Experts Criticize Plan to Fight AIDS by Increasing Methadone Use

Drug-abuse experts lashed out Wednesday at a government proposal that would increase the availability of methadone, a popular heroin substitute, to curb the spread of AIDS among intravenous drug users.

Speaking at a public hearing at the National Institutes of Health, drug-treatment professionals assailed the proposal as a misguided “quick fix” that could cause significant damage to the quality of drug treatment in the United States.

“Stopping intravenous drug addiction is more than just a matter of handing out methadone,” said Dr. Tom Kosten of the American Psychiatric Assn., speaking before a panel of federal drug and AIDS policy-makers.

Kosten warned of “the potential for poorly run” methadone programs and said the best way to curb both AIDS and drug abuse among intravenous drug users would be to increase funding to hospitals and clinics that offer full drug rehabilitation programs.

Methadone, which satisfies an addict’s craving for heroin without producing the same euphoric high, is taken orally in liquid form. As a result, it reduces the risk that addicts will contract acquired immune deficiency syndrome by sharing needles.

The Food and Drug Administration currently requires virtually all drug-treatment facilities that provide methadone therapy for heroin addicts to offer it in conjunction with full counseling on drug addiction and on safeguards against AIDS.

Three of every four such centers, however, have waiting lists of up to six months for new admissions, and only one in five addicts even seeks treatment, according to federal officials.

Under a plan proposed last March by the FDA and the National Institute on Drug Abuse, clinics would be allowed to dispense methadone to more heroin addicts, rather than turning them away, on an emergency “interim” basis. The addicts would remain on methadone for up to six months, or until spaces could be opened for more extensive therapy.

Backers say the plan represents the most cost-effective way to reduce the exposure of heroin addicts to AIDS as a result of needle-sharing.

But critics countered Wednesday that the FDA is trying to attack one disease, AIDS, by retreating on another, drug addiction. They said that the proposed “interim” services would undermine the overall drug therapy and contended that methadone is not in itself a treatment.

Making methadone available to more addicts would make “an illusion of cost-effective treatment,” said Irv Finkelstein, chairman of the New York Committee of Methadone Program Administrators. “We must expand comprehensive care, rather than create minimal treatment.”

Finkelstein said that increased reliance on methadone would create other problems, such as groups of loitering addicts, violent episodes and increased community anxiety.

Panel members repeatedly asked the critics whether they would prefer to turn away addicts entirely or provide them with a legal substitute.

“ ‘Nothing’ is not the only alternative to methadone,” replied Dr. J. Thomas Payte, a member of the American Society of Addiction Medicine and a drug-treatment specialist from San Antonio.

“Methadone (used alone) is probably the most expensive alternative available,” Payte said.

The National Institute on Drug Abuse estimates that about 500,000 of the nation’s 1.2 million intravenous drug users are heroin addicts, or about 17% of all drug abusers nationwide.