a new methadone clinic in Newington is bustling, but is enough treatment available for a growing population of addicts?

Matt Walker gets up before 6 a.m. every day and starts his car in the crisp, pre-dawn gloaming. If he takes the highway, he can reach Newington from his Salisbury, Mass., home in 30 minutes. But Walker prefers a more leisurely route, cutting through back roads lined with oaks and evergreens. The daily commute to and from Merrimack River Medical Services in Newington takes a two-hour chunk out of his day, but he doesn’t mind. A good thing, because there is no closer methadone clinic to his home. 

After leaving the clinic, Walker usually visits a nearby park where he can work on his knuckleball. A recovering opiate addict, he is still adjusting to a life removed from the emotional peaks and troughs of rampant drug abuse. He is unemployed, but he is healthier and more emotionally stable than he has been in years.

On Jan. 8, Walker sat in the Portsmouth Public Library perusing online science journals. He wore a tan leather jacket and blue jeans and tucked his long brown hair behind his ears. Originally from Texas, Walker speaks with a southern twang that makes him sound younger than his 35 years. He looks his listener in the eyes, occasionally rubbing his chin or the bridge of his nose as he articulates his thoughts.

There was no indication to suggest he had swallowed 180 milligrams of methadone, a synthetic opiate used to squelch the cravings of recovering addicts, only an hour earlier. His eyes were not glazed, his speech was not slurred, and he was perfectly alert.

“One of the misconceptions is that people who take methadone are high all day, walking around among us stoned, and that’s just not the case,” Walker said. “I had my dose before I came and saw you, and I’m on one of the higher doses, and I’m not stoned, I’m not drooling … At this point I feel no effect whatsoever other than the absence of the unpleasant effects of not having it.”

Those “unpleasant effects” stem from an opiate addiction that began as an effort to treat severe bouts of depression and psychological anguish that have haunted Walker since the age of 14. He is bipolar, and he struggled for years to find an affective method of coping with episodes of depression that pushed him to the brink of suicide. 

Unable to deal with the intense periods of despair, Walker first turned to alcohol as a teenager. It took several years of heavy drinking before he realized the booze was only intensifying the problem. At the age of 25, he discovered he could order opiate-based medications over the Internet. The pills worked better than anything he had tried before, including conventional drugs for treating depression.

“The only thing that really worked was opiates,” he said. “It just deadens it enough to make it possible to get through the day and into tomorrow.”

Walker used the pills intermittently whenever his attacks of depression became unbearable. But with the media trumpeting abuse problems across the nation, online prescriptions became more difficult to attain. Then Walker collided head-on with a crippling bout of depression, the worst he had ever experienced.

“If I had had to continue last year with nothing, I was going to shoot myself. There is just no way around it,” he said.

Unlike most methadone patients, Walker never used heroin or bought drugs on the street. Instead, he researched ways to cultivate his own potent medicine from the poppy plant, drinking it in the form of a homemade tea.

Walker is reluctant to disclose the ingredients of the concoction he consumed on a daily basis for nine months. The last thing he wants is to inspire a new generation of potential drug users. His creation was just as potent and addictive as heroin and other opiates, he said.

The drugs helped Walker numb the feelings of melancholy and dejection that tore at him for six stormy months. But after the stretch of depression elapsed, he found himself unable to walk away from the powerful drug.

“After six months of opiates, you’re gonna be pretty hooked. So that’s pretty much where I found myself,” he said. “The psychological foundation had alleviated … but at that point I had the addiction.”

Walker soon realized he needed help to kick the drug he had been using to medicate himself. He began discussing the problem with his wife of 14 years.

“My wife and I talked about it and she said, ‘Why don’t you go to a methadone clinic?’ And I never really had thought about it before,” he said. “Psychologically there’s a stigma to it, and you just don’t imagine that you would be someone who would go to a methadone clinic.”

But once he spoke to staff at Merrimack River Medical Services, Walker realized his perception of methadone clinics was far from the reality. The facility looked like any other doctor’s office, and the nurses and therapists welcomed him with professionalism and sincerity.

After six months of daily methadone doses and weekly counseling, Walker says his need for methadone is similar to a diabetic’s need for insulin. The synthetic opiate slakes his cravings and prevents the aches and shivers of withdrawal, keeping him stable and preventing him from getting sick.

“It’s exactly like being a diabetic or anything like that where there’s an amount of medicine that I need on a regular basis,” he said. “The ritual of it for me does a world of good. Every morning I have to get up and I have to go. I can’t just stay in bed and feel awful.”

getting clean
The clinic in Newington opened last summer with very little fanfare and has remained largely hidden from the public eye.

Tucked away in an industrial area off Shattuck Way, most Seacoast residents are probably unaware of the facility’s existence.
But the services offered inside are crucial for helping recovering addicts bring structure to their chaotic lives.

“When you’re using heroin, your life is spiked. You’re either high or you’re low,” said Bob Potter, vice president of development for Community Substance Abuse Centers. “The beauty about methadone is that it stabilizes you and it keeps you at an even keel.”

Community Substance Abuse Centers is a private, outpatient program that owns a total of 12 methadone clinics in Massachusetts, New Hampshire, Connecticut and Maine. Its sister company, Merrimack River Medical Services, operates the three locations in New Hampshire. The state’s first clinic opened in Hudson in 1999 and was followed a few years later by a facility in Somersworth. When surveys found that people were commuting long distances to reach the Somersworth clinic, disrupting work and family schedules, a third location was established in Newington.

Dressed in a suit and tie, Potter visited Newington on Jan. 3. He said the operation has run smoothly in its first six months. The number of daily clients has swelled to at least 65, about 20 of whom were adopted from the Somersworth location.

New clients at the clinic must go through a rigorous intake process, answering questions about how long they have been using and how often they use. A doctor or nurse practitioner then conducts a physical examination to monitor withdrawal levels. They also check for track marks and take urine samples to ensure that the individual is an actual addict, not an imposter trying to get high on methadone.

“The intake is pretty intense,” Potter said. “We have to see some physical signs of withdrawal and some confirmation that they have been using opiates.”

If the addiction is severe, signs of withdrawal are not difficult to recognize.

“Withdrawal has been explained to me over 30 years as the severest case of the flu that you could ever have,” Potter said. “Sweats, tearing, diarrhea, aches and pains, headache, nausea—and the only thing that will make that go away is using an opiate.”

Upon entering the clinic, patients present photo identification cards to a receptionist before entering a small room with two “dosing windows.” Nurses in a secure dispensary administer the liquid methadone in plastic cups, providing the appropriate dosage for each patient. The patient swallows it down, chases it with some water, then leaves.

A single dose of methadone helps slake opiate cravings for 24 to 48 hours. Depending on their tolerance levels, different patients require different dosages. When the proper dosage level is established, the drug stabilizes patients without intoxicating them, enabling them to function through work and family chores.

The clinic in Newington serves doses seven days a week, from 6 a.m. to 9 a.m., and offers counseling until 2 p.m. Generally, the patient must enter the clinic alone and consume the drug on site, but longtime patients can earn the privilege of “take-home” doses.

But administering medicine is the easy part. Anyone who has experienced a prolonged opiate addiction is extremely prone to relapsing, even months or years after the initial habit has been kicked.

Even as the physical cravings dwindle, it is difficult to let go of the rocky lifestyle to which addicts become accustomed. Most longtime addicts have reduced their social acquaintances to other users. After years of spending every waking moment in search of drugs, they do not know what to do with themselves when the habit is gone.

For many, the key to long-term success is mandatory counseling that helps recovering addicts adjust their routines, discover new interests and bring structure to their lives. The counseling is uniquely tailored to the needs of each individual patient.
“We’re very active in our patients’ lives,” said clinic director Matt Davis. “They’re very disenfranchised.”

If a patient misses an appointment, staff members start making phone calls to find out what happened. Random urine tests are administered to make sure patients stay away from other opiates.

But the transition to a drug-free existence is not immediate, and a zero-tolerance policy would not benefit patients, Potter said. As much as he would like to see patients kick heroin completely after one dose of methadone, his experience in the business tells him it’s not that simple.

“If you’ve been using four times a day, seven days a week before you got here, and a month after you’re in treatment you’re using three times a week once a day, we see that as progress,” Potter said.

If a client consistently fails urine tests or skips appointments, the stakes get higher. Counseling is increased, and privileges like take-home doses can be delayed or revoked. Eliminating a patient from treatment, however, is a last resort.

For the average patient, methadone treatment lasts from 18 months to two years. But the demand for counseling remains even after the patient no longer requires medication. Departing clients are usually referred to other outpatient programs like Narcotics Anonymous.

“Unless you keep support systems in place, it’s a pretty good bet that you’re going to relapse at some point,” Potter said. “Why people relapse is beyond me. It’s beyond, I think, any medical specialist. You can have your life under control, you can be stabilized, you can be drug free, but for some reason—your dog gets run over, you get in an argument with your boss, your wife threatens to leave you—and you know in a heartbeat that if you stick that needle in your arm or you snort that bag you’re gonna feel better and you won’t have to deal with this.” 

relapsing
Potter’s words about the tendency to relapse made me wince a little. In October 2004, one of my best friends died of a heroin overdose in Oaxaca, Mexico. He was 32, and he had been clean for the better part of eight years.

For those of us who were close to Jeff Waleryszak, who grew up in Exeter, the shock of his death is still felt in our daily lives.

His vibrancy and humor won over everyone with whom he came in contact. He laughed easily and naturally at rudimentary things, and his laughter was infectious. Jeff and I toured Zagreb, Croatia, together in 1999. Six months later we were snorkeling in Lanikai, Hawaii. We went hiking and lake diving in New Hampshire and Maine, and frequented the bars of Portsmouth and Exeter. He wrestled with his darkness in private.

The image of Jeff as a down-and-out “junky” is completely incongruous with my memory of him as a radiant connoisseur of life. But heroin does not discriminate between the wise and the ignorant, the poor and the affluent, the young and the old.

According to his friends and family, Jeff started experimenting with heroin sometime between his freshman and sophomore years at Pitzer College in Claremont, Calif., where he majored in psychology. He continued using the drug recreationally through college, then delved deeper into addiction after graduating and moving to Los Angeles.

“L.A. is a vicious city, and heroin was definitely making a comeback, particularly there and in New York,” said his younger brother, Seth Waleryszak, who remains a close friend. “He was with the wrong type of people.”

When he was clean, Jeff occasionally told us unsettling stories about the depth of his abuse.

“A friend of his actually overdosed on heroin, his roommate, so my brother put sugar in his mouth and tried to revive him,” Seth recalled. “When he revived his friend and put him in the bathtub and everything, the first thing my brother asked him was, ‘Do you have any more?’ … He shared that story with certain friends just to kind of tell them the magnitude of his problem.”

Jeff eventually recognized the gravity of his affliction. He would later tell his mother that he tried using methadone in California but found it did not help. An obstinately independent person, he was also skeptical of counseling. He turned instead to his family and flew home to Exeter.

“Mostly he came home because he was battling the addiction,” said Carol Waleryszak, Jeff’s mother. “He broke it to me first, he always felt he could talk to me, and then I broke it to his father. But it was something that was very hard to hear.”

Under the watchful eyes of his family and friends, Jeff seemed to convalesce in Exeter. But he remained resistant to professional help.  

“After he came back home, the first time we sat down and talked about it,” said Ric Waleryszak, Jeff’s father. “We told him we’re willing to help pay his way for counseling. But I think he was embarrassed about it, and it’s something he thought he could handle himself.”

Jeff eventually moved to San Francisco and then returned to the Seacoast, where he engaged in social work and thrived for several years. He later moved to Hawaii with his girlfriend, where he worked with behaviorally troubled teenagers.

Jeff’s first known relapse occurred when he hit a rough patch with his girlfriend in Hawaii. Eager to snuff the problem before it could spiral out of control, he returned home once again. I can still see him rolling back his sleeve to show me the track marks in his arm, and I remember how his voice trembled as he solemnly made me promise never to try heroin. I promised.

This time, Jeff told his parents he was willing to seek counseling. He began seeing a therapist in Dover, but found the experience utterly distasteful and quickly abandoned the treatment. Seth believes his brother’s background in social work made him immune to its effectiveness.

“It’s tough to swallow a philosophy that’s trying to make you into some sort of monk,” Seth said. “Jeff liked to have a glass of beer, or two or three. I don’t think that was any trigger for his death… I think the emotional turmoil he was going through was more of a trigger.”

On the surface, Jeff had been doing extremely well since relapsing in Hawaii. But the vestiges of addiction can manifest themselves at any time. And as Seth noted, Jeff’s trigger was relationships.

After returning from Hawaii, Jeff began dating a beautiful woman he met while vacationing in Oaxaca. The two were close to marriage when she suddenly returned to Oaxaca and ended the relationship with a long-distance phone call. Jeff promptly bought a plane ticket to Mexico, saying he needed to bring closure to the relationship.

On the evening of Oct. 26, 2004, I was making plans to watch Game 3 of the World Series between the Red Sox and the St. Louis Cardinals with Seth and his cousin, Graham Waleryszak, also a close friend. I called Graham shortly before the first pitch. He answered the phone with an odd quaver in his voice.

“Kanner,” he said. “Jeff’s dead.”

getting help
In 2005, about 108,000 people over the age of 12 tried heroin for the first time, according to the National Survey on Drug Use and Health. Even more disturbing, the number of fatal heroin overdoses increased by 166 percent between 1990 and 2000, according to Community Substance Abuse Centers. During the same period, the purity level of street heroin increased by about 50 percent and prices dropped to about $5 a bag. 

Rockingham County Attorney Jim Reams said heroin abuse on the Seacoast has increased dramatically in recent years and is spreading to a younger population.

“It has clearly increased,” Reams said. “Every police agency on the Seacoast reports more heroin usage than in the past and lower prices and more experimentation by high school kids.”

There are no state funded programs for drug treatment in Rockingham County, and Reams firmly believes the availability of treatment must be enhanced.

“We’re not even close, and I think Rockingham County is particularly underserved,” he said, adding that he has spoken to Department of Health and Human Services Commissioner John Stephen about coming up with ways to fund treatment centers in the area.

The average methadone patient is between the ages of 20 and 30; by law, patients must be at least 18. But people of varying ages and income brackets show up for treatment. Some patients are pregnant. Others have contracted HIV from needle sharing.

“I think heroin is rampant on the Seacoast,” said Potter. “I think I could probably set up a satellite methadone clinic in just about every community from Newington right down to Salisbury.”

There are a total of eight clinics in New Hampshire, each of which treats an average of 200 to 300 patients. In 1995, Maine had only one methadone clinic, with about 200 patients. Today, there are six clinics with around 2,500 total patients, and new clinics are on the way in Portland and Rockland, said Kimberly Johnson, director of the Maine Office of Substance Abuse.

Ten years ago, less than 1 percent of all admissions for addiction treatment in Maine were related to heroin or prescription opiates. That number has swelled to about 25 percent, Johnson said.

But for every addict receiving treatment, there are six to 10 untreated addicts in the community, according to Community Substance Abuse Centers.

Establishing new clinics requires considerable work. Even if a suitable space is found and zoning regulations are met, it is not easy to convince town officials and residents that a methadone clinic won’t bring a flood of loitering junkies to their doorsteps.

In the case of Newington, Potter met repeatedly with the town manager, planning board and police chief before opening a clinic. He gave public presentations and fielded questions from concerned residents. He also met with the fire chief, who worried that his emergency medical technicians would be tied up responding to overdoses.

So far, the operation has led what Davis called a “benign existence.” The clinic is located out of the public’s view, which reduces anxiety for residents and provides anonymity for patients. Newington Police Chief Jon Tretter said the clinic has not caused any problems during its first six months.

“We had spoken to other police agencies that had clinics in their jurisdictions and I guess you never know, but I don’t know that we were overly concerned with it being here.”

Tretter said heroin abuse remains a major issue in the area, and the clinic has not had a significant impact on the problem.
“We certainly haven’t seen an increase or decrease in crime due to that being in Newington,” he said.

Reams noted that heroin addicts typically commit a variety of crimes to support their habits, and methadone clinics like the one in Newington have the potential to reduce crime rates in the community.

“I think that prosecutors nationwide have been supportive of treatment programs for that reason,” he said. “We have plenty to do. We don’t need to be re-arresting people time and time again.”

While Davis wants to keep things quiet at the clinic, he also wants addicts to know that treatment services are available. The facility has the capacity to serve twice its current clientele.

“I think in the beginning when a clinic opens, not everyone is aware of it,” Davis said. “We need to let the community that we serve know that we’re here.”

All N.H. clinics are privately owned, for-profit facilities regulated by the state and others. For example, Merrimack River Medical Services is certified by the state of New Hampshire, the Office of Substance Abuse and the Pharmacy Board in Concord, the Mental Health Association in Maryland, the federal Drug Enforcement Administration and the Commission on Accreditation of Rehabilitation Facilities.

The cost of receiving treatment is $100 a week. A number of insurance policies are accepted, including N.H. Medicaid, Behavioral Health Network, Teamsters Behavioral Health, MaineCare and Anthem.

Matt Walker said he has struggled to find insurance coverage to pay his $400 a month methadone expense. But he said he would let the power go out in his house before giving up the treatment. He pays out of pocket and has received assistance from his father, who recently visited from Texas.

“He’s a pretty hardcore Texas cowboy. He’s not inclined toward a lot of liberal hippie shit,” Walker said. “But he does appreciate practical efficacy. If something works, keep doing it. And he could see that this is clearly working for me.”

Success rates for methadone programs are difficult to measure. Davis, who has been working in the addiction recovery field since the 1970s and directs all three clinics in New Hampshire, said small victories are achieved every time a client walks through the door for a dose of methadone or keeps a counseling appointment.

Although data show something like 90 percent of urine tests in Newington come back clean, real progress is measured in the clients’ daily lives. The fruits of success come in the form of a recovered driver’s license, a new job or a patched family bond.

While methadone is not a flawless panacea for the heroin problem, it is the most successful proven treatment available.

“Of the various treatments available (for opiate addiction), methadone maintenance treatment, combined with attention to medical, psychiatric and socioeconomic issues, as well as drug counseling, has the highest probability of being effective,” reported a panel of experts convened by the National Institutes of Health in 1997.

Despite its advantages, methadone has its own baggage.

Abuse issues have sprung from its increasing popularity as medically prescribed alternative to highly addictive, opiate-based OxyContin. The pill form used for pain treatment is an entirely separate issue from the liquid form used to treat opiate dependence, but state officials hope the public will differentiate between the two.

In 2005, there was a record 176 overdose deaths in Maine, 67 of which involved methadone. But few or none of the overdose deaths associated with methadone involved the liquid form used for opiate dependence, said Joe Harding, director of the N.H. Office of Alcohol and Drug Policy. Harding said methadone remains vital to those trying to wean themselves off opiates, and the liquid form has not caused problems of abuse.

Doctors are exploring other drugs to treat opiate dependence, including buprenorphine, which is available under the brand-name Suboxone. Johnson said Suboxone is not as potent as methadone and can be consumed in the form of a tablet that dissolves on the tongue.

Matt Walker said he tried Suboxone but found it was too mild to overcome his intense withdrawal symptoms. Johnson confirmed that the drug does not work for everyone and is not intended to replace methadone—only to provide another option for recovering addicts.

Meanwhile, the methadone industry is growing across Maine, she added.

“We have had a dramatic increase in opiate addiction and therefore we have had a dramatic increase in demand for treatment,” Johnson said.

hope
The morning after Jeff Waleryszak’s death, friends and family gathered at his grandmother’s house. Ric and Carol soon arrived and confirmed what many of us already suspected. A medical examiner found two track marks in Jeff’s arm. The first shot got him high. The second killed him.

Jeff’s parents still struggle to understand how a young man with such charisma, ambition and love could fall victim to an affliction publicly associated with sordid crime and decadence. Beneath the jovial, outgoing surface we all witnessed, the fanged demons of addiction waited in his bones and organs, waiting for a weak point. Although heroin and other street opiates are illegal, people from all walks of life make the mistake of experimenting. Once addiction sets in, the user has contracted a disease of the brain and the opiate has become a biological necessity.

“If you’re addicted, it’s like having a 50 pound gorilla on you. He’s always there,” Ric said.

Ric and Carol, who own Exeter Elms Campground, said they have never so much as smoked marijuana. The inescapable nature of addiction and the tendency to relapse is therefore especially difficult for them to grasp. They wonder if they could have done more.

“The last couple of years I’ve had a really tough time,” Ric said. “It’s something you probably never get over. I guess it’s in degrees. I’m getting to the point that maybe I’m coming on the other side, but I don’t know, maybe two weeks from now if you ask me that question I’ll be in a hole again. ... There’s not a day that I don’t think about Jeff at some point.”

There is no way of knowing whether prolonged methadone treatment or extensive counseling could have prevented Jeff’s death. Like Matt Walker, Jeff’s friends and family that hope increased awareness will help dissolve the harsh social stigma attached to drug addiction and pave the way for more treatment opportunities.

“The public perception of drug abuse is that a drug addict should be blamed for their own mistakes; that they are somehow guilty of something, of weakness, and so they need to deal with it,” Seth said. “Really, I think people who work in recovery or social work actually see it more as a disease.”

“I think the first thing that has to happen is that people need to realize the extent of the problem, and I don’t think we have any clue still in this area,” Carol said. “I think we like to just put our heads in the sand and pretend it isn’t happening.”

Walker fears that hundreds of drug addicts in the Seacoast do not realize that treatment options exist. Methadone clinics do more than provide resources to help patients battle addiction. They show addicts that they are not alone.

Walker said he intends to continue using methadone and receiving treatment indefinitely. At the clinic in Newington, he has watched patients undergo profound transformations. Every morning, he arrives for his dose and sees the familiar faces of other patients, and he can watch them getting healthier. Those who are committed to getting better make gradual progress with each passing day. They get jobs. They buy new clothes. They stand upright when they walk, and they take good care of their families. 

“You see healthy children inside playing with toys, and they’re clean and obviously well fed and well cared for. They’re loved. And if this hadn’t been available, if there hadn’t been a clinic for these people to go to, what would those children’s lives be like?” Walker said. “Everyone’s a son, everyone’s a father or a friend, and I really think that it does matter that these people are given an opportunity to craft a life again. And how do you measure the good that comes after that?”