NEW RULES FOR 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.