Treatment for Drug Addicts

As the executive director of the oldest and largest clinic system for the treatment of heroin and cocaine addicts in Southern California, I am grateful for the eloquent and enlightening series by Barry Bearak (“In the Shooting Gallery: Addicts and AIDS,” Sept. 27-30). He captures the essence of the addict’s plight, when medical detoxification cannot be rapidly and inexpensively obtained.

The New York situation described by Bearak is actually quite different from that in Southern California. Beginning in the early 1970s a heroin treatment clinic system has progressively emerged to the point today that over two dozen low-cost methadone clinics are available for heroin treatment in the Los Angeles Basin. Heroin addicts can enter out-patient methadone detoxification or maintenance treatment for a cost of approximately $6 to $10 a day. The State of California pays for poverty-level addicts through the Medi-Cal program. Laws unique to California allow law enforcement to identify addicts and arrest them, and for our courts to mandate treatment through parole or probation. Only addicts who desire free methadone maintenance treatment are delayed from immediate admission.

Our system in Southern California appears to have paid dividends. Whereas 50% to 80% of addicts entering methadone treatment on the Eastern seaboard carry the AIDS virus, only 1% to 3% of addicts entering methadone treatment do so in Southern California.

Unfortunately, we can end up in the deplorable situation described by Bearak if responsible government officials do not recognize a new development. Many persons who initially became addicted to cocaine during the 1980s have now become addicted to heroin and vice versa. Consequently, about 40% of today’s heroin addicts are also addicted to cocaine. These dually addicted persons may carry AIDS, as well as a very high rate of syphilis, hepatitis B and C, tuberculosis, and staphylococcus infections. Most “crack” babies are now born to mothers who are dually addicted to heroin and cocaine. The treatment of choice for these dually addicted patients is methadone initially and then subsequent detoxification from cocaine. Responsible government agencies need to consider Bearak’s article a wake-up call. While none of our clinics had waiting lists six months ago, we now have waiting lists in such varied communities as El Monte, Simi Valley, Oxnard, Bakersfield, Atascardero and Pomona. For the compassionate needs of the addict and for the protection of the public’s health, we must act rapidly.

FOREST TENNANT MD

Executive Director

Community Health Projects Medical Group

West Covina