Robert Fuller was never your typical street junkie.
He's a disabled veteran who was shot in combat in Korea and received the Purple Heart. He worked all his life, and he used to have a low opinion of drug users.
Then, in 1986, he underwent surgery for kidney cancer. The doctors prescribed him dilaudid, an opioid, for his pain.
He would continue to take painkillers for the next 16 years, eventually devoting all his time and money to getting his hands on them.
"It became where I needed more and more and more to stay out of pain," recalled Fuller, 68. "And before I knew it, I was addicted."
In April, Fuller and a friend, Lynn Peterson a 49-year-old recovering drug addict decided together that they would try methadone.
"We just kind of put our foot down and talked about it and decided, we want to have a better life," Peterson said.
They went to the McMaster Center, part of the El Paso County Health Department, which has offered methadone maintenance treatment since 1969. So far, they say, the treatment has allowed them to stay clean and begin to live normal lives. Peterson holds a professional job, and they hope to some day move out of their apartment and buy a small house.
"I didn't think it would work, but it has," Fuller said of the treatment.
The slashing sound
So it came as highly unwelcome news to Fuller and Peterson when they found out recently that the methadone clinic is closing. In the wake of funding cuts ordered by Gov. Bill Owens, the Health Department announced in July that it will stop providing methadone treatment and try to hand it off to an outside provider by July of 2003.
In reaction, Fuller and Peterson, along with about 40 other methadone clients, have started a group called Advocacy For Recovering Addicts, or AFRA. The group is circulating a petition that they plan to submit to local politicians, asking that treatment continue at the McMaster Center, or that the same level of care be provided if someone else takes it over.
Another aim of the group is to inform people about methadone, because of the many stereotypes surrounding methadone clients, Fuller says. Opioid dependency, he says, isn't just a habit but a disease that affects a range of people, from strung-out street junkies to successful professionals.
"My goal is to educate the public," Fuller says.
New clients daily
The El Paso County Health Department is the only public health department in Colorado offering methadone treatment. Elsewhere around the state, providers include a variety of nonprofit and for-profit agencies, operating with a combination of taxpayer and private funds.
The McMaster Center's methadone clinic has approximately 210 clients, according to Lisa Chambers, who runs the clinic. New clients come in daily to get their methadone, which is administered in a form similar to cough syrup. As clients advance in their treatment, they earn the right to take home doses for progressively longer periods of time, up to a month. The basic monthly fee for clients is $100.
A synthetic drug, methadone is considered effective in treating addiction to opioids -- a class of drugs that includes heroin, morphine and OxyContin -- for a number of reasons. It prevents the severe withdrawal symptoms experienced by those who have developed a physical dependency on opioids. But at therapeutic doses, it doesn't give clients a "high" -- and it also contains a chemical blocker that prevents users from getting high on other opioids.
Research suggests that drug addicts who switch to methadone become far less likely to commit crimes and more likely to have successful family lives and careers.
"Seventy percent of our clients, you wouldn't know them if you met them on the street," Chambers said. "They have jobs. They buy houses. They are in all kinds of walks of life."
Though some methadone clients eventually manage to wean themselves off drugs entirely, many have such a severe addiction that they need methadone indefinitely. At McMaster, some clients have been on the program ever since it started 33 years ago, says Chambers.
While most local methadone clients are former injecting drug users, about 20 percent are people who became addicted to painkillers.
The clinic doesn't just hand out methadone, but also offers clients individual and group counseling. Fuller and Peterson credit the counseling for their initial success.
"A lot of it had to do with the support we got," Peterson said.
Why fix it?
With the McMaster Center's methadone clinic widely praised for its success, ending it makes no sense to Peterson and Fuller.
"If it's not broken," asked Peterson, "why fix it?"
But according to officials, the Health Department's mission is to focus on services that no one else provides. If another methadone provider can be found, it makes sense for the department to hand someone else the task and shift taxpayer money to other areas, said Royann Killoren, chair of the El Paso County Board of Health.
"I think it's generally accepted that government shouldn't provide services that the private sector provides," Killoren said. "We're a free-enterprise system."
Earlier this year, in a similar move, the department handed off its prenatal-care program to the Community Health Center, a local nonprofit provider. That transition has been highly successful, says Rosemary Bakes-Martin, the Health Department's acting director.
Killoren says neither move had anything to do with criticism of the Health Department from Tom Huffman, chairman of the Board of County Commissioners, who earlier this year accused the department of spending too much money and promoting "socialized medicine." Killoren and Bakes-Martin both said the discussions about handing off the methadone treatment program began more than a year ago.
Follow the money
But now, such a move has become a financial imperative, the officials say. In vetoing portions of Colorado's 2003 state budget, Gov. Owens slashed $759,000 in funding for the El Paso County Health Department -- more than 4 percent of its $17.2 million annual budget.
The methadone program's budget is approximately $800,000 per year. Of that, roughly $300,000 comes from the Health Department's general budget, $250,000 comes from client fees, and $250,000 comes from Connect Care, a nonprofit agency that contracts with the state of Colorado to administer drug and alcohol treatment programs statewide.
The Health Department has signed an agreement with Connect Care asking the agency to find another methadone provider by next July. Steve Gilbertson, a deputy director at Connect Care, said he has approached a variety of nonprofit and for-profit agencies, at least two of which have expressed interest in taking over the program.
The biggest problem, he says, is the funding. Without the $300,000 from the Health Department, it will be difficult to maintain the same level of service without increasing client fees.
"What we're in effect trying to do is figure out how to move it into the community with about two-thirds of the funding," Gilbertson said.
He fears it may be impossible.
"We're going to lose something in the level of care," Gilbertson said. "It may not have all the bells and whistles it's had in the past."
An essential service
One way or another, methadone treatment will continue, officials say. Killoren says the Health Department will remain involved in making sure it does, even if the department doesn't actually run the program.
"Methadone is an essential service; it has to be provided," Killoren said. "We can't possibly turn our back on that."
Fuller and Peterson said cutting people off from methadone treatment, or significantly reducing the quality of service, would have negative consequences not just for clients, but also for the community as a whole. Crime would go up as clients relapse into their old drug habits, and more people would seek medical treatment for drug-related illness and overdoses, causing insurance rates to rise.
"If you look at the big picture, [methadone treatment] benefits people in ways that they don't even know," Peterson said.