Six days a week, about 300 people funnel through the nondescript EJAL Health Services building in Glen Burnie to take the dose of pink liquid methadone they depend on to keep withdrawal at bay.
They're of all ages, races and backgrounds - dentists, used-car salesmen, undertakers. Some bring their small children with them, making a few of the clinic's neighbors in the Crain Highway warehouse strip assume it's a day care.
But residents, business owners and elected officials in Baltimore's suburbs are mobilizing against methadone clinics, fearing that they will attract crime and drugs to their neighborhoods. Residents in Elkridge and Columbia's Oakland Mills recently promised protests if proposed treatment centers open, and the Baltimore County Council passed legislation last year prohibiting methadone clinics in residential areas.
Communities in Louisiana and Ohio are setting up roadblocks to keep out methadone clinics. Even Dr. Leon Flemembaum, who owns EJAL and another methadone clinic in Ellicott City, can understand their anxiety.
"I'm also a father. I wouldn't take a chance on my children," he said. "I wouldn't take a chance on anybody's children."
But substance abuse experts say heroin use is growing in Maryland's suburbs. Demand for treatment is increasing as well.
Nationwide, more than 1,200 clinics distribute methadone, which relieves withdrawal symptoms for those addicted to heroin or prescription painkillers such as OxyContin and Percocet.
Developed in the 1930s in Germany as a synthetic substitute for morphine, methadone is still prescribed as a painkiller. In the late 1960s, treatment centers began to treat opiate addictions with methadone, said Dr. Jerome Jaffe of the University of Maryland's School of Medicine, who was appointed during the Nixon administration as the nation's first "drug czar."
Methadone advocates compare the drug to those used to control high blood pressure, heart disease and other ailments. They contend that drug addicts are no less deserving of medication to treat their condition.
But groups such as Drug Watch International frown on long-term dependence on any narcotic.
Wayne Roques of Drug Watch International said encouraging people to use methadone treats only the physical symptoms of addiction, not the problems that drive them to drugs. Even if someone is able to work while using methadone, he said, they're only working to pay for their next dose.
"There is nothing crueler than keeping a person addicted to drugs," said Roques, a former agent with the federal Drug Enforcement Administration. "It's the most pathetic thing in the world."
Maryland, with 43 methadone clinics, ranks among the top 10 states in the nation, said Robert Lubran, a director at the federal Substance Abuse and Mental Health Services Administration. Baltimore, with 18 clinics, has the highest concentration of facilities in the state; Montgomery and Harford counties have four each; Baltimore and Anne Arundel counties have three each; Howard has one with another proposed; and Carroll has one.
Heroin is among the top four drugs mentioned by those seeking treatment in the counties surrounding Baltimore, according to data from the Center for Substance Abuse Research at the University of Maryland. And more people in Anne Arundel, Baltimore, Harford and Howard counties are dying of overdoses - 140 in 2001, up 47 percent from 1997.
Experts say that as addiction to heroin spreads from city to suburbs, treatment has to follow. Only about 20 percent of the more than 102,000 people who need drug treatment in Baltimore's surrounding counties receive it each year, according to the substance abuse center. In contrast, 41 percent of the 58,000 addicts in Baltimore are treated.
"We see our kids leaving Howard County, driving to Baltimore, buying the heroin they need and taking it back," Howard County Police Chief Wayne Livesay said at a recent community forum.
And clinic operators say opponents of methadone clinics probably know someone affected by drug abuse.
"I guarantee you, if you shook the family trees, someone with an addiction problem would have fallen out of them," said clinic operator Neal Berch after a contentious recent meeting with those protesting his proposed methadone treatment center in Elkridge.
Methadone, now manufactured generically, is available for less than 50 cents a day, said George E. Bigelow, a professor at the Johns Hopkins University's Behavioral Pharmacology Research Unit. But other services required by law - counseling, regular urinalysis - cost more. Publicly funded clinics offer treatment on a sliding scale based on one's ability to pay, but the increasing number of private, for-profit clinics are more expensive.
Richard Coleman, 49, of Dundalk pays $90 a week to get methadone at EJAL. He has been clean for two years after using heroin since he was 12.
Coleman worked at Bethlehem Steel Corp. for 27 years and is studying to become a pharmacy technician. He said he would never have been able to pursue a new career without the help of methadone.
"I'm not being killed going to get it; my health is good now," he said. "Methadone makes you maintain a healthy life, and no one would be the wiser."
Opposition to clinics
Despite evidence of methadone's effectiveness, a number of jurisdictions nationwide have taken measures to block clinics. A five-year moratorium on new clinics went into effect in Louisiana on July 1, after a study showed that the state's 14 clinics were about 3 1/2 times more than were needed.
Ohio allows only private, nonprofit clinics or those run by the government. Methadone clinics in Pennsylvania cannot operate within 500 feet of a residential area, public park or church.
The Baltimore County Council passed a measure in April last year barring methadone clinics from operating in residential areas. However, the matter is in litigation after a federal judge ruled that the law violated an order that methadone clinics be treated the same as other medical offices.
After a methadone clinic tried to move into Columbia, some Howard County officials are calling for similar legislation.
But Ellen Weber, a professor at the University of Maryland School of Law who has represented clinic operators, said such laws are "highly suspect" and would probably not be allowed under the Americans with Disabilities Act. The act does not allow different standards to be imposed on facilities that serve individuals protected under the measure, she said. Recovering drug users fall into that category.
"Much of this is fear of the unknown and a failure to look at the objective data that already exists that [shows] that programs operate well and operate safely and don't present any risk at all to the community," she said.
But the mere mention of a new clinic can send fear rippling through a community. When news broke in June of a methadone clinic planning to open in the Oakland Mills village center, near three schools, three community meetings attracted more than 100 angry residents. Local officials pledged their support.
"I don't think people have any greater concern than that for their children," said Barbara Russell, the Oakland Mills representative on the Columbia Council.
After three weeks of community protests, the clinic's president notified the state that he no longer planned to open a clinic there.
Community members in Elkridge are raising similar protests after learning that a clinic is to open near homes and school bus stops. Resident Helen Homon said the community felt "blindsided, disrespected and incensed."
In Timonium, a coffee shop owner has drafted a petition to urge Baltimore County to move the Awakenings Counseling Center, which the county helps fund through grants, after recent allegations that people, possibly clinic clients, tried to sell drugs in his business.
"It is a real, real problem," said John Kerney, a lawyer representing the coffee shop. "And the sad thing is that you don't have any of these clinics next to the county executive's home or next to the county councilors' homes, but it's OK to put it next to our business."
In Maryland, methadone clinics must be approved by the state health department, the federal Drug Enforcement Administration and the Center for Substance Abuse Treatment, an arm of the U.S. Department of Health and Human Services. The state does not consider local impact and is not required to inform the community.
But after the outcry in Oakland Mills, Nelson J. Sabatini, secretary of Maryland's Department of Health and Mental Hygiene, said that once the state receives an application to operate a methadone clinic, the department will place an ad in area newspapers and notify local officials.
One way to avoid conflict is to locate clinics away from places where they might cause disruption, operators said. Running a clinic near schools is "not smart," said Ron Jackson, executive director of a nonprofit group that runs four methadone clinics in Washington state. Neither is dispensing methadone near residential areas, fast-food restaurants or retail outlets.
"The confluence of the traffic is not real good - that's a polite way of saying it," he said.
Communicating with the community is just as important, clinic operators say. It is a philosophy that officials at the Glenwood Life Counseling Center in Baltimore's Govans neighborhood developed over time.
After a loitering problem developed in the 1980s, a liaison from the clinic has attended meetings of resident and business groups for the past 15 years, said executive director Frank Satterfield.
When the center operated a health clinic, it offered free physicals to children attending summer camp. Glenwood also received letters of support from community associations before embarking on an $800,000 expansion to build a child care center and playground, which the neighborhood can use.
"Whether you should or whether you have to, we like to go through the community," Satterfield said.
Rodney W. Jackson, 44, a former heroin addict who receives methadone treatment at Glenwood, said those protesting clinics need to understand that the facilities benefit communities by helping addicts start new lives. He said he tries to clear up misconceptions about recovering addicts.
He overhears employees at a doughnut shop near the clinic routinely complaining, "Here come the damn methadone people." To their surprise, he told them, "I drink met."
"It saved my life," Jackson said. "I was homeless. [Now] I have an apartment, I have a job. I got my dignity back."