From: (Eboka) Newsgroups: alt.drugs.hard Subject: NYT Methaodne article Date: 29 Sep 1998 17:53:33 GMT The New York Times September 29, 1998 Page A1 Federal Proposal Would Provide Methadone to More Drug Addicts By CHRISTOPHER S. WREN The White House's top drug official is to announce today a policy to expand the availability of methadone to all those who need it, despite Mayor Rudolph W. Giuliani's criticism of the drug as simply exchanging one addiction for another. The official, Gen. Barry R. McCaffrey, is expected to outline a major overhaul of Federal plans to treat heroin addiction in a speech today to a national conference of the American Methadone Treatment Association in Manhattan. The plans to be presented by General McCaffrey, which incorporate ideas from Government agencies and other specialists in substance abuse, recommend that for the first time, doctors be allowed to administer methadone to patients in the privacy of their offices. Methadone is now dispensed at special clinics, at times that may make it difficult for some recovering addicts to hold down jobs. The new policy would make methadone treatment available to any addict who requests and needs it. Methadone is used by 115,000 Americans addicted to heroin and other opiates. They account for a fraction of the country's estimated 810,000 opiate addicts, some of whom cannot find treatment giving them access to methadone. No cost figures for the new program were available yesterday. The policy is being announced at a time Mayor Giuliani has questioned the need for methadone treatment. The Mayor has said he wants to end government's role in providing the drug, a synthetic substance used to curb the craving for heroin. The Administration intends to redraft the Federal regulations governing methadone in December or January. Officials said they doubted that Congressional approval would be needed for the changes, and they foresaw no barriers at the Federal level. States have wide control over the availability of methadone, however. New York State is the country's largest methadone provider, and Connecticut has considered giving doctors a more central role in dispensing it. But eight states -- New Hampshire, Vermont, West Virginia, Mississippi, North Dakota, South Dakota, Montana and Idaho -- do not permit methadone clinics, forcing residents who need it to travel to other states. The hope is that a stronger endorsement of methadone's efficacy by the Federal Government will encourage states to set up or expand methadone programs. Among other changes, the Food and Drug Administration would turn over the regulation of methadone to the Substance Abuse and Mental Health Services Administration. The plan also includes the creation of a comprehensive evaluation and accreditation system to assess methadone treatment at clinics, which vary widely in the quality and quantity of services. Mayor Giuliani has sharply criticized methadone treatment, describing the physical dependence it creates as tantamount to enslavement, and has attacked General McCaffrey for endorsing it. Yesterday, the Mayor fired a fresh broadside at the White House drug policy official. "I guess General McCaffrey has surrendered," Mr. Giuliani told reporters, "and essentially, what he'd like to do is deal with heroin addiction by making people addicted to methadone, which maybe even is a worse addiction." Medical experts have described methadone as the most effective treatment available for heroin addiction, saying that it has been studied more thoroughly than almost any other medication. A recent study by the National Academy of Sciences called methadone "more likely to work than any other therapy." Mark A. R. Kleiman, a professor of public policy at the University of California at Los Angeles, said in a telephone interview that the Federal changes announced yesterday sound very much like the recommendations made by the panel of specialists at the National Academy of Sciences. "Everybody in the field agreed that the panel got it right," Professor Kleiman said. "If what the panel said is going to be policy, I can only say, 'Hurray.' " Professor Kleiman added, "The devil's in the details, and I don't know the details. But breaking methadone free of the shackles of the methadone treatment system has to be the right thing to do." During a visit to a methadone treatment center in lower Manhattan yesterday, General McCaffrey once again declined to respond in like manner to Mayor Giuliani, calling him "a great mayor" who had made New York City a safer place to live. But in an implicit reference to the Mayor's criticism, General McCaffrey also cautioned against engaging in "shoot-from-the-lip policy analysis." He added, "You've got to be cautious about the reality of 40,000 people" in New York State who are enrolled in methadone maintenance programs. General McCaffrey listened to addicts with first-hand experience with methadone when he visited the Lower Eastside Service Center on East Broadway yesterday. The center provides comprehensive methadone and other drug treatment for 2,500 clients a year, said its president, Eileen Pencer. Mark Adorno, who has taken methadone for six years, told General McCaffrey: "It keeps me functional. I'm able to work and support my family. Without it, I'd be sick." Gina Neveloff, who takes methadone to stave off the heroin addiction she acquired at 15, said, "For me, it puts some kind of sanity back in my life." But Scott Riley, who said he became addicted as a soldier in Vietnam, said methadone had not worked well for him and that he chose total abstinence, a more difficult alternative that Mayor Giuliani favors and that General McCaffrey also endorses. General McCaffrey, who was badly wounded in Vietnam, appeared moved by the stories he heard from the recovering addicts. "In the Army, we give big medals to people who are heroes, and that's what I think you are," he said.