Every morning, Ed, 52, takes a life-saving medication.
Last week, for the first time in 20 years, he got his medicine in Lancaster, where he lives.
He went to Ganse Apothecary, 355 W. King St., and a pharmacist filled his prescription for methadone.
It was not only a first for Ed, which is not his real name. It was a historic first for those hoping to improve the lives of people who are dependent on heroin.
Ed is one of 20 former heroin users in Lancaster County in a federally funded study that allows him to seek the care of a doctor and pharmacist, just like patients with other health problems, rather than being tied to a methadone-dispensing clinic. Across the country, methadone is available, with rare exceptions, only at clinics. The regulation helps keep the potentially lethal drug out of the wrong hands.
Few dispute that methadone treatment is effective and helps to reduce crime, disease and death, but because of regulations and opposition in some communities to clinics, at least one in five heroin addicts can't get the medicine.
"What do you do when you're a heroin addict without treatment?" asked Ernest Drucker, a New York-based researcher who is conducting the study. "You buy and sell heroin to support your habit."
Addiction struggle
Drucker, director of public health and policy research at Montefiore Medical Center in the Bronx, N.Y., said someone like Ed appears to be ideal for office-based methadone maintenance because he is stable, law-abiding and has not used illegal drugs in years.
Ed got hooked on heroin in his teens. He started on methadone in his early 20s at a clinic run by Lancaster General Hospital. He stayed clean for 12 years but resumed shooting heroin after the clinic closed about 1983. Lancaster County has not had a clinic since.
Ed tried to quit heroin several times but had long-term success only after going back on methadone in 1998, when Advanced Treatment Systems of Coatesville opened.
For a long time, Ed drove daily to the clinic, a 60-mile round trip. By downing a daily dose of syrupy, cherry-flavored methadone, Ed's health and outlook on life improved, and for a long time, until being sidelined by disability, he was able to hold a job.
"Without (methadone) I couldn't stand to be in my own skin. I felt I was going to explode," Ed said. Methadone "seems to take that all away. I feel like a human being."
By attending counseling and staying off illegal drugs, Ed earned the privilege of taking methadone home -- at first one dose and, eventually, six.
Last week, Ed stopped driving to Coatesville altogether. As a study participant, he sees internist Dr. Samuel A. Rice of Lancaster, who prescribes the methadone and leads group counseling for the 20 participants, and he gets his prescription filled at Ganse Apothecary.
Reducing stigma
In coming months, the study will expand to Baltimore and Albuquerque and Santa Fe, N.M. Drucker added Lancaster at the urging of Robert Field, a semi-retired developer and property manager and an advocate of drug-law reform.
Field recruited Rice, pharmacist Jerry Ganse and Jeffrey Kegley, executive vice president of Advanced Treatment Systems, for the study and secured regulatory waivers.
"The purpose was to demonstrate that people who have finished primary (addictions) treatment are capable of receiving care in an ordinary environment," like a diabetic using insulin, Kegley said.
"They will either pay out-of-pocket or have insurance coverage. This is not costing the public a nickel."
Ed said methadone "kept me alive and makes me all but normal." In seeing a doctor and going to a pharmacy weekly, he feels even more normal.
"I don't have to stand in line. People aren't approaching me for this and that. And I don't have to worry about the travel," Ed said. "It takes that craziness out of the whole situation."
Physician-based treatment has the potential to improve care, reduce costs, such as emergency room visits, and let clinics focus on addicts with the greatest needs, many of whom now go untreated, said Jerry Flanzer, an administrator with the National Institute on Drug Abuse, which is funding the study.
"This should be a win-win," Flanzer said. "It's amazing we haven't done it before."d
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