METHADONE ALTERNATIVE COMPLICATES

BANGOR - Opponents of a proposed methadone clinic here applauded President
Clinton's recent approval of an alternative drug, putting yet another
wrinkle in debate about the controversial clinic planned for the city.

"This should change everything," said Robert Q. Dana, a drug addiction
specialist at the University of Maine, an opponent of the clinic. "I think
this suggests that we should clearly step back and get our focus on what's
happening at the national level."

Under the Drug Addiction Treatment Act of 2000 signed by the president, the
drug buprenorphine still needs approval from the federal Food and Drug
Administration before it can be used to treat opiate addiction. The
narcotic is currently approved for use as an injectable painkiller.

FDA approval is expected any day, federal health officials say.

The new development attracted the attention of officials at Acadia
Hospital, who likewise welcomed the alternative while noting the methadone
option still is needed to treat opiate addiction.

"It doesn't change anything at all," Lynn Madden, vice president of
administrative services at the Bangor-based hospital, said of the new
drug's effect on plans for a methadone clinic. "We'll continue to use
whatever drugs are most appropriate for our patients, and for some folks,
there's still a place for methadone."

Acadia, at the request of the state Office of Substance Abuse, applied in
February to open a methadone clinic at its Indiana Avenue facility.

The prospect of the clinic has since divided the community, prompting the
City Council to form a special committee on opiate addiction to study the
regional problem and the need for a methadone clinic in the city.

The committee will next meet at 6 p.m. Tuesday in the City Council chambers
at City Hall. Among the items to be discussed at the meeting are
alternatives to methadone, including buprenorphine.

Buprenorphine, like methadone, blocks an addict's craving for heroin or
prescription painkillers. Unlike methadone, however, buprenorphine is
longer lasting, less addictive and less likely to result in a fatal
overdose because it does not suppress breathing.

But while the drug may be all those things, it is also less potent, said
Dr. Paul Tisher, the hospital's vice president of medical services, and
therefore not a substitute for methadone in cases of severe and entrenched
addiction.

"What we know about buprenorphine is what we've read, and right now it's
not clear that buprenorphine is going to be up to the task of stabilizing
those with severe addiction problems," Tisher said.

Should FDA approval come as quickly as expected, the drug could be
prescribed for heroin and opiate addicts in the privacy of a doctor's
office as soon as January.

The new practice would mark a significant departure from the present
routine of dispensing methadone in daily doses at a central,
government-sanctioned clinic, Dana said.

"Making this kind of treatment less invasive will only be beneficial
because the research is very clear that less invasive treatments produce
better outcomes," Dana said. "It's about respect and dignity for these
patients."

Dana predicted the new drug would bring into treatment those addicts who
previously shied away from methadone clinics for fear of being seen.

The Maine Department of Mental Health, Mental Retardation and Substance
Abuse Services agreed to postpone the licensing of the Bangor methadone
clinic until January 2001, at which time the council's special committee is
expected to issue its final report.

Kimberly Johnson, director of the state Office of Substance Abuse, also
said there were no plans to scrap the methadone clinic in favor of the
relatively new treatment option.

"If it turns out to be way more effective than methadone, that could be one
thing," Johnson said. "But it's just too soon to say."