IN CLINICS, A NEW ERA FOR ADDICTS

Federal Rule Changes Will Help Fight Problem, Officials Say

At the 500-patient Model Treatment Program on First Street NE, the line
forms early, and daily. Patients show their ID to the burly guard. Move
upstairs to the Spartan, white-walled clinic. Wait their turn to approach
the window at the nurses' station behind inch-thick glass. Announce their
case number and receive their cherry-flavored dose, the small cup of methadone.

Swallow it. Then speak, to prove they aren't saving it to sell on the street.

In some ways, the methadone clinic system has remained unchanged for 30
years, since the synthetic narcotic came into wide use for treating
addiction to heroin and other opiates.

That is, until Friday, when long-awaited federal measures took effect that
begin to treat methadone more like a medicine than a controlled and
dangerous substance -- and those who take the drug at the nation's 1,200
methadone clinics more like other patients in the American health care
system than stigmatized addicts.

Methadone patients, many of whom have submitted to years of daily lines and
weekly urine tests, found reason to hope in the new rules: For instance,
now patients who remain clean of illegal drugs for two years will be
allowed to take home as much as a month's worth of methadone.

And patients can expect individualized care plans and a voice in how their
clinics operate.

"I and thousands of other people have been fighting for 30 years to get
this through," said David Monosson, a district methadone treatment advocate
and a patient at Model Treatment Program.

While some patients eventually stop taking methadone, which reduces or
eliminates the craving for heroin and other opiates and eases withdrawal
symptoms, others remain on it their entire lives.

While methadone remains a Schedule 2 drug, the highest classification of
controlled pharmaceutical, under the new rules the Food and Drug
Administration ceded its oversight of clinics to the Department of Health
and Human Services.

Each clinic will need to be newly accredited under the new rules, aimed at
improving the quality of care and access to it.

"This is the beginning of a new era for methadone treatment," said H.
Westley Clark, director of the federal Center for Substance Abuse
Treatment, announcing the rules Friday at a Baltimore methadone clinic.

Detractors have called the drug a substitute addiction, but advocates,
including Clark, call methadone "the most effective medication we have to
combat heroin and other opioid addiction."

"We believe the new program will help destigmatize methadone and allow the
public to see it as a medication to help those who suffer from the disease
of opioid dependency -- no different from medications to help control other
diseases such as diabetes or heart disease," Clark said.

The changes are based on recommendations by several groups, including the
National Institutes of Health, the Institute of Medicine and the General
Accounting Office.

Speaking from his office, Dennis Scurry, chief medical officer of the
District's Addiction, Prevention and Recovery Administration, said he
embraces the new rules on methadone.

"With it, this guy can keep a job, keep his marriage, have the respect of
his children. Take it away, he'll be a street addict."

The old restrictions were counterproductive, he said.

"Why should someone be subjected to the indignity of a urine specimen if
they have been clean for five or 10 years? Why should a person have to come
in every day if they have been compliant? Why can't they take it home for a
week or a month? We don't tell a person to come in every day for an
antibiotic."

There are about 980,000 heroin addicts in the United States. Roughly 20
percent receive methadone as part of an addiction treatment program,
according to federal estimates, and countless more are on waiting lists.

Staff members at Bon Secours New Hope Treatment Center in Baltimore, which
serves 700 patients a day, said they hope the new rules will help open more
treatment slots.

The clinic has 200 people on its waiting list, and counselor Pierre Parker
said he wishes it could accept anyone who wanted treatment right away.

"They call that the teachable moment," he said.

Patient Gregory Manning Sr., of Baltimore, a Vietnam War veteran who has
found relief from his addiction, agreed. "They should make intake shorter."

He said he is grateful for his treatment.

"I am a whole lot better than I was last year," Manning said. "This is a
blessing right here."