Two federal agencies Thursday proposed to help fight AIDS among heroin addicts by allowing interim methadone treatment in cities where comprehensive treatment programs have waiting lists.
The plan, published in the Federal Register, was proposed by the Food and Drug Administration and the National Institute on Drug Abuse to make methadone treatments available to more addicts sooner and reduce exposure to AIDS through needle-sharing.
Also Thursday, final rules went into effect to streamline regulations governing methadone treatment programs and make other changes, including elimination of the counselor-patient ratio at treatment clinics. Previously programs had to have one counselor for every 50 patients.
Intravenous heroin addicts often share needles and, in doing so, become infected with the virus that causes the deadly disease.
Methadone, which is used to help relieve an addict's craving for heroin, is taken by mouth, which eliminates the risk from needles.
Although methadone is best used as part of a comprehensive treatment program that includes counseling and other vocational and rehabilitative services, many clinics have waiting lists of six months or more, the agencies said.
About 500,000 of the estimated 1.2 million intravenous drug abusers in the country are heroin addicts, and three out of four cities with methadone treatment clinics have waiting lists, the institute said.
Under the proposal, heroin addicts would be able to receive methadone treatment seven days a week at outpatient clinics and from mobile medical units, but the drug would not be provided for take-home use. Participants would be counseled on avoiding acquired immune deficiency syndrome.
The proposal is based on a pilot program at Beth Israel Medical Center in New York, which "appears to have reduced the use of needles," the two agencies said.
Critics of the methadone proposal say it is likely to be ineffective because heroin users are increasingly injecting cocaine and other drugs--habits that cannot be treated with methadone. They charge that the "no-frills" methadone would be an inexpensive way to provide treatment that fails to address the more complicated reasons for addiction.
"This is ridiculous . . . it's the worst possible thing to take place," said Dr. Beny Primm, director of New York City's Addiction Research and Treatment Center. He said he fears there would be "no monitoring of other behavior" such as cocaine use.