A recovering heroin addict pays a price for causing trouble at a clinic. 

Tough Medicine

Jeremy Hudson's goal in life is to keep off heroin. So far, he's gone a year and four months without it. And for Hudson, 27, that's a record.

Seven years of heroin had cost Hudson and his family cars, jobs, houses and relationships. Then methadone helped him get his life straight. "It's taken me a year now, and I'm just starting to get little things back," he says.

But what happened on Sept. 30, he says, could jeopardize it all. It also raises questions about overcrowding, clinic policy, due process and the appropriateness of certain treatment methods.

In order to function normally, Hudson has been standing in line every morning for 16 months to swallow 70 mg of red liquid methadone that his blood absorbs quickly. The routine costs him $70 a week, far less than his $100-a-day addiction to heroin did.

That Sunday morning in September, Hudson, his wife and their 3-year-old son piled into the car and left their Brandermill home in plenty of time to make it to the methadone clinic before it closed at 10 a.m. They arrived at the tiny green cinderblock Richmond Treatment Center at 1601 Overbrook Road at 9:25, where 200 people go every day to treat their addiction.

According to Hudson, when they got there three people were waiting in line at the door. By 9:45, Hudson says, the line outside had grown to between 50 and 60 people. Hudson became anxious. He had never seen a line like this. But he had never been turned away.

Typically, a nurse dispenses the liquid methadone and asks about the patient's progress, says Hudson. One person goes in as another comes out. Each dose takes two to three minutes. But this day was different. The line didn't move. According to Hudson, about eight patients who were already inside the building when he arrived received their methadone dose and left. At 10, the assistant director opened the door only to say the center was closed, Hudson says.

Fuming, Hudson went to the side door, which was locked. More than a dozen people, including Hudson, started banging on the front and side doors. Hudson was furious. He recalls yelling, "What the hell's going on? This isn't right." Hudson says the assistant director told everyone to go home or the police would be called. Later, Hudson says, he was told he was inciting a riot.

After trying to page the clinic's new director, Wade Glover, whom Hudson had never met, and trying — unsuccessfully — to get his methadone at a nearby hospital, Hudson and his wife went home. He spent the rest of the day in bed. But of the others who were turned away, he says: "Probably half those people went out and used that day."

But that wasn't the end of Hudson's troubles.

What Hudson says happened on Sept. 30 at the Richmond Treatment Center is apparently not representative of procedures at other local clinics. Directors and counselors at each tell Style that whoever is in line or in the waiting room by the time the window closes is given the medication.

Methadone is a synthetic opiate-based narcotic that is used to treat heroin and other opiate-based dependency. While it is not the only treatment for heroin addiction, it blocks highs and minimizes the withdrawal effects of the drug.

The state's Department of Mental Health, Mental Retardation and Substance Abuse Services oversees licensure of public and private methadone clinics, and sets regulations regarding hours of operation.

Because methadone must be taken daily, each center must be open seven days a week, 12 months a year and for at least two hours outside of regular business hours. All four Richmond clinics have morning and afternoon hours, except on weekends when only morning hours are available. It's left up to the individual clinics to set policies about late arrivals and lines.

There are four methadone clinics in Richmond providing counseling and treatment for more than 800 methadone patients. Two of the Richmond-area methadone clinics are nonprofits; two are private, for-profit clinics. Last year one of the nonprofit clinics, Human Resources, was ordered to close for a few days because it had been serving too many patients. It has 300.

"The problem with most of the clinics is they're full," says Chuck Adcock, director of the Medical College of Virginia's Family Counseling Center.

Indeed, with a rise in heroin use in recent years, local methadone clinics have become overcrowded. According to the Office of National Drug Control Policy there are more than 810,000 people in the United States dependent on heroin. In Virginia, state officials say, that number is nearing 50,000.

Missing a methadone dose is miserable for addicts, but "it's not a life-threatening withdrawal," says Karen Redford, clinical supervisor for substance abuse services at Richmond Behavioral Health Authority. Methadone is designed to act for 24 to 36 hours. "He's not going to die, but he may feel like he is," she adds.

On Monday, Oct. 1, Hudson arrived at the clinic at 6 a.m. to receive his dose as usual. No one at the clinic mentioned the aberration of the day before, he says.

Worried that Hudson might be turned away again, Hudson's mother, Connie Hudson, went to the governor's office that afternoon to report that people had been turned away from the clinic the day before. After meeting with one of Gov. Jim Gilmore's assistants — who didn't return Style's calls — Connie Hudson says she stopped by the Richmond Treatment Center to explain the complaint.

That evening, Hudson says, Glover, the treatment center's director, called Hudson to arrange a meeting. When Hudson arrived at the clinic at 8 a.m. on Tuesday, he met Glover for the first time. He says Glover asked to hear his side of the story. Then, Hudson says, he was told that three witnesses claimed that on Sunday he had threatened one of the staff members.

Hudson was then told he was being placed on what is called a 10-day "administrative detox," a kind of disciplinary measure — used by many clinics — exacted when a patient abuses the program. The patient's methadone dose is quickly reduced — in Hudson's case it went from 70 mg to 15 mg in a week — until the patient is off methadone completely. Then he's taken off the program.

"He was not only turned away at the window, he was discharged," says Connie Hudson. "We think they're detoxing him quickly because we made waves."

Glover says his hands are tied. He declines to talk about Hudson and what he alleges took place at the clinic, saying a federal confidentiality law prohibits it. "What's awkward for us is the client can say whatever they want about us," Glover adds. "We can never tell our side of a complaint."

As to the clinic's policy on closing times and people waiting in line, Glover says: "Our policy is to medicate as many people as we can safely." Glover adds that the clinic services 90 percent of its 215 "clients" a day; who gets medication can depend on the line. "It's like when you got to catch a plane," he explains. "You have to get your ticket and check your luggage. It takes time and you know to get there early." He says all the clinic's patients know this.

He also says that depending on the "evaluation of the situation," the state views a 10-day "administrative detox" as an appropriate way to remove a patient from a methadone program.

Hudson says he plans to file a civil rights complaint with the state's Department of Mental Health, Mental Retardation and Substance Abuse Services against the Richmond Treatment Center. "He does have recourse if he feels retaliated against," says Margaret Walsh with that state office.

But Karen Redford of Richmond Behavioral Health Authority says Hudson will find proving his case difficult to do. "The only thing he can hope to argue is they administratively detoxed without due process," she says.

Meanwhile, Hudson is trying to get into another methadone program before he starts to go through withdrawal. Two clinics have offered to take him. At press time Hudson was on his last day of detox from the Richmond Treatment Center.

"My legs feel like rubber and my joints feel like they're on fire," he says. "Last night I couldn't even sleep. I'm really scared. I've been to lots of clinics and lots of rehabs to get off this stuff. But every addict I've talked to who goes through a rapid detox goes back to heroin."

"My fear is that he'll go back to heroin and die," says Hudson's mother. "He's my only son. I don't want to lose him."

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