VERMONT'S FIRST MOBILE METHADONE CLINICS CONSIDERED A SUCCESS

ST. JOHNSBURY -- Before dawn in a snowy parking lot, the first
patients arrive for their daily doses of methadone.

One by one, they climb into what looks like a big white camper.
Inside the 38-foot truck converted into a clinic they talk to a nurse
who is standing in an office behind plate glass. They down their
liquid medicine out of a plastic cup and within minutes are on their
way home or off to work. By 8 a.m., the clinic has served nearly two
dozen patients.

Four months after the state's first mobile methadone clinic opened in
St. Johnsbury to treat heroin and other opiate addiction, the program
is considered a success.

"People are really benefiting from this intervention," said Alan
Aiken, director of BAART Behavioral Health Services, which operates
the program.

Many no longer have to drive to Burlington or Massachusetts for daily
treatment. Others have been referred to the methadone program from a
needle exchange program formed in town to prevent the transmission of
diseases by drug users through needle sharing.

"We have some real success stories here," said Steve Kline, who
drives the mobile clinic to the parking lot at the Northeastern
Vermont Regional Hospital every morning.

He describes a man who used to be homeless and slept under a bridge
but now has an apartment, a job and a car since he starting taking
methadone several years ago in another program.

The success has been years in the making. Former Gov. Howard Dean
opposed offering methadone treatment, fearing the clinics would spur
illegal drug activity.

Dean eventually agreed to the introduction of methadone after the
Legislature limited how and where it could be offered.

Nearly two years ago the Department of Health proposed placing a
clinic in the Northeast Kingdom because of the high cost -- $450,000
- -- of transporting people from the area to existing clinics in
Burlington and in Massachusetts and New Hampshire for treatment in 2003.

"It took the community a while to realize that it is in their
backyard one way or the other," said Kline, a member of a community
advisory board that oversaw the details of the clinic. His own
daughter is in a methadone program in Connecticut and was featured in
a local documentary about heroin addiction.

"And it can be in their backyard being treated as a medical illness
and being treated or it can be in their backyard filling up the
jails. Those are the two alternatives. We learned that in a long process."

The clinic and a second van in Newport opened in August and are
expected to eventually serve up to 150 people. St. Johnsbury now has
about 30 patients and can take a total of 75. The town set a cap at
30 initially to see how the program would run before increasing the
numbers. The Newport site is serving about 55 so far.

Barbara Cimaglio, deputy health commissioner for substance abuse,
said they are believed to be the first two mobile clinics in rural
United States and pilot projects for Vermont as it looks for ways to
fight heroin addiction.

Heroin use has jumped in Vermont since the 1990s. The Health
Department has no way to measure the number of Vermonters using
opiates, but said the number of people seeking treatment has
increased from about 200 people to at least 1,100 in the last six
years. Another 1,000 to 2,000 are believed to be addicted.

A fixed clinic opened in Burlington in 2002 and serves about 100
patients. The state also is considering placing a mobile clinic in
Bennington to serve patients in southern Vermont.

In St. Johnsbury, organizers hope to eventually expand the clinic by
driving it to other areas such as Hardwick.

But methadone has its critics. And a number of communities have
rejected plans to host their own clinics.

"I think there's always going to be people in any community that are
opposed to that type of treatment," said St. Johnsbury Town Manager
Michael Welch. "That it's supporting the habit, that it's a
substitution program, you're substituting one drug for another."

Methadone eases withdrawal symptoms from opiate addiction but does
not cure it. Counseling and case management also are part of the
treatment, Aiken said. Some stay on methadone for months, others for
years and even a lifetime.

It's better than offering no treatment, supporters say.

"It definitely is an improvement over not providing anything or
shipping people to Massachusetts every day to get this treatment,"
said Welch, also a member of the community advisory board. "At least
with this program they have an opportunity to stay here where they
live. These are residents of this area, they can get a job ... and
perhaps lead a much better life than they would otherwise."

While some critics fear a methadone clinic in their town will cause
an influx of people or may lead to a rise in crime St. Johnsbury and
Newport have seen no change.

"It's worked out fine. We haven't had any problems," said St.
Johnsbury Police Chief Richard Leighton.

"I think people associate these folks that are seeking treatment with
the drug and problems associated with heroin and heroin users and
those are the fears," Welch said. "And for the most part,
particularly with this population, it's people that are trying to
change their lives, so you don't see those type of problems."

For the police chief, the benefits of the clinic are obvious.

"They're our brothers and sisters; we gotta help them out," he said.

"You can either have the people get their methadone here in town and
then be able to go to work and lead a productive life or travel eight
hours a day to New Hampshire and not be able to work. For me it's a
no-brainer."