NEW REQUIREMENTS FOR ACCREDITING METHADONE CLINICS

Methadone clinics for the first time must be accredited in a manner
similar to other health facilities, say new government rules intended
to improve quality of treatment for heroin addiction.

Under the rules, published Wednesday by the Substance Abuse and Mental
Health Services Administration, clinics that distribute methadone and
other addiction-treating medication must tailor therapy to addicts'
differing needs, provide more physician supervision and take other
steps proving quality.

"We want to promote state-of-the-art treatment services," said Dr. H.
Westley Clark, the agency's substance abuse treatment chief. "We
already know every program is not going to survive this," although he
added that most methadone clinics will meet the new accreditation standards.

Until now, methadone clinics have been inspected by the Food and Drug
Administration, but those inspections were widely criticized as
inadequate and the FDA is quitting them.

Instead, SAMHSA will contract with private organizations - the one
that accredits hospitals is a candidate - to inspect clinics and
report which ones meet new government quality standards. Clinics will
have two years to comply. SAMHSA is part of the Health and Human
Services Department.

Methadone, a synthetic narcotic, has been used for more than 30 years
to treat heroin addiction, by suppressing withdrawal symptoms and
curbing craving. Another substance called LAAM also is used. Doctors
are anticipating FDA approval of a third therapy, another synthetic
narcotic called buprenorphine, later this year.

The White House drug policy office estimates the nation has 980,000
heroin addicts but that only about 20 percent receive methadone or
LAAM.

There are about 1,000 U.S. methadone treatment programs. They're
controversial, as some neighborhoods object to the clinics despite
scientific evidence of their effectiveness. Some states have no
clinics; others have only one or two in the entire state. Still more
have long waiting lists of addicts seeking treatment.

The new rules are "a positive step forward," but it's unclear how much
they will improve patient care, said Holly Catania of the Lindesmith
Center-Drug Policy Foundation, a New York-based institute that
advocates drug policy reform.

"I don't know if that in fact will happen from this change," she said.
"What is disappointing is there's nothing in the regulations that
would expand access to this lifesaving treatment."

The foundation had pushed the government to allow private doctors to
dispense methadone, something not in the new rules.

Clark said the first step is to improve existing care, but that he
also hopes to address accessibility.

One new rule, however, should free some room in crowded methadone
clinics, he said: Instead of restricting recovering addicts to a
six-day methadone supply, those who do well after a year's treatment
can take home a two-week supply and those doing well after two years
of treatment can take home a month's supply.