Methadone’s effect on addicts and communites

Eric Alamo shielded his eyes from the sun as he walked out of the Carmen Iris Capeles Treatment Clinic on Westchester Avenue.  It was an unusually hot and humid August day in Hunts Point. Alamo had walked three miles for a fifteen-minute appointment, his shirt drenched with sweat from his trek. It wasn’t much better inside—the air conditioner wasn’t working.

Alamo was a heroin addict for 34 years. Living on the streets for a good part of his life, he said he chased garbage trucks down Hunts Point Avenue for scraps of food after his mother’s suicide left him parent-less at the age of 12. He remembers the day, December 26^th, 1972, when his mother poured gasoline on herself and died by the flame of a match. At that time, he said, his extended family took him in, allowing him to “run wild in the streets.” Alamo joined a gang the same year, then, at age 13, began shooting heroin.

Today, Alamo said he suffers from psychological trauma from witnessing his mother’s death. Similarly, after years of injecting heroin, he contracted Hepatitis C. This is only compounded by what he calls “a bum leg”, caused by a motorcycle injury rendering him permanently dependant upon a cane. His injury, Alamo said, was “a wake-up call” to “go clean.” This was four years ago, and now at age 50, he said he has made great progress in rehabilitating himself. “At first it was really tough,” Alamo said, referring to his withdrawal symptoms, including intense stomach pains, “But I haven’t touched the stuff in years, and I’m proud of that.” Alamo heard about the Capeles Clinic from a friend who was undergoing treatment there for heroin addiction, “Methadone really helped him out,” he said. “And I knew that’s what I needed to do to get off the streets.”

Methadone, a synthetic opiate, has been used in New York City and throughout the United States for treating withdrawal symptoms associated with quitting heroin after long-term abuse. According to a 2005 report by the National Institute on Drug Abuse, methadone clinics, such as the Capeles Treatment Clinic, started in urban areas during the 1970’s and 80’s. In the South Bronx, methadone clinics were used as a preventive force against diseases such as Hepatitis C and HIV, which were spreading at alarming rates among drug users who were sharing needles to shoot heroin.

While many clients of methadone clinics, like Alamo, claim the use of methadone has allowed them to end years of abuse, many local community members disagree. Some politicians, neighborhood residents, and even some of the clinics’ workers, oppose the use of methadone, seeing the treatment of heroin through the administration of another narcotic as perpetuating addiction. Louis Krigger, the clinical director of the Capeles Treatment Clinic, said he was ambivalent with the results he had seen with methadone treatment.

“A lot of people come in here,” Krigger said. “Some people require methadone six days a week to get them through the withdrawal symptoms, some only need to come in once a week. If methadone is used for the right reason, it can have good results.”

Krigger has only worked at Capeles for four months, but has been involved in heroin treatment programs in the Tremont community of the Bronx for the past 15 years. In the Capeles Clinic, he has more than 600 patients, with only 10 counselors and clinicians to treat them. He said the number of patients sounds startling, but is typical for most methadone clinics throughout the United States. “The last clinic I worked at had nearly 1,000. You’ll see most places in New York will have 500 to 900 clients,” Krigger said. “Some clinics may be the only one for an entire state, so they might have much more than that.”

According to New York State’s Department of Health, there are 30 methadone clinics in the Bronx, more than a quarter of methadone clinics in New York City. New York City’s total 86 clinics make up more than 75 percent of the methadone clinics in the state. The high density of methadone clinics in the Bronx has been a source of anxiety for some community leaders and residents, who are wary of the drug treatment centers marring their neighborhood. John Roberts, the District Manager for Community Board 2 in the South Bronx, said that his district does not have any methadone clinics of its own. In a phone interview last week, Roberts said, “It’s kind of like having a strip joint in your neighborhood. People don’t want that. I’m proud there aren’t any methadone clinics in Community Board 2.” Since several methadone treatment centers, including Capeles, reside within blocks of Community Board 2’s western boundary, Roberts is concerned about the clientele methadone clinics bring into his community. “Because of the concentration of methadone clinics, a lot of people are coming in from other areas to get treatment around here. People stand outside of clinics causing trouble. While drugs may always be here, if it’s out of sight, it’s out of mind,” Roberts said.

Some neighborhood residents also wonder whether patients are using methadone for its proper purpose. Wanda Caceres has been a clinician at Capeles for ten years, and lives a few blocks away from the treatment center. “The way that society is now, there are a lot of people looking to get more drugs,” Caceres said. “A lot of homeless people buy methadone, or go into the treatment program trying to get some. People are using it to get a high. Since I’ve been here, the number of people coming here has definitely gotten higher.”

Advocates for methadone treatment have said such anxieties are unfounded. Supporters cite methadone’s high success rate in moving addicts from heroin dependency. A 2008 study of Bronx methadone clinics conducted by Dr. Julia Arnsten of Montefiore Medical Center showed 99.8 percent of random drug tests of methadone patients yielded no heroin use. On average, the study’s subjects stayed in methadone treatment for 2.7 years until they were released from rehabilitation.

Some clinicians believe the drug is not enough to rehabilitate addicts. Ira Marion, the Executive Director of Albert Einstein College of Medicine’s Division of Substance Abuse in the Bronx, said the “profile” of the heroin addict has changed from 30 years ago. Many suffer from mental health issues such as depression and schizophrenia. In addition, many come into clinics with existing addictions to other drugs, like cocaine, crack or OxyContin. Marion said methadone is important in getting addicts off heroin to move into more comprehensive care. “The approach to treatment should be leading clients to a more productive life, rather than being drug-free,” said Marion. “Once a patient is off heroin, we can begin addressing their other needs.”

Marion also disagrees with the “not in my backyard” attitude many residents have concerning methadone clinics. “We have to get the morality part out of drug treatment. The idea that methadone clinics are hurting communities keeps addicts from searching out treatment. But no one would tell a diabetic to stop taking insulin because it’s a drug.”