Methadone Makes Sense; Cutting It Doesn’t

Two political heavyweights, New York Mayor Rudy Giuliani and federal drug czar Gen. Barry McCaffrey, are squaring off on a major issue of drug policy.

McCaffrey wants to make the heroin-blocker methadone available to all addicts who need it, not only in public clinics but also in the privacy of doctors’ offices. Giuliani wants to cut off methadone treatment in New York City--which has almost a third of the nation’s 800,000 addicts--on the theory that curbing addiction requires zero tolerance for this legal medication. Extensive scientific research and three decades of experience with methadone suggest that anyone interested in reducing the nation’s drug problems should be rooting for the general, not the mayor,

Developed in World War II as a synthetic alternative to morphine, methadone allows heroin addicts to function normally, both physically and mentally. Daily oral doses do not produce the “high” of heroin because methadone occupies the brain’s endorphin receptors in a long-lasting stable way, in contrast to the spiking pattern of intravenous heroin use. Methadone maintenance also means reduced risk of AIDS, hepatitis and other infections spread by contaminated needles.

Over more than 30 years, methadone maintenance has been more thoroughly evaluated than any other type of drug treatment. Studies have consistently found that patients in methadone programs achieve substantial reductions in illegal drug use, criminal activity and hospitalization. They also show much greater productivity than untreated addicts.

The 1997 National Treatment Improvement Evaluation Study confirms earlier evidence of methadone’s positive results in cutting patients’ illegal drug use by as much as half. A similar study in California in 1994 found that methadone patients showed greater reductions in drug use and criminal activity than addicts in other kinds of drug treatment programs. After extensive review, a distinguished panel of the National Academy of Sciences’ Institute of Medicine recently recommended expanding methadone treatment and allowing doctors to dispense methadone directly, as McCaffrey is now proposing.

Methadone treatment continues to be severely limited, not because it has failed to demonstrate its effectiveness in curbing drug use and crime but because of the kind of ideological objections that Giuliani has voiced to using any drugs to treat addiction.

What this country needs is more methadone treatment for our heroin addicts, not less. Today, only 115,000 methadone slots are available to treat an estimated 800,000 heroin addicts. In California, 32,000 slots are available for an estimated 160,000 addicts. New York City, with 250,000 addicts, the largest concentration in the country, can treat only 36,000 with methadone maintenance. Of course, not all heroin addicts seek treatment, and methadone is often the treatment of last resort for those who have not succeeded in other programs. Nonetheless, studies indicate that methadone treatment would be accepted by at least half the nation’s addicts if it were available.

The Giuliani-McCaffrey dispute is front page news in New York, in part because the general also wants states to enlarge their methadone treatment programs. With a gubernatorial election coming soon in California, it would be timely and important for Democrat Gray Davis and Republican Dan Lungren, the two principal candidates in the country’s most populous state, to declare their positions on this issue as well.

If Giuliani succeeds in depriving New York’s addicts of methadone treatment, he will bear sole responsibility for the increase in heroin addiction in his city and for the crime, disease and misery associated with heroin use. Meanwhile, McCaffrey has concluded that the evidence is overwhelming in favor of expanding methadone treatment as the best way currently available to reduce heroin dependency. By making methadone available in doctors’ offices as well as public clinics, which are often overcrowded, inaccessible and inconvenient, more addicts will be helped on the road to recovery.