S.F. Seeking Approval of Methadone Expansion

Officials hope to make this the nation’s first city to allow private physicians to prescribe methadone to heroin addicts.

Saying their city is in the grips of a heroin epidemic, officials want to lure more addicts into taking the replacement drug.

The Board of Supervisors asked the health department more than a year ago to look into ways of expanding methadone treatment beyond the city’s seven methadone clinics. The department has drawn up a plan. Last week, the federal Substance Abuse and Mental Health Services Administration said it will fund a feasibility study of the program for the city.

“There is a growing heroin problem around the country and there are not enough treatment slots to meet the needs,” said Dr. H. Westley Clark, director of the substance abuse administration. “Expanding treatment for heroin addiction by the medical community is a promising approach that the center believes is worthy of exploration.”

City officials say they hope to complete their study and launch the program within a year.

Under current federal law, methadone treatment is restricted to specialized, closely monitored public and private clinics where the drug is dispensed, usually daily, to patients who are registered in a treatment program.

Different Perspective

Although methadone has been used in clinics for 30 years, it is still a controversial treatment for addicts. Last year in New York, Mayor Rudolph Giuliani launched a campaign against clinics, saying patients should be steered into abstinence programs instead.

San Francisco’s plan would allow addicts to be treated in the privacy of a doctor’s office and would possibly allow them to receive doses of methadone at designated pharmacies. It could be implemented only if the city received permission from both state and federal agencies that now register methadone clinics.

Under current federal law, it is illegal for any doctor to prescribe methadone. San Francisco would probably have to register its effort as an experimental program to receive an exemption from the law.

Methadone does not cure heroin addicts, but it can help them stay healthy and functional and is often used for years.

“A heroin addict’s life is out of control,” said Alice Gleghorn, research manager for the city’s Community Substance Abuse Services. “Methadone reduces heroin use, reduces addiction to this drug and stabilizes other aspects of an addict’s life. There are many people who are on methadone and none of their close associates know it.”

A synthetic narcotic developed in Germany during World War II as a painkiller, methadone--which is given to addicts in liquid form--staves off withdrawal sickness without making patients high.

For years, San Francisco has ranked third--after Baltimore and Newark, N.J.--in per capita heroin-related hospital admissions. Health department officials estimate that there as many as 15,000 addicts in this city of 750,000. About 3,000 heroin addicts are currently being treated in the city’s methadone clinics, and 400 addicts are wait-listed for the clinics.

San Francisco’s heroin problem made local headlines last January, when the son of singer Boz Scaggs died of a heroin overdose in a seedy San Francisco hotel.

“Being that San Francisco is known for having an incredibly rich supply of heroin, it may actually attract people looking for heroin,” said Dr. David Hersh, acting director of San Francisco General Hospital’s department of substance abuse and addictive disorders.

“San Francisco is cursed with a particular type of heroin, black tar heroin that is sloppy stuff that can carry infection and is difficult to inject, but can pretty much only be used by injecting,” Hersh said.

In February 1998, county supervisors asked the health department to establish a task force of physicians, addicts, clinicians and state and local officials who deal with substance abuse issues to study ways of expanding methadone treatment.

The group came up with a plan for the health department to train dozens of physicians in methadone treatment for addicts.

Restricting methadone treatment to clinics, Gleghorn said, leaves too many addicts untreated.

“There are many people who are not able to get to clinics, who are not able to comply with the strict clinic structure or who are not comfortable going for privacy reasons,” Gleghorn said. “Our plan is designed for people who are not availing themselves of clinics. We’re talking about direct access.”

Clinics generally require patients to come for a dose at specific times. If the patient misses an appointment, Gleghorn said, he or she must simply wait until the next preset dosage is dispensed.

“It makes much more sense,” she said, “to have all treatment needs centralized under one physician than to have to go cross town to receive treatment from a clinic for addiction,” Gleghorn said.

Patients would have greater flexibility with private physicians, and might be able to take home larger quantities of methadone for self-dosing. Currently, clinics allow only “stable” patients, who have demonstrated an ability to show up for appointments and attend counseling sessions, to take home as much as a week’s supply of methadone.

The White House Office of National Drug Control Policy estimates that there are 810,000 heroin addicts in the United States. Of those, no more than 170,000 are in methadone treatment programs.

San Francisco’s plan comes at a time when the federal government has proposed shifting the administration of methadone clinics from a regulatory agency, the Food and Drug Administration, to a service agency, the Substance Abuse and Mental Health Services Administration, that would accredit clinics.

In 1997, the National Institutes of Health recommended that heroin addiction be treated more like other medical conditions. In 1995, the federal Institute of Medicine said that federal regulations put so great an administrative burden on clinics that the quality of care was diminished.