New Drug Gives Addicts a Way Out
Emilia Askari, Detroit Free Press- 2/7/2003

Odis Rivers was hooked on heroin for 20 years. He says he tried to stop a thousand times without success. Then he heard about a professor at Wayne State University who was offering addicts a new way to quit: taking a new medication called buprenorphine. Rivers signed up for the clinical trial in 1997. He hasn't used heroin since. In 1999, he tapered off of buprenorphine and says he has been drug-free for more than two years now.
    Rivers and federal experts say buprenorphine can be life-changing not only for heroin addicts but also for the rapidly increasing numbers of people abusing pain-killers, which can mimic heroin's effects on the brain. "I was having big withdrawal symptoms. It eased all of those symptoms down," Rivers said last week. "That way, I was able to think clearly and make good decisions. It turned my life around." Rivers of Baltimore lived in Detroit until he finished the Wayne State study two years ago.

Alternative to methadone
The medication offers tens of thousands of addicts in Michigan -- and millions across the country -- an alternative to methadone, which for three decades has been the predominant choice, besides quitting cold turkey. Dr. Vipul Patel, who works in a Henry Ford System substance-abuse clinic on Maple Road in West Bloomfield, is one of 19 Michigan doctors who have received government clearance to prescribe buprenorphine. "I haven't had any chance to use it yet," he said last week. "But I want to help my patients. I want to see if it's a better alternative."
    Buprenorphine holds promise for addicts of opiate drugs, which include heroin and many pain killers, such as darvon and codeine. For years, heroin was the most-abused drug in the family. Recently, however, abuse of pain-killershas soared as doctors focused more on pain control and prescribed more painkilling drugs.
    Now, the number of people abusing painkillers nationwide exceeds the number who use heroin, according to the Substance Abuse and Mental Health Services Administration. While heroin has the image of a "street" drug linked to poverty and crime, painkilling drugs often are abused by middle-class people with jobs and families. Detroit ranks sixth among major U.S. cities tracked by the federal government for abuse of painkillers, according to the substance abuse administration. It ranks eight in heroin use.
    Buprenorphine, sometimes called "bupe," has several advantages over methadone for treating addiction to heroin or painkillers. The primary advantage is that any doctor who goes through a day of special training and registers with the government can write a prescription for buprenorphine. Methadone is heavily regulated and dispensed only from drug-abuse clinics that require patients to stand in line daily and drink their dose in front of a nurse. Buprenorphine is a pill that can be taken as infrequently as once every three days -- in the privacy of the addict's home. Currently, health officials estimate that only 20 percent of heroin addicts are trying to quit with methadone.
    The percentage of painkiller addicts using methadone to try and kick their habit is thought to be much smaller. "It is so insensitive and stigmatizing that people have to go to a methadone clinic," said Dr. Calvin Trent, director of the Detroit health department's bureau of substance abuse. "It's really good that people will be able to get this new medication from their family doctors."

Opiate withdrawal
Both methadone and buprenorphine reduce or eliminate withdrawal symptoms and craving for heroin or other opiates, such as painkillers. But users can easily become hooked on methadone, taking the medication for many years. Buprenorphine is easier to quit, according to doctors who have studied it. Also, it's much harder to overdose on buprenorphine. In fact, if you try to take a lot of it you won't get high because the medication has a "ceiling" effect, said Robert Lubran, director, division of pharmacologic therapies of the government's Substance Abuse and Mental Health Services Administration. In fact, buprenorphine is commonly mixed with another medication that actually will induce withdrawal symptoms if it is taken in larger-than-prescribed doses.
    Some drawbacks of buprenorphine, which is produced in the United Kingdom by a conglomerate called Reckitt Benckiser, better known as the maker of French's mustard and cleansers such as Lysol and Woolite:
* Buprenorphine costs about $10 a dose, compared to $3 a dose for methadone.
* It's still not known the cost of the new medication will be covered by Medicaid and various HMOs and insurance companies.
* Buprenorphine cannot help some people who now need very high doses of methadone to reduce their drug cravings.
* It doesn't necessarily come with the psychological support and counseling that is required at methadone clinics.
* It can kill patients who try to overdose on buprenorphine in combination with other drugs such as alcohol. "It's not a totally safe drug. I don't think any drug is totally safe," Lubran said. "It's another treatment option. We hope this is going to be the new path to recovery."

Painkilling treatment
Buprenorphine is itself a painkiller. It has been used to treat opiate addiction for more than six years in France, during which time the number of opiate-abusers there has fallen dramatically. Buprenorphine now is sold throughout Europe for opiate treatment. The Federal Drug Administration approved it for that use in the United States last October.
    The government plans to allow 6,000 doctors nationwide to prescribe buprenorphine. Each will be permitted to prescribe the drug to no more than 30 patients at a time. "We have many antibiotics," said Dr. Charles Schuster, director of Wayne State's addiction research institute and the professor who helped Rivers and about five dozen other heroin addicts quit using buprenorphine. "We need to have more than one way to treat opiate addiction."

Drinking Water May Make Ecstasy Hangover Worse
Dianne Partie Lange, Los Angeles Times- 2/7/2003

The mild headache, vomiting and lethargy that are sometimes thought of as an Ecstasy hangover may be a warning sign of swelling in the brain. And one of the usual remedies -- drinking water -- will probably make the condition worse. Perhaps dangerously so. A case report of a young woman treated for hyponatremia -- low levels of sodium in the blood that causes fluid to build in the brain -- was published in the December issue of the Journal of Urban Medicine to alert physicians to the problem.
    "People who take the drug tend to dance and sweat a lot, and so they drink a lot of water. At the same time, Ecstasy causes the release of antidiuretic hormone, which causes this extra water to drive down the sodium level in the blood. This causes fluid that normally stays in the bloodstream to go into the brain, causing swelling and interfering with vital brain functions," says Stephen J. Traub, an author of the report and co-director of toxicology at Beth Israel Deaconess Medical Center in Boston. Anyone with signs of hyponatremia -- drowsiness, slurred speech, vomiting, headache -- should go to a hospital or call the nearest poison control center.

Report Details Heart Risks of Cocaine Use
Reuters News Service, 2/7/2003

BOSTON -- Most cocaine users who seek emergency medical help because of chest pains are not actually having a heart attack, and doctors can usually send them home after observation, researchers said Wednesday. But the finding does not diminish the risk of heart disease posed by cocaine, which was used by an estimated 3.7 million Americans in 2002. Within an hour of taking the drug, the risk of a heart attack soars to 24 times the normal level, the researchers said. Each year $83 million is spent to treat the thousands of cocaine users who spend several days in U.S. hospitals after complaining of chest pains linked to the drug. The medical community has been looking at whether such patients can be discharged early if tests show no evidence of a heart attack.
    A study of 344 patients at the Hurley Medical Center in Flint, Mich., concluded that cocaine users who have chest pains may not be having a heart attack, but they face a good chance of developing one with future use of the drug. "Many patients have little or no idea of the cardiovascular risks associated with cocaine use," said Robert Kloner and Shereif Rezkalla in an analysis of the results in today's New England Journal of Medicine, where the study was published. Kloner, of the Good Samaritan Hospital, and Rezkalla, of the University of Southern California, both in Los Angeles, said a heart attack can develop in first-time cocaine users, occasional users, and long-term users.

 Michigan Appeals Court Upholds Revocation of Social Worker's License
Associated Press, 2/8/2003

MANISTEE, Mich. -- The state was correct to discipline a social worker for failing to act on knowledge that might have prevented the abuse of a child, the Michigan Court of Appeals has ruled. The court said the state Board of Examiners of Social Workers was correct in 1998 to revoke the certification of Mary Becker-Witt. Becker-Witt failed to report that one of her clients had admitted in 1993 that the client had performed oral sex on her toddler son in 1987.
    In its Jan. 31 ruling, the appeals court reversed a 2000 decision by Circuit Judge James Batzer, who ruled that the state could not discipline Becker-Witt because she owed a legal "duty of competence" to her client but not to the child, the Traverse City Record-Eagle reported. The three-judge appeals court panel rejected that argument, saying instead that social workers also have a duty to children and the general public to report suspected abuse. Becker-Witt, who was a social worker for Community Mental Health for Manistee-Benzie Counties when her license was revoked, also was fined $5,000.
    Michigan's Child Protection Act requires all social workers, doctors, teachers, therapists and other professionals to report abuse. But it wasn't until 1994 that Becker-Witt mentioned the sexual abuse to a Family Independence Agency worker, who immediately requested an investigation into the client. As a result, the child was made temporary a ward of the court. An administrative law judge said Becker-Witt's failure to report the child's abuse directly contributed to the child abusing a neighbor boy months after Becker-Witt was informed of the abuse by her client. Robert Kaufman, Becker-Witt's attorney, said his client will appeal the latest ruling.

Massachusetts Governor Reverses Mental Care Cut
Ellen Barry, Boston Globe- 2/8/2003

Swayed by the protests of mentally ill people and their caregivers, Governor Mitt Romney yesterday reversed his decision to eliminate the state's 40 psychiatric day treatment programs -- the first such reversal since the governor announced sweeping emergency budget cuts last month. The programs, put in place years ago as state mental hospitals were emptied, provide daily activities and monitoring for 4,900 of the state's most severely mentally ill citizens.
    ''We have pretty much decided this was a mistake. This was a core service,'' Health and Human Services Secretary Ron Preston said yesterday. ''I'm not embarrassed about whether mistakes happen along the line. The question is, are you going to reconsider what you've done.'' Preston warned that the reprieve may be a limited one: Next year the governor may still reduce psychiatric day treatment programs to serve only ''a few hundred'' clients in most severe need.
    The 40 day programs cost the state about $11 million a year in Medicaid payments, and the cut would have saved about $1.1 million from the 2003 budget -- part of a $75 million Medicaid savings that Romney announced last week. Preston said the $1.1 million would be cut elsewhere in the Health and Human Services budget, but would not be more specific. ''We have pretty much got it solved,'' he said.
    The reversal came at the end of a week of mobilization to protect the programs. Clients participate in therapeutic activities such as cooking and art projects, but a more important function, staff said, is to head off emergency hospitalizations and making sure they do not become isolated and depressed. Staff said day treatment provides support that clients lost when they moved out of state hospitals, like coordinating housing and medicine.
    ''There was a promise,'' said Judi Ash, who oversees two psychiatric day treatment programs through the North Suffolk Mental Health Association. ''We moved these clients out of hospitals, we moved them into the community, we tell them we're going to support them.'' Canceling the day programs would ''pull the rug out from under them.''
    At the Lawrence F. Schiff Center day treatment program in Cambridge's Central Square, 53-year-old Susan Winniman, one of the last residents of Metropolitan State Hospital, declared yesterday that she was ''rebelling against Romney'' because of the threatened cuts, which were to go into effect April 1. Word was spreading about a protest scheduled for next week on Boston Common.
    The cut had also come under criticism from state Senate Ways and Means Committee chairwoman Therese Murray, a Democrat from Plymouth, who argued that the programs' clients could easily become violent without community support, and ''the public will quickly become aware that they are not getting treatment.'' Over the last year, people with major mental illnesses have been responsible for at least five homicides in the Boston area.
    Preston said the testimony of mentally ill citizens and their families at a hearing on Thursday had been ''compelling.'' ''We have heard probably more about the psychiatric day treatment program than any other'' cut, he said. ''You have to look at it intrinsically. What really is lost? What these people were saying was . . . that they were living on the edge and this was making a real difference,'' he said. ''Looking at that, we were persuaded.''
    Reached late yesterday, community mental health providers praised Preston's decision to reconsider the cuts. ''It's wonderful and reassuring to realize that if they do make a decision that turns out to not be the best one . . . they're willing to make a change,'' said Dr. Bruce Bird, CEO of the North Suffolk Mental Health Association. ''It was a decision that was obviously not as well-informed as it should have been.'' Preston said the governor's health policymakers had decided on the cuts during a marathon budget-cutting session in which commissioners suggested ''the things that would do the least damage.'' The day treatment programs were an optional program under Medicaid, which itself accounts for one-fourth of the $23 billion state budget.
    Cuts to Medicaid are expected to affect mentally ill citizens in a variety of ways this year, including tougher eligibility requirements, copayments, and rate cuts to providers. Much care for the mentally ill was transferred onto federal payrolls during the 1960s, as states shut down their long-term care facilities, noted Dr. Paul Appelbaum of the University of Massachusetts Medical Center, who is serving as president of the American Psychiatric Association. ''This was a deliberate move to try to save money by putting these people on Medicaid rolls,'' he said. ''Now, with people looking at the Medicaid budget and looking for places to cut,'' it should be no surprise that care for the mentally ill will be disproportionately affected.
    For now, though, the news was good, said Sister Tuyet Tran, a Dominican nun who has spent three years building up the city's first treatment program for Vietnamese immigrants. Among the clients who now attend regularly is a 35-year-old man who saw shadows sneaking toward him to kill him. His parents tried for years to handle his delusions themselves: By the time they reported that they needed help with him, he had chased his father around the house with a knife until the elderly man jumped out a second-story window. The man's English has improved so much that he instructs the other clients, and yesterday he gave an interview in an attempt to save the program. ''Thank God,'' Tran said. ''I'm so happy, my lips are touching my ears.''

Clinic Denies Link to Woman Convicted of Methadone OUI
Associated Press, 2/8/2003

PORTLAND, Maine -- A Westbrook methadone clinic denied Friday that a Yarmouth woman who was found guilty of operating under the influence of the heroin substitute had been at the clinic prior to her arrest last year. Jordan Levasseur was not a patient at CAP Quality Care on May 10, 2002, the date that she was stopped for driving erratically on Interstate 95, said Stephen Cotreau, CAP Quality Care's clinical director. A urine test revealed that Levasseur had methadone in her system, according to testimony by a drug recognition expert. Cumberland County District Attorney Stephanie Anderson said Thursday she was troubled by the case and found it hard to fathom how the clinic could give anyone methadone and advise them that it was safe to drive.
    Cotreau said methadone does not impair cognitive functions and that Anderson's comments reflect an alarming ignorance of methadone and its use in treating addicts. ''Numerous epidemiological studies have confirmed that methadone does not impair driving skills and that methadone patients are not involved in driving accidents at greater rates than the general public,'' he said. Cotreau said Anderson's alarmist statement that patients in methadone treatment pose a public safety risk was preposterous. ''If we are going to address the disturbing and complex issue of drug addiction in our society, we need to do it with facts not with political posturing and scare tactics that only lead to dangerous misperceptions about this issue,'' he said. A message seeking a response from Anderson was not immediately returned.g

Heroin Is Making Deadly Inroads In New England
Pamela Ferdinand, Washington Post- 2/8/2003

PORTLAND, Maine -- A chef, 26, clean and sober for several months, fatally overdosed on heroin sold to her by a close friend here in January 2002. Then a financial adviser, 27, a heroin addict, was found dead from a methadone overdose. Three days later, a heroin user in his forties collapsed after overdosing and died on a step leading into his apartment building.
    They were only the beginning of a deadly spiral. Last year ended with Portland setting a record for itself, with 28 drug-related deaths, two-thirds of them involving known heroin users. Meanwhile, 80 miles away in the rural community of Farmington, the drug also had made its potent presence felt with three deaths last spring, including two men in their thirties who overdosed together one night. "Throughout the state, heroin is an epidemic. No question," said Portland Detective Sgt. Scott Pelletier, a supervisory special agent with the Maine Drug Enforcement Agency.
    Maine is not alone. All across northern New England, heroin is addicting younger users, increasing other crime, and killing addicts at an unprecedented pace, according to law enforcement and public health agencies. While not creating the number of addicts of larger metropolitan areas such as Boston and New York, heroin is especially devastating in a mostly rural and geographically isolated region. Communities in these small states lack extensive drug treatment centers, and drug-related deaths and crimes are straining the resources not only of police but also of medical examiners conducting more autopsies. "It's a scary time for us," said George Festa, who directs the New England High Intensity Drug Trafficking Area, a coalition of law enforcement agencies.
    The fears once associated with big cities are unsettling teachers and parents, who say the new wave of heroin use is felt more directly in small towns. "What's going on here has been going in urban areas for a long time," said Dale Conoscenti, a restaurant owner in Montpelier, the Vermont capital. His son, 25, a longtime heroin addict, was recently sentenced to six years in federal prison on drug and gun charges. "It's an epidemic in Vermont because you look at the population and the isolation, and it's a big deal when you have only a certain amount of kids and a certain percentage of those kids are involved in heroin."
    Most heroin arrives in northern New England along Interstates 91 and 95 from New York and the Massachusetts drug-trafficking centers of Springfield, Holyoke, Lawrence and Lowell. Dose bags in the Bay State sell for as little as $4 each, getting more expensive further north, police said, but still remaining cheaper and more available than other illicit drugs or prescription opiates such as OxyContin. What's more, purity levels exceeding 80 percent are attracting a new generation of drug users who don't inject but snort or smoke it.
    In Maine in 2001, admissions to heroin treatment programs outpaced cocaine-related admissions by 90 percent, and heroin abuse contributed to nearly three-quarters of the more than 80 drug-related deaths that year, authorities said. Heroin-related arrests by the Maine Drug Enforcement Agency rose by 50 percent, along with increased federal convictions for offenses involving heroin, a trend police and prosecutors said is continuing. A second methadone clinic opened in the Portland area, and firetrucks as well as ambulances now carry naloxone, which blocks the effects of opiates to help prevent fatal overdoses.
    Only a decade ago, heroin was rare in this region. Police knew local addicts by name, and prosecutors considered heroin-trafficking cases a novelty. All that has changed, to the extent that drug overdose deaths -- many of them involving heroin -- have equaled or exceeded the number of homicides in recent years; the number of heroin addicts regionwide is estimated in the thousands. In Farmington, the rural college town of 7,700 where three people died last spring, heroin was almost unheard of when Lt. Jack Peck became a full-time police officer 18 years ago. Yet heroin-related investigations have become fairly common. "Years ago, you pretty much knew who the users or dealers were, or at least you had information. Now we don't know who the players are at times," Peck said. "We had two people die of heroin overdoses [recently], and we never knew them until that day."
    In Vermont, where 13 people died from heroin and morphine overdoses last year, the number of people ages 18 to 24 seeking treatment for heroin addiction increased roughly sixfold between 1997 and 2000, authorities said. Heroin makes up nearly half the cases investigated by the state drug task force, and heroin cases at the state forensic laboratory have risen 400 percent over the past year.
    Last fall, a woman taking out the garbage one morning discovered her son, 20, had fatally overdosed in a junk car in the back yard of a house where another addict had died, and a female heroin user, 23, suffered a suspected fatal drug overdose in late December. In addition, three dozen pregnant women in Vermont have sought treatment over the past six months for heroin addiction, eight times the number reported during all of 1998.
    So dire is the situation that Vermont paid $1.5 million last year to send heroin addicts to a detoxification program in Upstate New York because it lacked treatment services at home, said state Sen. James Leddy (D), who is chairman of the Health and Welfare Committee. "Our jails are filled, our courts are closed, our emergency rooms are dealing with overdoses," said Leddy, who pushed for the opening of the state's first methadone clinic in October. "There's not a community of any size in this state that isn't experiencing a serious heroin problem."
    Across the border, New Hampshire heroin treatment admissions statewide increased more than 100 percent from 1996 to 2000, and nearly half of the 31 drug-related deaths two years ago involved heroin and morphine, with victims as young as 18, authorities said. A Merrimack Valley heroin distribution ring involved an elementary school principal and a grandmother who stashed the drug under a sink for her son. Last year, a man, 44, died in the public restroom of a hospital after snorting heroin marked with a picture of a red devil.
    A statewide heroin task force is being formed because of an increase in the number of teenage users, said Riley Regan, director of the New Hampshire Division of Alcohol and Drug Abuse Prevention and Recovery and a former heroin addict. "I'm beginning to find an openness to people willing to recognize the heroin problem," he said. "It's affecting the kids who are closer to home."

Delaware Lawmakers Know Sting of Gambling Losses
Craig Whitlock, Washington Post- 2/9/2003

The unexpected phone call from the coroner in Las Vegas came on Nov. 4, 1997, Election Day in the city of Annapolis. The somber message interrupted a day of politicking for Del. Michael E. Busch, the future speaker of the Maryland House of Delegates and next-of-kin to the deceased. Busch immediately boarded a plane for Nevada, where his father had spent more than two decades in self-imposed exile, living in a flophouse on the fringe of downtown Las Vegas, the gambling capital of the world.
    Larry Busch, once a successful small-town lawyer, father of the local football hero and three girls, had mysteriously abandoned his family and career in the early 1970s. Without explanation he moved west, where he lived out his days as a recluse, a small-time card shark who preyed on naive tourists in the casinos on the weekends.
    The son tried to claim his 72-year-old father's belongings but was told there were none. Just the dead man's clothes on a bed in the rooming house, a couple of Social Security checks that hadn't been cashed, an envelope containing his identification cards and an empty wallet. The body was cremated. No obituary or death notice in the papers, nor any memorials to mark his passing from emphysema.
    To this day, no one knows what inspired Larry Busch to leave his family and his Glen Burnie law practice, why he was drawn to the seedy side of glittery Las Vegas. There had been no evidence he was a gambler in Maryland, save for the occasional hand of poker. Some thought maybe he was too prone to drink. Others figured he was depressed. "It's a mystery that no one will ever know the answer to," Busch said in an interview in his office in the State House. "All of a sudden one day, he just up and left. He never saw my mother again. He never saw any of my sisters. I tell you, I have a real tough time talking about it."
    What is clear is that the rise and fall of Larry Busch left an indelible impression on his son, who in January ascended to one of the most influential posts in Maryland politics. Since becoming speaker, Busch (D) has emerged as the leading foe of the movement to legalize slot-machine gambling in Maryland. Although his views on slots were known before the General Assembly convened for its annual 90-day session last month, the depth of opposition has caught many lawmakers off guard, including his longtime friend, Gov. Robert L. Ehrlich Jr. (R), who is leading the charge to bring casino-style gambling to the state. But Busch says neither Ehrlich nor anyone else in the General Assembly knows the story of Larry Busch, a secret he has kept hidden from even his closest allies.
    Busch, 56, agreed to talk about his personal history for this article, but did so reluctantly, saying he was worried people would misconstrue his position on slots or dismiss him as an anti-gambling moralizer. "People are going to say, 'No wonder Busch is against this, it's just because it's a personal family issue.' But that's not it," he said. "I've certainly gambled before. I accept it for what it is. I'm not making a judgment on my father or others who do that. "But the point of this is that I have had great exposure to the issue. I understand more about gambling than most people, more than I should probably admit to. When people talk about bringing 4,500 slot machines to a racetrack or casinos in the Inner Harbor, I know exactly what that means."

A Lesson Learned
Busch is not the only prominent lawmaker in the General Assembly whose stance against slots is shaped by personal experience. In the summer of 1955, a Charles County farmer named Henry Middleton cashed a check for about $600, the entire proceeds from his wheat harvest. Then, over a 48-hour period, he gambled away almost every nickel.
    In those days, slot machines were a common sight in Southern Maryland, a huge money maker for taverns, motels and country stores along the U.S. 301 corridor, then a major north-south highway. Although Middleton was not a frequent gambler, the father of 14 children decided to try his hand at the slots in Waldorf. He hit a run of bad luck and, desperate to win back his money, kept losing more. By the time he was done, Middleton had lost the entire wheat check, which his family was relying on to pay taxes and put food on the table.
    For a time, he thought he might be forced to sell his 288-acre farm, which had been owned by Middletons since the 17th century. A relative bailed him out with a loan, but the experience turned him against gambling for life. The episode also shaped the politics of one of his seven sons, Mac, who later became a state senator and now serves as the influential chairman of the Finance Committee. "I just remember we were one worried family, that we didn't know how we were going to make ends meet," said Sen. Thomas M. Mac Middleton (D-Charles). "It was a very humbling experience for my dad and my family."
    Three years after almost gambling away the farm, Henry Middleton embarked on a political career, winning election as a judge of the Orphans Court in Charles County, a post he held for 28 years. He used the part-time job as a pulpit to rail against gambling, which held great sway over the local economy.
    Back then, Southern Maryland was known as Little Nevada, one of a handful of places in the United States where commercial gambling was legal. County budgets were heavily dependent on gambling dollars, but the slots were loosely regulated and served as a magnet for organized crime. After a fierce debate that lasted years, the state banned the machines in 1963, although they were not completely phased out until 1968.
    Mac Middleton took over the farm from his father and still raises cattle and Christmas trees when he's not legislating. He is now perhaps the most outspoken opponent of slots in the Senate. Unlike Busch, Middleton tells his family story often and with little prompting. "My dad saw the evils of slot machines," said Middleton, 57. "I tell people that he would turn over in his grave if I wasn't part of some kind of opposition, if I didn't try to resist in some way."

'It's Mind-Boggling'
Larry Busch was a self-made man. He paid his own way through college and took night classes at the University of Baltimore's law school. He founded a two-man law practice in Glen Burnie and made decent money from criminal work and domestic cases. He and his wife, Pat, had four children. The oldest by seven years was Mike, a natural athlete who brought a measure of fame to the family. Mike starred in football at St. Mary's High School in Annapolis and earned a scholarship to Temple University. In college, he broke the school single-game rushing record and drew heavy interest from professional scouts. His senior year, Mike badly injured his knee. It ended his dream of playing in the pros, a dream shared by his father. In hindsight, Busch wonders if his injury weighed more heavily on his dad than he realized. "In some respects, he lived vicariously through me," he said.
    Friends of both men doubt that the football injury prompted Larry Busch to abandon his family not long afterward. But they remain at a loss to explain his behavior. "They were close, he and his father were very close," said George F. Johnson IV, a longtime friend of the Busch family and now the sheriff of Anne Arundel County. "It's mind-boggling why things unfolded the way they did."
    One day, Larry Busch left the house and never came back. He stopped work on his legal cases and failed to show up for hearings. A Circuit Court judge tracked him down, asked him if he was out of his mind and told him he better start paying attention to his clients. He refused. "All of a sudden, he was among the missing," said Richard L. May, a friend and lawyer who practiced on the same block in Glen Burnie. "He was a great father when Mike was growing up with athletics and all, until all of a sudden came this change. He just turned into this recluse."
    Larry Busch's family struggled in the wake of his actions and was quickly forced to make painful adjustments. Suddenly on her own, her husband refusing to pay child support, Pat Busch had to care for three daughters, the youngest of whom was 4 years old. She took an entry-level job with the Motor Vehicles Administration, sold the Busch's big Colonial-style house in Severna Park and moved the family to Baltimore to live with her mother.
    Mike Busch graduated from Temple and landed a job as a history and social studies teacher at St. Mary's, his alma mater. But with little money of his own to contribute, he felt helpless. "I obviously witnessed the residue it left on my mother and my younger sisters," he said. "My mother, she was the greatest. She had to go back to work and take care of everybody. Nobody in my life is more of a hero than my mother."
    Larry Busch floated around Maryland for a couple of years, before deciding in 1975 to move to Las Vegas. Upon leaving, he told his son: "I'm 50 years old. I want to live the rest of my life and not worry about anything." It would be 15 years before Mike Busch heard from his father again.

Betting Against the House
On almost a daily basis since the legislative session began, Busch and Middleton have issued stark warnings about the downside of bringing huge numbers of slot machines to Maryland. Ehrlich's proposal would legalize 10,500 of the machines, about half the total number in Atlantic City. They would be confined to four racetracks, three of which sit in blue-collar or predominantly black neighborhoods. Busch and Middleton argue that it makes no sense for the state to plunk gambling temples in the middle of poor communities, places that already struggle with crime and joblessness. Such operations will breed social ills and tempt the elderly or working-class people to gamble away their savings, they say.
    Not everybody sees it that way. The Ehrlich administration projects that slots would eventually generate $1.3 billion a year for the state treasury and the horse-racing industry. Under the governor's proposed legislation, the state would set aside $500,000 annually for programs to help compulsive gamblers. In a recent interview, Ehrlich was asked if he ever knew anyone with a serious gambling problem. "I know people who have gotten into trouble with alcohol, and chocolate and gambling," he said. "There's a small percentage of society who cannot handle freedom." Added his second-in-command, Lt. Gov. Michael S. Steele: "It's a behavioral issue. Just like smoking. You wanna stop -- you stop."

Family Reunions
In 1990, Mike Busch, by then a state delegate, received an unexpected phone call from his father, who said he was still in Las Vegas but refused to disclose his exact whereabouts. It was an awkward renewal of their relationship. After pressing his father to allow him to visit, Mike Busch flew to Nevada. But Larry Busch got cold feet and failed to show at the airport. With no address or phone number, his son returned home. Months later, they tried again. Mike Busch promised that he would not pass judgment, he just wanted to make peace. This time, his father agreed to a reunion.
    Over the next seven years, Busch made several trips to Las Vegas to visit his father. They did not talk about the past, at least not about the painful parts. But the son got a taste of his father's lifestyle, which included regular casino visits. They gambled together, mostly card games, seven-card stud and blackjack. "When I visited my father, I enjoyed his company," Busch said. "We played cards, we bet on football games. I did it all. Sometimes I left with an extra buck or two, sometimes I lost a buck or two."
    Larry Busch took his son to some of his favorite haunts: the Frontier, Binion's, occasionally the Golden Nugget. The casinos gave their customers discounts on meals and drinks, helping Larry Busch get by on a meager income from his winnings and Social Security. Mike Busch retains vivid memories of his visits to Las Vegas, particularly of older people like his father who lived unglamorous lives amid the neon and the high rollers. "I don't want people to think I have this aversion to gambling," Busch said. "I've come to grips with all of it. I don't begrudge people who want to go bet on horse races. "But my perspective on this is that I have a pretty thorough understanding of what's involved in gambling of this magnitude, so I'm very cautious about sending Maryland in this direction."

Methadone, Once the Way Out, Suddenly Becomes a Killer
Pam Belluck, New York Times- 2/9/2003

PORTLAND, Me. - Methadone, a drug long valued for treating heroin addiction and for soothing chronic pain, is increasingly being abused by recreational drug users and is causing an alarming increase in overdoses and deaths, federal and state officials say. In Florida, methadone-related deaths jumped from 209 in 2000 to 357 in 2001 to 254 in just the first six months of 2002, the latest period for which data are available. "Out of noplace came methadone," said James McDonough, director of the Florida Office of Drug Control. "It now is the fastest rising killer drug." In North Carolina, deaths caused by methadone increased eight-fold, to 58 in 2001 from 7 in 1997 -- an "absolutely amazing" jump, said Catherine Sanford, a state epidemiologist. In Maine, methadone was the drug found most frequently in people who died of overdoses from 1997 to 2002. It was found in almost a quarter of the deaths. In the first six months of last year, methadone killed 18 people in Maine, up from 4 in all of 1997. Dr. John H. Burton, medical director for Maine Emergency Medical Services, said hospital emergency rooms were seeing "a tidal wave" of methadone related cases.
    The increase in methadone overdoses and deaths has floored many drug experts because methadone, which does not provide a quick or potent high, has long been considered an unlikely candidate for substance abuse. It can be hours before a user feels any effect, and it works more like a sedative than a stimulant. And because methadone is considered an important and, affordable tool for treating addiction and pain, health and law enforcement officials are facing a quandary: how to stop methadone abuse without curtailing its valuable uses -- and especially without driving addicts back to drugs like heroin. "We've got years of experience with methadone and suddenly we've this problem," said Dr. H. Westerly Clark, director of the federal Center for Substance Abuse Treatment. "We realize that lives are being lost and we're trying to stop that. But we're trying not to do quick fixes that will cause us more problems."'
    The surge in methadone abuse appears linked to several factors, including the growing abuse of heroin and OxyContin, a powerfully addictive prescription painkiller. Health and law enforcement officials are reporting that some of these addicts are turning to methadone when they cannot get the other drugs. At the same time, methadone has become more available. Physicians are increasingly prescribing it for pain relief, in part because law enforcement officials have been cracking down on OxyContin, and more methadone clinics have sprung up to treat the growing number of heroin addicts. "The availability of methadone for treatment and pain has put people who would not normally be in a position to divert drugs in that position," said Sgt. Scott J. Pelletier, who works for the Maine Drug Enforcement Agency handling drug cases in Portland and Cumberland County, where methadone caused at least 30 deaths in 2002, according to the state medical examiner's office.
    In most states with increased methadone deaths, the methadone being abused appears to be tablets prescribed for pain. These are sold or sometimes given to addicts by people who have stolen them from patients or, in some cases, by the patients themselves. Addicts either swallow the tablets or grind them into powder that can be inhaled or turned into liquid and injected. In Maine, however, and to a lesser degree in a few other states, the authorities say much of the methadone has been the liquid form used in drug clinics and spread, in some cases, by clinic patients. Many clinics across the country, following federal guidelines designed to make methadone treatment more accessible, have stopped requiring patients to take all their daily doses at the clinic, and instead are allowing them to take home doses of methadone once a week or more.
    In Chicago, "kids are now coming from suburbia and they're buying methadone on the street," said Dr. Ernest C. Rose, a specialist in drug addiction who works for several methadone clinics there. "In the inner city, you can get 80 milligrams of methadone for $20 to $30, which is a lot cheaper than a heroin habit would be. We do see a lot of methadone getting diverted out here on the street from the clinic, and we have to watch our clients very carefully because it's a secondary source of income for a lot of them."
    There are no national figures for methadone deaths or overdoses. But the federal Drug Abuse Warning Network reported that in 2001, 10,725 people turned up in emergency rooms after having abused methadone. That is nearly double the number of such visits in 1999. Experts say those attracted to methadone fall mostly into two categories: people already addicted to other opiates, and naive, sporadic drug users who have often never tried methadone before. "Most people who are addicted for any period of time aren't out chasing the buzz anymore," Dr. Rose said. "Most of them are trying to keep their sick off, and methadone will do that." Naive users might be "people who are just at a party and someone will give them some methadone," said Dr. Burton, the emergency medicine specialist in Maine. "They might mix it in with a beer or with some other drug. They take it thinking it's just like any other drug and will give them a buzz, and they end up either dead or deeply unconscious."
    Methadone's delayed narcotic effect and its lack of a potent high are important reasons the drug can be so dangerous, experts say. "By the time they've actually overdosed, no one is with them to see what's happening," said Kimberly Johnson, director of the Maine Office of Substance Abuse. Joseph Haddock, an analyst for the Justice Department's National Drug Intelligence Center, said some people, unaware of the drug's delayed effects, "take methadone, don't get the effect that they want, take more methadone, still don't get that reaction, and they take more methadone, so they end up overdosing."
    How large a dose can cause an overdose can vary widely. Methadone is often taken in combination with alcohol or other drugs, which may make it more harmful. Typically, Experts say, pills prescribed for pain are about 5 or 10 milligrams each, meaning several pills might be needed for an overdose. Liquid for addiction treatment usually ranges from 50 to 500 milligrams.
    While methadone has been available as a pain medication since World War II, many physicians have only recently begun to prescribe it, said Dr. Edward C. Covington, director of the chronic pain rehabilitation program at the Cleveland Clinic in Ohio and a past president of American Academy of Pain Medicine. The change, he said, is partly the result of a new consensus that chronic pain should be treated and a wider awareness that methadone is a legal and effective way to do so. Doctors wary of prescribing OxyContin because of warnings from the police about the potential for abuse have also turned increasingly to methadone, Dr. Clark and others say. Dr. Covington and other experts say some doctors also prefer methadone because it is far cheaper than OxyContin, it does not generate as much of a high as other drugs, and its effects are slower, seemingly making it less likely to be abused.
    But methadone is also complicated to prescribe. Doses are often difficult to calibrate, Dr. Covington said, because the drug accumulates in fatty tissues and is slowly released in the body. "Methadone is probably one of the very few drugs that I've seen doctors almost kill patients with," he said. "It's that hard to use when you first start to use it. If it's on the street, we're going to be seeing some deaths."
    Officials in several states are pressing for electronic monitoring of prescriptions filled by pharmacies, which can indicate whether patients are getting identical prescriptions filled in different places. Dr. Andrea G. Barthwell, the White House drug czar's deputy director for demand reduction, said her office wants to educate physicians better about methadone and root out unscrupulous doctors who help patients who are abusing or selling the drug. Prosecutors in Virginia, Florida and elsewhere are bringing charges against such doctors.
    Grappling with methadone used in addiction treatment may be even more difficult. For three decades, many health experts have praised methadone for pulling addicts away from heroin. While those addicts usually remain on methadone for long periods and may never be able to function without it, many lead productive lives, experts say. To make methadone more accessible, the Substance Abuse and Mental Health Services Administration in 2001 relaxed its policy on distributing it. In the past patients who reliably took their methadone each day could earn the privilege of taking as many as six days' worth of doses home. The new rules lengthened that to 31 days, a boon for people who had to travel long distances to clinics.
    But while experts like Dr. Barthwell, a past president of American Society for Addiction Medicine, consider patients who earn 31-day take-home privileges to be highly unlikely to sell their methadone, they worry more about another policy that allows clinics to close on Sundays and to send even new patients home with a "Sunday bottle" of methadone. "Some of these people exchange their Sunday bottle for other drugs or money," Dr. Barthwell said. "It may be their only source of currency until they are on a stabilizing dose of methadone and are functioning well enough to get a legitimate job."
    In Maine, state officials and law enforcement authorities said that take-home methadone--which comes in stronger doses than methadone tablets prescribed for pain -- had caused most of the deaths. In some cases, Sergeant Pelletier said, clinic patients would "stockpile" a small amount of each take-home dose and sell the methadone, trade it for other drugs or give it to a friend addicted to other drugs. What is more, the vast majority of the people who died in Maine were not clinic patients themselves. Maine's methadone clinics are cooperating with state officials and have agreed to tighten procedures. Dr. Marc Shinderman, the operator of CAP Quality Care in Westbrook, said his clinic was now open every day. Longtime patients are permitted to take home at most only two weeks' worth of methadone.
    More programs are available to educate patients about the consequences of letting others sample their methadone. Dr. Shinderman's clinic requires that people return empty bottles of take-horn methadone, and is switching as many patients as possible to tablets, which the clinic says it hopes will be less likely to lead to overdose. Dr. Shinderman said he was "mystified" about why so many of the deaths in Maine were attributed to methadone from clinics "Methadone has been around long time and diversion has been around a long time," said Dr. Shinderman, who also operates clinics in Chicago. "It's a kind of a puzzle. People should be somewhat sophisticated about methadone."

Recently for Drug Addicts, Methadone Has Is a Double-Edged Sword
Pam Belluck, New York Times- 2/9/2003

WESTBROOK, Me. - When Michelle, a 24-year-old drug addict, was looking for a fix, methadone, with its minimal, slow-action high, was not her first choice. Her preference was heroin, and she described herself as so hooked on it that she would make her 4-year-old son and 2-year-old daughter "sit in the other room while I shoot up." But recently, Michelle and her husband, Shannon, who spoke on condition that their last name not be used, found they could sometimes get methadone more easily than other drugs. "I've done methadone when I needed something and there was nothing else around," said Michelle, who, along with her husband, a 32-year-old cocaine addict, recently enrolled in an addiction treatment clinic. "On Halloween night, for me to be able to take my kids trick-or-treating, we did 30 milligrams apiece and then we were able to go trick-or-treating. I'm thankful that I took that methadone or my kids wouldn't have had Halloween."
    In Maine and elsewhere, methadone has slipped quietly onto the drug abuse scene, filling in the blanks when drugs like OxyContin and heroin were in short supply. Most indications are that, like OxyContin a few years ago, methadone first became a problem in rural areas, like Appalachia and parts of Maine, and has been spreading to other parts of the country, law enforcement officials say. In an increasing number of cases, methadone abuse has proved deadly, and sometimes, the victims have rarely, if ever, used methadone before. On occasion, a victim was given the drug by someone who had been prescribed methadone for pain or was enrolled in a methadone clinic, a friend who was trying to help an addict unable to find other drugs.
    The Portland police say Seth Jordan's death was like many they have seen this year. In April, the police say, Mr. Jordan, 27, was given his first dose of methadone by Scott Darling, a patient at the CAP Quality Care methadone clinic in this Portland suburb, Mr. Jordan was found dead in the hall of his apartment building, having apparently fallen asleep on the floor before the overdose hit. Mr. Darling has since been charged with manslaughter, one of several cases in which prosecutors have pressed criminal charges against a clinic suspected of providing methadone linked to a death. Bob Jordan, Mr. Jordan's father, said his son had struggled with mental illness for several years and took illegal drugs. Still, Mr. Jordan said, "I was totally stunned that Seth would have taken that methadone and that he would have died from it."

St. Elizabeths Mental Patient Fled 12 Times
David A. Fahrenthold, Washington Post- 2/10/2003

On a morning in mid-December, a man moving his truck found a dismembered body behind a dingy boardinghouse on Kennedy Street NW . There were 262 homicides in Washington last year, but this one stood out as among the most gruesome. The victim had been beaten about the head and body and slashed in the throat. Both his legs had been severed. Three weeks later, police charged 60-year-old Joseph D. Hilliard , a former tenant of the boardinghouse, in the slaying and moved him to St. Elizabeths Hospital, the psychiatric facility in Southeast Washington.
    For Hilliard, the hospital was a very familiar place. Hilliard was first admitted to St. Elizabeths in 1974, when he pleaded not guilty by reason of insanity to another murder charge. A paranoid schizophrenic with the gift of charm, he has never been released. But he has escaped a dozen times. All told, Hilliard has spent more than eight of the past 29 years away from St. Elizabeths. Once, he went to California and got married. After another escape, he went to Pennsylvania and was convicted of throwing a woman from a window.
    Despite his history, Hilliard was allowed by St. Elizabeths staff to walk around the hospital grounds alone in 2001. In December of that year, he escaped again. Then he allegedly did something he had never done in the previous 11 escapes: kill. Police found Hilliard in blood-stained clothing three days after the slaying at the boardinghouse. The victim, 51-year-old David E. Edwards, had just moved into the basement of the house . At the time Edwards was slain, Hilliard had been on his own for one year and four days.
    St. Elizabeths officials said that when treating the mentally ill -- including the criminally insane -- it is necessary to extend patients small freedoms in the hope that they will adjust and eventually be able to reenter society. They said that unaccompanied grounds privileges, like the ones Hilliard had the 12th time he escaped, are considered a valuable part of therapy, a step toward the real world, if the patients are ready for them.
    Hilliard is by no means the only person to escape from St. Elizabeths, which has about 500 patients. Roughly 200 of its patients are people who were committed because of criminal cases, known as forensic patients, including John W. Hinckley Jr., who shot President Ronald Reagan and three others in 1981. D.C. police files indicate that 22 patients were reported missing from the hospital in the last four months of 2002. That's as many as went missing in all of 2002 from Virginia's Eastern State Hospital in Williamsburg, which is about the same size.
    Some city officials and mental health specialists questioned how St. Elizabeths let Hilliard get away again. "Wow. It's hard to believe that after the escapes, he was given an unaccompanied grounds privilege," said Harold J. Bursztajn, a professor of psychiatry at Harvard Medical School. "If you leave someone unaccompanied when there's a potential of escape, you're not providing the most adequate care." "This," said D.C. Council member Adrian M. Fenty (D-Ward 4), "is egregious incompetence."
    The first killing tied to Hilliard took place more than 30 years ago. Court records say that Hilliard, who is originally from Fayetteville, N.C., pulled a knife on Billy Boy Everette there in December 1972, and then took Everette's wife, Estherine, with him to Washington. Hilliard and Estherine Everette lived in the 200 block of N Street NW for much of the next few weeks. On Jan. 19, 1973, they had a fight, and 12 days later, Estherine Everette was found dead in an abandoned house nearby, with a stab wound to her chest, court records say. Hilliard fled to Florida, where he was arrested and subsequently entered a plea of not guilty by reason of insanity. The court accepted his plea. In 1974, he was sent to St. Elizabeths, whose sprawling campus was then run by the federal government.
    His first escape in 1976 lasted less than a month; Hilliard returned to St. Elizabeths voluntarily, court records say. Later that year, he escaped again. The back-and-forth continued in 1977, when Hilliard left the grounds two more times. In 1978, Hilliard escaped yet again and went to Pennsylvania, where court records say he was charged with aggravated assault and served about three years of a prison sentence. He was returned to St. Elizabeths upon his parole from Pennsylvania in 1982. He didn't stay long. In 1983, he escaped again. This time he was gone eight months, during which he met and married a Nicaraguan woman in California.
    Court records indicate that St. Elizabeths officials were concerned about the problem of his escaping. "He has resided on every level of security . . . [and] has held grounds privileges, only to escape or be found in possession of drugs and thereby return to maximum security and restart the cycle," Department of Health and Human Services officials wrote in 1987. The D.C. government took over St. Elizabeths in 1987 but was unable to break the pattern. Hilliard's escapes continued: 1988, 1994, another in 1994, 1995 and 1999.
    Hilliard's cousin Catherine Johnson expressed surprise when told that he had been at St. Elizabeths for a 1973 slaying. He had told her he was in St. Elizabeths for having too many traffic tickets and fake identification papers, she said. "He didn't ever say anything about murder," Johnson said of the 1973 killing. She said Hilliard often called her from such places as Las Vegas, and she sometimes saw him in their home town of Fayetteville. Once, she said, he came home with a Cadillac and said he had become a car salesman. "He's been out of St. Elizabeths probably more than in it," said Johnson, a schoolteacher in Fayetteville. "He kept leaving, and I don't think they do any looking for him when he leaves." She said Hilliard, whose criminal record dates to 1959, started to show signs of being erratic before he dropped out of high school. Still, she said, he can be quite charming and usually has no trouble convincing people to help him.
    About two years after Hilliard returned from his 11th escape in 1999, court files say he had unaccompanied grounds privileges at the hospital. Hospital officials declined to say what led the Inpatient Services Division Review Board to approve those privileges. On Dec. 9, 2001, Hilliard set out for the chapel by himself at 9 a.m. He did not return. That afternoon, Hilliard was reported missing to D.C. police. A warrant was issued for his arrest, and his case was referred to the U.S. Marshals Service based at D.C. Superior Court. Marshals declined to comment on the case. An official said that marshals look for St. Elizabeths escapees as they would for other fugitives.
    St. Elizabeths officials said Hilliard was deemed ready for another chance, despite his escapes. "If you elope, we don't hold it against you for the next 20 or 30 years," said Joy Holland, chief executive officer of the hospital, using the mental health system's term for escapes: "elopements." "You have no choice but to look at how an individual is progressing," Holland said. St. Elizabeths officials said they were required to give Hilliard an opportunity to progress. They said the law requires they move patients to the least restrictive setting under which they can be safely and effectively treated.
    Other mental health specialists talked about the difficulty of finding the right balance for treating -- and securing -- the criminally insane. If all hospitals simply locked up their forensic patients, "you'd have thousands and thousands of prison forensic beds" for criminally insane patients, said professor Joel Dvoskin of the University of Arizona medical college. "And somebody's got to pay for that."
    Robert Keisling, a former D.C. mental health official, said that St. Elizabeths patients often escape after they are allowed "on-grounds" privileges, since guards don't stop them from walking out the gate. "Once they get privileges to get out of the ward, there's basically nothing keeping them on the grounds," said Keisling, former director of the emergency psychiatric center, who left the government in 1999. Linda Grant, a spokeswoman for the department of mental health, declined to say if Keisling's description was accurate. She pointed out that forensic patients accounted for 12 escapes in all of 2002. That's down from 27 four years ago, she said.
    Sometime last year, Hilliard began living in the basement of the unlicensed boardinghouse in the 600 block of Kennedy Street. Though the house's owner declined to comment, two tenants said they believed Hilliard was not paying rent. Hilliard sometimes threatened them and told them he had escaped from St. Elizabeths and had killed before, the tenants said. The tenants, who asked not to be identified because they are witnesses in the criminal investigation, said David Edwards -- whom they called "painter man" because he worked on painting jobs -- was supposed to move into the basement Dec. 12. That evening, one of the tenants said she heard Hilliard talking outside. "If I can't live in the basement, whoever lives there, I'll kill the [expletive]," she recalled Hilliard saying. Later that night, one of the tenants said she heard sawing. The next morning, Edwards's body was found in the back yard. A few days later, police found Hilliard back at the house, wearing clothes covered in blood, according to charging documents.
    City mental health officials would not comment on Hilliard's current security arrangements at St. Elizabeths. He is awaiting a preliminary hearing in D.C. Superior Court. Tenants on Kennedy Street NW said last month they were frightened he would escape yet again and return to their home. "He said he was going to come back and kill everybody in here," one of the tenants said. "You got people walking the halls with hammers and sticks."

Survey: Teenagers' Ecstasy Use Levels Off
Larry McShane, Associated Press- 2/10/2003

NEW YORK -- Teen use of Ecstasy has leveled off, but most American youngsters see no great risk in experimenting with the drug, according to a study released today by the Partnership for a Drug-Free America. The partnership's annual study found that 45 percent of youths ages 12 to 18 saw a great risk in trying Ecstasy once or twice -- more than the 42 percent who felt that way in last year's survey but still the minority opinion. The statistics tell a different story: In 2001, there were 5,542 emergency room visits related to Ecstasy use, up from 253 in 1994. The number of youths using the drug remained stable: 9 percent in this survey, compared with 10 percent a year before. A partnership survey released five months ago found that only 1 percent of American parents believed their child had ever tried Ecstasy. "Our latest reading of the Ecstasy market offers a more encouraging picture, but does not -- and should not -- suggest that we have turned the corner on this drug," said Steve Pasierb, president of the partnership.
    Other findings of the survey:
*77 percent of teens believe there is a great risk of Ecstasy addiction, up from 73 percent.
*76 percent believe there is a great risk involved in using Ecstasy regularly.
*35 percent who attended a "rave" had used Ecstasy, compared with 5 percent of all other adolescents.
    The survey also found that marijuana remained the most widely used illegal drug, with 40 percent of youths saying they had tried it at some point. As for legal drugs, alcohol and cigarette use were not as prevalent. According to the survey, 53 percent reported alcohol use in the last year, down from a high of 63 percent in 1997. And 28 percent reported smoking a cigarette in the last month, down from a high of 42 percent in 1998.
    The study was conducted among 7,084 teens nationwide, with a margin of error of plus or minus 1.5 percentage points. Data was collected from April through June 2002 from questionnaires students filled out anonymously. The Partnership for a Drug-Free is a coalition of communications professionals aimed at reducing the demand for illegal drugs. On the Internet: See the Partnership for Drug Free America: www.drugfreeamerica.org

 Court Rules Insane Man Can Be Executed
Associated Press, 2/11/2003

LITTLE ROCK, Ark.— In the latest bizarre turn in a nearly 25-year-old death row case, a federal appeals court ruled that a mentally ill inmate can be put to death even though he would be too insane to qualify for execution without his medication. A sharply divided 8th U.S. Circuit Court of Appeals lifted a stay of execution Monday for Charles Singleton, saying his medically induced sanity makes him eligible for the death penalty.
    Singleton's defense argued that the Arkansas inmate was in a precarious situation: taking anti-psychotic medication was in his interest but not if the resulting sanity puts him on the path to the death chamber. Six of the 11 judges on the St. Louis-based panel said that because Singleton prefers to be medicated, and because Arkansas has an interest in having sane inmates, the side-effect of sanity should not affect his fate. The four dissenting judges said it would be wrong to execute Singleton, who becomes paranoid and delusional when not medicated, and sometimes is still psychotic while medicated. One judge abstained. "Based on the medical history in this case, I am left with no alternative but to conclude that drug-induced sanity is not the same as true sanity," dissenting Judge Gerald Heaney wrote. "Singleton is not 'cured'; his insanity is merely muted, at times, by the powerful drugs he is forced to take."
    In October 2001, a panel of the 8th Circuit ruled that Singleton be sentenced to life in prison without the possibility of parole. The state appealed, and the court reversed that ruling Monday. Assistant Attorney General Kelly Hill said Monday that the state had to continue pursuing the case because Singleton was sentenced to death. "We are going to do our statutory and constitutional duty," Hill said. "If the court says it is constitutional ... we will take the necessary steps. If the court says it is unconstitutional, we will abide by that decision."
    Singleton was convicted of stabbing grocer Mary Lou York to death in a 1979 robbery. She identified him as her attacker before dying. Singleton's lawyer, Jeff Rosenzweig, said he would likely ask the 8th Circuit to withhold a final order which would authorize Gov. Mike Huckabee to set an execution date so he can take the case to the Supreme Court. "This is one that the Supreme Court may want to look at," Rosenzweig said. "The question is whether you can execute a man whose sanity is artificially induced." "What is the power of the state to give medical treatment that has the effect of causing his execution?" Rosenzweig added. "You should forbid execution under those circumstances."

Judge Rejects D.C. Plan To Treat Drug Offenders
Arthur Santana, Washington Post- 2/11/2003

An initiative passed by D.C. voters last fall that would require the city to offer treatment to scores of nonviolent drug offenders cannot take effect because it illegally dictates how the D.C. government must spend its money, a judge ruled yesterday. The ruling by D.C. Superior Court Judge Jeanette J. Clark was a victory for the D.C. government, which filed suit to block the initiative from becoming law. D.C. officials said the measure would generate huge costs and jeopardize the future of an existing drug court.
    Voters overwhelmingly approved Initiative 62, which was meant to give certain nonviolent drug offenders the option of having their criminal cases dismissed by entering drug treatment programs. The treatment was supposed to take the place of jail and be overseen by the D.C. Department of Health, not the court.
    The D.C. corporation counsel's office filed suit Sept. 20 to void the measure, contending that the District's Home Rule Charter bars ballot initiatives from appropriating funds. A hearing was put off until after the Nov. 5 election. In her opinion, Clark declared that the initiative "would constitute an improper intrusion upon the discretion of the Mayor and the Council to allocate the amount of funding for drug treatment that they determine can be provided."
    Proponents of the initiative had been pushing D.C. officials to find the money to run the treatment program. If the funding had been approved, the initiative would have become law in October, backers said. It would have made treatment available to people arrested with drugs such as morphine, PCP, cocaine, methadone and methamphetamine. "We're not happy about the decision, and we're going to be talking to our lawyers about an appeal," said Opio L. Sokoni, the initiative's campaign coordinator, adding that the proponents also will reach out to D.C. Council members. "They can look at the legislation, and they can put in what they want to put in, and they can take out what they want to take out," Sokoni said. "They can deal with funding any way they want. We believe that if they make this a priority, they can get it done."
    Peter Lavallee, spokesman for the corporation counsel's office, said he was pleased with the judge's decision. "As we contended all along, the judge agreed that the initiative process is not the appropriate process to appropriate funds," Lavallee said. The ruling means that D.C. Superior Court's 10-year-old drug court will continue to handle the city's drug offenders. The drug court, like the initiative, allows many offenders to enter treatment programs. But the drug court relies upon the judge's prodding -- and the threat of jail as a sanction -- to motivate offenders to stay in treatment. Judges regularly check on progress that offenders are making. The initiative called for jail as a last resort, mostly for participants who commit new crimes or represent a danger to others. In the current drug court, offenders who relapse can be sent to jail for three days at a time or removed from the program.
    Judge Melvin R. Wright, the most recent judge to preside over the drug court, said he opposed the initiative "because studies show that drug treatment without sanctions in a criminal justice setting doesn't work." Rufus G. King III, the court's chief judge, declined to comment on the ruling but said he was pleased that the current drug court will continue. "In an ideal world, we would have unlimited money for unlimited treatment, but that isn't the situation we have," King said. "I think that what this decision says is that it's up to the city council to decide where to get funds and how much to devote to treatment, rather than leaving it up to the electorate."
    Initiative 62 was modeled after measures that were passed in recent years by voters in California and Arizona. Sokoni and other backers maintained that drug addiction should be treated as a disease and that most relapses are part of the overall recovery process, not occasions for punishment. Sokoni estimated that there are 60,000 people in the District who need drug treatment but that only about 10,000 are receiving it. "That's a crisis," Sokoni said.

Maine Ordered to Hire Outside Expert to Help Mentally Ill Kids
Associated Press, 2/13/2003

PORTLAND, Maine -- A federal court ordered state officials Wednesday to hire an outside expert to remedy problems with Maine's system of tracking the hundreds of children who need psychiatric services. The order shows that the state Department of Behavioral and Developmental Services has failed to comply with aspects of its agreement to provide timely in-home treatment to mentally ill and disabled children.
    Maine is legally obligated to provide in-home services to the children who, under Medicaid rules, are entitled to receive assistance within six months of when they ask for help. But the state has failed to keep the agreement it signed last May to settle a class-action lawsuit, said William Kayatta, one of the lawyers who filed the suit known as the Risinger case. ''The agency was given ample time to figure out how many kids need help and yet, as appalling as it sounds, they have no idea,'' he said. Kayatta said the state promised to develop a new computer system to keep better track of the children. But while the new tracking system was being set up, the old one was shut down, he said. State officials eventually offered only an estimate that close to 800 children were either waiting for in-home help or were waiting to be evaluated for services, Kayatta said.
    Deputy Attorney General Paul Stern, who has represented the state's mental health agency, did not dispute Kayatta's claims. ''It's fair to say when the new administration was apprised of this situation the governor's office took it very seriously,'' Stern said. ''We're moving forward to provide these children with the services that they're entitled to.'' Gov. John Baldacci has promised to streamline the four state agencies that provide services to mentally ill and disabled children.
    The court order filed Wednesday requires the state within six days to hire an expert to evaluate the status of affected children, and to make sure they receive services within 180 days. If the state does not follow the expert's advice, the matter can be brought back to court, Kayatta said. Lynn Duby, who on Tuesday announced her resignation as commissioner of Behavioral and Developmental Services, did not return phone calls seeking comment.

Custody or Care: Agonizing Choice for Parents of the Mentally Ill
Shaila K. Dewan, New York Times- 2/16/2003

For the parents of some severely mentally ill children, it can come to this: pleading with emergency-room psychiatrists who have no good answers. Listening grimly as caseworkers spell out their lack of options. Appearing tearfully before family court judges as they take what they regard as a last desperate step in pursuit of medical care. What these mothers and fathers are being urged to do is agonizing: give up custody of their children and turn them over to New York's child welfare agencies so that they can get the mental health care that they otherwise cannot afford or gain access to.
    Repeatedly, these parents say, they are told that giving up their children is the only way to help them. Private insurance does not pay for children who may need a year or more of intense treatment, at costs that can exceed $60,000 a year. For the many who cannot afford that, the number of state financed beds for mental health patients is tiny and the wait long. But a child placed in foster care can be sent to facilities that, while not designed to deal with mentally ill children, have many more openings and at least some psychiatric services. "That was the hardest decision I ever had to make," said Donna O'Clair, who with her husband, Tom, allowed Schenectady County to take custody of their suicidal 11-year-old son when he needed more care than their health insurance would cover.
    The state's Office of Children and Family Services, which oversees New York's child welfare agencies, does not keep a count of how many children are turned over to it in need of mental health care. And the state says its policy is to discourage the practice. But judges, lawyers, social workers and parents from Brooklyn to Buffalo say it happens regularly. In New York City, for example, officials at the Administration for Children's Services say about half their intensive-care beds are filled not by abused or neglected youngsters, but by those placed there directly by their parents or through a court program for troubled youths that parents enter voluntarily.
    "There are all sorts of permutations of folks trying to get into the foster care system because they have not been able to get into the mental health system," said Raymond Schimmer, the executive director of the Parsons Child and Family Center in Albany, which runs mental health and foster care facilities. "In extreme cases, you have parents who claim that they've abused or their children."
    For parents who resort to giving up a child, eight of whom were interviewed for this article, the experience is fraught with uncertainties. They have the right to ask for their child back but must win the approval of a judge. They receive legal notices warning that after 15 months in custody, their child could be put up for adoption. They have no control over where their child is sent or, in some cases, the treatments the child receives. Some parents have, for periods, lost track of their children entirely. "Do you make children with cancer have their parents give up custody so they get the care they need?" asked Tracy Zeltwanger, a county worker in Watertown who was prodded to relinquish custody of her 9-year-old son,, Corey, who has early-onset bipolar disorder, doctors say. Ms. Zeltwanger ultimately refused.
    New York parents are not alone. At a time when health care costs are soaring and the number of children with complicated disorders is increasing, the experience of giving up custody in search of care is a phenomenon throughout the country. As a measure of its prevalence, 13 states have passed laws to prohibit exchanging custody for care, according to the Bazelon Center for Mental Health Law in Washington. Such a law might help in New York if mental health resources were not so scarce, said James Dillon, a family court judge in Erie County. "But there are a limited number of beds," he said.
    For children who need extensive care, New York offers two basic options. There is the one that was explicitly intended for such children: the state mental health system, which has about 540 residential treatment beds. And there is the one that was not intended for them: the foster care system, which has about 4,000 beds but limited ability to handle mentally ill children.
    New York has tried to come up with alternatives that would allow more children to stay at home. The state participates in a Medicaid program that pays for services like in-home counseling for children who are at risk of being hospitalized, even if they are not eligible for Medicaid. Still, there are only 610 spots. So, to parents who say they have tried everything else, giving up custody can seem like the only option.
    Some parents, despite the pain of separation, are happy with the services they receive. Other families confront a host of difficulties. Once a child is in foster care, it is sometimes a bureaucrat, not a parent, who decides what medication the child receives. But the biggest frustration, parents say, is that giving up custody does not guarantee that their children are kept safe or given adequate attention.
    The money to provide mental health treatment in foster care is actually very limited. Often, said Harriet Mauer, the director of social work for Good Shepherd Services, a foster care provider in New York City, foster care facilities must turn to the same overburdened community mental health clinics that parents do. Often, a determining factor in treatment is simply the availability of an open bed. "They push the parents to give up the kids, and I don't understand why, when they don't have the care that they need," said Kathryn Strodel, a lawyer at Legal Services of Central New York, in Syracuse, who has represented parents who have relinquished custody.

A Child With Autism
Daniel is a 16-year-old, 200-pound autistic boy with an emotional disorder. He sometimes pretends that he is the Incredible Hulk and tries to rip off his clothes in public. There are dents in his mother's Bronx apartment from his punches. More than once a week, his mother said, she needed to call the police for help. "This is a child," she would say when she thought they were handling him roughly. Daniel would be taken to the hospital, calmed, and discharged.
    Agencies that deal with autism turned him down for placement for a variety of reasons. There were no openings at any state-run facilities. The mother's sister grew afraid to baby-sit. The mother said, "I've used sick days, vacation days, personal days and leave without pay to do what I've done with this kid." At the hospital, she said, she had been regularly told by doctors and social workers that the only way to get help would be to leave her son there, so that she would be reported for abandoning him and the state would take custody State officials say that the average wait for a mental health placement in one of their specialized facilities is about 2 & 1/2 months, but caseworkers and families report waits of 18 months. Some foster care providers say that many children who qualify for mental health services are never even referred to the state mental health agency but are simply diverted into foster care.
    After one particularly violent outburst by Daniel, his mother, in fear, left him at the hospital and called the child-abuse hot line to report what she had done. At a meeting with a social worker, she said, she agreed to sign over custody when a place in foster care was found for Daniel. It was not an easy moment.
    "It is very intimidating for families," said Karen Hebrock, who runs intake for the Hillside agencies. "It is a scary kind of thing." But this mother did it. "I didn't want Daniel to hurt someone or be hurt," she said. It was not clear, however, that the foster care group home where Daniel wound up five months later was prepared to handle him. On a visit in November, his mother discovered that four days earlier, without her knowledge, Daniel had been taken to the hospital with a head wound so deep that it required staples instead of stitches. A spokeswoman for the city's Administration for Children's Services said that she could not discuss specific cases, but that parents were notified of injuries. But when Daniel's mother demanded to know what had happened, she said, the center director "told me that he doesn't have to tell me nothing that happens to my son." Daniel has since been moved to another foster care group home.

Violent Threats
Mental illness is often cyclical. It rages and subsides, which can make it difficult for families to get help exactly when and for how long it is needed. More than once, Timothy O'Clair threatened his mother and brother with a knife. He had to be physically carried to school in Rotterdam, N.Y. One night, he threw rags into the family's furnace. Twice, he landed in a psychiatric hospital. Both times, it was about a week before the insurance company would decide to "bounce him," in the words of his father, Tom. It was, then, not too long before the trouble was too great. Timothy tried to choke himself at school, his grip so tight that the hall monitor could not pry his fingers loose. The O'Clairs -- Mr. O'Clair is a mechanic; his wife, Donna, is a nurse's aide -- knew that their son needed more than a week in a hospital. The Schenectady County Department of Social Services offered foster care. Mr. O'Clair said: "I am not a mom, so I don't know what emotions Donna had to fight with to go along with this. I just know it was real hard to go along with."
    After a brief stay at a standard foster home, Timothy was sent to a foster care bed at a residential treatment center run by the Northeast Parent and Child Society in Schenectady. Mrs. O'Clair watched tensely from the sidelines, taking her son to his doctor's appointments and going to see for herself that he was all right after he briefly ran away. The O'Clairs actually saw a marked improvement, and they felt that the county was interested in their son's well being. After seven months, Timothy was allowed to come home. He had therapy and his medication was monitored. But things began to fall apart again. Six weeks after his release, Mrs. O'Clair found her son hanging in his closet, a suicide at 12.
    Mr. O'Clair laid some blame at the feet of an insurance system that does not cover mental health at the same rate as physical health. "We would have liked to have gotten him to a doctor more often, instead of when the insurance allowed it," he said. "I feel like if we hadn't been so restricted on the access to the care, maybe he would still be here."

A Need for Attention
Sometimes the foster care system absorbs mentally ill children even when their parents do not voluntarily give up custody. For the Kendalls, the trouble with their daughter Jamie started roughly at age 12. She told outlandish lies, once producing a photo of a baby cousin as proof that she had a son. She disappeared for days at a time. The diagnosis was histrionic personality disorder, an illness characterized by a pathological need for attention. But the remedy proposed was a court program intended to deter budding juvenile delinquents. At the school's urging, Jamie's mother, Elaine Kendall, a Cheektowaga, N.Y., postal worker, filed a court petition stating that Jamie was a "person in need of supervision."
    Jamie was assigned a probation officer and ordered to get counseling. For a time, she wore an ankle bracelet. When she misbehaved, her probation officer threatened her with a foster care placement. Ms. Kendall said she did everything she could to avoid having Jamie sent away. She tried unsuccessfully to get her into a children's psychiatric hospital or a day treatment program. She scoured the Internet for programs her insurance might cover. The county social services department provided a succession of social workers and crisis counselors, but turnover was so rapid that they rarely had a chance to see Jamie in a crisis period. A judge eventually ordered Jamie into foster care and on to the Wyndham Lawn Home for Children, a residential treatment center in Lockport N.Y. Nine months later, she came home and promptly ran away again. "The placement did absolutely nothing,". Mrs. Kendall said.
    Jamie eventually returned to foster care. What is striking about cases like Jamie's, said Ruth Foster, the director of public policy for Families Together, an advocacy group based in Albany, is that what help she did receive came from the state's social services office, not its mental health system. It amounts, she said, to nothing better than a patchwork solution for a very demanding problem. Families Together is pushing legislation; that would require insurance companies to cover mental health at the same rates as physical health, and other groups would like to see a law forbidding child welfare agencies to require custody.
    State mental health officials, for their part, insist that there is a wide array of such services available, including in-home counselors. "There are some states where their approach is to force the parents to relinquish custody," said Dr. James C. MacIntyre, the clinical director of the bureau of children and family service at the State Office of Mental Health. "That is not and never has been New York's approach, and in fact New York has many other options that are out there."
    But Jamie's family was never offered them, and twice she wound up being placed in foster care as a way to get help. Jamie, 16, is now home. She has joined an all-star cheerleading team and has just started a new job at a car wash. At school, she has been classified as emotionally disturbed, so she attends a special class of only six students. The Kendalls have worked their way to the top of a four-month waiting list for some mental health services that insurance does not cover. But Mrs. Kendall did not hear about the special class or the services from Jamie's' school or probation officer. She learned about them from her brother-in-law, who happens to work for the county. "I said," recalled Mrs. Kendall, "this is probably what we needed all along."

Studies Link Memories, Suggestions
Associated Press, 2/16/2002

DENVER - A study presented yesterday shows just how easy it can be to induce false memories in the minds of some people. More than one-third of subjects in the study recalled being hugged by Bugs Bunny at Disneyland - impossible because Bugs is not a Disney character - after a researcher planted the false memory. Other research, of people who believed they were abducted by space aliens, shows that even false memories can be as intensely felt as those of real-life victims of war and other violence.
    The research demonstrates that police interrogators and people investigating sexual-abuse allegations must be careful not to plant suggestions in their subjects' minds, said University of California-Irvine psychologist Elizabeth Loftus. She presented preliminary results of recent false memory experiments yesterday at the national meeting of the American Association for the Advancement of Science. Loftus said some people may be so suggestible that they could be convinced they were responsible for crimes they didn't commit. In interviews, ''much of what goes on -- unwittingly -- is contamination,'' she said.
    A key, researchers said, is to add elements of touch, taste, sound, and smell to the story. In the Bugs Bunny study, Loftus talked with subjects about their childhoods and asked not only whether they saw someone dressed up as the character, but also whether they hugged his furry body and stroked his velvety ears. Later, 36 percent of the subjects recalled the cartoon rabbit. In another study, Loftus suggested frog-kissing incidents that 15 percent of the group later recalled.
    In other research presented yesterday, Harvard University psychologist Richard McNally tested 10 people who said they had been abducted, physically examined, and sexually molested by space aliens. Researchers tape-recorded the subjects talking about their memories. When the recordings were played back later, the purported abductees perspired and their heart rates jumped. McNally said three of the 10 subjects showed physical reactions ''at least as great'' as people suffering post-traumatic stress disorder from war, crime, rape, and other violent incidents. ''This underscores the power of emotional belief,'' McNally said.