doesn’t mean the program is a failure.
“It gets them off the street for 21 days, it introduces them to the clinic and methadone,” she said. “I know they will probably go back out into the streets, but at least they know there is some place they can go to for help.”
The three week-program can be a turning point for addicts because they are exposed to the myriad of programs the clinic offers, she said.
“It’s a one-stop shopping model,” she said, pointing to parenting classes, HIV testing, nutrition courses, vaccines and medical care available at the clinic.
The medical side of the clinic helps pregnant addicts, including 30 hours of required prenatal and post-partum classes.
Women also receive prenatal care referrals and the doctors apprise clinic workers of the mother’s progress. To date, more than 200 babies have been delivered through the clinic’s pregnant addict program since it opened in 1986.
“These are folks who are on the streets and afraid of institutions and what they represent,” Barbara said. “So, it’s very important to have this for them.”
Most of the addicts who come to Cornerstone enroll in the clinic’s long-term methadone “maintenance” program in which the drug is dispensed to them on an open-ended basis.
Only a fraction of those, between 5 to 10 percent, will eventually wean themselves, Quenon said. But a larger number, more than 60 percent, will eventually kick heroin completely and maintain a stable life using methadone, she said.
“It worked for me for years, which is why I came back,” said a 36-year-old East Los Angeles woman named Rosie, who brought two of her children with her to the clinic.
“I went clean after my pregnancy and stayed clean for a couple of years using methadone,” she said. “Then I had family problems and I got back into heroin. So that’s why I’m here.”
Still, Rosie said she plans on being one of the few who actually wean themselves from methadone and go completely drug free.
“Some people use methadone as a crutch, but I am not going to make this a way of life,” she said. “I’ve got better things to do.”
Barbara Casucci’s husband, Michael, clinic co-director, watches the addicts file past him in pairs to the box office window of the dispensary where they receive a small plastic vial of the drug. Staff members must monitor the addicts as they swig the doses, making sure they aren’t keeping any of the drug in their mouths to smuggle it outside.
The Casuccis admit that when reduced to the bare essentials, methadone programs do trade one addiction for another. But in that trade, addicts can go from “slamming” $150 to $200 in heroin a day to taking a single dose of methadone, they said.
Instead of trying to support a $1,000-a-week habit, the addict has only to pay $160 a month for methadone maintenance treatment. Ultimately, methadone is a cheaper, more convenient and safer addiction to maintain.
“It may seem like a lot of money,” Barbara said. “But it’s negligible to what an addict has to pay to support a habit on the street. That’s why I say we are doing the police a favor. You can figure out where addicts get the money.”
Yet critics remain far from convinced that methadone programs work. Some argue that the treatment is little more than a crutch for criminals.
Addicts often use methadone as a shield, said Sgt. Ed Huffman, a veteran sheriff’s narcotics officer at the Norwalk station.
“They are constantly telling us they are in a program in the hope that we won’t take them away,” Huffman said. Yet if they have shot “smack” they’ll be arrested whether they are in a program or not, he said.
While methadone may ease the physical craving for heroin, Huffman said heroin users are just as addicted to a freewheeling lifestyle totally centered on “scoring” as they are to the drug.
But addicts can be taught to change their way of life, Michael Casucci argues, even if they aren’t drug-free.
“You may never stop them or cure them, but you can stop them from robbing. You can stop them from killing. You can stop them from spreading AIDS,” he said. “That’s what I care about.”
Eight years of heroin, 21 days of methadone
Heroin has made Tony Perea what he is today.
Unemployed and living on welfare, he’s done jail time for committing more crimes than he can remember. He and his girlfriend are trying to raise their four children while living in a tiny motel room.
Perea has spent the better part of eight years shooting what is known on the street as “smack.”
But now he is trying to change all that. For the third time since 1988, he’s entered a methadone detoxification program, this time undergoing treatment at Cornerstone Health Services clinic in Pico Rivera.
Statistically, the odds are stacked overwhelmingly against him. Officials at Cornerstone note that more than 90 percent of the addicts who enter their detox program eventually return to heroin.
He has less than a week left in the 21-day program, and on this lazy summer afternoon, Perea is at home with his family, reclining on a couch in a tiny room at the Lyn Mar Motel.
He occasionally glances over at his girlfriend of nine years, Denise Torres, who is sitting close by for support. Torres is a recovering addict who started using heroin when she moved in with Perea and his relatives.
His constantly tapping foot and darting eyes belie his otherwise languid demeanor. The children mill around the room, seemingly oblivious to their father’s words.
“A lot of my family was into heroin and I just followed right in their footsteps,” he said. He eventually succumbed to temptation and stuck a needle in his arm for the first time in 1985.
It didn’t take long for the unrelenting craving to set in.
“Once you start getting strung out on it, you need it every day,” he said.
Perea said he stole from department stores to support his habit: clothes, music tapes and anything he could easily lift and then return for money back.
“It was a monotonous routing,” he said, one that made him a familiar face to California’s criminal justice system. Perea estimates he’s been arrested at least 15 times.
There were times when the couple went straight, managing to clean up for six months at a time, but they always fell back into old habits.
Eight years of junkie hell has been a long road for Perea, one he said he simply couldn’t handle any more.
“It got to the point where I was afraid to go to sleep at night, knowing I didn’t have enough money to buy a fix in the morning,” he said.
The HIV virus sweeping through the ranks of intravenous drug users also convinced Perea and Torres to try the treatment again, before it is too late for them to mend their ways. He said both have tested negative for the deadly virus, so far.
Though he wants to rid his body of heroin, Perea said he knows withdrawing from methadone can be just as bad or worse than heroin withdrawals.
Perea said he was arrested in October of 1991 for possession of heroin and drew a two-year prison sentence. Because he was on a methadone maintenance program at the time of his arrest, Perea was forced to kick the drug cold turkey behind bars.
While it eases the craving for heroin and doesn’t build a need for ever larger doses, health officials have said methadone has a longer “half-life” – longer withdrawals.
“When I was arrested this last time, oh boy, did I kick! I had some serious withdrawals. I was hitting the walls,” Perea said. He recalled the long sleepless hours that would pass before he would eventually nod off, only to awake suddenly, his body twitching.
While Perea said he hopes to stay clean and avoid becoming reliant on a methadone maintenance program, he supports those who count on the drug every day.
“It’s not heroin. It’s legal. And people don’t have to steal,” he said.
Perea said he wants to take being clean one step at a time. Already free from having to hustle up a fix every four hours, Perea said he has more time and money to spend on his children.
From there he wants to find a job – he’ll take anything – and get his family out of the motel.
Big plans, perhaps, given that methadone failed to keep him clean the last two times. Yet Perea remains optimistic that this time will be different.
They plan to cut off their old friends and cling together. They hope family bonds will prove stronger than heroin.
Perea knows the odds. He just wants to beat them.
“Just will power,” he said. “Sheer will power. That’s all we can do.”
