THE DRUG PROBLEM

Gov. Howard Dean placed important emphasis in his budget address on the need
to combat heroin use in Vermont. At the local level, health care officials
are trying to determine the best way to respond to the growing problem of
heroin addiction.

Last year the Legislature passed controversial legislation authorizing the
establishment of methadone clinics in Vermont hospitals. But as health care
officials contemplate the possibility of methadone distribution, they are
far from viewing it as a panacea.

At the outset Dean opposed the legalization of methadone, which is a heroin
substitute used to help addicts break their habits or at least to keep their
addiction under control. Dean argued that using methadone was only
substituting one drug for another and that the establishment of methadone
clinics could have the detrimental effect of drawing addicts in search of
methadone to the community.

Now that methadone use has been authorized, the Rutland Regional Medical
Center is proceeding cautiously. Officials there are waiting to see what
kind of regulations the state adopts for methadone clinics and what kind of
funding the state provides.

Dean's message on the heroin problem was welcome in the Rutland community
because of a recent increase in heroin use and a dramatic rise in the kind
of robberies and other crime usually associated with heroin addiction.
Dean's focus on the problem, combined with federal support obtained by Sen.
Patrick Leahy, ought to bolster law enforcement efforts to rein in the
problem.

Dean mentioned that he would be expanding drug treatment efforts, which is
where methadone comes in. But as health care officials describe the kind of
treatments necessary to combat heroin use, it becomes apparent that
methadone is only part of the answer.

The most effective treatment for addicts is the kind of intensive and close
case management that helps addicts put their lives back together.
Frequently, addicts don't want any treatment at all. Unless monitored,
methadone users may be doing nothing to stay off other drugs, such as
cocaine and alcohol. For methadone to be effective, it needs to be part of a
comprehensive and aggressive treatment program, which for many addicts may
not include methadone use at all.

Health care officials say that in Rutland County only 37 people have sought
outpatient care for heroin addiction. That is a small number, though it has
a big negative impact in terms of wasted lives and potential for crime. Now
is the time for the state to confront the problem of what to do with those
37 and the additional addicts who have not yet sought treatment.

Dean makes no apology for his own strongly punitive approach to the problem,
but effective and aggressive treatment may be a more cost-effective approach
than throwing dozens of people in jail, where nothing is done to break the
pattern of addiction and criminal behavior.

The fact that methadone has now been authorized does not solve the problem
of heroin addiction, but it does give the state the opportunity to decide
what kinds of programs are most effective and how seriously it wants to take
the problem of drug addiction.

In Rutland, where the problem has caused a noticeable rise in crime,
effective law enforcement must be joined by effective drug treatment. As
state officials draw up plans for their newest chapter in the war on drugs,
let's hope they decide to provide the Rutland region with the resources for
treatment that will work and for the law enforcement efforts needed when
treatment fails.