Pubdate: Thu, 12 May 2005
Source: Urban Tulsa Weekly (OK)
Copyright: C 2005 Urban Tulsa Weekly
Contact:  http://www.urbantulsa.com/index2.asp
Details: http://www.mapinc.org/media/3536
Author: G.W. Schulz
Bookmark: http://www.mapinc.org/find?143 (Hepatitis)
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

THE MISERY INDEX

Methadone Patients Desperate For Relief From Drug Withdrawals Make An 
Entrepreneur's Dream Of Repeat Customers

"Heroin is the only thing, the only gift the darkness brings."

- -Steve Earle

Christopher has seen the deepest recesses of hell.

Ten years of mixing copious amounts of dangerous narcotics finally 
culminated in a trip to the Intensive Care Unit at Saint Francis Hospital 
two months ago.

He doesn't remember much. He'd been carelessly combining his regular 
methadone treatments with a low dose of the benzodiazepine Xanax.

The methadone was being administered to him by a for-profit Tulsa clinic 
that specializes in its distribution for the treatment of heroin addiction. 
The Xanax was prescribed to treat anxiety by a private doctor who didn't 
know Chris was on a methadone regimen.

His urine tests kept turning up dirty at the clinic, but the clinic didn't 
do much about that, he says. Things went okay for a year or so mixing the two.

Things changed, however, when Chris mixed the cocktail with an 
additionally, high-powered dose of Xanax he got from a friend who used it 
to pay off a cash debt.

For a few nights in a row, Chris would consume the toxic combo producing a 
fantastic high until finally trying to make his way home from the friend's 
only to wake up an hour later passed out in his still-parked car.

"It's kind of like heroin junkies," Chris said. "When someone dies on a 
shot, then people go buy that heroin, because they know it's really good. 
If you're going to die from it, you're going to get a really good high from 
it. Even though I knew that, I still did it."

He survived, but it was enough to bring his extensive life of drug 
addiction to an end.

Chris can't recall the first time he shot dope, but he remembers when his 
stomach began twisting into knots of excitement at the very sight of a needle.

Chris, of course, is not his real name.

Few recovering drug addicts are proud to recount to family and friends in 
print the late nights smoking crack, eating pills, shooting coke, heroin 
and Oxycontin, driving home from Austin after picking up better shit, 
throwing up from the car window, a friend passing out at the wheel and 
sending the car 180 degrees onto a dirt road off I-35 Christ knows where in 
Texas, throwing up again after making it home in a trash can on the side of 
the house while the parents ignorantly continue gardening, landing in the 
hospital with Hepatitis C or skin bubbles caused by repeated injections in 
the same area of the arm that burst and reveal a surreal image of the major 
blood communicators beneath.

Indeed, he isn't proud of remembering that early group of friends.

"Amongst all those friends, about a third of them died, and a third of them 
went to the clinic," he said. "Or, they're in prison."

Finally, that last night two months ago, his breathing began to slow. He 
knew what was happening. He called his dad. His dad took him to the 
emergency room.

All he remembers from there is waking up periodically and clutching 
panicked at the plastic tubes snaking down his throat. The device was 
delivering charcoal to his system, which clings to the narcotic and passes 
it safely out of the body. The Narcan they'd shot him with didn't work. 
Narcan instantly reverses the effects of narcotic overdose, but sends 
addicts into a violent fit of withdrawal.

"It was bad," he said. "I aspirated and got pneumonia on top of withdrawals."

The withdrawals. Heroin withdrawals can take on such severity that they're 
capable of killing some addicts, striking the body with deadly seizures. 
Methadone withdrawals are considered a bit easier, but still painfully 
halting. Sweating. Shaking. Cramps. Wild swings of emotion. The sensation 
of intensely cool temperatures.

His family was there with him. He told them he was making it. Inside he was 
crumbling. He did make it, but not without that few days of hell first.

For more than a year, he'd been attempting to lower his daily methadone 
dosage and get clean completely. But the clinic he was going to, Tulsa 
Rightway Medical, would only take him down five milligrams a week. Starting 
at a daily dose of 110 milligrams, it would take months to escape--or a 
near-death experience.

But drug addiction is more complex than a simple narrative of Chris's struggle.

An Urban Tulsa Weekly investigation reveals there are two distinct stories 
to methadone in Tulsa.

One involves for-profit methadone treatment clinics enduring reams of 
legally required paperwork and government regulation, legal battles, and 
teams of sometimes cynical, embattled nurses and counseling staffs 
encumbered by Al-Anon rhetoric and Social Workerease. Add to that a bottom 
line that includes an incentive to make a profit.

The other story: Private medical practices are prescribing methadone to 
chronic pain sufferers who often fail to fully grasp the pharmacology of 
the drug and as a result, end up dead or wind up selling the drug on the 
street.

Next week we'll report on the dramatic rise of methadone-related deaths 
among chronic pain sufferers in Tulsa.

This week, we'll take a look at the clinics and two individuals working 
toward an end to their addictions.

Be The End Of Me

Chris's boyish looks and comfortable middle-class background hardly fit the 
profile of a criminal. He has, however, struggled with an addiction to 
heroin, and an ambivalent relationship to the methadone that saved him.

The medical community has historically disassociated itself from the world 
of substance-based addiction treatment enabling savvy entrepreneurs to 
profit handily from a product that attracts a powerfully committed segment 
of the consumer population with little need to advertise.

While methadone dispensers play an invaluable role in the world of drug 
treatment, the city's for-profit clinics have strained to execute their 
mission during a time when the approaches to treating drug addiction 
nationally are slowly changing.

And while the stigma surrounding addiction has eased over the decades, drug 
overdose is hardly relegated to the poor and uneducated as is often still 
depicted in popular culture.

State death records show that early on April 20, 1975, Lawrence Richard 
Wilcox, cousin to Tulsa Mayor Bill Lafortune, died of a heroin overdose.

He was 23.

Drug addiction is a brain disease, says Dr. William Yarborough, an 
associate professor of medicine at the University of Oklahoma Schusterman 
Center in Tulsa. He says the brain chemistry of some enables them to escape 
a full-blown addiction following initial experimentation with an addictive 
drug. It's not unlike a heavy smoker's undying commitment to cigarettes 
compared to a smoker spending years only lighting up a few on the weekend 
along with drinks while never becoming addicted.

Combine the brain chemistry of a born addict with the physically addictive 
properties of opiate drugs and the result is a serious public health concern.

For some addicts, a simple inpatient, 30-day detox regimen at an 
abstinence-based treatment center is enough to help them overcome 
addiction. For others, brain chemistry and biosocial circumstances make 
them highly vulnerable to relapse, which means repeated exposure to 
infection from dirty rigs and a tragic cycle of failed sobriety.

"Abstinence is always the best first approach with drug addiction," said 
Yarborough, who is also medical director for an area abstinence-based detox 
program. "But abstinence from mind-altering substances doesn't always work 
for everybody. The outcomes for community abstinence programs may only be 
10 percent; sober for one or two years. Methadone programs may have 30, 40 
and 50 percent success rates in keeping people out of trouble."

Methadone was first synthesized and used in Germany during World War II in 
the 1940s to treat illicit drug use.

Early protocols for application of the drug failed until the 1960s when two 
doctors changed their approach using longer-term methadone maintenance with 
more success. Poorly considered preliminary regulatory schemes were too 
weak to prevent widespread abuse and diversion of the drug until the 1970s 
when federal and state officials established additional governance of 
methadone's usage.

Methadone is an opiate "agonist," which means it acts similarly to 
morphine, yet it produces little of a euphoric sensation and blocks the 
effects of other illicit drugs making it an ideal substance with which to 
treat chronic drug abuse. It also has a long half-life, meaning it can fend 
off symptoms of withdrawal for significant periods of time. However, the 
amount of traces that can remain in the body, i.e. how long it takes for 
the body to metabolize methadone, varies from patient to patient.

Today, methadone is used largely to treat addictions to heroin and legally 
prescribed Schedule II drugs like Oxycontin, which have recently become a 
major focus of press attention.

The drug is additionally cheap and easy to produce making it a pragmatic 
safety net for the portion of the drug-addicted population that Yarborough 
described as highly susceptible to repeated relapses.

The dirty secret, however, is that some patients, including Chris, contend 
methadone withdrawals are worse than those associated with heroin. And 
methadone, Chris learned, cannot block Xanax.

Chris had finally turned to the methadone clinics after more than one visit 
to inpatient detox centers around the city failed. The detox units with 
pleasantly connotative names like Laureate and Valley Hope only exposed him 
to other addicts he could get high with after he got out. Following a 
diversionary trip to detox he'd taken to avoid jail time for his third DUI, 
Chris headed to the clinics."I smoked some crack with this guy, and I 
realized I was going to start shooting heroin again," he said. "So I went 
to the methadone clinic two days later."

That was four years ago.

The Business End

A doctor named Gary K. Borrell established Oklahoma's early methadone 
clinics in the 1980s in Tulsa and Oklahoma City maintaining them until 1998 
when he sold them to a businessman named Richard Yanko, according to court 
and state incorporation records obtained by Urban Tulsa Weekly.

Yanko has since assumed ownership of the two clinics with his wife Leslie 
under a variety of company names. The company now does business in Tulsa 
under the name Life Improvement Center, located near 41st and Mingo in East 
Tulsa. The Yankos manage clinics in Nevada and Arizona as well.

Two attorneys named Karen Byars and Richard Anderson formed Rightway 
Medical in 1999 from the ashes of an administrative fallout at LIC that 
involved an LIC security guard and the clinic's director, trusted by Yanko, 
who jumped ship to Rightway. The Tulsa location is off 110th East Avenue. 
Another location was opened around the same time in Oklahoma City.

Two other clinics exist in the state as well: New Beginnings in Oklahoma 
City and the VA Hospital methadone clinic, also in OKC, which treats war 
veterans addicted to drugs.

The for-profits became what is today 55 percent of the nation's methadone 
clinics.

When patients first enter the clinic, they're given a health exam, and a 
doctor, over a series of days, determines the severity of their addiction 
and adjusts their methadone dosage accordingly. The process is called a 
"peak and trough." The patient receives approximately 10 additional 
milligrams a day until they reach a level that enables them to maintain 
normalcy.

"It does an excellent job of giving someone back their functionality so 
they can address these other areas that have gone to waste in their life," 
said Johnny Mark Kirk, clinic administrator for Tulsa Rightway and a 
recovering methamphetamine addict.

Costs to the patient for the program amount to an average of $55 a week 
plus additional fees for late payment and dosing and $15 for "arranging for 
guest dosing" at other treatment programs. Patients can receive from as low 
as two milligrams to as much as 180 milligrams a day. Rates for the patient 
remain flat regardless. But, sources says, the cost of methadone to the 
clinics can amount to pennies per 100 milligrams.

 From there it's pretty much up to the patient how long they remain on 
methadone. Urban Tulsa Weekly interviewed two patients who'd both been on 
methadone for more than 10 years. Like Chris, the other individual began at 
LIC, and following disenchantment with their program, moved to Rightway.

If the patients keep good behavior over a period of time, they obtain 
"take-homes," which means they can receive wafers or liquid dosages that 
can last them up to a month at a time, according to David Morgan, 
Rightway's clinical director in Oklahoma City. A dirty UA can mean a "loss 
of privileges," and the patient is forced to return to the clinic early 
each day for their dose.

Kirk said consistently dirty UAs, such as a patient continuing to mix 
methadone and Xanax, can get you kicked out of the program. He said each 
time it occurs, the patient is harangued with a speech asking why they 
would threaten their treatment, or they're eventually referred to an 
inpatient detox facility.

"If you decide you're not going to quit taking benzos, and you're 
continuing to get dirty UAs from them, we're not helping you," Kirk said. 
"We try very hard to see any effort and improvement in the patient. As long 
as you're trying and things are getting better, we're going to work with you."

But Chris says he rarely didn't show dirty piss and was never punished 
beyond his loss of privileges at either clinic, which he didn't care much 
about. He added that counseling sessions, considered an integral part of 
methadone treatment, often lasted for just a few minutes before he was sent 
home. He spoke sarcastically about the "goals" set for his treatment.

Kirk also hesitated to explain that a significant portion of patients can 
remain on the program for years at a time, generally, he said, chronic pain 
patients struggling with an addiction to pain killers.

OU's Dr. Yarborough said long-term methadone treatments are not necessarily 
a terrible thing, although the public tends to cringe at the thought of 
indefinite maintenance.

"The government likes to talk about eventual goals of getting people off of 
methadone," he said. "If I have a case where someone comes to me and seems 
really motivated to get off their methadone, sometimes you can make 
suggestions about how to do that slowly. But the first thing I ask them is, 
'Why do you want to get off the methadone?'"

Counselor Kirk said patients are regularly encouraged to consider beginning 
the process of tapering off methadone. But Chris laughed when asked to 
confirm Kirk's statement saying he had attempted at both clinics to lower 
his dosages by the week, and not only was the process tediously slow, some 
weeks the nurses altogether wouldn't lower his dose claiming it hadn't been 
authorized by the clinics' doctors.

And, of course, recovery is technically bad for business.

State regulations require that counselors keep reams of files detailing the 
use of admission criteria, projected length of treatment, mental health 
specifics, a patient's "assets and liabilities," ongoing care plans and 
counseling hours logged, all designed to insure treatment is going as 
planned and half-ass addicts aren't just looking for another hook-up.

And all of it's accompanied by a plentiful array of paperwork, which was 
made partly available to Urban Tulsa Weekly following a bit of a struggle 
with the Oklahoma Department of Mental Health and Substance Abuse Services.

Kirk said admission and maintenance criteria are based largely on an 
Addiction Severity Index and outlines set by the American Society for 
Addiction Medicine.

The Drug Enforcement Administration regulates virtually every single drop 
of methadone that leaves the clinics. Kirk even pointed out bottles turned 
upside down to catch the leftovers in small cups. Literally millions of 
milligrams of methadone pass through the clinics during a six-month period 
with maybe 70 or so milligrams unaccounted for by the end.

Nonetheless, the state still apparently believes both Tulsa clinics have a 
difficult time updating their records sufficiently enough to prove their 
treatment standards are complete.

The Paper Chase

Every three years the Oklahoma Department of Mental Health and Substance 
Abuse Services will re-certify the state's methadone clinics following the 
approval of a sampled inspection of patient records.

The clinics are notified in advance of the inspections, but records we 
obtained from ODMHSAS showed that advance notice still wasn't enough for 
clinics to insure compliance at least during the time that state 
bureaucrats were hanging around.

The clinics are given a point score after the records inspection that 
should amount to 100 percent, which the clinics must reach before becoming 
re-certified.

In 2002, all of LIC's sample records reviewed failed to properly document 
ASAM admission criteria, and portions failed to include missed treatment 
and counseling sessions, projected lengths of treatment, follow-ups after 
discharge and counseling referrals to outside organizations. The files also 
failed to adequately indicate whether methadone was even the right 
treatment for individual patients.

Due to the deficiencies, the LIC clinics were placed on "conditional 
certification," which meant they needed to implement measures to prove the 
files would be better maintained in the future before reaching full 
certification.

But it wasn't the first time the citations had occurred. LIC was 
continually cited for many of the same reasons over a period of two 
inspections reaching back to 1993. Following 1998 inspections, Yanko sent 
ODMHSAS copies of memos he'd distributed to employees that were intended to 
show the clinics had improved on the deficiencies.

Which drug users actually should be eligible for the program became an 
issue in 2003 when William Bryan Sargent's mother sued LIC for negligence 
after her son died of methadone toxicity. Just two days after he'd begun 
receiving treatments at the clinic in Oklahoma City for an addiction to 
pills, William overdosed, because an inordinate amount of methadone had 
gathered in his liver and his body had failed to properly metabolize it.

Jana Sargent's attorney, Murray Parrish, said the clinics could keep track 
of methadone retention levels by observing daily UAs in the earliest phases 
of treatment. He said a UA the second day of treatment would have indicated 
that too much methadone was filling William's liver.

While LIC claims William was the first death on its watch, a toxicology 
expert testifying for Parrish said he'd seen several similar cases in 
Texas. After interviewing LIC employees, Parrish said he "perceived 
standards to be too low" for entrance into the methadone programs.

Eventually Yanko complained to ODMHSAS that some of the state's regulations 
seemed to serve no real purpose and overlapped policies LIC already had in 
place. Both LIC and Rightway had been cited for not properly assembling 
case review teams of medical specialists that independently analyzed and 
authorized treatment plans for patients and their eligibility for entrance 
into the programs.

"When a Team has been in place, nearly 100% of its activities have 
consisted of rubber-stamping the actions of the professional staff," Yanko 
wrote to ODMHSAS in 1999. "Indeed, we know of no other state in the nation 
which provides for the redundancy of a case review team."

For the record, Yanko failed to return repeated interview requests. Calls 
to LIC clinics in Tulsa and Oklahoma City went unanswered. An LIC clinic 
administrator eventually declined comment.

Becky Brooks, a former LIC counselor and now a certified trainer for the 
National Alliance of Methadone Advocates, says the peer review teams are no 
longer in place. Now the state requires that clinics be certified by an 
accrediting body such as the Commission on Accreditation of Rehabilitation 
Facilities.

All of the state's for-profit clinics are accredited by CARF. But Brooks 
says the standards for CARF accreditation are too low, because the clinics 
prepare patients for interviews with accrediting agents rather than 
advertising the opportunity for patients to meet with the review team "as 
is suggested by best practice guidelines."

Counselor Kirk notes that Rightway received a particularly exceptional 
score from CARF in 2003.

"This is an extraordinary accomplishment, as only 3 percent of CARF surveys 
result in no recommendations," a CARF letter stated to clinic director 
Byars following the accreditation review.

Urban Tulsa Weekly was unable to obtain records of the accreditation and 
inspection process conducted for either of the companies by CARF.

As far as inspections go, however, the biggest blow for LIC came in 1997 
when federal prosecutors sued the clinic for $50,000 following a DEA 
inspection that revealed LIC was not participating in a methadone registry 
with adjoining states. The law was designed to prevent patients from 
crossing state lines and acquiring methadone illegally from a series of 
clinics.

Tulsa Rightway Medical has faired better overall with state inspections in 
its notably short existence.

The clinic scored 100 percent on the first shot of its most recent 
inspection in 2004. But in 2001, Tulsa Rightway, too, was cited for failing 
to document "initial observable conditions" of patients and how long they'd 
been addicted to narcotics when they appeared at the clinic for treatment. 
The deficiencies improved enough for Rightway to receive the 100 percent 
score last year.

The state's certification director for ODMHSAS, Meredith Martin, told us 
clinics rarely fail to eventually make certification after deficiencies are 
improved upon. We could not reach her for a follow-up interview due to 
medical leave she had taken.

Still, while the clinics have enough to worry about under state and federal 
scrutiny, the more compelling tales to tell regarding Tulsa's methadone 
programs involve their administrative battles inside the state's courtrooms.

 From Ashes Rise

When Richard Yanko took on ownership of Life Improvement Center in 1998, he 
promoted his trusted employee, Gary Agger, to clinical director of LIC's 
Tulsa and Oklahoma City locations.

He updated the facilities' computer and database systems and began paying 
for Agger to attend management conferences and workshops to expand his 
skills. Yanko later contended in a lawsuit that during the time Agger was 
learning how to better-manage a methadone clinic, he was clandestinely 
forming a competing clinic, known today as Rightway Medical, with another 
LIC employee and the two attorneys, Byars and Anderson.

Yanko complained that the man he invested in to run his own clinic took the 
knowledge he acquired, along with the company's proprietary records and 
patient files, and proceeded to conduct a "telemarketing campaign" to pull 
patients away from Life Improvement Center, all while continuing to work 
for LIC.

Yanko then rattled off in court records a list of claims against Rightway's 
founders including that Rightway had told LIC patients they would not have 
to be "serviced by African Americans," their physicians would not be 
contacted if they were found to be mixing benzos with methadone, they would 
illegally receive free methadone and extra take-homes and that LIC's 
methadone had been slandered as "generic." The narrative of the suit reads 
as if the two clinics were merely competing to sell ice cream, not a 
narcotic substance designed to treat a powerful drug addiction.

Regardless, Yanko's only legal option was to ask the judge for an 
injunction that would bar Rightway from benefiting from the stolen files. 
The judge ruled Yanko's evidence was insufficient to prove his trade 
secrets and patient lists were misappropriated and that his business would 
suffer irreparable harm.

Yanko alleged in an affidavit that Agger continued to deny his intentions 
to resign and open a competing clinic, even after being confronted with the 
rumor, while still working at LIC. Finally, in June 1999, Agger did resign 
to the "shock" of Yanko.

Immediately afterward, Agger expressed interest in buying LIC from Yanko, 
according to the suit. Even following Agger's deceptions, Yanko considered 
the deal and agreed to turn over sensitive financial information about his 
company without first requesting a signed non-disclosure form and an 
agreement to return the records. Rightway, Yanko further asserted, never 
returned the records and refused his offer of an $800,000 cash deal.

As the story unfolded, more employees left LIC to help form Rightway, 
including another counselor and a nurse.

One knowledgeable source said Yanko had simply never expected to face 
competition in the for-profit methadone business and would thus do whatever 
it took, including embellishing accounts of how his former employees had 
established his new competition, to ensure his methadone monopoly. The 
source said Rightway had no reason to steal patient files when the patients 
were likely to become quickly aware of any alternative providers in the 
city, regardless of how the new business was promoted.

Then again, employee shakeups at the state's methadone clinics aren't 
uncommon. An LIC security guard who left Yanko to help form Rightway 
recently left that company, too, for a job at New Beginnings in Oklahoma 
City. He just couldn't get along with Rightway's ownership, a confidential 
source said.

Golden Arm City

Dee Dee has been on methadone more than 10 years.

Like Chris, Dee Dee's name has been changed to protect her identity. And 
like Chris before he landed in the hospital, she's tired and ashamed of 
being on methadone.

"You have to bite a bullet at some point and it takes a while," she said. 
"[But] once you get on it, it's very, very hard to get off it."

Dee Dee's tried to escape before. She laughs about the "goals."

"I've set so many goals over the years," she says.

She's gotten as low as 10 milligrams a day before sensing the beginnings of 
withdrawal and going back up fearing the full impact. She'd need at least 
two weeks to suffer her way to sobriety. But she doubts she could get two 
weeks off from her job.

Dee Dee says she's always held a job throughout her entire adult life as a 
drug addict. But for more than a decade, the cloud of methadone has 
remained--she says it's the worst addiction she's ever had. And, she says, 
neither clinic in Tulsa has ever suggested even beginning the process of 
withdrawal without her prompting them first.

"The monkey never dies," a dealer says to heroin addict Frank Machine in 
the 1955 film The Man with the Golden Arm. "You kick him off your back and 
he just hides in the corner waiting his turn."

New developments in the drug industry have at least begun to offer Dee Dee 
options. In late 2002, the FDA approved a drug to treat addiction called 
buprenorphine. The drug lasts longer and creates even less of a euphoric 
sensation than methadone. It also produces a significantly lower degree of 
risky respiratory depression.

"The new medications, along with a new law passed in 2000, permit 
physicians to use this medication to treat opiate addiction right in their 
office," said Nick Reuter, a senior public health analyst for the federal 
Substance Abuse and Mental Health Services Administration. "It provides 
another alternative to the methadone program-based treatment system."

Rightway Medical has begun to offer buprenorphine at its clinic in Oklahoma 
City. Clinic administrator Morgan says the alternative is promising.

"We only started it in January, but it seems to be very effective," he 
said. "Patients have stated that it makes them feel more normal."

But it's not cheap. Right now it costs about $110 a week at Rightway. The 
Tulsa Rightway clinic will begin offering it soon, counselor Kirk says.

Reuter said SAMHSA doesn't necessarily view the drug as an alternative to 
methadone maintenance treatment programs. Rather, he said, the drug's 
availability fills a void for 200,000 to 600,000 Americans desiring 
substance-based treatment, but unable to access it in their area.

But Reuter said SAMHSA has tried to target physicians with office-based 
practices who can make the drug available to patients who might need it, 
which suggests a fundamental shift in the way the nation is approaching 
drug addiction treatment.

Ten years ago, family physicians may have been much less likely to involve 
themselves in treating addiction, but now doctors can and are treating 
addicts the way they would any other patient's illness or diseases. 
Fourteen doctors in Oklahoma are already licensed to prescribe 
buprenorphine, Reuter says.

Dee Dee said over the past 10 years, she's seen the clinics' doctors no 
more than once a year, and she said she's still too embarrassed to tell her 
private doctor that she's on methadone.

She still worries that people will find out and wonders how long anyone can 
take it.

She admits the years have felt like wasted time.

"Sure I can be pissed off about it," she said. "But I walked in there on my 
own free will. It's not like there are a lot of options to choose from."

Next Week: Misery Index, Part II. 'Till death do us part.
- ---
MAP posted-by: Elizabeth Wehrman