Project MOD helps heroin users control addiction

01:00 AM EDT on Sunday, September 5, 2004

BY TOM MOONEY
Journal Staff Writer

PROVIDENCE -- Most mornings Kathy St. Jean walks the five-mile loop from the Amos House shelter to the clinic on Huntington Avenue for her methadone, walking streets she would otherwise be prostituting herself on if not for 70 milligrams of clear liquid narcotic served up in a paper cup.

"This is my area," she says on one of her daily pilgrimages for her dose. "Parkis Street, Elmwood, Sprague, Broad."

As a heroin user, she never tracked how much she injected each day or how much money "the monster," as she calls her addiction, demanded she raise. What is the sum of as much as possible?

"I'd have one date for fifty bucks and then I'd rob the next one for $250. I'd come off one high and shoot up again, just because, if I could."

She glances toward the old factories sitting back off Sprague Street where prostitutes ply their trade away from the police.

"If not for Project MOD, I'd be right out there," she says. "It's scary back there at night. There's nowhere to run."

PROJECT MOD (which stands for Methadone Opiate Dependency) is one of the few programs of its kind in the country. Run by The Miriam Hospital and financed with a federal grant, it provides heroin users leaving the Adult Correctional Institutions with free methadone for three months and then another three-month supply at half-price.

The stabilizing replacement drug stops heroin users' insatiable cravings without creating the euphoria, allowing them to function more normally.

By intervening at that critical juncture when drug users like St. Jean are being released, Project MOD organizers hope to break their well-tread cycle of relapse, lawlessness and reincarceration.

"This is just a no-brainer," says Dr. Josiah Rich, of The Miriam Hospital, who has worked for years with HIV-infected inmates at the ACI. "You have people who are addicted to narcotics and because of their addiction they are cycling in and out of jail. We have a great treatment; it's highly effective in reducing criminal behavior and HIV and improving health, so why not treat them?"

Not only does the methadone improve the users' health and reduce the risk of HIV infection (passed through the sharing of dirty needles), it's also much cheaper than incarceration.

The annual cost of housing an ACI inmate is about $36,000, compared with about $4,100 for a year's supply of methadone.

AT 45, St. Jean's circuitous struggle with drug addiction and hard time is written in craggy wrinkles around her blue eyes.

She was in sixth grade when she broke the arm of a boy who kept pulling her blond ponytail. She threw a typewriter at him and ended up in the Training School. She was 15 and a runaway when she began using drugs and prostituting herself on her neighborhood streets of South Providence.

She was 23, using heroin and starting a five-year sentence for robbery, when she gave birth in prison to her first child. And she was 35 and on home confinement when she delivered her second child.

"I've been in and out of jail all my life," she says. And for much of that time a heroin user.

"I loved it as soon as I tried it. It took away all my problems. I just thought it was the world. I loved the drug so much."

Michelle McKenzie, the director of Project MOD, says research suggests longtime use of heroin can permanently alter the brain so that users forced into abstinence through prison can still crave the drug after long periods of sobriety.

St. Jean says there were many times during her incarcerations for shoplifting, robbery and prostitution when the thought of using heroin and cocaine filled every conscious moment.

"I would talk about how [high] I was going to get as soon as I got out. I couldn't wait."

McKenzie's research shows the staggering rate of relapse for untreated released inmates.

Nationally, as many as 75 percent of parolees with histories of heroin and/or cocaine use return to drugs within three months of their release. And in the last two decades, as society has clamped down on drug offenders, the nation's prisons have swelled.

Project MOD began enrolling former inmates for its program in May 2003. Of the 205 who have since signed on, 59 have dropped out before completing the six-month treatment and counseling program.

Of the 146 who finished, 50 (or 34 percent) reported being employed full- or part-time afterward, compared with only 12 percent at the time they entered the program. And 40 (28 percent) reported still using heroin compared with 82 percent when they started the program.

Only about half of the participants remain in treatment. Many can't afford the $80 a week for methadone, increasing the odds that they will again seek heroin on the streets.

Still, McKenzie says the program is worthwhile; many heroin users try and fail several times before controlling their addiction.

METHADONE has been controversial. Though it has been used for 30 years as a means of controlling opiate addiction, it is also addictive and highly regulated.

In 1998, Mayor Rudolph Giuliani announced a plan to end methadone-treatment programs in New York City, saying the treatment was substituting one addiction for another.

But Giuliani reversed himself six months later after stunned national and local drug-treatment experts persuaded him that methadone, not abstinence, was the best hope for the vast majority of recovering heroin addicts.

Methadone must be dispensed from licensed clinics, whose appearance in some communities has been anything but welcome. Heroin users must endure the humiliating routine of visiting the clinic every day to receive their dose. (Methadone is dispensed in 13 locations in Rhode Island.)

Methadone has been more widely accepted in other countries. For example, in Australia, Canada and Europe, prisons routinely treat addicted inmates with methadone while they are serving time. The synthetic drug prevents the painful symptoms of withdrawal (severe nausea, diarrhea, agitation) and thus helps maintain prison order.

In the United States, entrenched prison culture -- which has historically dictated that incarceration is a prison's main objective -- has hindered wide use of methadone, researchers say.

While the ACI and other prisons do administer methadone to pregnant inmates -- and occasionally to those already in a methadone program who are spending a few days behind bars -- few corrections officials, McKenzie says, want to advocate for a controlled substance.

The state Department of Corrections is more open to the idea than many other prison systems in the country.

"I think it's just an evolution of the professionalism of corrections," said Scott Allen, the ACI's medical director. "We are nationally finally looking at the things that go beyond our doors. For the last 30 years, the conversation has been about locking them all up. I think we've gotten to the point where people are correctly asking: 'Boy, they keep coming back. Can't we do something about that?' "

Corrections Director A.T. Wall is a vocal supporter of Project MOD, which he sees as promoting public safety by improving public health.

"We take a practical and pragmatic approach to substance-abuse treatment," Wall says. "If somebody needs methadone in order to avoid committing a crime to get illegal drugs, or risking their health by injecting themselves with a dirty needle, then we think they and the public are served by making methadone available."

When an inmate walks free from the ACI, Wall says, "it is our experience that those first couple of days after prison are critical. If needs -- be they housing, income or substance abuse -- aren't met very quickly, an opportunity is lost and the ex-inmate starts to cycle downward again. They return to prison after having caused further harm in the community."

"It's less expensive to provide the treatment needed for someone to get back on their feet than it is to incarcerate them."

Project MOD officials saythat eventually they may consider providing methadone -- or other new promising drugs -- to inmates prior to their release if it would improve their chances of staying clean and lawful.

Allen, the ACI's medical director, says that if treating inmates prior to release increases their chances of continuing methadone treatment afterward, "then yes, I think it's a reasonable thing to look at."

St. Jean says she is certain what would have happened had she not enrolled in Project MOD when she was released in July, after serving 60 days for assault.

"I would have come out and craved the same [drugs] and dug myself a deeper hole."

Now, after about a month on methadone, "I haven't even craved a nip" of alcohol.

On her way back from the methadone clinic, St. Jean says, "I don't want to be homeless. I don't want to keep living the way I've always lived.

"Some day I'd like to take my kids to a movie. I'd love to see a play downtown. You know I've never even been inside the Civic Center."