The Register-Herald, Beckley, West Virginia

CNHI Specials

February 8, 2013

Drug users turn death dealers as methadone hits streets through clinics

WASHINGTON — After Jennifer Vanlieu turned to methadone treatment to beat an addiction to heroin and pain pills, she morphed from drug-user to convicted drug-dealer.

Vanlieu said she got a carryout methadone dose at a clinic operated by CRC Health Corp. in Richmond, Ind., in March, 2010, and then gave about 15 milligrams to her friend Carissa Plemons. Plemons died hours later, after ingesting a lethal mix of methadone and other drugs, according to police reports.

Take-home methadone - doses patients carry out instead of taking at clinics - enabled the abuse, said Vanlieu, 26, who was sentenced to six years in prison for dealing the drug to Plemons. While she didn't sell it to her friend, she said in an interview that other clinic patients often re-sold their take- homes. CRC is owned by Boston-based Bain Capital Partners and is the largest U.S. provider of methadone treatment.

"Some would sell it in the parking lot," she said.

Liquid methadone, used for decades to help addicts abate withdrawal symptoms as they quit heroin or other opiates, is leaking into illegal street sales via take-home doses, according to law-enforcement officials in Indiana, Kentucky, Virginia and West Virginia. Investigators in each of those states have linked such "diverted" doses to clinics operated by CRC.

Some former employees say the company, which operated 57 clinics in 15 states last year, works to maintain high enrollments despite chronic understaffing, increasing both CRC's profitability and the chance that its take-home methadone doses will be abused.

"That was the culture - keep the census up," said Mike Liaudaitis, who worked as a counselor at CRC's clinic in Goldsboro, N.C., from mid-2009 until early 2011. He recalls being swamped with a 64-person caseload that exceeded the state's limit of 50. Counseling suffered as a result, he said. "We had no choice but to buy into it to keep our jobs."

Cupertino, Calif.-based CRC, which also operates in- patient treatment centers, youth programs and weight-management services, doesn't put profits ahead of patients, said Chief Executive Officer R. Andrew Eckert, in a statement issued in September. He defended carryout dosing, which can help keep patients on methadone and off illegal drugs, by easing the inconvenience of having to visit a clinic daily.

"Our mission is to help these individuals, but sadly, we cannot report 100 percent success," Eckert said. "No treatment provider can."

While any health care company encounters "instances of chance that are regretful and unfortunate," there are "hundreds of thousands of clients our facilities have successfully treated since our founding in 1995," said Kristen Hayes, a company spokeswoman, in an e-mail. CRC has experts who visit each clinic to maintain quality and guide improvements in counseling and other areas "unlike any other provider in the business," she said.

In states where CRC has had its highest patient-counts - Indiana, West Virginia, California and Oregon - available data and interviews show the company tries to provide take-home packages, which range from one dose to as many as 30, more often than other clinics.

"Clearly the company is saving money if they're distributing multiple take-home doses at one time," said West Virginia Delegate Don Perdue, a Democrat who has pursued stricter oversight of for-profit clinics. "They don't have to have as many staff handing out the merchandise."

In the small towns where CRC has clinics, its methadone has surfaced in criminal cases, police and prosecutors say. Dearborn County, Ind., officials are planning a $10 million expansion to the local jail, needed partly because of crimes tied to CRC's clinic in Lawrenceburg, said prosecutor F. Aaron Negangard.

"We've had people come down to the methadone clinic and rob a bank because they need money to pay for methadone," he said. "We've had people at the McDonald's shooting up. Whether it's dealing or someone giving take-homes to a friend, it's been a huge problem."

In Kentucky, officers who raided a Kenton County house found a "moonshine jar" containing about a quart of liquid methadone, said Rob Sanders, the state prosecutor in Covington. Two residents of the house, both patients at the Lawrenceburg clinic, "were collecting methadone and selling it," he said.

In Virginia, 3-year-old Trevor Hylton died on Sept. 30, 2009, after drinking methadone that his mother, Lisa Michelle Hylton, said she left on a kitchen counter in a cough-syrup cup.

She later told authorities she got the dose from a drug dealer whose girlfriend was a patient at a CRC clinic, said K. Mike Fleenor Jr., the Pulaski County prosecutor. Police searched the alleged drug dealer's home and found methadone bottles from CRC's clinic in Galax, Va., Fleenor said.

Hylton, 41, is serving a 20-year prison sentence for second-degree murder and child neglect.

At least two dozen people have been charged with illegally diverting methadone from a CRC clinic in Cedar Bluff, Va., said Tazewell County prosecutor Dennis Lee.

"The potential for abuse is tremendous," Lee said. "The potential for profit is also great. I've often said that if I were a smart businessman, I would have invested in methadone in the 1990s."

Federal patient-confidentiality laws prevent CRC officials from discussing individual cases, said Philip Herschman, the company's chief clinical officer, in an emailed statement. CRC follows "specific and rigid" state and federal rules in deciding which patients get carryout doses, he said. Safeguards include lock-boxes and spot-checks, in which patients are called back to clinics to account for their take-home bottles, he said.

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