They come by the hundreds every day to stand in line for a swallow of the bitter red syrup that will ward off the pain of heroin withdrawal for another 24 hours.
The methadone ritual takes only 10 minutes -- seven days a week. The addicts come in, pick up their prescription cards and have them signed by a counselor before going to the nurse's window for the medicine. Once they've taken the medicine, some clients stay to chat with counselors or socialize with other addicts. Most leave quickly for jobs or other business.
While methadone is stabilizing 2,300 of the District's addicts, the $2,8 million program that issues the red substance is feeling the impact of staff shortages and employe skepticism about whether the methadone maintenance program, now over a decade old, helps addicts conquer their habits or merely creates another form of addiction.
"The system is saying, 'You can have a habit, but you can't shoot what you want; we'll give you something else,'" said Gloria Hardy, an experienced counselor at the Q Street drug treatment clinic. She said she considered government-sponsored methadone worse than heroin because it is distributed free of charge and provides no motive for quitting.
"It keeps them (methadone users) thinking dependently," said Hardy. "They can't even go on vacation -- they'll get sick without meth."
Hardy also said she considered methadone "a form of genocide," noting that many of the inner-city addicts across the country are poor and black. She said she'd like to see more psychiatric and vocational counseling available in lieu of longterm dependence on methadone.
At least one addict agrees.
Methadone "is a dictatorship . . ." said Brenda Brown, a 34-year-old heroin addict from Southeast, as she burrowed under the bedcovers on a warm May afternoon. Brown was in the process of withdrawing from methadone, which she has used on and off for nearly 10 years. She recently became a resident at Rap Inc., a drug-free treatment program in Northwest.
Methadone is just a substitute for heroin, Brown said, adding that it has caused her to lose most of her teeth. She said she had tried to kick her drug habit many times and failed. Each time she'd get strung out again, she'd be arrested and ordered back onto methadone, she said.
Brown said she didn't want methadone. "I was into dope, I just didn't want to stop." Because she continued using heroin with the methodone, Brown needed much more herion to obtain a hallucinogenic effect. "I don't call that rehabilitation," she said. "I'd rather go back to jail than go back on methadone."
Joseph P. Savoy, head of the bureau of drug treatment for the city's Alcohol and Drug Abuse Services Administration, supports long-term use of methadone in some cases. Some people, he said, have been on methadone for a decade and aren't using other narcotics, are not in jail, are working and are contributing to society. Why take thme off, he asks?
Methadone, or "meth," is a pharmaceutically pure narcotic that is addictive but, when given in small daily doses, does not produce hallucinogenic effects. Side effects are difficult to document but, according to patients and some medical personnel, they include loss of appetite, suppression of sex drive, constipation, sweating, tooth decay and sluggishness. s
Across the nation, methadone has been sharply criticized as a bandaid approach to treating drug abuse. At the mayor's drug abuse conference in March, community representatives registered their frustration and dissatifaction with the use of methadone to treat the symptoms but not the disease of drug addiction.
The Alcohol and Drug Abuse Services Administration (ADASA), part of the Department of Human Services, operates nine durg abuse treatment clinics. It now is serving 2,300 narcotics users, about 250 more than the program's capacity, said Savory. But his number represents only about 20 percent of the estimated 12,000 to 14,000 addicts in the city, he added.
John L. Emery, acting budget administrator for ADASA, said the situation may get worse before it gets better. Last year about 20 administrative slots were lost in the citywide reduction in force; but most were not crucial positions, he said. Emery beleives the more serious problems is that there are not enough counselors.
There are 92 counseling positions in ADASA, according to Emery. Twenty slots are currently vacant because of staff turnover, he said.
ADASA's medical director, Dr. Kurt Brandt, said the bureau also has lost four doctors and 14 nurses is the last 18 months. Most left for better paying jobs, he said. ADASA currently has 378 employes.
The city is now at the "apex" of an increase in the number of narcotics abusers and that growth in overloading the system, said Emery. Funding for the treatment program has remained about the same for the past two years. Emery said that employe allotments already have been made for fiscal 1982 and it will take another 18 months to review requests for additional workers to expand service in fiscal 1983.
"I'm sure clinic managers are feeling the crunch," Emery said.
Another blow to the program in the opinion of some drug counselors is the elimination of the inpatient, drug-free treatment program at D.C. General Hospital and a substantial reduction in the number of urine tests made to determine whether clients in outpatient clinics are still using drugs.
Savory said the inpatient program called Emerge House was underused, however, and urine surveillance too expensive.
Although the clinics offer clients the opportunity to wean themselves from narcotics, about 70 percent remain on methadone maintenance, he said. Last year's figures show that 66 percent of clients were readmissions: mainly persons who dropped out of the program earlier or who had started using drugs again.
"It's clear in my mind (that the program's purpose) was to reduce the use of illegal drugs and to control those individuals who committed crimes," Savoy said. Methadone treatment in the District began in 1969. Even today, he said, "We're not trying to cure people, we're trying to hold the line, offer alternatives to incarceration."
Clients enter the drug treatment program voluntarily or are sent there by the courts. Those who have used drugs for less than a year are put on a 21-day detoxification program with daily decreasing amounts of methadone. Those who have used narcotics such as heroin, codeine. Dilaudid or morphine for more than a year are put on methadone maintenance and remain in the program an average of 18 months. Some become drug-free, but most of those who leave the program are dropouts who eventually will return, said Brandt.
"I don't go along with the earlier idea of methadone -- that it sould be taken like insulin for the rest of your life," said Margi S. Truesdale, acting chief of ADASA's substance abuse division. She believes methadone should be used to keep patients comfortable just long enough to get a job and get their lives back in order.
"Methadone takes away the anxiety of pain of withdrawal and makes them (addicts) more susceptible to counseling," Savory said.
However, at the aging Q Street clinic with its exposed pipes and peeling olive-drab paint, counselors say drug abuse is a mental health problem. With a caseload of 50 patients per counselor at the busier clinics, they can't give clients much help with job training, job referral or psychiatric care.
A majority of clients are under-employed, undereducated and inmature, and suffer from low self-esteem, Hardy said. Until those problems are taken care of, the life style of addition -- the use of an escape mechanism -- will be perpetuated, said Hardy, herself a recovered drug user.
According to the counselors, 30 percent of clients in the program continue using other drugs. "When you're in an addictive state of mind, you try to get something for nothing," said Hardy. They come when they get tired of "ripping and running," she explained. "Meth will hold them when they can't get street drugs."